Going back to go forward (8)

A common theme on adoption blogs and forums is the bewilderment that joyful times are always followed by intense lows. Why can’t a traumatised child just be happy, fin? Adoptive parents acknowledge the difficulty their new child has in regulating negative emotions, but rarely acknowledge that affect regulation goes both ways. The real on-going trauma of neglected and abused children is not poor regulation of negative emotions but in their inability to feel without every feeling digging up the earth under their feet.

Gosh, intelligent adults barely can make this connection, how is a child supposed to know that the anger, fear and shame following such a happy day is not:

1)      Due to their parents (mean and cruel!)

2)      Due to their identity (naughty boy!)

The point is, they can’t.

I am left just as bewildered, as I research more into adoption, reading personal accounts, wondering how I ended up being 30 and relating to the emotions and actions of traumatised 4 year olds.  Am I what they have to look forward to? Or were these adopted children rescued in ways I never was?

Last night was difficult. I played with (emotional) fire and (yes) got burned. Knowing how to tap into my EPs doesn’t mean I’m capable of managing those feelings. As a result, I’ve been physically ill for weeks, as well as suffering from dissociation, derealisation, and depersonalisation. Just one of the latter would be traumatising enough.

I visited an interactive art exhibit in Manchester over the holiday, staring blindly at the 113-beats-per-minute flash of my lightbulb. It looked like a tiny bird, fluttering amongst a ceiling of slow giants. Every other light bulb was half the pace of mine. What is wrong with me? I wondered. My face flushed, because I felt fine. I felt fine. But my heart knew differently. When did 113 beats per minute become fine?

More and more, I regress. As the childlike parts become dominant, I can feel whole sections of my brain going dark. The dissociation comes on more strongly at night. I panic at the sight of a strange man in my bed, my husband. And I realise now why I always think he is a family member. That part of me doesn’t know I am married. Therefore, a stranger in my bed must be my mum or my brother. Imagine waking up naked next to your mum or your brother. The disgust, shame, and confusion is overwhelming.

It only takes a moment, a single breath, to become grounded again: to cognitively realise where I am and who I am. But the feelings persist: an unearthly vacancy of self.

Last night, I experienced a key emotional memory. My EPs flashed me in one big synchronised chorus. Remember this? Remember feeling like this? This is you.

I dissociated strongly in response and then relied on distraction to get me to sleep. The visual memory remains, but could I find my way back to the feelings, when my therapist asks me? Already this morning, I find myself denying them. That’s not me. There’s nothing wrong with me. This isn’t a repression; the feelings and memories are already gone.

I’m restless, unable to work, searching for a new project to distract me. Therefore, we must be making progress. We must have hit a nerve. I’m torn between believing I can integrate this mess, undo decades of damaged attachments and emotional trauma, and the blissful ignorance of giving up. That’s called fear, and since I (the ANP) am feeling it, we must be getting somewhere.

I just wish I knew where.

Read on the NHS Choices blog.

Going back to go forward (7)

I now have a handle on this therapy business. Sure, it's about trauma, affect regulation, coping mechanisms, attachments… but mostly it's about owning up to me. Knowing me. Being me, without shame.

The labels, the theories, they are all metaphors in the end. Complex PTSD, Dissociative Disorder, Schizoid. Psychological theories say I have one ANP (apparently normal part) who controls my actions and oppresses the two EPs (emotional parts) that have split as a result of childhood abuse and neglect: one for bad feelings (EP-Sad) and one for good feelings (EP-Happy). That's a fair enough theoretical model. What's real, though, is my experience, my choices, me. So, enough of the theory.

Therapy extends beyond the hour with my Therapist.

The big unsolved question from the last session was 'where is my safe place' ? I sat in the chair, tears streaming down my face, staring vacantly, feeling lost. My eyes slowly and fearfully scanned the room. I looked inside. I imagined trees. I couldn't feel safe. Did I have a safe place?

She left the room. Relief sifted the shame away. I glanced at my phone. She returned.

"Distraction." My voice was quiet. I didn't look at her. "I usually rely on distraction."

We moved on. At the end of the session, she pointed out my pin, and I smiled, but not at the compliment. She was distracting me. And I, I was being me, in everyone else's heads but my own. Fair play.

But the work continues without her.

Today, while writing this blog entry, I found my safe place.

I'm grateful there are parts inside that are smarter than me: parts that unconsciously reach for familiarity and expression. Parts that find their own voice even if it isn't through my thoughts or my lips. Even if it is in ways that others don't expect or accept. Ways that I don't even expect or accept.

I'm also grateful that it's Christmas. Because my happiest part, my most fragile part, feels safest here. EP-Happy sings Christmas songs all year long (annoys my dear husband to no end) but it's only at Christmas that she can do it without judgment, inhibition or shame. It's safe to be her at Christmas, despite all of the sadness and grief that surfaces from EP-Sad, too.

But this story isn't really about Jingle Bells or presents under the tree or turkey dinner. It's not even about Christ's birth. It's about listening, connecting my parts together, and feeling safe.

It's safe to be me at Christmas, because it's safe to be Christian at Christmas. Silent Night. Away in the Manger. We Three Kings. The First Noel. No matter what I believe about God, the greatest sense of calm comes to me in the form of Christian music. When I was younger (and in much more pain), Christian music gave me a voice; it connected together my experiences and my feelings in a way that no one… nothing else... did.

I stopped listening to music because it was affecting my mental health, and that was a mistake. It helped to silence EP-Sad, but I also silenced EP-Happy in the process. I should have known better. In struggling to find EP-Happy at counselling several years ago, I realised listening to music was a clue. I wrote it on my board. And still didn't learn.

Since beginning therapy again this winter, I've started listening to more music. I also started eating more carbohydrates, so raise your glass for bad habits, eh? Except music, it wasn't all bad. And my body knew better than me. I started to preferentially play my Christian music. First Jars of Clay, then WOW mixes, then Christmas music, and then.. "My Will" came on while I was writing today, and it hit me.

"Complexity haunts me, for I am two men
Entrenched in a battle that I'll never win.
My discipline fails me, my knowledge it fools me
But you are my shelter, all the strength that I need."
-Sung by DC Talk

I was calm.

