Mental Health

Building social support

/ Sarah K Reece / 9 Comments

Some of us find ourselves in a place where we are deeply isolated in our lives. This is sadly a common problem for many people with ongoing mental health problems. Social support is one of the factors that help to build our resilience – our ability to handle difficulties. Isolation has been a major problem for me most of my life, and in my opinion certainly contributed in a big way to the mental health problems I was suffering as a young child. There are many different things that can contribute to becoming isolated, which can change the kind of approach you may find most effective in overcoming it. In my case, some of the things behind my isolation were very simple ones – such as being a creative arty person in a small school with a strong sports focus. Others were compounding issues such as developing PTSD in my teens and finding my peer group weren’t able to support me – their withdrawal distinctly increased my symptoms and distress which only made me more different and awkward and therefore more isolated. This kind of spiral – the experience of mental illness and/or trauma makes you behave differently and need different things, which can lead to your social support withdrawing, which can make the illness and distress worse – is a common one for many people. In addition, withdrawal from social contact is a pretty common symptom in many mental illnesses, so your social network can fall apart or move on while you’re hunkered down in a burrow somewhere. When you start to feel better and look around, it’s a bit like Rip Van Winkle coming home to find the whole world changed and his children grown. But too, for a lot of us isolation is part of the landscape in which vulnerability to trauma and mental illness is then grown.

I’ve rebuilt my life on more than occasion only to have it all burn again, and I’ve learned a few things from mistakes I’ve made over the years. Maybe some of these will be helpful to you.

  1. Sometimes you have to leave. I could bend myself into pretzel shapes trying to make friends at school, but really what I needed is to look elsewhere. There’s a few reasons for this – one of which is that having been targeted by bullies, even students who liked me were afraid of also being bullied if they spent time with me. But that’s another story! It would have been better for me to have been home-schooled and looked for mates in after school drama classes and activities like that.
  2. Borrowing the social network of a friend or romantic interest. It’s nice to be invited out and have people to hang around with. But if things go pear shaped you’ll be left picking yourself up on your own. Some of the energy you’ve invested into those relationships could have been spent making mates of your own.
  3. Putting up with very unequal relationships. It can get tempting to take what you can get and accept some miserable relationships when it seems that nothing else is on offer. I don’t mean never care about anyone else, or don’t be kind to your elderly stroppy neighbour. I mean taking on someone and treating them like your best friend when that’s really not what they are. Confiding personal information that is later used for gossip, nursing them through heartbreak when they never show on your bad days, always paying for the night out when they could afford to shout it now and then.
  4. Expecting more of your mates than they’ve got. When I was a teenager dealing with PTSD my mates at the time freaked out and distanced themselves. That was really painful and unhelpful, but I do get that a bunch of 15 year olds really weren’t equipped or supported to know how to relate to me. They had no idea why I was so reactive and overloaded, and frankly if I’d been given good support from other adults they might have had a model to emulate. Most of us don’t have friends who are deeply educated and experienced in mental health and trauma sensitivity. They are going to get it wrong. (frankly, even if they have loads of information and experience they will still get it wrong! That’s just the nature of being human I’m afraid) I use a lovely quote by Barbara Kingsolver as my own guide:

The friend who holds your hand and says the wrong thing is made of dearer stuff than the one who stays away

We all need contact with other people to maintain mental health. There may be different quantities for different people – some of us need more social contact than others. We also need a range of different kinds of relationships in our lives, from the barest acquaintances to the closest of kindred spirits. Sometimes we may be better at maintaining one kind of relationship than others. Some of us have a couple of really close mates but almost no one else in our lives. It doesn’t matter how awesome the friend is, you still need other layers in your life. Others of us maintain a healthy bunch of friends we see now and then, but never seem to find anyone really close. Some of us find ourselves in a pretty bleak space where we don’t really have anyone.

I started rebuilding my own networks from the outside in. That is, I started looking for acquaintances and people I might hang out with occasionally before I went looking for closer friends. There’s less being asked of someone at this level, so a lot more people will make great acquaintances. A few years back I started going to Mifsa (Mental Illness Fellowship of SA) looking for company. When I first walked in to the activity centre and looked around, I was really disappointed. No one else there seemed to be like me at all. Many of the other people openly asked what I was diagnosed with when they first met me, which I found really confronting. I was at the time very closeted about my mental illnesses and I refused to disclose. On one occasion another participant took this as a challenge and told me they’d be watching me to work out what I had! This wasn’t a great start and I stopped going.

Then it occurred to me that there could have been a whole stream of people like me, with my interests or similar experiences coming through the activity centre over the years – but until one of us stayed put we were never going to meet each other. So I decided to keep going anyway. It helped to have somewhere, however imperfect. Access to resources such as the internet, landline phone, cheap meals and food bank helped get me through some really tough times. And although I wasn’t close to most of the other people there, they were company, someone to play pool with or watch a movie with. Just that basic friendliness meet a need for me.

Sound Minds (Voice Hearers Group) was  a real turning point for me. Again, initially it was less than ideal. I was the only person there with a dissociative diagnosis, and at that time Mifsa had no books, fact sheets, experience or resources of any kind geared to dissociation. I had to explain myself a lot and I was very stressed and sensitive about my diagnosis. But I was accepted, and they let me come and be upset about my life without telling me I should look on the bright side. Out of this the Dissociative Initiative was born and now things are changing. Sound Minds was also originally geared towards education. The first time I went along and shared that I was lonely, the room went quiet. Several other people then shared that they were lonely too, and it was just something to get used to. I went home and decided that a room full of lonely people was daft. Gradually the group became more social, and now I have the whole bunch round to my place for a camp fire catch up regularly.

I’ve started to build networks through the mental health community by turning up to lots of events and being friendly and talking with other people. I’m starting to get to know people. I also want to make connections through different networks – which is part of the motivation for the mad amount of study I do in different areas. But I started much smaller – by looking in places where I had interests (such as art) or felt accepted despite challenges (walking into a building marked “Mental Illness Fellowship”).

I have also found online communities at times to be very supportive. Facebook helps keep me in touch with people I don’t get to see often or those I don’t know well enough to give my details to. Skype keeps me linked in to people a long way away. Some nights just being able to find someone else awake and have a quick chat even if about nothing personal has helped take the edge off. I’ve been part of online groups through Yahoo which helped me to understand a lot more about my mental health and have other people to talk to.

For relationships that have been intense and distant, as in the instance of some family members, I’ve read about relationships under stress and learned about boundaries, polarising, and other common issues. I’ve worked on lowering the intensity and reactivity in these relationships, resetting back to friendly acquaintance if I can and re-growing things gently. I’ve also done a lot of work on myself, accepting myself, learning assertiveness, better communication, and how to better contain the kinds of symptoms that cause me problems in my relationships – such as raw emotional intensity, impatience, ambivalence, emotional disconnection and preoccupation, irritability, and… you get the picture. I’ve had to do a lot of building a better relationship with myself instead of trying to resolve emotional pain through company. Having said that, I’ve been quite stunned at the incredible difference having some emotional and social support has made for me. A lot of that emotional reactivity and instability have settled by themselves. It is too damn hard to do this all by yourself.

I’ve had to let go of some relationships that were really important to me because they weren’t working and sometimes I am just too fragile to handle it. I’ve also had to learn how to accept a relationship that isn’t quite what I wanted or that changes over time. Sometimes you end up in a relationship where you are treating the other person as a best friend and they are treating you as an acquaintance – so you do a lot more nurturing and being involved then they do. It’s been a hard lesson to learn that sometimes if that’s the level of relationship they want or are comfortable with, that’s what it needs to be. Very close friends take time and energy to maintain, and there’s only room for so many in our lives sadly. Sometimes you think someone is awesome but so do a few other folks and they’ve already got their complement of close mates. It’s okay, keep looking, if you’re a good friend and you let things develop at a good gentle pace, you’ll make them.

How to call Mental Health Crisis Services

/ Sarah K Reece / 7 Comments

Mental Health Triage is our Crisis service in SA, and whilst they have an incredibly important job, they can at times be difficult to interact with. Sometimes this is just determined by who you get on the other end of the phone and how bad a night they’ve had so far. I’ve had to call them as a carer or friend on a great many occasions, and I’ve learned a few strategies that seem to make things a bit easier for me. Your mileage may vary, but here’s my tips:

1. Have a clear goal in mind
Before you start the call, work out why you are calling them. I know this can be difficult when things are in crisis, but if you don’t know what you want, you’re not all that likely to get it. Are you updating them with important information? Do you need them to speak to the person you’re worried about? Are you hoping for a visit from their staff? Do you think the person urgently needs hospital? Do you need police support? Work this out before picking up the phone if you can.

2. Gather the person’s information
I can never remember everything I was going to say once I’m on the phone. Write down a list, and tick them off as you go. Having everything in the one spot means less fuss running to check the name of the current treating doctor, or what dosage of medications they’re on this week. The more chaos and change in the person’s life, the more important it is you take a few moments to check all your information. You may need to know the person’s

  • current diagnosis
  • medications
  • treating doctors/therapists
  • hospital ID numbers
  • full name
  • address
  • date of birth
  • phone number
  • dates of important events (eg. she was last in hospital on…, he stopped taking his medication on…)

You can still call if you don’t have these – eg. you’ve just stepped in to help a stranger in crisis on the train – but if you can put this information together first it will help smooth things.

3. Lay out the situation really clearly and simply
Mental Health Triage get millions of phone calls from desperate, incoherent, stressed out people. Assume for a moment they have no files whatsoever on your person, even if they do or should have. Give them the dot-point version (that you’ve already written down) of what’s going on and explain very, very clearly why you are concerned. For example:

I’m calling on behalf of my friend Lauren. She has schizophrenia and becomes suicidal when she is unwell. I’ve just discovered she stopped taking her antipsychotics on Tuesday, she’s not eaten in several days. She’s just phoned me very upset because she thinks her neighbours are trying to kill her. She is barricading her apartment.  I’m concerned that she is a danger to herself and unable to care for herself at the moment. Can you please speak with her or send someone to her apartment.

Don’t assume anything. Don’t assume that it’s obvious you would want the police to come, or that the person clearly needs hospital. Don’t assume that saying something like “He’s becoming very withdrawn and won’t speak to me” will ring the kind of alarm bells for them that it does for you. You need to tell them that the last time he did that, x happened. Tell them what you need and explain why.

4. Cry some place else
That sounds pretty harsh, but I’ve found that if I keep really clear in my mind that Mental Health Triage are a crisis response service, not a counselling one, I have an easier time in conversations with them. Very occasionally a lovely person will look out for you and let you talk for a moment about how you’re feeling and coping. But going in, I assume that they are not there to meet my emotional needs. I am as calm, clear, and professional as possible.

This doesn’t mean your emotional needs aren’t important! On the contrary they are extremely important and it’s best to take them to safer places they are more likely to get met. If you need to follow or precede a call to Mental Health Triage with one to Lifeline, a good friend, your Mum, whoever, then do it. But in all crises, there’s a time to cry and shake and feel things, and a time to call the police and clearly tell them your address – or whatever. Don’t get them mixed up if you can.

5. Recruit help
Sometimes in a developing crisis you have your hands so full with the person you don’t have the energy or time to make phone calls as well. If a couple of you can work as a team that can take a lot of the pressure off. I’ve done this quite a bit, someone sits with and calms down the person, someone else makes the important calls. Doing it all yourself is a recipe for burnout.

Also use this technique if for some reason Crisis Services aren’t taking you seriously. I’m sorry to say that as the carer/family/friend your experience and opinion often count for very little. If you are looking out for someone with high risk issues such as a person with Borderline Personality Disorder, there will be times when you really struggle to get the help that’s needed. Persistence is the key. Keep calling them, and get everyone else who’s worried to call them too. There are resources and supports out there, but unfortunately they tend to go to the squeaky wheels. Don’t suffer in silence, squeak as loud as you can. There’s a lot of decisions made that are more about personality than anything else – sometimes one staff member will block all access but if you call back in 6 hours the next will be on board. Sometimes you only get the service your person needs because they are fed up with dealing with the calls, and while that is awful it’s better than nothing.

6. Do without them wherever you can
Especially if your person if in chronic distress, try not to escalate a situation by jumping for Mental Health Triage every time they wobble. Look at the patterns – eg issues with medications etc. and expect more of the same. Try to take as much of it in your stride as you can. There isn’t a magic fix for these kinds of issues. As much as we told to ‘ask for help’, there is no quick way to take away emotional pain. A lot of the help and healing your person needs is probably not going to be found in the crisis services. They can hospitalise or medicate, but that’s about it really. Sometimes that’s life saving, and sometimes it’s just more running around only to have them back home in the same mess in a week, or two days, or 6 hours. It’s not always worth it.

Concentrate your energy whenever you can on the other supports – finding a good doctor, a therapist, social support, maintaining stable housing etc. Be aware of the limitations of crisis services and don’t get hooked on the idea they can offer a solution that they can’t.

7. Give them feedback when you can
Crisis services can be frankly a horrible place to work. Any kind of front-line work like this has a lot of people having the worst days of their lives, feeling totally overwhelmed and miserable. If you have a positive experience, be sure to let that person or the service know that what they’ve done has made a difference. Treat them with respect and dignity. We need to look after the good folks in these kinds of roles so they stay around and look after the next person. On the flipside, if you have a terrible experience and have the time/energy, make a complaint. Be clear about what you wanted and what you didn’t like. It won’t change the world, but it can be part of culture changes.

8. Maintain credibility
As a friend, family member, or carer, you may be quite surprised to find how little your opinion counts. This holds true in my experience, even if you have extensive experience and qualifications in mental health. That can be a shock. If Mental Health Triage or any other service decides that you are overly anxious/unreliable it will be next to impossible to get them to take you seriously. The heart-wrenching thing is that there is basically no accountability in mental health. If your person kills themselves after you spent days arguing they should be in hospital, it is extremely unlikely anyone will be held to account for it. Additionally, we are in a no-win situation where suicide is often considered to be proof the person was beyond assistance anyway. This means you are far more invested in the outcome then nearly anyone else you will speak to – often including the person you’re worried about.

It’s not unusual to find that one minute you are told your person is not unwell enough to be offered a service and the next to be told they are too unwell. You may also discover processes that make your person much more unwell and distressed such as turning them away from services and telling them “until they actually self harm (instead of thinking about it), or have active suicidal ideation (instead of ‘passive’ thoughts) they can’t receive help”. Many people in distress start self harming or planning suicide due to situations like this. Many also become aware that the services are actually harming them and refuse to engage anymore, even with the good useful ones. It’s a crazy-making process and there’s nothing wrong with you if this stresses you out terribly too – but be careful of letting them see the impact on you. It’s a normal response to cry and yell but in mental health and crisis services will be seen as a sign of you ‘not coping’ and being mentally unwell, and therefore unreliable as a reporter of whatever is going on.