My safe place is listening to Christian music. Not a palm-lined paradise or army of pillows. Moreover, my safe place is where I feel whole: where EP-Sad and EP-Happy hold hands, which is a fanciful way of saying I allow myself to be happy and sad at the same time. I allow myself to be me. I am happy, sad, and grateful to have moments of brilliance like this from my ANP.

Merry Christmas.


Read on the NHS Choices blog.

Going back to go forward (6)

The first post I ever shared about my mental health echoes in me.

I didn't know then what I have a good idea of now: that my collective physical and mental health problems, complex personality changes, and emptiness were a result of a dissociative disorder. In fact, it wasn't until CandyCan joined the mental health blog that I started to wonder why my experiences were so similar. I didn't have DID. That's impossible.

And then my new therapist started almost immediately into transactional analysis. Integration this, Parent-Child that… psychological babble. Just semantics, really, to help us have a common language. That's all. Right?

She got frustrated when I couldn't answer her questions. Was I being resistant? I had answered honestly: I didn't know. Nothing caused it; No one told me my feelings didn't matter. But they did; she insisted.

I couldn't see it. Couldn't feel it. Why won't my therapist accept this?

And then she lucked out: I got triggered, and she finally pulled something emotional on her fishing line. But neither of us expected how painful my reaction would be, and I left, traumatised.

When I was finally alone, I cried to exhaustion, because I finally realised what my therapist wanted me to reveal and what I was trying so desperately to protect:



They say that people who have experienced abuse or neglect as a child spend a lot of effort trying to convince themselves and others that they are fine, that it was nothing, if they can even recall it in the first place.   I thought that was just dissociative amnesia, but now I realise dissociative disorders are more complex than that. I might have some cognitive memories of the abuse and neglect, but my emotional memories were sliced right out, until I could sit with a straight face and wonder "why am I so unwell?" My life was fine. My day was fine.

But really, I haven't been fine for a long time.
---

Therapy last week was different. For one, I was exhausted from the crisis at our previous meeting. I had experienced derealisation, depersonalisation, and a resulting 4-day migraine. I also realised that there was a lifetime of emotion tucked away somewhere inside me that I've never owned up to. To put it simply: I was terrified of me.

But I don't like not having the answers, so I took the most important question from the week before (what was I feeling) and investigated.

At first, I was angry at my therapist for expecting me to answer something I simply had no answers for. Then when my therapist asked me if I was angry with her, I was angry at myself. I battled between these two emotions (Anger at Therapist and Anger at Self) while I struggled to tell her. As I struggled to say it, I had to push through a growing Fear (directed at Self) in response to the Anger at Self. When I finally squeaked out a 'Yes', I panicked because the Anger at Self skyrocketed.

It felt like I was abusing myself. It felt just like I felt when I was being physically abused for the first time. Anger, fear, panic, and finally shame. Shame was the hardest emotion to name; it took me days to recognise it. And when I explained all of this to my therapist, she praised me animatedly...

…and then verified: I said the FIRST time? I paused. Yes, I guess I did say that. And I understood what she noted, unsaid: (1) there were other times I was abused and (2) I must have been dissociating by the time they occurred.

Sometime in the latter half of the session, my therapist pulled out the empty chair. I knew immediately what I would be asked to do and started shaking and crying. Panic. Fear. Something saying no, and something saying yes. "What do you want to say to her?" Her being the Child, of course, and me being the Parent.

I tried desperately to calm me down, the mess of emotions inside. Meanwhile my therapist didn't want a repeat of the week before, so she pulled out the stops trying to calm me down. We don't need to do this. Just say the word, and she'll put the chair back.  A moment, please. I raised my hand. "I just need a moment."

It just got worse. I looked at the chair. I needed to talk to my therapist, not myself. Barely in time, I bubbled out "I have nothing to say to her." The chair was pulled quickly back. And within seconds, everything inside went quiet. Blessed relief.

But let's take a step back, too. You see, while I was fighting myself, my therapist was trying (desperately?) to calm me down, letting something very interesting slip in the process. She asked me which part was present.

Like most of her questions at the time, I didn't reply.  And even in that moment, I thought she had made a mistake. My parts can't be present. They aren't those kind of parts.

She let me interrupt her. I wondered how I was going to admit it. So I didn't admit it. I simply told her what I knew:

"When we first moved, I became very depressed and missed my first home terribly. But most of all, I missed me. You see, ...I did everything I could to protect and preserve that part of me, until it was safe enough to be whole again.

But it never became safe."
Sound familiar? Here is what happened next:
"Sometime after the last move, I gathered together all the photographs of me (my parents were prolific) and split them into piles." I raised my right palm. "Me." I raised my left palm. "and Me." The tears started to flow.

"It was so easy to do. They were two different people." Sadness. Grief. "Why didn't anyone else notice? I wasn't me anymore." I looked forlorn. My voice cracked. "It was only supposed to be for a little while. I.."

"I didn't mean to not listen to her." I'm sorry. "I didn't know I wasn't listening."

"I just want to go back." I weeped. "I just want to be whole again."

My therapist had been quiet, not even writing notes. But I could read her reply all over her face. Pride.

For most of our sessions, I had been either overwhelmed with emotion or numb from dissociation, so this moment of fragile and honest grief manifesting so calmly stood out.  There was more unsaid in the silence before she spoke. It felt like she took my hand, but I know she didn't. She simply looked me in the eye and gave me hope.

A far cry from "Perhaps therapy isn't right for you."

I went home and pulled out the photos. I pulled out my writing. I posted here.
The evidence piled. But I wasn't convinced until this morning, as my husband drove us to the store. I was revisiting the empty chair situation in my head. Play by play. As an outsider. This wasn't out of ordinary; I always playback situations afterwards, chattering with myself about what it all meant, reprocessing every detail.

Oh, my god. I was chattering with myself.

There she was. There we were. There I was. This is how I did it. Isn't it? Decades of neglect and abuse.. this is how I survived. She took on the emotions, I took on the thoughts, and afterwards we got together and shared notes from a safer place. We soothed each other.

Immediately I remembered us, shaking alone in the woods in the middle of winter while everyone else enjoyed dinner inside. Aged 14. I remembered going to bed at 5 pm and talking the day over. Aged 12. I remembered my glands being so swollen I couldn't breathe. We barely got through the night. Aged 20. 