You need to do whatever you can to retain what little credibility you have. That means working with the system and accepting it as it is, instead of being fooled by the packaging into thinking it’s going to adapt to you. The more you can mimic their behaviour and speak their language – detached, professional, calm, courteous – the better chance you have of being taken seriously. As much as you can, make them like you and want to help you. Don’t let them write you off as emotionally unbalanced when the stakes are this high.

9. Ignore useless advice
As a carer/friend/whatever, you will get a lot of contradictory, useless and unhelpful advice. The crisis services are really good at this in my experience. Boiled down most of the bad kind turns out to actually be something like this: “If you were less involved, no one would be ringing me about this difficult person and my job would be easier”.

I’ve had the bizarre experience of being told off by one staff member for being over-involved and not involved enough in someone’s care within the same conversation. If it can be made to be your fault somehow you will probably hear about it at some point. A lot of people who know nothing about you or your caree will tell you how to care for them and let you know they think you’re doing a pretty lousy job.

Others will laud you and invite you to collude with them in how awful the person you care about is, or offload their frustration or distress onto you. Not your job.

I’ve also had experiences of emotional blackmail from crisis services, including Mental Health Triage, for example being told “But what if someone else dies tonight because your (person) was in the last hospital bed?” Some people find it difficult to work in a service and acknowledge its limitations. When things fall apart that means it will turn out to be the person’s fault, or your fault. Expect this and learn to tune it out as much as possible when picking them up on it would only distract from your goal. Find somewhere safe to rage or cry about it later. Don’t take it on board or let people undermine you.

10. Maintain value

There’s often a conflict between your perception of the person’s value and that of the services. People do get written off in many different ways, “it’s just behavioural”, “they’re doing it for attention”, “he’s a hopeless case”. Most services are kindest to people in the first instance of crisis, in short term crisis, and to people who are from the most culturally valued backgrounds. If your person is marginalised in some way, and/or has been in crisis for awhile or more than once, then they are risk of being devalued. As this happens the services may refuse to engage them at all, and/or the ‘care’ they receive may actually be thinly veiled contempt. Some services have endemic problems with treating all people with mental health crises this way, for example both police and ambulance services have many wonderful compassionate individuals, but also many who are cruel and use abuse and neglect to harm people. Sometimes this is a lack of understanding/training/empathy. Sometime it is simply a form of victim blaming where limited resources and too many people in need are blamed on those perceived as undeserving/not really in need. Victim blaming is endemic in our culture around mental health and the crisis services are not immune. 

You may see issues such as stitching self harm wounds without anesthetic, cruel responses to distress such as isolation rooms and inappropriately high dose sedatives, needlessly rough handling, leaving people in wet/soiled clothes, deliberately choosing procedures the person finds frightening, not allocating a bed, losing personal belongings, and traumatic conversations. You may not even be aware many of these things are happening as people in crisis often find it difficult to communicate. There are many subtle ways someone can be punished if they have been perceived as ‘wasting precious health resources’.

Be sensitive to subtle signs your person is being devalued and fight back by humanising them. Dress them in good or formal clothes. Do their hair. Show photographs of their family or children. Find small ways to remind people of their job title or degrees or educational plans. Bring flowers when you visit, even if this is their 100th hospitalisation. If you can, complain about or directly confront any abuse or neglect you witness. (once in an ER I overheard staff laughing about my person while I used the public toilet) Emphasise their dignity. Make sure staff are aware you see this person as valued and you are plugged in. Having even one member of staff see your person as valued and not to blame for their suffering will help protect them.

11. Don’t let the system burn you out

If the circumstances are desperate, use every bit of leverage you have to get care. Once I was homeless along with the person I was caring for. They were in life threatening crisis and I had no resources to support them. Mental Health Triage were flatly refusing to offer any services and running us around by sending us to hospitals then losing the referrals and the case notes, forgetting we were waiting for a consult, and so on. When I complained about the situation I learned the team had assumed I had a “home with a husband and white picket fence and was just offloading family I didn’t want to care for onto the over stretched mental health system”. No one actually asked me, and these assumptions were putting us at great risk.

Once I managed to get someone in crisis admitted to hospital only by threatening to kill myself. (the logic of admitting someone to hospital on the basis of someone else talking about suicide is mind bending) Another time someone had spent over 12 hours in Emergency with open wounds, untreated and without food, water, or a bed. They finally stitched her up when I threatened to contact the local newspaper health reporter. Another time I refused to allow someone home so the hospital would be forced to admit them.

These are not things to consider lightly and they may cost you all the credibility you have built up. But while there is a lot of lip service to the idea that your needs count too, it is not uncommon for carers to pick up the tab for overtaxed services. Sometimes this is the best thing you can do – bring in meals they actually eat, make sure someone gives them a nicotine patch within the first 48 hours, correct the wrong med they are being given. But also, you mustn’t let them lean on you when it’s killing you both. It is not the person in distress’ fault the services are broken. Nor is it yours.

12. Be careful – Manage their anxiety

Sometimes the best crisis care is sitting in the backyard and throwing ice cubes at the fence, screaming in the car with the windows wound up, or 9 hour baths. For some people and in some places, crisis services can be not just traumatic but lethal. Police do kill people in crisis. You may be very low risk and find that hard to process, but it means think twice about how you navigate and advise in crisis especially someone else who is at high risk. 

Competent crisis intervention recognises that crisis is vulnerable, volatile, and sometimes beneficial. It is about connecting, validating, empathising, and de-escalating. It is profoundly human. If you want to watch competent fictional crisis intervention, checkout the series Flashpoint. This exists in our crisis services but it’s not across the board by any means, and is largely a result of informal people skills. Meaning that those who were already good at this make great paramedics, social workers, etc. And those who were already awful are rarely improved through their formal qualifications.

It’s hard to get inside the head of someone who makes things worse in a crisis or hurts someone already in so much pain. Sometimes you can understand the different perspectives better when you apply your own empathy – a nurse sick of being attacked is obviously going to be more focused on neutralising threat than emotionally connecting. A police officer who believes someone in psychosis is sick and needs treatment won’t stop to think about the process and if it’s trauma informed – getting that person into hospital quickly is their job, and it’s the person’s job to comply (in their mind). Sometimes crisis services are best not called, or called only when you have the capacity to influence, calm, and de-escalate them, too. 

***

Most of that isn’t fair at all. You’re already working hard to support the person, probably exhausted and scared out of your mind, and feeling all the intense feelings that crisis generates. Services like Mental Health Triage should get that and accommodate you and your needs too. I couldn’t agree more – and occasionally it may happen that way. But that’s not been the norm in my experience. Take good care of yourself, it’s phenomenally exhausting supporting someone in crisis.

If it all goes belly-up and you can’t follow a single one of these tips but you need them, call Mental Health Triage anyway.

If your person is dealing with anything longer term such as dissociation, multiplicity, an eating disorder, borderline personality disorder, PTSD or psychosis, you may not get any useful support from Mental Health Triage at all I’m sorry to say. The level of discrimination against dissociative and multiplicity conditions is extreme and many crisis staff consider them all faked for attention. Most crisis services won’t respond to eating disorders unless the person is in acute medical crisis and even then there’s a lack of training about what to be aware of. You may have some intense advocating to do and sometimes have to fit the services to your own approaches, such as using the ER to re-enforce that someone with an eating disorder must eat at home or they will be taken to hospital. The hospital may not be happy about their role in this process but they don’t have to be.

Your best route is to stay out of crisis as much as possible, and get good support staff on board. Finding ways to manage crisis without needing services can also protect you both. You may need to get private hospital cover and look for a psychiatrist with admitting rights instead of risking the public system.

It’s also important to be aware that the highest risk time for issues like suicide is often just after the sense of crisis has eased. Discharge from hospital for example, is a common time people are highly vulnerable, traumatised, and feeling very alone and exhausted. While this has been widely recognised for a long time, in most settings little has been done to address it. Sometimes not being able to access services is a twisted blessing in disguise.

Good luck, take care, and get some support.

Mental Health Triage in SA: 13 14 65
Lifeline: 13 11 14

Conflicting Needs

/ Sarah K Reece / 2 Comments

Feeling absolutely stuck is a pretty common experience for many of us with mental health challenges. Sometimes we feel stuck because nothing we’re trying is working. Sometimes the limitations brought about by chronic difficulties such as severe anxiety or dissociation can make us feel absolutely trapped. In some cases we feel stuck when we have more than one conflicting need. Feeling pulled strongly in very different directions, we’re under constant pressure we can’t seem to alleviate. Moving in any direction makes the pull from the opposite even worse. It’s a difficult place to be in.

Image courtesy of Adrian van Leen, rgbstock.com

People in chronic emotional pain and those who’ve been traumatized often struggle with these kinds of polarizations. There are many paired and opposing needs, that when felt strongly at the same time can immobilize us. It’s deeply frustrating and upsetting and can lead to a spiral of intense distress and chronic anxiety that makes it even more difficult to think clearly or communicate about. Some common examples are the need to talk about something and an equally strong need to keep it secret. A need for social contact and a need to be alone. A need to break out of the routine and a need to stay with the familiar.

Something I found helpful when this gives me trouble is to realise that paired contradictory needs are actually common to all people. Granted, most people don’t feel them quite so strongly at the same time, but all people need things like social contact and time alone at different times and in different amounts. Some of the child development frameworks (particularly the attachment ones) talk about two of the basic needs of growing children; a need to explore, experiment, try new things, and a need to be nurtured, to feel safe, to be bonded. Children routinely switch between these two needs, how much of either they need is determined by their temperament, the environment, parenting approach, and experiences.

Children who are frightened, stressed, or traumatized will often experience less interest in exploring, and a much stronger need for nurturing and safety. Sometimes they will ‘regress’ to an earlier level of development for a time, they might stop speaking or sleeping independently. Usually once the stress has passed that need to adventure will come back and they will regain those skills and set out to investigate their world again.

I found it very helpful to realise that not only are contradictory pairs of needs quite normal, but that both are equally important to meet. In fact, their contradictory nature is actually complementary – they balance each other out. If children didn’t feel a drive to explore and master, to taste, hold, throw, build, dig, investigate, and learn they wouldn’t grow up and develop into adults. If they didn’t feel a need for safety, security, familiarity, nurture and bonding they wouldn’t learn empathy, love, social connection and kindness. These needs balance each other out.

With that in mind I found myself looking at this stuck place in a different way. Instead of asking myself which need should be met, I started to look for ways to meet both of them. I know that it can feel completely impossible to do that! Sometimes one could be met in a small way, then a little of the other, then back to the first. Children run out to explore, then come back to check family are still there, then run off again. It’s absolutely fine to take turns. Part of the nature of those of us who are in chronic pain is to start to think in very absolute terms. It can be difficult to think in small steps – today I’ll go out to that art opening and see people, then this evening I’ll turn off my phone and stay in and read.

Sometimes it takes some really creative ideas to find ways to meet opposing needs. Sometimes the way the needs are framed makes it impossible, but if you can dig a little, you might find another way to look at them. For example – ‘I want to see a therapist/I don’t want to see a therapist’. They can perhaps be expressed as ‘I need some help/I need to stay safe’. Once you reframe them that way it starts to become possible to meet both – for example going to see a new therapist, but deciding not to talk about certain things until you get to know them and develop some trust. Promising yourself that you wont keep going if they are not safe, or that you will look for another therapist instead of opening up is one way of meeting both needs. Or deciding that for the moment, seeing a therapist would be too distressing, and deciding to use anonymous helplines on occasion, or read a book about your difficulties instead are other ways of meeting both needs; getting help and staying safe.

Once you start to move out of the either/or mindset and see both needs as important, you can start to unpick the knots that keep you feeling stuck and find a way to move forwards. Over time I’ve found that my brain has come to understand this approach and work with me much more. As long as I’m reliable about doing things like taking turns which need I’ll meet, the intense feelings start to settle down. It’s a little like having two dogs that can’t be walked together. At first when you take one out, the other barks and whines and makes a huge fuss. But if you’re reliable about taking the second one for a walk too, after a while the one left home trusts that you will come back for it and it settles down and lets you get on with things in peace.

People with parts can sometimes find that different needs are compartmentlised within different parts, which can set the scene for a lot of internal conflict. Treating all these needs as valid and valuable, and understanding that a lack of balance is the result when they get cut off from each other can make a big difference to restoring some calm and safety to warring multiple systems.

A final note – we can also get very stuck when one of a complementary set of needs is completely suppressed. If we only feel the need for safety and familiarity, and never the need to adventure our world can become very small. If we only feel the need to be social and never to be alone with our thoughts we can lose our chance to learn about and care for ourselves. Again, small steps towards the other need can be better than huge changes. Little moves in the other direction can help to unfreeze us and wake up that other need in us. We all naturally have a different balance of needs as part of our personality. Some people love comfortable holidays in five star hotels, others spend their free time white water rafting. There’s nothing wrong with this, it’s part of the marvellous diversity that makes up the human race. But if you’re feeling unbalanced and stuck, it might help to spend some time with or read about people who exemplify the need you’ve lost touch with. Just a little love of home can stabilize chaotic wanderlust, just a little curiosity can inspire a recluse to try something new, just a little sharing can reconnect someone isolated by secrets.

 

DID Card

/ Sarah K Reece / 7 Comments
Recently someone gave me a few of these very interesting little cards. They are the size of business card, and use that minimum of space to share vital information about the nature of DID. In the event of a crisis I imagine they could be very helpful!

They also provide a link to a website in the UK – you can find it here. It’s quite comprehensive with a lot of information and resources. I would love to set up something like that here in Australia! I’m going to chat to the members of Bridges and the Dissociative Initiative about perhaps making up our own cards of information like these. One of the things I’d like to see is a second complementary card that discusses dissociation. Something that frustrates me a great deal is that in all the hype over multiplicity, those dealing with dissociation that presents in other ways – such as amnesia, depersonalisation, loss of senses etc. can be overlooked. Multiplicity is one manifestation of dissociation, but severe and chronic dissociation in any other areas can be equally distressing and disabling. I’ve been searching for books on dissociation but not multiplicity for Bridges (as the group offers support to people with either experience) and I’ve been quite frustrated at the appalling lack of information out there! The majority of the books in this field concentrate on either general trauma phenomenology, or multiplicity.