I guess Truth really is a Spectrum.





Read on the NHS Choices blog.

Going back to go forward (5)

When we first moved, I became very depressed and missed my first home terribly. But most of all, I missed me. You see, to protect myself from the trauma of continued neglect and abuse, I had split part of me off.  I did everything I could to protect and preserve that part of me, until it was safe enough to be whole again.

But it never became safe. Not for years and years, not until I was a grown woman, married. And now I'm thirty, battling with a precious cargo: Me.



When I returned from therapy last week, I bawled and bawled. As my dear husband came home to a sad and vacant wife, I had no words to tell him why. There are not many precedents for "Me and Me, we cried together."

Many professionals don't believe in dissociative identities. There are a few fine things in life that we can hold to be sacred, and being 'I' is one of them. The idea that a single person's identity could be fragmented into two or many parts is possibly a step of Truth too far. But, in reality, there are no steps. There is no category, no line separating Eve, Candycan, and me. Truth is a spectrum.

Call her my past. Call her my Child. But in truth, she is me. In fact, she is the me I've always wanted, more than anything in the world, to be. Every moment of every day since the split. She has always been with me, and I've always felt her there. Days, weeks, years passed. The photographs began to fall into two piles. Me and Me.

Obligations and responsibilities grew. I grew. She didn't. I was torn between trying to forget her and wanting her desperately.

"Turmoil twisting inside me
Figuring out what I should be

Find the piece that goes there
Find every single care

Put together what I once was
Who cares what the new one does?

Watching all the days go past
All the days I see go fast

Losing all the time I had
Had no time to be sad."

Reading these couplets, written in those first few years following the split, makes it so clear how I struggled with dissociation. I thought I could fix it. I thought I could fix it alone. 

"Twist and turn every which way
Wrenching apart every single day"

But the more years passed, the harder it became to admit that something was wrong, muchless what was wrong. In a breathless moment, someone caught a glimpse.

"Irgendwie lebt sie sowieso in ihrer eigenen Welt -- allein."
In any case, she lives in her own world, alone.

Perhaps had I let them closer, they might have noticed more. But instead, ten years passed.

"My heart raw against the world
my eyes tearing and dazed
staring back into
life-altering changes
horribly

    unpoetic

tentative homeostasis
phew.

    phew.

        phew.

too much weakness in
self-provoked emotions
finally freed by this emptiness
and a callous heart
afraid of itself
seeping soothingly
into childhood dreams"

My body and voice grew older. And the truth was ringing, ringing out. But we all refused to see it, even as I wrote it. Still a child, still knowing better than anyone what was going on, and still with no idea what to do about it:

"When I walked in the empty room my heart beat with a fear unimaginable. My backpack slid off my shoulder, crumpling on the knob beneath my coat. The air smelled of crayons and glue. My gut felt as though it were in my mouth when I took my cap and hit it under my lunch. My hands were cool and moist, shaking from the deep inside. The desks were in pairs. I walked through the aisles wondering which would be mine. My shoulders were tense and my eyes were already tired under the dim yellow lights. My mouth was parched and dry, lips stuck together from being clenched so long. My stomach hurt and I was afraid... of who would walk through that door, of tomorrow, of the teachers, of anything I would need to face. I was so tired.

She told me to sit in a chair. I waited anxiously within myself, two personalities split by time. As the students came in, one by one, I stared at their eyes, wondering, doubting them, doubting myself. I choked on my heart as I told them my name. I threw up my past with monotone interest. I felt so detached, lost, alone, but beyond it all afraid. A bitter anxiety echoed through me like an outpouring of anger. When I blinked it felt like minutes, and an hour felt at once like both a year and a second as my heart counted its beats and my soul held its breath. Memories flooded me. I knew the feeling of loss before I had ever known love. Reality felt like the screen of a television, blurring before my eyes. I grasped my chair. It felt like fire, but I knew it was my hands that were ice. I enveloped the cold and still my racing heart as the robot controlling me took out a pencil and began another first lesson of another first day."

How easily we [want to] forget. But there it is. And here I am, ten years later.

Read on the NHS Choices blog.

Going back to go forward (4)

"Perhaps therapy isn't right for you."

I was stunned. Emptiness was bubbling over the edges of my bowl. My therapist stared at me, unsmiling. I didn't know. I don't know. I wouldn't just make something up. I don't know how it felt. I don't remember knowing.

It started when I told her she asked the wrong question. She should have asked "Who told you your feelings mattered?"  She disagreed with me. She asked the right question. My question wasn't right. I don't remember what she said after that. Which probably means I already split, five minutes into therapy and 30 seconds into sharing how I felt.

So we moved on to my past. How did I feel when that happened?

I don't know. I tried to remember. But I couldn't feel anything. Couldn't remember.

"Perhaps therapy isn't right for you."

Did she say that to provoke me? We've only just started. She's already acknowledged how far back the splitting goes. Surely she isn't giving up now? Is she giving up now? I knew it would be hard. It should be hard. But I didn't expect her to say this. I went silent, searching.

She asked it again, a different way. I wondered how she could judge based on one difficult session. Did I think it was possible to engage in therapy?  Yes. Couldn't look her in the eye.

"Why?"

I glared at her, slicing away the feeling. "Because I have." She assumed I meant with another therapist, before her. In truth, I meant last week. Maybe she didn't know, didn't realise? I was agitated, perpetually crying.

The rest blurs between fumbling examples of integration, childhood and triggers, as the anger continued to bubble. I couldn't concentrate. Too busy trying not to shut her out completely.

I can't write about how I felt. Not even inadequately. That's why I'm in therapy. I never had a mother or a father to explain what these feelings meant. What their names were. What to do with them. That they mattered. That I could trust them. That I could manage them. How to listen.

"Are you angry?"  She knew I was angry. I knew I was angry. Angry is a very basic and loud feeling. I can name (and avoid) anger very well. "It's okay to tell me you are angry with me. I'm a therapist, we know how to cope with that."

I was angry. But it was more than anger making my body shake, my eyes stream, and my lungs spasm. It should be so easy to say it. I was angry. The words had been ringing in my head during the whole session. I am angry.

"Are you angry with me?"