It’s been suggested to me that perhaps considering this gap in the literature, I should write such a book, and I admit I’m giving it serious thought. When to find the time is probably the biggest consideration. What to write, how to structure it, how much research I’d need to do to back up my opinions, and whether to wait until I have professional qualifications in the field for greater credibility are all on my mind. There’s a WEA class on writing non-fiction coming up that I think could help me think about structure, layout and organisation. Part of my concern is also how to make it affordable so those who most need it can access it – perhaps through a grant of some kind? Also, making it shorter, a booklet, may keep costs and therefore prices down. The beauty of this blog is it is free for me to host articles and suggestions, but the net is not accessible to everyone and there is something to be said for being able to underline, asterisks or cross out things in a book if you are so inclined. In rare quieter moments I’m finding myself starting to work out the introductory chapter and the structure… I’m also doing training shortly about how to write grant applications, so I’ll keep this project in mind then. Perhaps I could secure some funding to keep the book inexpensive or even free? Who knows, you have to ask. 🙂

There are some possibilities coming up that perhaps more training and resources will become available here in SA soon. I’m very mindful that at present, while we have the group Bridges, we lack supports for carers/family, and also training opportunities for support workers and professionals. Talks are happening about what we can do in these areas, which is very exciting to me! A year and a half down the road from my first terrified talk about DID, I can now see what I’d like to change about the talk I wrote and better ways to present the information to make it easier to understand. Building a library of books and accessing journal articles in these fields has been absolutely invaluable to developing my framework and understanding of dissociation, multiplicity, trauma, and recovery, as has so many people generously and courageously sharing their personal experiences. There is so much to learn yet, but even the little we know now could make such a huge difference to so many people out there.

It breaks my heart that so many people are suffering so needlessly and so alone with these experiences. I am furious that some staff are still telling people that dissociation doesn’t exist or all symptoms are invented for attention. I am so distressed by the chronic pain, high levels of suicidiality and self harm within a population that has one of the best responses to appropriate support of all the mental illnesses! There is hope and there is help, but so many people don’t know that yet. There’s a lot of work to be done here. I did a course in Mental Health First Aid a little while ago, and it really frustrated me that a dissociative crisis wasn’t mentioned. Most people don’t know what one is, how to recognise or support someone in that situation. We talked about suicide, drug overdoses and panic attacks, which was great. Dissociation is also extremely common, often overlooked, and can be deeply distressing. Knowing how to recognise it and reassure someone in crisis that they are not going crazy, that these experiences are common and can be managed can sometimes make the difference between life and death. This is not rocket science! We can do this. We can make things a whole lot better for a lot of confused, scared, lonely, creative, resilient, amazing people out there who deserve a better deal.

What is Peer Work?

/ Sarah K Reece / Leave a comment

Peer Work is drawing from your own experiences to support someone else. It’s an idea that’s been around for many years in health, for example cancer survivors running groups to support people newly diagnosed. It’s fairly recently a role that’s becoming respected in Mental Health. At the moment many people are employed to support carers, perhaps called Carer Consultants, who have or are themselves carers and can support, educate and relate to other carers in a personal way. This is one kind of peer work. Consumer Consultants are people who draw upon their personal experience of living with or having had a mental illness themselves to support, encourage and educate other people. When the term Peer Work is used in mental health, this is usually the kind they are referring to. There are many names for this ‘peer work’ role such as Consumer Educators, Community Workers, Mental Health Educators, Peer Facilitators etc., and it’s becoming more common for mental health teams in hospitals and community centres to have Peer Workers on staff. Peer Workers are also often in voluntary roles such as visiting people in psychiatric hospitals.

What do you need to do to be a Peer Worker? You do need to be reasonably well yourself, whether living well with your condition, or recovered from an episode. Anytime you draw upon your experiences to help another person, you are doing peer work. Many peer workers find that this isn’t so much a job description as a part of how they live their lives. Even if you are very unwell and in hospital, if you can listen, encourage, give useful information to, or in some way make things easier for another patient, you are doing peer work, in my opinion.

If you’d like to become a peer worker, there is some training you can do, through the Peer Work Project here in SA. It will also help if you spent time with other people with mental illnesses through a community centre or online perhaps. Often we know a great deal about our own condition, but very little about other mental illnesses. Broadening your knowledge can help you relate to and support more people. I’d suggest you attend or volunteer at a local club, centre, or hospital that supports people with mental illness.

What does a Peer Worker do exactly? Well, that depends, the roles can vary tremendously. Some people work one on one and support people living with mental illness. Some people give talks, sharing their story with different audiences – perhaps people who have little experience of mental illness and who may benefit from putting a human face on labels and conditions. Other people run groups, perhaps around a skill, activity, or particular experience (eg. anxiety). Some people do admin and get peer related resources up and running such as online websites.

Being a good peer worker involves a passion for this work, a willingness to be open about your experiences, excellent listening skills, lots of patience, and good support. Good boundaries, a degree of stability, and the ability to handle having a foot in both worlds (part ‘consumer’, part ‘staff’) will help a lot. Peer Workers, like everyone else in this field, are vulnerable to burn out so you really do need to take good care of yourself, have good support and pay attention to your early warning signs. Having said that, for many of us the opportunity to convert painful experiences into something that helps people and to feel useful is a crucial part of our recovery. If it suits you, you can find a good balance, and you have good support, then Peer Work can be one of the things that supports your mental health.

New training opportunities

/ Sarah K Reece / 3 Comments
Hot off the press – What’s On has details for some great training coming up with very limited places. If you’re interested in peer work or art, or looking for free or low cost courses, hop over there and check them out! I’ve booked in to a few of them myself.

Back to cleaning and sorting…

Nesting

/ Sarah K Reece / Leave a comment

Nesting is an idea that may be useful for you to explore if feeling chronically unsafe is part of your life. This may be as part of an anxiety disorder, a dissociative condition, for someone with self harm issues or who is highly reactive to triggers, and so on. The idea of a nest is to create for yourself a bolt hole to retreat to when you are feeling very unsafe and overwhelmed. Kids often instinctively do this, they may hide under the bed or in a cupboard or up a tree when they are scared. If you did this as a kid it may be you can replicate a similar sense of safety for yourself now by tapping into that good memory. I used the term nesting to describe this behaviour because it is so strongly linked in to your environment rather than other techniques that may be about self talk or moving your body in calming ways for example. That’s not to suggest this is in some way a better approach – there’s a lot of options out there and by no means do they all work for everyone. Nesting is also often the term used when a parent prepares a room or nursery for a child, and that has a similar concept behind it – to make a safe, comfortable pleasant place.

For many people, their home is their nest and they feel safe there and don’t need to think any further about it. To them, the idea of creating a nest for yourself may seem a bit ridiculous or childish. But many of us who feel chronically unsafe don’t find our home serves this purpose, and sometimes harking back to childhood and finding a way to calm our ‘inner child’ is more effective than efforts to maintain a mask of being ‘grown up and coping’.

If you can make your home feel safe that would be fantastic. If you live alone, it may be that you need good bolts on your windows, a lovely big dog, your own posters on the walls or music playing to help you feel like you belong and this is your space. If you’ve been burgled or assaulted in your home, this might be a real challenge. It can feel like the walls were torn apart and your sense of security turned out to be an illusion. The memories of people who came into your space may linger and torment you. You can over time reclaim your own space and drive these memories out. But if you’re having trouble with this, you might find it easier to start with something smaller.

It can be ideal if your bedroom is a safe place for you, especially as we spend so many hours sleeping and vulnerable there. For some of us though, the bedroom is the most tainted and difficult room in the house. If this is causing you major problems, don’t be afraid to rearrange. It doesn’t matter if you sleep on the couch or drag your mattress into the kitchen. Whatever you need to do to start to feel a little safe is worth trying. Once you can find a toehold on safety, it may be then that you can start to reclaim more and more territory. Sometimes it’s just finding that first toehold that gets everything started.

Follow your instincts in creating your own nest. If the wardrobe was a safe spot as a child, it may be that you can put a pillow, some stuffed animals, a flashlight and a book in there and hide out whenever the dissociation/flashbacks/panic attacks/urge to self harm etc gets bad. When I was a little kid, I read a book about meteors. It told the unfortunate true story of a woman who went to sleep one night in her rocking chair and was struck by a meteorite and killed. Being a highly stressed child with a vivid imagination, I linked her death to the act of sleeping and developed a terror of sleeping in my bed. For many months I went to bed obediently, then dragged my blankets off to the bottom of my wardrobe where I figured the meteorites wouldn’t be expecting me!

This little story is a great illustration of the kind of logic we have as children, and this kind of logic can sometimes be in play for those of us under high stress. Sometimes if we can put aside our need to look ‘normal’ we can speak our own emotional language and meet those needs. Whenever we do things that communicate to our self that we are looking after ourselves and working to make things safe we’re sending good messages. Sometimes that alone is enough.

One of my ‘nests’ is my bath. It eases joint pain, it wasn’t a tainted location for me, and I find it comforting and safe. My preference is to set up candles and oils and music and nest in properly. I keep topping up warm water and stay there as long as I need to. I find putting my ears underwater where I can’t hear anything but my heartbeat is very soothing. I’ve had some struggles with self harm when I’ve felt very unsafe, and there have been days where I’ve crawled out of bed and into the bath – with clothes or PJ’s still on, and just stayed there until I was safe to walk past the knife block in the kitchen. I think 9 hours was my longest stay. I might feel stupid or really annoyed with myself but I get out of those situations safely and that’s often more than the ER can offer me.

I’ve also used my computer space as a nest sometimes. Surfing the net can be quite trance inducing, hours pass without you really noticing. I’ve used this to reduce building panic or wait out dangerous situations too. When my bedroom has been simply impossible to cope with, I’ve dragged the mattress out into any other room and slept there that night. My bedroom has posters of my favourite artworks, an oil burner, music player, my journals, everything in it that I can use to make myself feel safe and at home. I put the kind of thought into it that expecting parents put into a nursery, and I keep playing around with the contents and arrangement until I find a set up that mostly works. It has to be familiar and to speak to me specifically. I often put up quotes and poems that I find inspiring or reassuring, and I keep my favourite books by my bed where I can reread them whenever I need to. Bolting back to a familiar environment is one of the keys of a good nest. For some people it might be their craft space, their kitchen, their shed, their garden… the possibilities are endless. All it needs to be is close by and some place that feels safe.

Fear and stress often have a regressive effect on us, and this can be really challenging to deal with. We are often deeply committed to our idea of ourselves as rational adults, and when we suddenly present with the emotional logic of a traumatised child it can take a lot of courage to face and meet those needs. But the pay-off can be huge. There’s a lot of ways to work on increasing a sense of safety, nesting is just one suggestion. If it doesn’t appeal to or work for you, try not to be too disheartened. You will find what you need. If you hadn’t thought of it but if it strikes a chord, you might want to go look at your environment with new eyes and see where your nest – or burrow, or eyrie, might be.

Newsletter 3

/ Sarah K Reece / Leave a comment
Here’s the latest Dissociation Link newsletter. You can access it in pdf form here to download, print, or share easily. Please feel free to pass it along. 🙂

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Labels – helpful or harmful?

/ Sarah K Reece / 2 Comments

It’s so interesting to listen to people talk about their experiences with mental illness. I’ve heard such a range of stories, from those who became unwell, received an accurate diagnosis and useful treatment, and drastically improved, to those who first suffered the terror of developing mental illness and then the terror of inaccurate, incomprehensible, and traumatic diagnosis and intervention. One of the areas I’ve noticed people have a range of reactions to is this issue of diagnosis, and whether labelling people’s behaviour and experiences is helpful.

The central idea behind the labels used in mental illness was to be able to group people’s experiences into similar categories and give them a name so that it was easier for one doctor to communicate to another what kind of struggles a person was having, and so that things that were found to benefit the majority of people in a group could be made available for them. Born out of the medical model, mental illnesses are listed as diseases, with the presumption that the processes can be measured, will be found to have a clear cause, and always only involve deficits. The reality is more complex, mental illnesses seem to function more as syndromes – clusters of ‘symptoms’, causes likely to be a combination of factors, and numerous subgroups who experience different sets of symptoms and respond best to different treatments. That’s still a medical model framework, and doesn’t account for people’s experiences that are positive, while still being different from the norm, or for the idea that some psychological processes seen as illnesses may be healthy responses to overwhelming circumstances.

When labels are experienced as helpful one of the things I hear most often is a relief that confusing and frightening experiences have a name. With a name, they can be talked about. There is a language to describe them, to take the intangible and the terrifyingly personal and communicate about it to another person. For myself, I have experienced dissociation for as long as I can remember. I didn’t encounter the word to describe it until I was in my 20’s. Prior to that I had no words to explain what I was experiencing, and no way to understand why I felt different, the nature of the gulf between me and my peers. That difference was formed by many things, such as The Gap, but I wasn’t able to express or understand the tremendous difference in the way I functioned. With no words for it, I was absolutely alone in it, unable even to ask for help. We need names for things to be able to talk about them. Many people are deeply relieved to discover their difficulty has a name, be it depression or mania or dissociation.

I’ve also experienced the enormous relief of discovering that reactions I didn’t like or understand in myself were part of a condition, PTSD, instead of just my own personality. Being able to locate my troubles as separate from me helped me to feel less shame and humiliation about them.

Labels also give us a community. With a label we have a chance of linking up with other people who’ve struggled with the same things and feeling less alone. There is a pool of resources (hopefully) we can seek out, books, community groups, organisations who exist to share information and strategies to manage your particular condition.

This experience of community can also be one of the things people find terrifying about labels. Labels are black and white. Many people have had the distressing experience of being hospitalised and aghast about their new ‘peers’, the other patients. There’s little room for degree, and people remember the extremes and the most unwell. A person diagnosed with MS immediately pictures wheelchairs and severe disability, a person told they have schizophrenia dreads a future of long term hospitalisation and unrelenting psychosis. For those of us who’ve come from a world divided into them and us, the sick and the well, the disabled and the rest of us, it’s a huge shock to the system to suddenly find ourselves in the other camp. We may reject our label, deny, downplay our symptoms, protest about all the things we can still do…. and at some point perhaps, realise that the entire rest of the disability community are saying exactly the same thing, and readjust our view of the world a little.

Where labels hurt is where they define us to the exclusion of all else – a person with Borderline Personality Disorder becomes “the Borderline”, instead of somebody recovering from a mental illness. Labels are also things we live to, children treated as if they are smart, hard working and will do well in school tend to live up to those expectations. The reverse also applies. Told we will be profoundly disabled, we will have our condition our whole life, we will never be able to work again or live without meds or have ‘normal’ relationships or live independently – many of us will live to fulfil those predictions. (a few of us with a tendency towards rebellion will use them as impetus to accomplish exactly whatever we were told we couldn’t) Labels can box us in, hold us back, define our world in a way that is deadening and takes away hope.

Labels can also cut us off from each other and from resources that are labelled in a way we’re not familiar with. I’m constantly coming across information in different areas that have developed independently. Because of our tendency as people to specialise, often useful ideas and resources are locked away in different areas. It needs people with broad interests, or experience in several different areas to link things back together. For example, people struggling with self harm have been developing comprehensive lists of grounding techniques – but few people struggling with dissociation have come across them even though my experience has been they are very helpful for dissociative symptoms. People who have a severe anxiety disorder don’t have access to great work being done about reducing ‘exposure anxiety’ for people with autism. People with MS talk to each other about ways to cope with symptoms such as numbness, muscle weakness, and chronic pain, but no one with Fibromyalgia is likely to pick up a book labelled MS and read about these, even though they have those same symptoms. People with a physical illness or disability are often deeply reluctant to seek help or information for emotional distress such as anxiety or depression because they need to view their symptoms as physical and collecting another label would only depress them further. Labels can set up a false separation between us, and cut us off from communities and information that would be helpful. For people with very rare conditions, labels leave them feeling deeply alone and envying people with more common conditions, and money and organisations to support and advocate for them.

I don’t care if you feel lonely because you have social anxiety, experience the classic negative symptoms of schizophrenia such as withdrawal, or are too exhausted and overwhelmed by your severe arthritis to get out of the house. That experience of loneliness is something each of these people have in common, and each could be a great support to the other. In our Voice Hearer’s Group some people have a psychotic condition, some a dissociative disorder. Some people hear voices as if someone is standing next to them speaking, others hear them within their mind. Some people have no diagnosis, or do not hear voices but hear or see other things. There is tremendous diversity in our labels, but we are united by a difficult experience, a need to speak about it and connect with other people. Labels that encompass whole complex conditions such as Bipolar can be less useful at times than a language to describe things such as anxiety, slow wound healing, or hallucinations. There’s a lot more common ground out there than we may think, and a lot to be learned from other people, however different their labels.

Artificial skin

/ Sarah K Reece / 4 Comments

No, I’m not talking about the burns unit, rather skin in a psychological sense. You may have noticed the idea of needing protection from the world turns up in my work on this blog, I thought I’d take some time to elaborate. I’ve often felt like I was thin-skinned – or even missing skin entirely. I’ve since discovered this can be quite a common experience for many people – especially in the trauma recovery or mental illness communities. I am sensitive to my environment, strongly affected by things and people around me. I feel emotions intensely and seem to lack a lot of the psychological buffers that help people shake things off. A lot of my life I’ve felt tossed about by emotional storms I can’t prevent but have to ride out. I’ve been missing some emotional skin – some of the personal boundaries that help to separate us from our environment and the people around us. I’m highly adaptive to different environments, and sometimes even to the people I spend time with, identity becomes blurred as I unconsciously take on their perspectives, mannerisms, language. I lacked defences to unfair criticism, being assailed with severe self doubt – what psychologists call ‘poor ego strength’. There is an inclination to obedience and submission that meant hours, days, or weeks could go by before triggered emotions turned up – ‘actually I feel really angry about that situation last week’, well past the point where those feelings could protect me or I could act on them.

This sense of lacking skin is linked for me to feeling raw, and chronically unsafe. Heightened sensitivity, perception, adaptation, and damaged boundaries all combine to create a painful state where I feel like all my nerves are exposed and I’m permanently vulnerable. One result of this state for me was to feel intense ambivalence about other people – both craving and deeply fearing contact. Another was difficulty with intense emotions, feeling ‘flooded’ and profoundly different from other people most of whom seemed unconcerned by events and experiences that I felt deeply.

I don’t feel so raw over the last few years, developing skin has been something I’ve been working on. I don’t mean I wish to be less sensitive or passionate, but in less pain, less overwhelmed by the world. There are tremendous positives to characteristics like sensitivity and adaptation. But without protection, without some buffering, it seems to me that they leave you vulnerable to exhaustion and despair.

I’ve found that I need artificial skin to survive. One of the first ways I started to create this was through my journals. I started writing when I was introduced to the idea of poetry as a kid. At about 15 I was carrying a big blue binder around with me everywhere and stuffing it with poems, notes and drawings. My level of trust was very low so it didn’t leave my side. Since then I’ve always kept a journal, usually of poems. This private space was my voice, a receptacle for all my intense feelings and a place I could be honest. There’s a fairy tale about a woman tricked into a horrific situation and forced to be silent. In it she digs a hole and screams all her agony into the earth. My journals are that earthen hole for me. Over time as I reread I learn about myself, I start to see patterns and needs. What was only a scream once has become a dialogue with myself.

Years later when I moved into a caravan, that also became part of my artificial skin. I’ve found I must have time alone to process or I do not function well. I also need my own space, a room or home that is mine alone, with no intrusion, no compromise, no sharing. This became the place I returned to from the world, to check in with myself. When I was caught up, over adapting, losing myself and my own perspective, the caravan was like a hermit crab returning to their shell. In it I felt safe enough to work out what I thought, I felt, a distance from the world that was essential to have the strength to disagree, to know myself and have my own voice. I was curious to later read Julie Gregory describing a similar process in Sickened where she lives alone in a house full of mirrors, learning who she is and what she needs.

Self talk has also become part of my artificial skin. Without the automatic buffering afforded by a ‘strong ego’, I have to talk myself through rocky situations. I coax, coach, and reassure myself deliberately when I encounter a situation that needs skin. I don’t just mean bad situations either, for example, I gave a talk in Melbourne last year that was very well received. I got a lot of hugs afterwards, which was enough to blow all my fuses and induce massive dissociation. I ended up hiding in the toilets talking reassuringly to myself, waiting for everyone to move on to the next talk and to be able to stop shaking and start to feel my feet on the floor again. Talking myself through that, and also finding someone else who knew me to take me for a coffee and just chat about ordinary things, served as my skin and helped to buffer me.

This brings up an important part of skin – other people. There are many ways people create skin, some of them have terrible costs. Some people emotionally numb, dissociate, or desensitize to distress around them, becoming cold or indifferent. There are a lot of forms of artificial skin that deaden you or are like armour covered in spikes that hurt people who move close. True artificial skin should ideally replicate as close as possible the natural kind – a permeable barrier that separates you from the world but does not leave you invulnerable to it, or inflict harm. Other people and how we are treated are an important part of our psychological skin. For me, becoming involved with the groups Sound Minds and Bridges exposed me to a whole room of people who treated me in a respectful, caring manner. Experiences of kindness and love build our self worth, and when we feel we are worth something it’s easier to protect and care for ourselves.

I’ve also done a lot to try and make peace with my nature. I’m always going to be someone who feels things intensely, who is affected by things around me. I have learned I need to hang on to the upsides of these qualities, to seek out role models who are also intense emotional people, and get less angry at myself for my weaknesses and limitations. Instead of blazing at myself with frustration and burning with fury that I’m weak, emotional, pathetic, always the drama queen – my journals have a lot of this kind of self hate in them – I try to be unsurprised and accepting of the downsides, and to enjoy and embrace the upsides. So I cried at work again – oh well. I write poetry that I like, I care deeply about other people (although being sensitive is no guarantee of always getting it right sadly, I still regularly miss the mark and feel upset about that), I live an intense passionate life full of art and depth and mood. These are things I value. If they mean I’m sensitive to criticism, vulnerable to being overwhelmed, and need to maintain an artificial skin to buffer the world, I can be okay with that.

If you feel that you’re missing some psychological skin too, perhaps some of these ideas might be useful to you, or get you thinking about the kinds of artificial skin you need. We don’t have to accept things the way they are. People with sensitive natures and boundary issues can still be resilient and learn how to protect themselves. The things that make you vulnerable are often also the very qualities that give life such depth and help you endure the hard times. Take care.

What do I have against positive thinking?

/ Sarah K Reece / 6 Comments

Let me caveat this by saying some of my friends love positive thinking. It clearly helps them to stay optimistic, look on the bright side, count their blessings, and make the most of things. I wouldn’t dream of trying to take it away from them or argue with them about it. People come from different places, react against different things and find different ideas helpful. But for me – I hate it. Positive thinking and I have a painful history.

When I was young several of my role models were great believers in positive thinking. I admired their attitude and absorbed all of their ideas about how to best live life. I took copious notes during talks, about overcoming adversity, always finding the silver lining, looking for the best in people, never giving up, and always remaining positive no matter what.

I fervently believed these ideas and lived by them. This had a number of unforeseen outcomes. I was incapable of believing ill of anyone, and therefore incapable of protecting myself from the school bullies. I behaved in a painfully naive manner, always looking for the best in people and frequently being taken advantage of. Never giving up meant I was unable to walk away from anything, any project, any relationship. If I failed at something it simply showed I had not tried hard enough. If a relationship died it evidenced my lack of extraordinary effort.

Having to be positive all the time left me incapable of expressing anything ‘negative’ without guilt. To cry, feel overwhelmed or afraid was to be weak. I never considered that my ‘dark moods’ may have a kernel of insight to them, whereas my ‘sunny days’ may be more about self-delusion than reality. I ignored every uncomfortable feeling, all those instincts that say ‘this worries me’, ‘they seem scary’, ‘I don’t like this’. I hoped for the best, forgave, turned the other cheek. I didn’t know that sometimes you need to be shrewd, cautious, un-trusting, and self-protective.

I’ve come through things that made me reject the ideas of positive thinking. I’ve been in situations where my best efforts were not enough. I’ve loved and risked and dreamed and been broken when I lost everything. I’ve learned there are many things I cannot control, and that running from pain strips me of all feeling. I’ve learned that we call it a risk because you may lose. I’ve learned that that point in the movie, where you appeal to their better nature and they melt, they just cannot treat you that badly after all – that there are people who reach that point and merely laugh at your naiveté. The world can be a very unkind place to people with Pollyanna ideals. And people with Pollyanna ideals may ignore all evidence of pain or abuse for someone else because they are too busy looking on the bright side and believing the best of people. It’s been hard for me to come to terms with that. It’s hard when nice people don’t want to know what’s really happening.

In my teen years I gravitated towards the goth subculture, because there I found people who ignored the conventions and expressed pain. When they felt bound and trapped they wore chains. I could not escape but I could at least protest. I could reject the conventions that silenced me, and find other ways to have a voice, and to speak my own truths instead of the scripts given to me.

My personal philosophy is oriented more to the idea of trying to be authentic than to be positive. I gravitate more to the idea of telling myself the truth than trying to believe affirmations that deep down, I simply reject. I don’t like fighting myself like that, and I don’t like feeling that I’m building castles in the air, that while I’m hopeful I can believe all these wonderful things but there may or may not be any reality to them. So when I’m exhausted, frightened or depressed, all my foundations disappear. I like to hold onto things I can still half believe when I’m in a black place. I also crave the freedom to be honest about how I’m feeling.

I think most people who are unwell feel the pressure to be positive. Children dying of cancer who are still cheerful are held up to us as examples. This burns in me. It feels like being silenced. One more time when I have to pretend the bad things aren’t happening, that I’m not in pain, not afraid, not dying inside. I’m scared by how many times I hear after someone has killed themselves – we didn’t know anything was wrong. I’m scared and angry that people in pain feel they have to keep it secret. I’m tired of making a secret of suffering.   I’m tired of being cheered up when what I want is connection, when I want are relationships that make it easy for me to be honest and hard for me to tell even sweet lies – instead of the opposite.

So for me, I’m always trying to hold onto my voice, to accept what I really feel, what I really think, or fear, or hope. I crave authenticity. I crave the strength to be honest. I want to speak the truth, even when the truth is horrific. I am a very positive person, I have a deep love of life and a dogged pursuit of hope. But I reach this almost by going in the opposite direction, by going down into black places, into bleakness, rage, despair, loss. I embrace these things rather than run from them. I want to be able to be real to the people around me. I want not to have to lie, not to wear a smiling mask over pain or emptiness. I want for people to be able to trust my smile and my tears. I want to be known. Somehow my journey brings me towards hope, joy, self compassion, and so many of the things I know those who love to think positive are also seeking. I just need to take a different road.

Survival lessons

/ Sarah K Reece / 2 Comments

Some time ago I became curious about what qualities and skills people use to survive extremely harsh environments, such as polar expeditions. I wondered if there was any overlap with the kind of skills needed to survive harsh environments closer to home, such as an abusive family or chronic serious illness.

I’ve read a couple of books about factors that influence survival and come across some interesting ideas, such as the notion that survivors of extreme circumstances seem to share an unrelenting will to live. It seems that perhaps some people reach a point where the cost to keep living is too high. The pain is too great, or the despair, the things they would have to do are too awful or exhausting. Others drive to live is so strong they will severe trapped limbs, drink their own urine, stagger for hundreds of miles. That’s not to suggest that the will to survive is the only factor – luck, skill, experience also play roles. Sometimes it doesn’t matter how hard you try, you simply can’t find your way back to safety. I’m also not suggesting that those who curl up and surrender to overwhelming circumstances are weaker or inferior. Both defiance and acceptance have their place in how we respond to the world. Sometimes those who defy, triumph, other times they do terrible things in their determination to live. Sometimes we mourn those who gave up before help arrive, other times we venerate those who refused to be dehumanised, who gave up their food or wrapped the last blanket around someone else. Sometimes we just mourn the loss of someone who faced hopeless and overwhelming circumstances.

It seems to me that there’s a lot of parallels between situations involving starvation, hypothermia, drowning, being lost or cut off from safety in an inhospitable environment, and those many of us face in our personal lives, children who are being abused, people living in violent homes, a family member struggling with a life threatening illness, those of us who instead face loneliness, humiliation, shame, grief, misery, hopelessness, or fear. The nature of the threat may be very different but the need to find a way through it, ways and reasons to endure or escape, and a way to balance survival and morality, these seem very similar to me.