But, it wasn't the anger making me so upset. It was me. I was fighting against me to say that simple word, like I was being tortured for a singularly valuable piece of information. Tortured by decades of precise and overwhelming control and invalidation, more like. I was afraid and…

"Yes." (Was that me saying that?) I was angry.

In therapy, this is called a crisis point. The goal is to be challenged into reaching a cathartic moment without going too far, because, if you go too far, you can open up all sorts of vulnerability and pain. This in itself can be traumatic. The client may not have the ability to cope, muchless learn from the experience. My therapist took a gamble, provoking me. I'm still not entirely positive she did it on purpose.

I reached crisis point. Every part of me was screaming. Literally? Does it even matter whether it was literal or metaphorical? My head was a mess. My body had been attacked. I was gasping for air, shaking uncontrollably, mindful that I may have finally answered her question the way she intended, but I had betrayed myself in the process. And who mattered more here?

I was still angry. Maybe even more angry. But when I finally calmed down, I was a bit less afraid. I was angry at myself.

She still asked whether I wanted to continue with therapy.  I still felt insulted she asked. But maybe this was protocol. In any regard, I was already split again, and nothing she said stirred anything in me, though I give her credit for trying to offer me some positive comments and stability.

How do I feel now?

I really don't know. But I want to.

Read on the NHS Choices blog.

Going back to go forward (3)

I was sixteen. It was partly cloudy. I sat in the middle of five columns of desks, one row from the back. So, their disbelief and disdain were obvious to me, when I raised my hand, saying "I disagree," and saw 19 heads turn around.

The history teacher tried to hide a smile. He knew I had more to add. But the other Elizabeth (one of three) in front of me had already interjected, turned completely in her seat to engage me: "Don't be ridiculous. No one could survive complete rejection like that."

I wasn't angry. I felt almost transcendent.

"Why do you disagree, Eliza?" The teacher asked.

I looked directly at the other Elizabeth. "You assume majority rules. But the way I see it, when everyone in the world is against you, telling you what you are, you have two choices: believe them or not. Just because everyone agrees on something, it doesn't make it true."

The teacher glowed.

I revisit this scene and this dilemma often. Was my logic wrong? Is it possible to persist in complete and absolute opposition? Without suffering psychological or physical damage? Without giving up or changing your belief/self?

By the time I was sixteen, I was already fully entrenched in my schizoid, dissociative ways. So it was easy for me to say it was possible. I believed I was living proof of 'girl versus world:' constantly under attack and utterly alone. But the poignancy of that memory reveals more: I also believed it was possible to prevail, regardless.

I relate to that girl. Another win for integrative theory.

Read on the NHS Choices blog.

Going back to go forward (2)

“Who taught you your feelings didn’t matter?”

The room went existentially dark, and my therapist disappeared into the shadows. I tipped into the bowl, sinking through my memories, searching.

She leaned forward, asking even more firmly, “Who taught you your feelings didn’t matter?”

I came through, empty-handed. No one told me I didn’t matter. I didn’t know what to say. Something wasn’t right about this. We moved on, but now that I can look back, I realize the problem wasn’t in the answer, but in the question.

She should have asked: “Who taught you your feelings mattered?”

The answer is: no one.

“It must have been very lonely, having no one.” She said at the end of the therapy session, following a brief review of my history. We got there eventually.

The bowl is filled with loneliness, and, to use a bit of Transactional Analysis, the Parent does everything it can to keep the Child drowning in it.

“On a scale of one to ten, one being not at all and ten being very much, how much do you want to change?”

That’s tough. I smile grimly, “I’m trying to decide which part to answer with. Should it be an average? Like, say 7-8?”

“Which part least wants to change?”

“The Parent”

“And how much does the Child want to change?”

“Ten.”

“How much do you believe you can change?”

“Ten. Absolutely, 100% ten.”

That surprised her. Most people enter therapy with a great desire to change but a low belief that they can.

From my perspective, I’d been in a therapeutic relationship with myself for most of my life, centred on this exact belief. I wouldn’t be seeing the therapist if I didn’t already know I could change. I wouldn’t be sitting anywhere, if not for the belief that tomorrow will be different.

Maybe those other people don’t want to believe they can change, because they are afraid of what is between This Me and That Me. That person in between is in transition: more incomplete than ever, more hypocritical, more indecisive, and more fragile.

It’s sensible to be afraid. Changing my shape also means changing the shape people have formed around me: more loss, more conflict, but also more opportunities. People will resist me, pulling me back into the drama and games.

Well, people would have resisted me, had there been any people left in my life besides my husband. I hope my future friends someday appreciate this journey, but something tells me they will never know.

Read on the NHS Choices blog.

Going back to go forward (1)

"I like to get right to the point."

Funny to hear that from her, after I spent weeks going over saying that myself. So I got right to the point and told my new therapist about my attachment disorder and my problems connecting my emotions to my thoughts and how I shut down in times of stress (particularly around my family) and finally how, though I don't believe diagnoses are necessary or appropriate, I was grateful to see so much of my own complexities explained by the schizoid personality descriptions. She nodded and took out a piece of paper.

"I'm going to draw two circles. One represents the inner world. One represents the outer world. Let's talk about John. At some point in childhood, something very big happens, which causes John to retreat into the inner world. It's so very big, that to cope, John slices off parts of his inner world, like his emotions, and locks them away. Other children may have coped in a different way, but John experienced dissociation."

I already told her I understood, so she didn't need to explain so simplistically.  But, it gave me time to relax and process meeting my new therapist, and I was grateful to have a picture to look at. So here is one for you:



"Everyone is different. Some people come to therapy and have many chunks cut out."

She went on to explain more about what therapy would entail -- re-integrating these various parts of me. The first step would be learning how to ground myself, and I started by sitting straight with my feet on the ground. She asked how I felt, but in truth I didn't know. Tense? She asked me to picture what I felt like inside, the tenseness. "What did it look like?"

"A bowl"

"What is the bowl made of?"

"It's tightly woven."

"Is it heavy?"

"Compared to what?" My cognition broke through: I chuckled, to which she quickly retorted to stop laughing, it wasn't funny, and I blinked. It's nice to be startled. Though I disagree that I laugh because it helps me avoid feeling, I was pleased to be challenged so directly. Respect + 1.