I once watched a documentary, the name of which escapes me, about how men in the polar regions coped with such a difficult environment. It put forward an interesting idea that stuck with me, that the key to navigating a stressful environment with chronic unpredictable crises, is to be able to respond very quickly to the development of a crisis, and then to wind down afterwards equally quickly. They had as an example a fire in the campsite. A fire in the poles is incredibly dangerous, most of the water is frozen ice or snow so it can be difficult to put out, and all supplies are terribly precious and difficult to replace, possibly the difference between life and death. Men who had been dozing, reading or relaxing playing cards were shown rushing to action. In a heartbeat they ran out to the fire and efficiently had it under control. Having responded to the emergency, they came back to their quarters and returned to dozing, reading and playing cards. They said these were key survival skills, to respond very quickly, and to get out of crisis mode very quickly. Sustained crisis mode is very dangerous, burning energy very fast like running on turbo. You can’t afford to be depleted in a survival situation.

When I thought about how I manage crises like this I decided I do pretty well at responding quickly. I tend to be the first person to spring into action in a first aid situation, I’ve helped out at fires, talked to suicidal people, nursed dying pets to the vet, and so on. I’m good at recognising and quickly responding. I’m not so good at the wind down afterwards. Having gone into high alert crisis mode, I tend to stay there for hours or days. I find it really difficult to wind back down to regular functioning. I think cats are amazing at this, they go from sleeping to manic to sleeping again with barely a pause between. One of the things I’ve noticed for me is that staying in crisis mode exhausts me. It also ‘stacks’ the crises, instead of separating them into distinct experiences. What I mean is that without getting any downtime between events, each crisis feels worse than the one before. Each exhausts me further, leaves me more depleted and discouraged, life starts to feel like I’m under siege, an army camped at my gates, staring at a larder of dwindling supplies.

Working on coming down between crises can be hard. Once you’re all wound up and on high alert and running on adrenaline, there can be a warped logic that says ‘Oh we’re here now, might as well stay here, the next crisis wont be far off anyway’. Without downtime though, you never get to restock your larder. You are like an engine in neutral with the pedal to the floor, accomplishing nothing but burning fuel. We can’t function well when we don’t get the chance to take breaks, wind down to normal functioning, and take something in. Whatever nourishes you – reading, touching base with a friend, gardening, playing music, having a bath, going for a run, having a good laugh, playing with kids, sports… whatever it is you need it. You have to take time out of crisis mode and take in some sustenance. It doesn’t matter what the nature of your difficult environment is, whether it’s something you’re working to change or something you can’t, whether the stress is physical illness, abuse, mental illness, family breakdown, financial crisis, housing stress… one of the things that may help you get through is to resolve that every minute that something terrible is not happening right now you will wind down and replenish. It doesn’t matter if you’re having Monty Python film nights between visits to the hospital, or snatching 20 minutes to tend a garden, anything that breaks up the unrelenting stress and nourishes you will help you survive, endure or escape.

Anything in your life that you can enjoy or appreciate will nourish your spirit. In times when I’ve been struggling with suicidal feelings I’ve reminded myself of prisoners of war starving, of their joy when released at such ordinary luxuries as salt on their food or soap when bathing. Not to belittle my own struggles or make me feel guilty, but to remind me to tune in to these things. To feel the softness of soap bubbles on my hands, the cool clean water running through my fingers. How good it feels to drink when you’re thirsty, to wash your face when you’re hot and tired, to stand barefoot in the warm dust, in the cold mud, on the cool earth.

They don’t make up for the pain of whatever you’re going through, maybe nothing can do that. But they break the pain down into parts, the crises into mouthfuls instead of unrelenting distress that goes on for weeks, months, years, and strips every resource, every last bit of energy, hope, optimism and tenderness from us. Just a moment can give us a little sustenance, and can break up the bad times. You don’t want to have bad years. You can break it down to bad hours, bad days, bad times, with good times between, with peaceful times, with a little pleasure or silliness or rest. Last year for me was a very bad year. It was also a very good year, because I’ve been fortunate enough to have opportunities arise, people who care about me, and because I work on snatching back any moment I can to get out of crisis mode. I’ve written more about this idea in Self Care and a Myth of Crisis Mode.

If we can teach soldiers and explorers skills to cope with harsh environments, I can’t see why the rest of us can’t borrow some of the ideas and apply them to our own lives.

Trauma Myths – there’s not many of us

/ Sarah K Reece / 2 Comments

There’s a few common myths about trauma that I come across pretty regularly, and this is one of them. In mental health, the role of trauma is one that is debated all over the place. For example, there’s people who argue that Borderline Personality Disorder is caused by childhood trauma, and those who argue that it is likely a genetic predisposition to an emotionally reactive way of relating to people (among other issues). Personally, I think that it’s entirely possible that there is more than one way to end up developing a mental illness – for example some people with a psychotic disorder have their first episode in the wake of a major life stress, others were just minding their own business and the world turned upside down. What we do know is that some things can be inherited, and the combination of an inherited vulnerability with a high risk environment is exactly the kind of circumstances where people are most at risk of manifesting a mental illness. Nature and nurture both play a role, and traumatic events are one of the things that can make someone more vulnerable to mental illness. While trauma is always at play in a condition like PTSD, it may or may not have a role in causing some other mental illnesses.

Some mental health staff have taken this to mean that learning about trauma and how to work with traumatised people is a specialised field that is useful for only a very few participants. That’s not my perspective. For a start, when we look at the statistics of people who are the most severely impacted by their mental illness, such as inpatient populations, the numbers of those who’ve experienced major trauma are very much higher than the general population. These traumas may not have had a role in causing their mental illness, but they can certainly make it much more difficult to manage one! So trauma sensitivity has a real relevance in mental health.

Another thing is that having a mental illness can be very traumatic in and of itself. One of our great fears is that we are going insane. Madness holds a terror for most of us, and developing a mental illness can feel like we’re going mad. We may have terrible fears about our state of mind, our experiences, trying to keep our job, worrying about how we’ll raise our children. Experiences such as being chronically suicidal can leave us afraid of ourselves, mistrusting our own mind. It’s not like this for everyone, some people become very unwell without realising it, others may be caught up in their experiences (such as delusions or mania) and even enjoy them. But for many of us mental illness involves severe emotional pain and fear.

Various interventions can also be traumatic. Being confined to a hospital, room, or bed, being medicated without any choice, not being allowed to smoke, to drink, to wear your own clothes, be with your family or pets, have internet access or your phone is effectively being kidnapped. I’m not suggesting that the intention is to traumatize people through ‘assertive engagement’. And I’m not saying that some people who are desperately unwell and a danger to themselves don’t appreciate being kept safe for a time. But the loss of control experienced in severe mental illness, and the loss of control that comes with experiences like being shackled to a bed, even when it’s done by kind and caring people, can be traumatizing, and can also replay earlier traumas.

Not everyone’s experiences getting help in the mental health system are good either. Imagine waking up in hospital from a suicide attempt to be told by the nurse that it would have been better if you’d died because they need the bed for people with real illnesses. Imagine being told by your doctor that your condition is incurable and degenerative and you will likely become less and less lucid and be unable to live independently. Imagine being told that you are faking your condition to get attention, that unless you follow through and kill yourself nobody will believe that you are genuine, and even then you would just be proving that you were a hopeless case. The oath to first do no harm is not always upheld, and some people are caused terrible suffering by the people who are supposed to help them.

When you include experiences of stigma or discrimination, attempts at disclosure that go badly, the grief and loss of having relationships break down under the strain, giving up study or losing employment because of the mental illness, the idea that there’s quite a few people with trauma issues of one kind or another really makes a lot of sense to me.

The other aspect to this is that behaving in a way that is appropriate for a traumatized person isn’t inappropriate for an un-traumatized person. Being sensitive to issues of control, proximity, touch, pacing of treatment, confinement, respect, and the need to listen doesn’t go astray for anyone. Being sensitive to the possibility of trauma is being sensitive and engaged, taking your cue from the other person and adapting to what is helping and working for them. There’s nothing inappropriate about that! Even when the condition isn’t a trauma origin one, and you haven’t been told the person has a trauma history I’d be careful in assuming that trauma isn’t relevant. There’s a lot of people for whom it is, and thoughtful sensitive support can make a big difference!

 

Dissociation and food

/ Sarah K Reece / 12 Comments

I’ve not come across a great deal of information about the relationship between food issues and dissociation. My colleague Cary is working on a thesis on the topic, and it came up the other day in our group Bridges. Many of us who struggle with chronic dissociation also have some difficulties with food. This is by no means all people, dissociative experiences can vary significantly from person to person. What do I mean by food issues? I’m talking about struggles that range from entrenched eating disorders to milder difficulties. Some people have a tendency to starve themselves, others find themselves overeating. Personally I struggle with a binge-starve cycle that slows my metabolism, wrecks my energy levels, and causes my weight to fluctuate. Dissociation and food issues can go hand in hand. People who struggle with over eating sometimes describe ‘unconscious eating’ where they consume food without being aware of it. Most of us know the annoying experience of reaching for a cup of tea and discovering we’ve already drunk it without registering. For some people this goes a step further and they find themselves looking at a clean plate and wondering what they had for dinner, suddenly realising the biscuit packet is empty, or finding themselves roaming through the cupboards looking for snacks whenever their concentration wanders.

Not eating due to dissociation can also be a difficulty. Personally this is something I’ve realised I have quite a problem with. When I’m very dissociative, I tend to lose my sensations, so I can’t feel things very well. That includes the sensation of hunger. Without that cue, I would at times go for several days without realising I hadn’t eaten. This starvation would do nasty things to my blood sugar levels and usually increase my dissociation. It wasn’t until I started fainting that I realised this was quite serious. A combination of sleep deprivation, starvation, and extreme stress has produced the most severe and terrifying dissociative experiences I’ve ever had, something like a drug overdose high. I now have to use the time of day as my cue to eat, and as I do eat more regularly it’s been exciting (but also freaky) that my sense of hunger has been returning.

The binge part of this cycle for me is that erratically I would eat large meals of high sugar foods. With my metabolism slowed down, I don’t tend to feel hungry and I’ve lived for many years on one meal a day. The binging has been a problem since childhood, when I would hoard, an on occasion even steal, sweets. At the time I was confused and deeply ashamed of this compulsion. At times my behaviour seemed to resemble an alcoholic, with sugary foods hidden in stashes that I consumed secretly, at high speed, at times of stress, and felt deep guilt and shame about. I teetered for many years on the edge of adding a purge component to this cycle, and deliberately cultivated a phobia of vomiting to help keep me away from this.

I’ve come to understand my food struggles as being created by a number of different issues. One of them is attachment problems. This is about our experiences as children, and how we now tend to view and react in relationships. For some people with attachment problems, ‘comfort food’ goes a step further and children may hoard food in fear that their needs will not be met and as an attempt to be self reliant. Another component is self image and self loathing issues, born out bullying and humiliation during childhood and teenage years. A deep ambivalence about food and myself makes it difficult to have a healthy relationship with food. Another component for me is intense stress. Sugar cravings are common for people who experience intense stress, because adrenaline and sugar have a relationship in the body. I’ve found I tend to crave sugar when I’m stressed. Another factor for me has been that at times I’ve been threatened or physically assaulted, which is just the kind of situation that makes you wish you were bigger and more imposing. This can lead to weight gain.

Food issues can also be a kind of self harm. There are many ways to play out self loathing, to try to override emotions or memories, and to express pain, and needs around control. People used to living in a disconnected dissociative state may use over eating or starvation to trigger dissociation when they feel overwhelmed. Others may use the discomfort of overeating or the pain of hunger pangs to reconnect them to their body and help to manage dissociation.

So, what can be done about this? Firstly it helps to know that food issues and dissociation often re-enforce each other. They easily form cycles where the dissociation aids the food problems and having problems with food makes you more vulnerable to dissociation. This cycle will need to be broken. For me, I’ve had to move quite slowly on reducing my issues. Several years ago after my most severe dissociative episodes involving low blood sugar and sleep deprivation, I made a rule that I had to eat one meal a day. At the time that was quite a challenge. I also started to examine what was behind my difficult relationship with food, and started to tease out the emotional components and work on them. One of the biggest I started with was the issue of self loathing. Initially I couldn’t imagine a life without it, but I could see how badly it was crippling me and kept working away at it. On bad days I can’t eat, and if I force myself to I will only be terribly ill and likely vomit. I don’t force myself. When stress levels are high, energy is diverted away from the digestive system. There’s only so much I can do and I let myself off the hook on the bad days. The goal is sustainable change, not re-enacting abusive scenarios where I feel terrible and out of control.

A couple of years ago I moved up to two meals a day. I was able to sustain that except for periods of homelessness when I tended to drop back to one or less. Now, on good days I have three meals. Possibly half my week is like this at the moment. I also tried to link food to good experiences – so I often eat a snack or even lunch in my groups because they are such a safe and positive environment for me. And I wanted to remove shame and humiliation from eating. I dismantled my stashes and decided that if I was going to eat something like chocolate, I would do it openly, I would enjoy it, and I would feel no shame, even if I gained weight or people made rude comments. These movements, little by little, have moved me towards a better diet, better energy, and better health. My cholesterol level which had been rising is now low and stable. My weight has stabilised, and my health is better than it has been in many years. I no longer diet, I refuse to engage in fads or restrictions, ‘bad foods’, or an obsession with ‘healthy’ food. My goal has been to tune back in to my body, to eat and enjoy eating, to have fuel, and to get back to the good side of being fussy about food – the pleasure of good food and my love of cooking, the kindness and care of preparing good tasty food for people you care about, and to resolve issues of shame, control, stress, and comfort in my journal rather than my diet.

If you’re struggling with dissociation and food, take heart, you’re not alone! It may be that a two pronged approach – working on reducing the dissociation, and working on understanding and resolving the drive behind the food issues will give you the best chance of making good changes. Food issues can be tenacious, deeply rooted, and re-enforced by the unkindness of our culture. You’re not going to make progress every day, and you may find that things change slowly with back steps and challenges along the way. I’d suggest watching those who have a good relationship with food and their bodies and modelling whatever you can.

If you’re a multiple, you may have food issues broken up among different parts. Sometimes everyone in the system is fine but one part has a major eating disorder. Sometimes the roles around food are broken up, perhaps one part cooks, another eats, and another cleans up the kitchen. Maybe you function just fine around food until the one who eats goes away for a while, or until someone who doesn’t eat ends up being out for a long time. I know that this kind of dissociation can add a whole extra layer of complexity to the situation, it may take a while to even work out what is going on and who is doing what. Be patient and gentle, you will make sense of it at some point and work out what you all need to do to make sure your body stays nourished and taken care of. Getting a hold on food issues may help you drastically reduce your dissociation and be an important part of your recovery. Best of luck to you!


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Feeling chronically suicidal

/ Sarah K Reece / 7 Comments

Wow, another big topic! I simply cannot do justice to these in a blog post, so please don’t be under the impression that my notes are in any way definitive. I just hope to share a few thoughts and ideas and maybe they’ll be useful to someone else. If not, there are a lot of books out there, and good support too (although you may have to look hard for it) so please don’t be discouraged, keep hunting for what you need.

Feeling suicidal has been something I’ve lived with for most of my life. I was first seriously making attempts on my life when I was 10 years old, feeling totally alone and overwhelmed and desperate not to suffer anymore. Since then it’s been a companion I’ve had to learn to live with, a shadow I can’t shake. It sits on my shoulder and whispers into my ear, weakens my courage and resolve, tells me that things will not get better. So how am I still here?

There’s a few nasty traps with feeling suicidal that I’ve been able to see and to some extent avoid. The first one is the idea that if you are sick enough, or in enough pain, that someone else will come and help you. This is a powerful rescue fantasy that the mental health system often inadvertently plays into, which is heartbreaking because no one can sweep in on a white horse and take your pain away. I once spoke with a young woman who tried to admit herself to hospital as she was feeling suicidal. They told her unless she hurt herself they couldn’t help her. So she did. Mental health staff will often draw distinctions between degrees of suicidiality – the occasional thought, feeling it strongly, making plans. Between so called ‘passive’ and ‘active’ attempts (those you have a good chance of recovering from and those you don’t). In my experience this is often done quite without any awareness that in an attempt to be taken seriously and gain the help they think is on offer, people often steadily graduate up the ranks to higher and higher degrees of suicidiality. What agitates me so much about this, is that a cross-wiring of kinds is happening here – good healthy impulses to get help and get better are being cross-wired into self-destructive acts. Now both the healthy and the unhealthy impulses are driving the person down into suicide – what hope do they have then?

Sadly, the line between the people not sick enough to need help, and those so sick they are considered beyond help is very fine in some circumstances. People find themselves unable to access services as their situation is not serious enough, and then unable to access them as they are too high a risk. A long time ago I discovered that my learned pessimism about other people’s power or willingness to help me actually stopped me getting worse in a misguided attempt to get support. It’s not an easy one to stay out of for me, a bit like a whirlpool that pulls at me. I have to mentally remind myself a lot that my energy must go into getting better and taking care of myself, that getting sicker to get help is like going deeper into the desert following a mirage of water. No hope lies that way.

Another trap I’ve noticed is using symptoms to express pain. The mental health system is at times very poorly set up to support people who’ve experienced trauma. Sometimes the number and severity of your symptoms are used to ‘grade’ how severe the experience you’ve come through is. This penalises you for being resilient, and leaves you caught between getting validation and acknowledgement for your trauma, or functioning to the best of your capacity. People with trauma can start to speak ‘the language of symptoms’, in inpatient settings they may compare severity of illness to rank their trauma along side each other and compete for the highest severity, comparing scars, numbers of diagnoses, amount of time in hospital, number of suicide attempts. Especially when your trauma is being denied or downplayed by those closest to you, the need to have it acknowledged can be so profound that people self destruct seeking that validation. This can be hard to understand if you’ve not experienced it. The language of symptoms is subtle and insidious and once you start speaking it it’s very hard to break. In this language suicide is seen as the ultimate way to express pain, to reject terrible circumstances, to show that you were a victim, and that your situation was so severe it was not possible to survive it. The way out of this is to refuse to rank trauma, to validate all harm and all pain, to take away the burden of ‘proving pain’ from people who are hurting.

The lure of safety is a trap that can make death seem enticing. People who’ve been badly wounded and broken can be willing to hide out in any port to escape the storm. It’s hard to keep hoping that tomorrow will be better when all your hopes are dashed. It’s hard to find strength when the bad days are horrific and completely outnumber the good. We can get to a point where we just want it to stop and will do anything to make it go away.

I turn these thoughts on their head whenever I can. Instead of seeing death as a peace that I am denied, I find anger in my heart at the thought that my story would end in such a miserable place. I use everything I have already survived as impetus to keep me going on – if I was going to give up, I should have done it 10 crises ago. I’ve already come this far now, nothing will take me down now. I find that it is crucial to reframe the seductive nature of the traps and find a way to think of things where continuing to live is being brave, is bearing witness, is triumphing over abusers, is having a voice, is all the things I long for. If you allow suicide to be framed in a way that it seems to contain the things your heart deeply longs for, then you are incredibly vulnerable to it because it will take all your strength to deny yourself what you so deeply desire and have within your power, and none of us can be strong all the time. For me it’s key to see these things as tricks and deceits, like sweet voiced sirens that will sing me onto the rocks if I listen to them.

I also hold onto many things that help to keep me in life and wanting to live. I do not have one precious thing, for that would make me terribly vulnerable to losing it. I have lost so many things dear to me in my life. I have many things, big reasons and little reasons that hold me here and keep me fighting for life. Some are huge ones – I want to write books, who would care for my pets, my family needs and loves me. Some are little ones – I’d planned to feed the ducks this evening, I haven’t finished making that birthday gift, the moon is so beautiful tonight, perhaps I’ll watch it set. They are my talismans against the dark, and they fail when the darkness is great. I hold one until its light goes out, then I put it back and take out another. The power of feeling suicidal is that it strips meaning from that which means most to us. In a black, fey mood, the thought that our children would miss us is suddenly hollow and devoid of power. I have learned to expect this and not be dismayed by it or blame myself for it. I rotate my reasons to keep going, and never hold onto one past its usefulness. In time it will regenerate and I’ll be able to use it again.

I also now know that there are times when all my reasons fail. When I am joyless and without love of life, when I have no hope for a future and can find no meaning in my pain. When to ask me to live is to ask to me to submit to torture and anguish. In these times I pour the pain out of me, into journals, I weep for hours, days, months, I scream myself to sleep. I accept that I am without hope, without reasons, and I put myself at the mercy of the world. If I am to die, then kill me, but it will not be by my hand. And if there will one day be a reason for me to have endured this, then spare me. I will wait for it. One day there will be reasons and meaning and hope and I will be glad to have endured.

I have also learned that not all change and help comes from within me. When I am deeply broken, I bind myself to stillness to keep me safe from my reckless longings, and I wait. I have learned that if I wait patiently, with my eyes open and my ears pricked and my heart ready, then something will change around me. I will read a book that speaks to me, or someone will say something that unlocks a peace in me, or some circumstance will change and give me hope. Sometimes my desire to be the agent of change, to fix the pain and put the world to rights is the very part of me that is most dangerous in despair. I hold myself still and wait for hope.

I also find hope in my ignorance. I remind myself how many books I have not read, the degrees I do not have, all the millions of people in the world with thoughts and ideas and theories and experiences I’ve never heard of. When I can find no way to patch together any hope with what I know, I go hunting for information and I tell myself that I will find it again. My knowledge is such a speck in the universe, and how much my world has changed with powerful books, good friends, sound advice, how much my inner life has grown and my strength increased as I’ve learned and understood more. And yet still I know so little. I cannot pronounce the certainty of despair when I have only the tiniest fraction of all the knowledge in the world. Other people have found hope, I will sit at their feet, I will watch their lives, I will find foundations for my own.

I abandon reason when reason drives me to despair. There have been times in my life when the anguish was so unbearable that I have broken inside and decided that it was no longer fair to ask me to endure it. That if love of my family kept me here, than that love was cruel. I have taken my hits and bled my last drop and no more can asked of me. I had no reason to expect that my life would become any different to how it has always been. In this place I cast about desperately for a reasonable response and could not find one. In the end I sidestepped the question entirely and concluded that if hope was foolishness and staying alive was madness than I would be a fool. A little madness can be a refuge from the relentless logic of such thoughts.

At times it is helpful to remind myself that there are those, only a very very few, who have hurt me for the sake of the pleasure of hurting me. That they would gain delight in knowing that I continued to inflict pain on myself long after they had gone. That dying by my own hand would be murder from an untraceable distance. I am a profoundly stubborn person. I decided if they wanted me dead, they were going to have to do it themselves. If there are black days where I live only to spite those who’ve hurt me, then so be it.

Feeling chronically suicidal can become a mental habit whenever things go wrong. Your brain tosses it up as an option like a big dumb dog dragging something horrible on to your bed. If you’re used of thinking of suicide when you’re stuck, it may help to talk back to your brain (politely) and tell it you don’t want this option at the moment. You want other suggestions and ideas about how to improve things. You may even write a list of all the various options open to you, and number them ahead of suicide in your list of ways to respond to your life. So perhaps suicide ends up being at option number 467, after

  • 452. Move to Japan and take up kite making
  • 231. Eat everything you can find in the fridge
  • 93. Call a helpline

I run my proverbial list in order from most to least likely to help, easiest to most drastic, and least to most harmful. Even self harm, total isolation, or an eating disorder are before suicide on my list. They I can heal from later, suicide I can’t. Some things – like harming someone else – are after it. It doesn’t have to be a good reason (although a good reason is better) it just has to be enough to get you through. Almost anything you do with your life should be above suicide on your list of options.

So the rope I have cast over this pit is woven from many different things, stubbornness, folly, faith, patience, experience and a deep love for life. No one thing alone could keep me safe, but between all of these things a kind of armour is made that helps to protect me from despair, a kind of path that walks me through the darkness.

I imagine that the things we each make this path from may be different for us all. It doesn’t matter if it makes sense to no one else, if it’s patchworked together, a jumble of contradictions, badly worn thin and with holes you have to leap over. It doesn’t have to be perfect, it only has to be enough to get you through this night. Tomorrow can take care of itself.

I hope you may find something here useful or thought-provoking. If you are feeling suicidal yourself, please take good care of yourself. Call someone if that may be helpful, do those things that keep you safe and give you hope, reframe it, wait it out, find someone to hold you, find reasons to endure, and walk gently. There is hope for us.

Australian 24 hr phone services:
Lifeline: 13 11 14
ACIS: 13 14 65
Suicide call back service: 1300 659 467

Newsletter 2

/ Sarah K Reece / Leave a comment
Here’s the latest Dissociation Link newsletter, you can access it in pdf form here to download, print or share easily. Please feel free to pass it along. 🙂

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Should we ‘never be a victim’?

/ Sarah K Reece / 2 Comments

Sometimes I come across the instruction to ‘never be a victim’.

It makes my skin crawl. The implication that in every situation you have a choice, that to be victimised is something you would choose, is just the kind of thing that makes me want to take those people to the places on the very edge of life. The places where you find out what you would do, rather than die. Where you learn about sadism, death, brutality, and brokenness. Where life or death comes down to whether you ducked quickly enough, wore shoes that are good for running that day, or if someone walked in the room just at that moment. They simply cannot be imagined. Only through experience and empathy do we glimpse the horror and misery of being a victim.

The other side of this, is that sometimes, there is a choice. And I still disagree with the instruction.

There are worse things to be in this world than a victim. Sometimes the choices we face are terrible ones. The world of violence and abuse is narrowed down to very few roles. Sometimes there is only a choice between being victim or perpetrator. I know that choice. I’ve felt that temptation, to reclaim power and to inflict fear. I know what it feels like to be wounded and full of rage and want almost more than anything to do to others as has been done to me. To see fear in their eyes and feel powerful instead of small.

Sometimes, choosing to be a victim is an act of courage.

The last time I was made to feel terrified, humiliated, devastated, there was a moment when all the noise had gone and I was alone in a room and I felt the world pause. Two paths opened before me. In one, I took my freedom and ran. In the other, I turned and hunted, furious and seeking to reverse the roles. I weighed my choices with great care, with passion.

I said in my heart, I will let you do this to me. It ends here. I accept, for just this moment, the role you have placed me in. I have been victimised. I’ve fought and you were more powerful. I’m wounded but still recognisable. If I take up the role of perpetrator now, I’ll lose even that. I’ll lose myself. So, I take the hits and I walk away. No revenge. It is human to be frail. It is human to hurt. I’m still who I was. There is a nobility in retaining the power to chose how you will respond, in refusing to be debased by their behaviour. You cannot hold others accountable for actions you choose to overlook in yourself.

It is sadly human to be driven by baser impulses, to tear down, to dehumanise, to humiliate and destroy. It is also incredibly human to rise above this, to be moved by compassion, to act with courage, to hold yourself to a higher standard. Humiliating experiences take away our sense of meaning and introduce us to a world where power is the only thing that matters. It is at times very difficult to hold onto our own moral code when it is seen only as weakness and inferiority. Many violent people believe that we all would behave as they do if only we had the strength. Under their sway we can become lost in their perspectives and forget the reasons we had for choosing to live as we do. Forget that those choices are not for their benefit, but for the protection of our own heart. Some abusers deliberately set up situations where they require the abasement of their target, where they turn mothers against children, coerce siblings into betraying one another, entangle a whole classroom of children into bullying the most vulnerable child. This betrayal feeds into their fantasy that all strength is power and all restraint and self control is only weakness masquerading as virtue.

People who have been victimised often struggle with violence revenge fantasies. Each person finds their own way through an understanding of these, and a way to make peace with them. Sometimes people who have been victimised fought back. I can still taste the blood of someone I once bit when he held me down. The aftermath of being able to fight back can be both empowering and destabilising. Some of us have exercised violence in the protection of someone else. Some of us have first run, and then gone hunting those who once preyed upon us. Some of us have run, and then gone hunting those weaker than ourselves. Some of us take our own pain as permission to wound and alienate people around us who we decide have been less hurt than ourselves. All of us must reconcile ourselves to our own capacity for violence, and find our own morality in choices we have made under incredibly difficult circumstances.

For me there is a peace in knowing that unless I voluntarily surrender my choice to be a person who acts from love and honour, it cannot be easily taken from me. There are things within us that are not easily destroyed, broken as we may feel.

This is why I get angry at the instruction to never be a victim. Even in being victimised there can be a virtue. Even in brokenness there is something whole, something deeply and beautifully human about choosing to live with scars rather than writing our pain in other people’s blood.