"What's in the bowl?"

That gave me pause. My eyes went cloudy as I looked inward. There was clearly something in the bowl, but I just stared right through it.  The doubt came through my answer: "Air?"

We talked more about emotions, and she noted how close they were to the surface. I fidgeted, but managed to keep my feet on the ground. My hands were twitching everywhere, and I often looked away, blinking away tears. As she confronted me, I struggled even more to keep control.

"What are you feeling right now? What is this emotion?"

My hands covered my face. I shook my head, breathlessly mouthing: "I don't know."

She paused for me. "Is it anger?"

Another pause. "Are you sad?"

I stared at the cloudiness inside the bowl. Part sad, I guess. "Yes." But it wasn't just that. Fear. Is that fear? I tried it on for size and choked on the words that didn't want to come out. "Scared."

Her quietness became animated, and she smiled. "Great!"  Obviously not great that I felt scared, but great that I managed to recognise and admit it. "You feel scared. What about?"

I wiped my wet, burning eyes and shrugged. "Not knowing what will happen? Not being able to predict?" More like, not being able to control it, control myself. But I couldn't say that.

She looked at me intently, and I don't think she missed what went unsaid. But then she asked: "And the bowl? When you were feeling those emotions, what did the bowl look like?"

The picture was already in my peripheral: I had been staring inwardly this whole time, after all. Withholding my chuckle, my lips curved as I explained, without hesitation:

"The bowl tipped."

I looked at her, and we both smiled in comprehension. This just might work.

Read on the NHS Choices blog.

Infertility = Vulnerability

It is insulting that, of all the cost-savings Primary Care Trusts could make, a few are trying to claw back their own financial mis-management by discriminating against infertile couples, promoting health inequalities through cutting the provision of NHS-funded IVF treatments. If preventing people from receiving the treatment they need to reproduce is the answer, surely it is more cost-effective to mandate birth control, heck, even hire cops to enforce abstinence, for the general public? Perhaps only let the healthiest, most intelligent, most successful people breed, to avoid poor lifestyle decisions and faulty genes. Bring eugenics back.

Bury, Warrington, and North Yorkshire are just a few PCTs who have cut NHS funding for IVF, and there will no doubt be more. It may have been a hard decision and it may only be temporary, but it is without a doubt the biggest mistake they could make in an already fragile NHS. Let me explain.

When I first trained in emergency first aid, I learned my ABCs. Airway, breathing, circulation. Make sure you can breathe. Make sure your heart is beating. Then take care of the rest.

When I trained in wilderness survival, I learned the priority of other needs: water, food, shelter, and sleep.

When I volunteered as a youth mentor, I learned how important personal safety, belongingness, intimacy, and self-esteem were to our well-being.

When I earned my university degree in human and evolutionary biology, I studied how all of these human needs revolved around one thing even bigger than us: reproduction. Without reproduction, no other priorities matter. There would be no more human race. There would be no life, period. This world is a celebration of our ability to persist. Improve, diversify and persist.

Those PCTs must have forgotten their basic biology, because I can't think of a single reason why anyone could help an ex-smoker breathe but not let an infertile couple have at least one chance of having a child. Sure, the world is over-populated. But I dare you to tell the soldier who just lost his legs that he shouldn't receive prosthetics because, don't worry -- everyone else can walk just fine. The human race will carry on.

Good for the soldier if he has the money to afford his own prosthetic legs or specialised wheelchair. Most don't. But why should the soldier go without legs so that I can receive therapy for my mental health problems? Who decided that my asthma medication mattered more?

Those PCTs have in effect told infertile couples who cannot afford IVF to go without having children just so PCTs can balance their accounts. We finally have the price for a human life, and it must be less than £5000 -- the current cost for IVF.

I no longer wonder why the mental health services in Northwest England are so over-subscribed, when their primary care trusts come out with decisions like this.  I hope they can put all of the money they save in 2012 into increasing the number of therapists, because it is going to take a lot more than 6-12 months to band-aid this sort of loss. And I don't just mean loss of children. I mean loss of respect and trust.

Many people disagree with me.

And in part, they are right. I could live without children. I could sell everything I had to fund my own treatment. And if the NHS didn't exist, that's precisely what I would do. But that's not the country we live in. That's not the healthcare system I work so hard for, every day.

Today, my husband and I lost another embryo. Can I call it a child? Is it the same as losing your teenaged son or your elderly mother?  Your sister, your lover, or your friend? We'll keep trying, because that's all we can do. You might feel a small amount of empathy for my loss, but I want to be completely clear: this month isn't any less hard than those months where our child ended even before conception. It is the same loss.

Grief isn't meant to precede joy. That's not the natural order of things.

And if infertility didn't go hand in hand with such stigma and shame, I'm sure more you would understand how it feels to be placed in the same category as hair implant surgery. Because more of us would speak up. But as for today, I can't even tell my family. Only our GP knows, and even our GP doesn't have time to care.

As the PCTs have been making so imminently clear recently. They are too busy with More Important Problems.

Read on the NHS Choices blog.

Having a Personality [disorder]

In between referrals, life goes on. I’ve lost 10 pounds just by eating less and exercising more (it really is that simple for most people). My asthma has returned following severe exposure to an obscure allergen. My partner and I experienced our first positive pregnancy test after years of infertility… and subsequently miscarried days later. I started a new project at work. And next month, I meet my next therapist.

Having a Personality (Disorder)

Inherent in personality disorders is the idea that something is broken. Something is causing pain or discomfort. And by virtue of this pain/discomfort, something needs to be changed.

It follows then, that there are many different sorts of personalities, none of which cause pain and discomfort. One person can even have multiple personalities. There are so many different ways to be human; some seem absolutely bizarre and impossible, but it’s important to accept that these differences are not inherently wrong and do not necessarily need ‘fixing.’

The first and biggest hurdle of a personality disorder is acknowledging something about you is different. Following that acknowledgment is validation from others… whether in the form of meeting people with similar personalities and experiences or in the form of a therapist diagnosing and reassuring you. This isn’t an easy process. For one, culture demands similarity, familiarity, and intimacy. The more you deviate, the less likely people will accept you. The less they accept you, the less likely they will be to validate your different perceptions and behaviours. You will probably even stigmatize yourself.