Poem – She falls

/ Sarah K Reece / Leave a comment

walking into the adult world
layers of illusions peeling away
and the emptiness beneath us all coming into view

the veneer of our security so thin
we are a lost race on a world
falling into space and our dreams
are a taste of death, first thing in the morning
and the last hour of night

in my minds eye
everyone I love is gone
it falls away

no island so remote
as to be beyond the touch of tragedy
we destroy it all and it destroys us

we live on borrowed time and the pain
catches up in the end
we pay for all our sweet days
all the debts are collected

There is no peace.

there are moments of joy.
touch on my skin
love in their eyes
dreams in my heart

but the dark always comes
and the light is so frail

all our hopes unwoven
our allotted happiness
spent like sand through glass

what does it all mean?
I hold her hand
and I can feel her slipping
night has its teeth in her skin

We live, we love and we die.

each moment is pulled like a cloth
over the emptiness beneath us
over the screaming terror and the helplessness
the hours that torture and the dreams that sustain

We fly a little, and then we fall.

Getting gung-ho about treatment

/ Sarah K Reece / 2 Comments

There’s a lot of room for different approaches to recovery from mental illness. Some people love affirmations, others write journals, some use humour… Something I’ve noticed doesn’t seem to work well very often is an aggressive approach to getting rid of dissociation. Some folks, once they’ve discovered what it is, get very keen about helping people to never dissociate. This dubious goal rather concerns me. Firstly, my personal approach to mental illness is about focusing on what I want rather than what I don’t. I mean, (one of) my goals is to have a passionate, meaningful life, one in which I can participate as fully as possible. My goal is not to get rid of dissociation. They sound similar but really they’re not. Certainly, being crippled by aspects of mental illness is something to work on, but it’s in pursuit of a higher goal. It is never the focus in and of itself. What does this mean? It means whenever my dissociation is low enough for me to enjoy life, I’m not sitting in therapy trying to get rid of the last of it, I’m painting! I’m down at the beach, out with friends, reading books, having a life. Every chance I get. These experiences give me the sustenance I need to get through bad times, they build my self esteem, give me hope, a sense of control over my own life, great comfort and joy. This is what it’s all about. I don’t mind limping a little, and I know that a great deal of the healing and recovery we need happens in normal life, in everyday relationships, in art and running and writing and standing in the rain.

Focusing on getting rid of a symptom like dissociation sets the stage for power struggles, for making assumptions about what is healthy, and for a ‘Russian roulette’ of symptom swapping. Dissociation for many people serves as a protective mechanism. Think of it as a fuse blowing in a house with dangerous wiring. You don’t wire over the fuse, or you risk burning down the house. You sort out the wiring problems so the house is safe, then you work on resetting the fuse. Good therapy always starts with helping people feel safe, and swapping out harmful coping mechanisms with healthy ones. You don’t just start kicking crutches out.

Therapists can become very frustrated with highly dissociative clients, thinking that if they could get rid of the dissociation, then they could get some ‘real’ therapy done. Trying to beat down dissociative defenses with an anxious client is likely make them worse. If therapy is perceived as a threat, the mind will continue to put all it’s energy into disconnecting as much as possible, using any method it can come up with. 

Not only can dissociation be protective, but the current definitions are so broad that getting rid of it entirely doesn’t sound like a good goal to me. If any form of disconnection from the present moment is defined as a form of dissociation, then we need some. We need space to daydream, time to get lost in our thoughts, in books or films. This is not black and white ‘dissociation bad’, ‘connection good’. In order to focus deeply, we disconnect from distractions around us. Creative people often describe this lack of awareness when they are deeply involved in their work. It’s healthy, inspiring, magic. This can be called ‘flow‘, or being ‘in the zone’, absolutely immersed in your task. Experiences of flow are thought to be highly protective against depression and anxiety. Some theories about hypnotic states are that we are all going into and out of different states throughout our days, without even noticing. We disconnect from events around us to ruminate and process thoughts and feelings, drive on auto-pilot, focus intensely during a stressful conversation, warm to friends and ‘come out of ourselves’ in their company, all the time changing our level of awareness of things going on around us and inside us. There can be a natural kind of rhythm to this process, we can have our own cycles of energy and focus, times when we are most focused externally and others when we are most aware of our inner lives. In some of these states we are very receptive, taking in deeply the things we say to ourselves, at others we have all our psychological defenses up. 

The thought of holding up a life where none of these things happen as the goal to strive for is horrifying to me. I value being able to disconnect from the day to day to find a place my heart soars. While I loathe being lost in severe dissociation, unable to see, feel, smell or taste, I also hate the ‘flatland’ of a totally symptom free life that somehow keeps being set up as the goal for people like me. A little madness is not a bad thing, a little dissociation that frees us to dream, likewise. The goal is about freedom, hope, peace, meaning, love, connection, art… being human. Even our weaknesses and limitations can be part of that goal. 

What I need when I’m lost and trying to find my way back isn’t someone trying to carve dissociation out of me like a tumour. I need to find a way back, like coaxing a small terrified creature to come out of the dark. The right person holding my hand can be enough to bring me home. Standing in a thunderstorm can be the intense sense of connection I need for a mind in flight to re-inhabit my body. Sometimes everyday life doesn’t have a strong enough call, it’s the song of the sublime that reminds me of who I am. It’s poems that make me cry and music that makes me feel safe and books that are paper receptacles for my shattered heart. These things that remind me that I am human, that I want to be alive, and that the world is deeper, sadder, richer and stranger than we think. 

Voice Hearers Conference

/ Sarah K Reece / Leave a comment
I found out this week about a Voice Hearer’s Conference in Victoria early next year! I’m quite excited and hoping to attend. I’d also love to speak there. So, I’ve submitted an application for a subsidy for the conference fees, and also two abstracts (written at very short notice!) for possible talks and a short biography. It would be great to have a chance to listen to some other wonderful speakers passionate about voice hearing. I’d also love the chance to share about how voice hearing and dissociation can be related, because in traditional psychiatry voice hearing has been seen as a psychotic symptom. Not all or even most people who experience severe dissociation hear voices, but some people do, sometimes as part of DID or multiplicity. The experience can be similar to those who struggle with psychotic issues such as delusions and disorganised thinking, but there are some differences too and I’d love to share about that and suggestions for approaches working with the voices of people who are dissociative. 

So, here’s my biography, which had to be under 80 words:

I experience voices as part of my dissociative disorder. I co-facilitate two groups at MIFSA, Sound Minds and Bridges, and love delivering talks about mental health. These groups have made a tremendous difference in my life, I’ve learned so much and been able to better manage my own conditions and find ways to ‘pay it forward’. I’m also a poet, artist, and blogger, passionate about educating, inspiring, and reducing stigma around experiences such as mental illness.

And here’s the abstract, under 200 words:

I will share my personal experiences with ‘mental illness’ and voice hearing. I was diagnosed with Posttraumatic Stress Disorder when I was 14, and later a Dissociative disorder, although my troubles started much younger. I now co-facilitate groups, one of them for voice hearers. I will share the experience of voice hearing from a dissociative perspective, other troubling experiences associated with this, and how my recovery journey is unfolding. I will explore the critical role of creativity in my health, and how I’ve worked to develop greater self-awareness and self-compassion to reduce conflict with my voices. Dissociation is an often misunderstood and feared experience, I will explain common dissociative symptoms, how they feel and affect me, and what I find helpful. For many people who hear voices as a part of a dissociative disorder, the classic episodes of wellness and sickness don’t apply, and identity is tangled with the experiences in a way that can make ‘me’ difficult to separate from the ‘illness’. I hope to inspire people to feel more comfortable and confident in navigating dissociative issues, and while the recovery process is very individual I want to encourage people that it is possible to live well with voices.  

I’ve also teamed up with a friend, Jenny, we’d love to present a talk together about how successful our voice hearer’s group Sound Minds has been, and how Bridges has developed from it. Here’s her biography:

I am currently employed at The Mental Illness Fellowship of SA as a peer facilitator of ‘Sound Minds’ a group supporting people who experience voices and as a Community Educator. My voices started at about 5yrs of age. At 22 following a car accident these voices came to the attention of the hospital staff. Psychotic illness was diagnosed. I am now learning the power of living beyond illness. It’s my passion to share this knowledge and help others.

Jenny also contributes to Mindshare, you can see her work here. We had a quick chat to both groups this week to see what they thought of the idea of Jenny and myself not talking so much from our own experiences but going to the conference as ambassadors of the groups, putting quotes and thoughts of group members into the talk. They sounded excited about that so that’s what we’ll do. Here’s our abstract for a joint presentation:

Jenny and Sarah each experience voices and are both peer facilitators of a SA Voice Hearer’s group called Sound Minds. We will share the development of this group from inception in 2009 to now. Sound Minds has encountered challenges and difficulties such as months of low attendance, and the instability of being an open group with regular new members. Over time, the group has grown and developed into a strong, caring community of people with very diverse experiences. We are thrilled with the success of this project and will share members experiences of the difference Sound Minds has made in our lives and our ability to manage our voices. This format has been so successful that in July 2011, after much planning, Sarah started a sister group called Bridges. Bridges runs on the same principles as Sound Minds but specifically with people wanting support for experiences around dissociation and/or multiplicity rather than voice hearing. The principles have translated well and Bridges is also developing into a strong, useful resource. We’re very excited by the benefits both groups are providing to their members, and will share how the voice hearing group format has broader relevance in mental health.

Fingers crossed! Even if this one isn’t our time, I’m excited about doing talks about these topics and I’m sure we’ll give them somewhere.

Trauma recovery – traumatic replay

/ Sarah K Reece / 3 Comments

If you’ve read a previous post of mine, about Territory, you may have concluded that I sound like a pretty fragile kind of person. And, to a certain extent, you’d be right. However, if you’ve ever seen me stand up to someone twice my size who’s screaming into my face, you might have to revise your opinion. I’m also really strong.

One of the difficult things about trauma is that it can leave you feeling so weak and powerless. To be in situations where your 100% best efforts could not stop terrible things from happening is crushing. Part of you goes dead inside. The hypervigilence part of PTSD, where you feel on ‘red alert’ all the time, just watching for the next terrible thing to happen, is incredibly exhausting. In some ways, it’s actually worse than having terrible things happen.

Let me run that past you again.

When awful things are happening I feel awful. I feel numb. I feel furious. I fight like hell. I feel strong. I feel helpless. I feel vindicated. And other people say things to me like “How are you still going?”, with respect.

When nothing awful is happening I still feel awful, numb, furious, but I have nothing to fight. I feel weak, helpless, stupid, pathetic, and full of self loathing. And other people say things to me like “What is wrong with you?”, with contempt.

There’s a really tricky effect of trauma called traumatic replay, where sometimes people keep somehow putting themselves in terrible situations. This in NO way means they are responsible for abuse! The person doing the abuse is always responsible for it! I shouldn’t have to say that, but the inclination to blame the victim is so strong that we all need reminding. Trauma can upset your mental wiring, your internal dials and alarms about safety and danger can be a bit unreliable. We try to walk straight and look out for ourselves but find ourselves listing to the left and drifting off course. This article is about some of the things that can drive that, so we can be aware of them in ourselves and override it. It’s not an excuse to blame us for accidentally drifting into dangerous territory and getting hurt.

There’s a few different things that can drive traumatic replay, and the above dynamic is one of them. To some extent, I’m ‘built’ to handle crisis, it’s the come down afterwards that kills me. I sometimes have to fight my own impulse to put myself in dangerous situations or spent time with aggressive people simply because they make me feel strong. I have all my psychological armor on, and suddenly I feel like I can handle anything. This can be pretty appealing. It’s also phenomenally dangerous, and difficult to understand if you haven’t personally experienced it! In a way, its like grief, everyone turns up in the first few weeks full of care. You’re so blasted numb with grief at that point you probably can’t even recognise most of them. Six months down the track you’re crying yourself hoarse and everyone else has moved on. People harmed by trauma are often told to move on. Terrible things can fragment you, part of you lives in the here and now, and part of you stays trapped in a dark place. Traumatised people trying frantically to move on are sometimes tearing themselves further away from a piece of themselves. Finding a way to balance that need to honour the past with the equally important need to connect to the present can be really difficult. But it can be done!

Another dynamic that feeds into traumatic replay is the refusal to accept that you were genuinely powerless to make that situation come out any better. That is really hard to accept. Blaming yourself can be easier because it preserves the illusion that if you had just done this or that, things would have been okay. So you get back into it, in one form or another, hoping that this time you will make it work out right. You can lose a lot of your life testing that theory.

You can be hurt because you’ve been so strongly conditioned to be obedient and compliant that you shut down and obey when threatened, because that’s how you’ve always survived before.

You can also seek out terrible things because waiting for them to happen – and being absolutely certain that they will, can be more distressing than having them happen. This is similar to the domestic violence cycle where the abused partner starts to trigger the violent reaction just to get out of the exhausting stage where tension is rising and violence is imminent and inevitable.

Really twisted up thinking that you deserve nasty things to happen to you can have you seeking them out. Self harm takes many forms and some of us are adept at finding other people who are more than willing to hurt us. Obviously, abusive people tend to foster this kind of self loathing in the people they hurt.

Familiarity can make you choose awful situations or relationships because sometimes it takes us a while to work out that ‘feels comfortably familiar’ actually may mean ‘is toxic’. Good environments can feel weird, we can feel out of place and awkward, it’s almost like culture shock, we don’t know the ‘rules’ here. I had an odd experience like that once, a man I was close to had some bad news suddenly and went quiet. I read the quietness and disappeared as quickly as I could. He was surprised and confused by my behaviour and later called me out on it, telling me how uncaring I’d been. That really surprised me, in my life, men getting upset and going quiet meant get out the way as quickly as possible, or they will blow up. I was applying a social norm to a different environment where it wasn’t the norm. Miscommunications such as this abound, and opportunities for the Gap to open up are everywhere. So people stick to what they know, even if it’s horrible.

Sometimes, limping around the ‘normal world’ feeling like a broken person is just too hard when we can feel like somebody significant in the trauma underworld of abusers and abused. We’d rather eat and be eaten than face innocence lost and the appalling misconceptions about how victims ‘ask for it’, ‘deserve it’, ‘let it happen’, ‘enjoy it’, or should ‘just choose not to be victims‘. Abusive people can be adept at making us feel special; we are the centre of their world even though their attentions are painful.

The last thing I’ve noticed can feed into traumatic reply is a driving need to deny that a trauma has had an impact upon us. Being victimised can be such a terrible thing to process, that we were made a victim can be so painful and overwhelming that we deny it entirely. We go out of our way to flaunt our lack of fear. We deliberately do dangerous things to prove that we’re not a victim. We ignore all our warning systems that say ‘that person feels creepy’, ‘that car park is pretty dark and deserted’, ‘I don’t like the way they touch me’, and in an attempt to prove how unaffected by trauma we are, we can put ourselves in the kinds of dangerous situations that no one else would.