If you aren’t able to accept your own differences, you will either be fighting them or denying them. Either way, in the best case scenario, you will be wasting a lot of energy just ‘getting by’. In a worst case scenario, you resort to drugs, self-harm, abuse, smoking, eating disorders, alcohol and so on. So, the second hurdle is self-acceptance, even if it means accepting that you are utterly unhappy about the sort of person you are and completely doubtful about your ability (or desire) to change. Change only follows acknowledgment and acceptance.

It may be this is all you need to cope. Someone with dissociative identity disorder does not need to integrate all of their parts. Someone with schizoid personality disorder doesn’t need to be more sociable. What anyone with a personality disorder really needs are the resources and skills to cope with who they are, so that they become just a personality (minus the disorder).

Everyone changes, grows, develops… that’s life. The only difference a personality disorder makes is that there are more hurdles between you-today and the you-tomorrow.

Being Schizoid

I have no friends, and despite being deeply lonely, I struggle to want friends in practice. I can’t even tolerate having family on the best days, and I barely sustain enough intimacy with my partner to conceive a child.

There are few opportunities for me to have a relationship which is safe… that grows at a pace and a distance I find comfortable.  The real world gives parking spaces for disabled, but you won’t find any equipment to service my handicap. I cannot sustain a friendship. My psychological soil is inhabitable.

The more judgmental readers might be secretly happy that my partner and I cannot reproduce… except, in reality that’s the third hammer to strike. I’m not a daughter. I’m not a friend. I won’t be a mother. With all of this emptiness, I’m not sure how much longer I can manage to be a wife.

So, if all I am …is an employee… what happens when I retire? What if I ever lose my job? What if I become unable to work?

Desperate for meaning doesn’t cut it. I can see why I’m such a high risk for suicide despite my lack of suicidal thoughts. There is a real danger that one day I will have no attachments left at all. No reason for today or tomorrow. No sign to anyone that anything is wrong.

I don’t want to change my personality. I just want to experience the ups and downs of being a wife, a mother, a friend, and a daughter, rather than the perpetual grief and shame hanging over me in every quiet moment.

Read on the NHS Choices blog.

Time to [redefine] Change

One in four people suffer from mental health problems at some point in their lives, a statistic which has been passed around and quoted so often, we’ve become desensitized to it. It’s supposed to challenge our culture (desire? habit?) of excluding people who experience mental illness by acknowledging the prevalence of it. But the problem (as usual) is a bit more complex. The Department of Health suggests that people can manage their mental health problems successfully, but “the biggest barrier to getting back on their feet is not the symptoms of illness, but the attitudes of other people.”

Time to Change’s recent social experiment (despite its design flaws) has elegantly shown that most people would prefer to date someone unattractive and uninteresting than someone with mental illness. Can I really blame them? I’m not sure I would answer any differently, and I’m certainly not obliged by Equality and Diversity laws when I choose who to spend time with and who to marry.

I chose my husband specifically because he was so stable and kind, and because I believed we would have genetically and socially superior children (Superior to me, that is). Would he have still chosen me had I opened the conversation with “I like Frou Frou and have a personality disorder” rather than simply getting to know each other slowly and sensitively as people? It’s a bit like stating on your first date that you are incontinent or have erectile dysfunction. Who is that helping, really – you or your date?

I defy anyone who feels the need to disclose that they suffer from mental illness to 'prepare' people. If we’re disclosing our personal foibles, what about disclosing our high cholesterol, our physical inactivity, our inability to take out the trash, or our secret belief that we are smarter than most people who will reply to our ad? Wouldn’t that be a fairer comparison than simply being Attractive, Interesting (+ BY THE WAY, Mentally Ill)?

It’s easy for me to toe the line. People with personality disorders are not even considered to be mentally ill by many experts. Ironically, without the power of excuse, all that leaves us PD folk with is stigma and exclusion. Under the new changing times, I am empowered to share that I suffer from depression and anxiety. I experience them from time to time, but I don’t suffer. So what am I left to say that anyone else is prepared to hear? Because personality disorder is not mental illness anymore. It’s me. Just Eliza. Attractive, interesting (+ BY THE WAY, Different).

This is not self-deprecation. A personality disorder is, by definition, undesirable. But I embrace the term. I am okay with being undesirable, moreso while the discomfort helps you realise the massive impact small choices can collectively have on a human life. We all affect each other, whether we are 'one in four' or 'three in four.'

I may be an unavoidably different adult with a spectacularly higher risk of both mental and physical illness (including suicide!), thanks to a gauntlet of attachment problems and series of unfortunate events. And I understand that 74% of you wouldn’t want to date me or be my flatmate. But you would be a fool to not appreciate the unique and powerful perspectives and contributions that people with mental illnesses and personality disorders have.

Let me redefine 'one in four' for you.

If your finger is bleeding, you wash it, bandage it, and more importantly – use a knife more skillfully and more safely in the future.

25% of our nation is bleeding, which means 100% of us need to care. And 100% of us need to change.


Read on the NHS Choices blog.

Fourth day of CBT

My therapist had a long talk with his supervisor about me. He revealed it suddenly, as though he wanted to say something else but couldn’t, and just as suddenly tried to explain himself, in anticipation of my own anxiety about breaches of confidentiality. But I’m not an ordinary service user. I know mental health workers discuss cases with supervisors and, where appropriate, their teams. It gives me more confidence and faith in the system to know therapists are supported. His concern was misplaced.

I’m no longer participating in cognitive behavioural therapy. [Avoidant tendencies, check] This is more than how frustrated I felt on my third day. Maybe it has to do with my therapist’s “long talk.” He has noted several times during our meetings how anxious and upset I was talking to him as though it was unexpected of me to be anxious and upset talking to a complete stranger whose sole role is to judge, challenge, change, and support you. What did he want me to say? Correct; I struggle to trust strangers who smile at me on the street, muchless strangers who have the ability to section me.

I agreed to step up my care to a clinical psychologist who would be better suited to help me using alternative therapeutic models. So, in a way, I was right last week. I like to think that my therapist’s supervisor found my case so interesting that she wanted to meet me herself. [Narcissistic tendencies, check]

In truth, I felt both relieved and guilty.

When I offered to quit entirely, my therapist’s reaction was immediately and strongly NO. I wasn’t even testing him; I really do want to quit. I work in healthcare; I know how precious these resources are. Someone else needs him more. I’ve coped for years. I can cope for more. But, NO. Apparently, NO.

The Guilt: Why would the NHS want to help me?

I’m not a risk to others. I’m not a risk to myself. I obey the law. I don’t misuse substances. I am intelligent. I am independent. I am hopeful. I contribute meaningfully and financially to society through work, volunteering, and community events.

Flip the coin.

I have a personality disorder, and I don’t even have the decency to be a vulnerable child, an offender, or a woman who self-harms. I am Other. I am less than 1% of the general population. No NICE guidelines exist for how to help me.

Stick my smiling face up on a poster. It’s possible to have “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it” and still succeed. It’s possible to succeed and still be broken.

Or in my case, in exile.

JustEliza says she's 'spent most of my life trying to solve the puzzle that is me'

The Relief: I found me.

A step up the mental health ladder means that something must be really wrong with me. All my Stigma bells rang when my therapist suggested I see the clinical psychologist instead. I knew the sorts of people who needed clinical psychologists. I never imagined myself one of them. Not even when I agreed.

Later that day, I devoured commissioning guidelines and service frameworks and, finally, diagnostic criteria on personality disorders. One link, after another, and then: I found me.

Take that, Clinical Psychologist. I’m one step ahead of you. I’m weak in the knees, fuzzy in the head, and filled with a sparkling mix of intimacy and revulsion at this discovery (and doesn’t that pretty much confirm it all). I have my ICD-10 code. I have my “emotional anatomy.”

Now, the reconciliation can finally begin.


Read on the NHS Choices blog.

The Little Penguin

If you watched BBC recently, you might have seen an animated short titled "The Little Penguin" by World of Happy.  For just a short time, you can view it again on BBC Iplayer. I hope they leave it up for longer, but if you can't find it, try youtube. I hope Giles Andreae doesn't mind me sharing the story here, as it's a very short, beautiful (albeit highly optimistic) lesson on one of the principles of Cognitive Behavioural Therapy: challenging negative thoughts.

There was once a little penguin who was frightened of the water.

"This is no way for penguins to behave," said his father. 

"Be gentle," said his mother, "for all of us have fears that others may find hard to understand. Come little penguin, come into the water with me" 

"But what if it's cold," said the penguin, "What if it's dark and deep? What if there is a big fat scary monster? What if I can't swim?" 

"Ahh," said his mother. "But what if it is light and beautiful? What if all your brothers and sisters are there? What if there are fish for you to eat and friends for you to play with? Come little penguin, take my hand." 

And with great courage and great trust, the little penguin slipped into the water, and, for the first time in his life, he felt the joy and freedom, wonder and delight, that every penguin's heart is born to know.

Read on the NHS Choices blog.

Third day of CBT

In the dream, I am worrying. I look at product after product on the shelf, until I forget I am standing, or where I am standing, or who I am. I've become simply a vessel for image after image of Possibility in the form of Sugar. I worry, visually, and then I wake, because waking is easier than making a decision. Than acting on a belief. Than believing anything at all.

My homework now includes The Workbook -- a collection of checklists interspersed with definitions and stereotyping -- which treats me like I, too, am just a checklist of symptoms just waiting to be defined. Did the person who wrote this ever have anxiety? I'm not sure she did. She might have realised how horrible it feels to battle intellectually with a form over whether "generalised anxiety is a problem for you."

I'm going to skip straight to Section 2: my own Five Areas Assessment. My therapist has now explained this approach to me 4 times. That's one for each time we've met, plus one extra when he was feeling especially pedantic. Essentially, our thoughts, physical symptoms, feelings/emotions, and behaviour all are linked and affect one another. This is basic science for someone whose post-graduate education focused entirely on theories of mind and behaviour, let alone someone who has already been labelled gifted. I'm not looking forward to the fifth time he explains it to me. If I interrupt, will I earn a new label? Difficult? Disrespectful? Impatient?

Shoot, there's another checklist already. I'm putting The Workbook away before I hurt it with my condescension.

We talked in circles this week, because we've finally reached the edge of his understanding of the human mind. I didn't think it would come this early in the process, and to be honest, I'm considering giving CBT up because of it. I feel deliciously mean just writing that, because essentially I just put my therapist, another human being, down.

Did you catch that? I'm being defensive. At some point, I shut the gate, and he's left standing outside, alone.

Cognitive Behavioural Therapy is meant to be challenging. It's good to have help, but we should all be doing this ourselves in the first place. But it's not as easy as thinking "Hmm, I am underestimating my ability to cope with this new situation. I feel unsafe and confused about what is happening to me. I am anxious." I know I can cope. I can make all of my problems disappear, one way or another, with distance and time. I don't worry about me.

I worry about you.

I worry, because I see you. I interact with you and I know you. My mind races through your life, calculating, estimating, testing, evaluating, predicting.  Is mind-reading so very wrong then, if I am always right?

I avoid you.

I avoid, because I would rather be alone than have the opportunity to manipulate you. And I will manipulate you, even if it's simply to counsel you. Knowledge is power, and power is responsibility, and I simply don't want responsibility for you.

There comes a point in your life when you realise you will never have what you want most. Is that what I'm grieving? That I won't ever be able to make everything right in the world? That I can't heal everything? I'm past adolescent, past puberty. I've discovered what I am capable of. I'm past exploring. I've recoiled.

My therapist challenged me this week. I reached the edge of my own understanding of my mind. I didn't think it would come this early in the process, and to be honest, I considered giving CBT up because of it. But that would be avoiding, again. So I challenged myself. I went home, and I wrote this, like I'm writing now. We talked in circles because I cannot resist shutting the gate. Because it's easier to be talked to about self-esteem, shaky hands, and shallow breathing than admit what I'm truly afraid of:

Hurting you.

Read on the NHS Choices blog.

Second day of CBT

Things I stopped doing because they made me feel bad:

Hearing the news

Listening to non-classical music

Reading crime thrillers

Watching violent movies

Developing friendships

Eating processed foods

Sometimes, I test the waters again. I rob a bank on a popular console game. I hear about a brutal murder-rape in the local news. I start reading a famous crime thriller series. I meet a friend for coffee. I microwave some chicken tikka masala. And the music tells me sweet dreams are made of these, but I know better. I’ve been having nightmares all week.

I’m not perfect at avoiding. But, I am practiced.

This week we talked about my past, and I've been paying for it all day in flashbacks, shaking hands, and racing thoughts. It’s been nearly twenty years since all of my bad habits began, but the penultimate one is not sharing how I feel, what I’ve experienced, with others. Complex trauma. Avoidant personality. Attachment disorder. I’m sorry; it’s just that… everyone else here seems identify with labels: Pregnant. Asthmatic. Diabetic. Bipolar. Obese. I thought you might want a label for me. Like Sociophobic. No?

In counselling, I realized being gifted meant more than being smart: it meant being differently human. In cognitive behavioural therapy, I am changing how I cope with being differently human.  And the rest of the time, I am unpacking just how different I’ve become, now that the worst is over.

The elephant in the room.

I am happier without you. Should I be happier without you? I feel guilty for this. I feel guilty for being alone so long, loneliness became my familiar. I feel angry, because you never found me. You never even looked for me. I never asked for you, so you never asked for me. And now they’re asking. Now you’re asking.

I have no idea how to answer.

I’m not even sure I want to.

Read on the NHS Choices Blog.

First day of CBT

“So, how does it feel during those low times?”

I had been rolling a piece of tissue between my fingers, sitting on the edge of my seat, leaning towards to the door, and facing away from him. This was very different from the quiet counselling I had two years ago. I could tell he was new but not new. New to CBT. Not new to caring. Caring, confidently.

I respected that. So, in that moment, I decided to be honest. I decided to look him in the eye as the first tears left mine, my voice just as firm as his:

“I would never, ever consider harming myself or others…”

I pause as my courage falters. Why am I sharing this? Why does it possibly matter?

“But I feel so detached. So apart from everything.”

The tissue was breaking apart in my hand.

“I deal a lot with death in my work. I’m unafraid even at the best of times. But at the worst, I feel jealous. When will it be my turn? When will it finally be over?”

The tissue falls to the floor in pieces, and I find myself sitting again on the edge of my seat, leaning towards the door, and facing away from him.

“I want to die.”

My eyes were cloudy, and I was falling into memories and shame. Without missing a beat, he asked, “So what did you think then?”

The river of self-doubt choked, like water rushing through a funnel, as I cast about my memories fishing for the Reason that I am still here. My voice cracked. My hands unclenched. But I still didn’t look at him. I knew immediately when I found it, waiting there at the depth of every murky bit inside:

“Tomorrow will be different.”


Read on the NHS Choices blog.

Catching you up (20)

40 weeks have passed since I wrote my last blog entry, just after I self-referred myself for the next tier of mental health services: cognitive behavioural therapy. I had taken dexamethasone to suppress my cortisol for an endocrinology test, and the side effects were unexpected: deep depression, anxiety, and suicidal thoughts.

The funny thing about feeling depressed, anxious and wanting to die is that they are just that: feelings. We can justify them, embrace them with logic, bury them with piles of sensation, or express them, but, at the source, they are combinations of chemical states in the body that we are consciously experiencing. They will affect us. They are not us.

I don’t often feel like I want to die, but I regularly do. Waking suddenly from an unsettled, deep sleep comes with a flood of deep syrupy emotion – a slick of separation between body and mind – that feels acutely like death. Like dying. I call it Liquid Dread: a sudden rise in cortisol without an associated rise in adrenaline. The DSM-IV calls it Depersonalisation.

Nothing traumatic provoked this particular feeling in this particular moment. My life hasn't been especially difficult, painful, or upsetting lately. For many (many!) years I thought it was. I thought, since I felt so detached and depressed, that I must be reflecting an awful, mad world.

I was, for the most part, wrong.

With practice, I learned to recognise these feelings for what they were: experiential manifestations of chemical imbalances. Distracting, annoying, but at worst: a disability. Not a definition of me. 

The causes:
Sleep deprivation (including Jet Lag)
Alcohol (usually by causing sleep deprivation)
Overconsumption of Carbohydrates
Drop in Progesterone/Estrogen (pre-menstrual)
Stress (especially acute episodes)

The cures:
Circadian rhythm balanced by adequate sunlight exposure
Vitamins & supplements, especially omega 3
Stress management
Balanced diet
Time (← absolutely essential)

If I stop taking my vitamins, start eating more chocolate and ice cream, become  socially engaged, stay up late, and avoid going outside: I can guarantee my poor health within a month. In an ordinary fertile month, the change in hormones in a female reproductive cycle bring a reliably severe and temporary pattern of depression followed by anxiety. If my body doesn't have the resources to cope with this hit, it takes even longer to recover, making me even more fragile to traumatic, stressful experiences, degrading my social relationships, and allowing my mind to associate even more negative feelings with my life.

In short, the further you fall downstream, the harder it is to swim back up.

Do I blame the cycling female hormones? My poor diet? My lack of sleep? A rude acquaintance? Or do I blame me, for being so sensitive and so perpetually weak?

I stop blaming.

Right now, I'm further downstream than I've been in months. I suffered jet lag, hormonal changes, poor diet, chronic stress and lack of vitamins. I felt depressed and,  even worse, detached; my choices continue to deteriorate. Another week of this and my immune system will fail. If my immune system fails again this year, I will be placed on probation for poor attendance. The disappointment and failure will colour my work relationships with shame. I will feel more and more anxious each day. My colleagues will see my anxiety and withdrawal and interpret it as rejection. They will, in turn, reject me. Feeling even more excluded and alone, I will look for and succeed in finding a new position, probably even a new career.

And all because I ate chocolate instead of carrots. Because the egg didn't fertilise and implant in my uterus. Because my cells weren't rejuvenated with sleep. Because I lacked familiarity and intimacy with others.

I'm sipping an iced rose wine in a dark room with no windows. The only light is the green of the football field. The only sounds are vuvuzelas and a quiet chittering of the commentators. I am balancing at high heights, but still, I know not to expect this brief high to last. Tomorrow I will feel worse, but if I make better choices, I will feel better.

Now, we are caught up.

Read on the NHS Choices blog.