It’s worth mentioning too, that some awful stuff happens in life. Just because you get a double dose doesn’t necessarily mean any of these are in play. Storms happen, sometimes we’re just unlucky.

Psychiatry used to assess these kinds of issues as masochism. Now there’s a better understanding of the kind of damage trauma can do to someone. Pain may be the result of these behaviours, but the desire for it is not usually what drives them. We’re seeking strength, a sense of undamaged identity, to feel like we control our own lives, to feel loved or powerful or right. It’s just that sometimes these desires take us to dark places.

I feel the pull of some of these. My thinking gets twisted, I want to feel strong even if it means I’m being torn apart, I want to be proved right even if it means that another horrible thing happens, I want to get it over with because I know it’s coming anyway, I want to be possessed by them even though they make me hate myself.

I fight it because I try to believe – even when I can’t feel it – that I don’t deserve this. Because I believe in a life that’s richer and deeper than the roles of abuser and abused. Because I feel such compassion for other people, and you can’t really help when you’re trapped in the underworld yourself. Because amazing people like Judith Herman have written books in which I see myself reflected without hatred or humiliation, and I find hope, and I want other people to find hope too. I try to find ways to accept the brutal lessons without letting them destroy me, and to grow beautiful things out of anguish and degradation. I know my own damaged wiring. I know the lure of self destruction. On the bad days I cry, “protect me from what I want”. And I hold on, and I hold on, until it eases.

Newsletter!

/ Sarah K Reece / Leave a comment
Well, this is something new from me! Today I wrote a short newsletter to distribute to the people who’d asked to be on a mailing list about dissociative information. It took a surprisingly long time to do, even though I used some articles from this blog! It’s not perfect but I hope it does the job and if the feedback is positive I’ll look at making it a regular thing to keep people in the loop. Just putting together a mailing list that makes some kind of sense, is private and secure, but can be shared between myself, Ben, and Cary (we’re the three founding members of this little community group who’ve been setting up Bridges and the talks and other Resources) has been quite a headache! I’ve never done anything like this before and it’s all learning on the go.

It’s taken me a couple of hours of reading through forums to work out how to embed the newsletter on this blog, but here we are! You can also go directly to the document here to download it, print or email it if you wish. Please feel free to pass it on to anyone who may find it of use. 🙂
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So, there you go. I think I’m just a glutton for punishment, making extra work for myself! I’d love to hear any feedback or constructive criticism you may have about it. 🙂

Trauma Recovery – Territory

/ Sarah K Reece / 6 Comments

The idea of territory can be a big issue for some people who’ve come through trauma, particularly the ‘interpersonal’ kind – that is caused by other people rather than natural disasters or accidents. It can be a little difficult to describe the kind of chronic anxiety that people can struggle with. Certain kinds of environments can become really stressful such as crowded events, places that are similar to the place where something bad once happened to you, or new places. I’ve had big troubles in this area myself, which is pretty common for someone with PTSD. In my case, I’ve found trying to take on environments like a university campus really challenging and stressful. I’ve found that thinking of this stress in terms of territory has been helpful for me.

On bad days, I don’t feel safe anywhere. It’s hard to even remember what it was like to feel safe. On slightly better days, there’s pockets of the world where I feel like I’m allowed to exist. These spaces feel like my territory. I know them well, I’m comfortable in them, I know where to retreat if I need to, where the exits are, the quiet spots. I feel much more comfortable in these spaces. Home, all being well, is a place like this. I feel much more relaxed because the space is mine, I’m very familiar with it, and I feel like I have the right to enforce my own wishes and preferences. These two aspects are key to my concept of territory; being very familiar with a place, and feeling like I have the right to be there as I am.

When I’ve been really struggling, my territory has shrunk down to nothing and nowhere has felt like my space. Over time, I’ve gained ground, partly by removing myself from some bad environments. I’ve worked on making some spaces feel like my own, such as my own home. The key then has been to try and expand my territory so that there are other environments I feel comfortable in, otherwise my world gets very small. One of the places I was first able to do this was public libraries. Libraries have traditionally been my haven, they are fairly quiet, not usually frequented by bullies, and full of books and information – and internet access, which was pretty important before I had my own computer and connection! One of my local libraries had an indoor garden which I immediately fell in love with. Another had comfy chairs and one of those vending machines with $1.80 nestle hot chocolates. I quickly felt at home. These places became pockets of new territory, like a chain of islands I visited. My goal was greater freedom so I kept adding new places over time, the local supermarket once I’d become really familiar with it, the walking track at the nearby park, a community center.

I’ve moved house a lot over the past 5 years, and I find this very disruptive. The dissociation means it takes a while for information like that to be processed. In a new house I’ll wake in the dark and not know where I am, get disoriented and lost easily when trying to navigate, drive back to my old place when I’m tired. One of the things I do is thoroughly explore a new area. I walk to the nearest parks, find fast food places for emergency meals, the chemist, go read all the community notice boards, collect the information at the local library, read the council pamphlets about community events. Knowing an area well helps me feel more comfortable in it and reduces that sense of permanent disorientation.

In tackling a new environment I take a similar approach. Let’s imagine a new community center. I’d go there sometime there weren’t many people, and investigate. Where are the toilets? The kitchen? The exits? Is there any quiet nook I could retreat to if I needed? Any garden or outside area to escape to? Is the physical environment welcoming or really challenging? Welcoming environments for me have open spaces, comfy seats, and lots of natural light. I’m less comfortable in squeaky clean corporate environments, and poor lighting, cramped space, closed doors and barred windows set my teeth on edge. Then there’s the issue of my place in this environment. How will it function? Are there areas I can’t go? Is it pretty relaxed? Would I get in trouble for ducking to the kitchen for a drink or sitting with my feet on the couch? The more rules and restrictions an environment places on me, the less it feels like my territory, and the more I’m a guest – in some spaces a barely tolerated guest. Where these rules are things I’d never do anyway – please don’t break the windows, it causes me less stress. Where they impinge on my ability to relax and function independently – I have to ask permission to go to the toilet, a staff member will bring me a glass of water if I ask for one, the less comfortable I am in that environment.

If I feel pretty comfortable to be myself, that taking the initiative or operating independently wont get me into trouble, then another thing I do to help myself cope with a new place is turn up early. If there’s an event on at 2pm I want to attend, but I’m feeling anxious, I might turn up at 1.30pm. It may be enough to just sit in my car, or I might be allowed to go and wait in the space. Not walking into a room already full of people but being one of the first to arrive helps me to feel I have a right to be there and that the space is part of my territory. This isn’t a dominating thing, I very much want other people to feel at home there too!

Volunteering helps me a lot with this issue too. Being part of the behind the scenes where you may be there at funny hours or when the place is normally closed, you often have access to screened areas and will spend downtime having a giggle with other volunteers after projects have been completed really help me to feel at home in a difficult environment. When you know where the glasses are kept, that the study door has to be bumped with your hip because it sticks in the heat, and that the third armchair is in that spot to cover a stain on the carpet you feel a much stronger sense of belonging and territory.

It’s not just difficult rules and hierarchy that can derail my ability to feel at home somewhere, rudeness or bullying can also derail me quickly. At one place I was starting to feel more comfortable in, I had an incident one afternoon that was quite minor but affected me strongly. There was a free resource in a particular location that I wanted to access, and another person was in the space. When I asked if I could get past them they were hostile and claimed the space as theirs, with no intention to move any time soon. I wasn’t expecting this and was suddenly unsure if I would be supported by staff in my reasonable request or if the other person would be supported as having the right to occupy it. Because I was only new to this location and my anxiety was pretty high, I felt the impact of this minor conflict. I went from feeling somewhat safe and at home to feeling intensely nauseous and distressed. I suddenly wanted to escape the environment as quickly as possible, but I also knew that if I walked out it would be incredibly difficult for me to come back. In this situation I was able to find a caring staff member to sit with me in a quiet space and let me express my distress. They didn’t tell me I was over-reacting or should be more assertive, they just gave me a glass of water and some sympathy for how upsetting it can be when you encounter a conflict like that you weren’t expecting. This quickly calmed me down and left me in a place where I certainly felt uncomfortable with this other person, but not generalised outwards to the whole environment. I was able to go home and I was able to come back and keep working on making that place part of my safe territory.

Being listened to and respected even if you’re not making much sense or speaking their ‘language’ goes a long way to helping me feel safe in new environments and that my needs and wishes will count and if I stand up for them I’ll be supported. I like to know what the rules are, written and unwritten, feel I could anticipate the reaction of the people running the place to any situation, and have enough space to breathe as my own person within it. Any opportunity to occupy it on an even playing field, to become more familiar with it, or to build connections with caring people there all help me to expand my territory and be more involved in the world around me.

 

Poem – Doubt

/ Sarah K Reece / 2 Comments

I sit by your bed in hospital and say
I love you, don’t go
and say – endure!
and say – it will get better!

I sit by your bed and hope
you wont make a liar of me. 

I sit by your bed and beg

for one more day
of the screaming pain
the nightmare you can’t wake from
and the darkness

strangest thing – they tell me
it is you who is selfish.

How do I know I’m multiple?

/ Sarah K Reece / 14 Comments

At Bridges, my group for people who experience significant dissociation and/or multiplicity, sometimes people express anxiety about their diagnosis. In fact, this area is surrounded by an intense anxiety that can make it very difficult for people to think clearly or feel okay about whatever is going on for them. Obviously we don’t diagnose each other or try to answer that question for anyone one way or the other, but to let people know they’re accepted and their experience counts whatever it turns out to be.

Some people develop serious mental health troubles, get referred to a psychologist or psychiatrist, and are quickly given an accurate diagnosis that fits their experience well. Some people have a much rockier path to working out what’s going on for them, and in the areas of dissociation and multiplicity, diagnostic uncertainty are pretty common. This can be really tough! Spending long periods of time struggling with diagnoses that don’t really fit, collecting many diagnoses, or having doctors trade them in for a new one every few months can be really confusing. For many people with a dissociative disorder, this is what happens. They may spend many years and receive many different diagnoses before a doctor identifies a dissociative condition.

If you have a psychologist, they can do certain tests where they ask you questions to determine if you experience a lot of dissociation. They may also be observing the kinds of changes in you that suggest multiplicity. Sometimes other parts will communicate with them directly and clear up the uncertainty. Books about DID generally list the obvious amnesia based indicators such as finding clothes and belongings you don’t recall purchasing that aren’t your taste, being approached by people who know you by another name, losing time, finding yourself in places and not being able to recall how you travelled there. If you don’t experience severe amnesia, it’s likely you won’t get these kinds of clues.

Dissociative Identity Disorder (DID) in particular is often treated as sensational, fundamentally different from any other mental illness or condition. There is considerable debate among professionals about how to identify and treat it, and whether the condition even exists. To be fair, every other mental illness in the DSM, and a few that aren’t, also have these kinds of debates. But the sensational way DID is often treated can mean that considering it as a diagnosis carries an extra anxiety. Many people who are diagnosed with DID feel incredibly anxious about this, afraid it may be true, and also afraid it may not be. So how can you know?

Firstly, by bringing the whole concern back down to earth. DID is not special, having it does not make you special, not having it does not make you special. Unlike a medical condition where x bacteria can be shown to cause y disease, the realm of mental health is far less clear. Dissociation occurs on a continuum from normal common experiences, right through to severe disruptive mental illness. Multiplicity likewise, is not black or white, you do or you don’t. Most multiples are actually diagnosed with Other Specified Dissociative Disorder (OSDD, formerly called Dissociative Disorder Not Otherwise Specified or DDNOS) as they don’t quite meet the rigid criteria for DID. Identity instability is a common symptom of several disorders, such as Borderline Personality Disorder, and Posttraumatic Stress Disorder. There is a continuum here also, from the usual human experience of being a person with different sides or parts, different facets to their personality, through to issues around identity instability, an uncertain or absent sense of self, distinct ego states especially related to strong emotion or trauma that can be suppressed or triggered, issues with being susceptible to engaging in expected roles, through to splitting of the personality into distinct parts that perceive themselves as separate and contain their own skills, needs, hopes and memories. This isn’t black and white, and if you’re struggling somewhere on this spectrum it can take a while to work out exactly where.

That’s okay! People with psychotic symptoms may be diagnosed with schizophrenia, then schizoaffective disorder, then psychotic depression. Because none of these conditions is treated in a really sensational manner, having the label change isn’t such a big deal. It should be that way for these issues too. In the end, the label doesn’t matter. What matters is finding a framework that makes sense for you and that helps you move in the right direction. If you’re feeling really anxious and uncertain, these questions may help clarify things a little for you.

  • Do your symptoms/experiences take energy to sustain, or energy to suppress? What happens when you’re tired and worn out – do they get worse or better?
  • Do your experiences predate therapy? For example, very different handwritings, hearing voices, a complex history of mental health problems that disappear and reappear, extensive amnesia.
  • Does the framework of multiplicity make sense to you?
  • Does it help? Is it reducing or increasing stress? (it’s okay if it’s doing both)
  • What happens if you trial the idea that you’re not a multiple? Do members of your system fight to get your attention, or does the internal stress settle down? Do you function better or worse? Is there still things going on you can’t explain?
  • Do any other frameworks fit your experiences? Identity instability rather than switching between parts, trauma related ego states? Do they fit better, worse, or as well as the idea of multiplicity?
  • What do your ‘other parts’ think is going on? Do you agree or disagree?

The thing is, certain types of therapy, such as family systems therapy, parts therapy, schema therapy and so on can be useful for anyone at any place on this spectrum. The basics of trauma recovery (where appropriate) also remain the same. Issues like needing to feel safe, to build your self-awareness, learn more about how to take care of yourself and listen to yourself are also the same. The format may be a little different, but the underlying issues of developing a good, loving relationship with yourself, learning how to manage ambivalence, dealing with triggers and reactivity, reducing dissociation, calming intense distress, reconnecting to buried parts… they’re all the same. I think one of the reasons the condition of multiplicity does fascinate people is because it is just normal human functioning writ large. We can all relate to the themes, although not usually the extent of the divisions. Some (by no means all!) theories of personality are that all people function as a collective, with sub-personalities managing different life areas.

So, from these perspectives, nailing down the exact label becomes less important, it may not even change the focus of therapy or recovery. There are people who hear voices and have a psychotic diagnosis who find a multiplicity framework useful and consider their voices to be parts of themselves. They don’t switch or experience amnesia and their diagnosis remains the same, but a multiplicity framework is useful to them. I’ve also read of other people who are encouraged to view their experiences as multiplicity who feel pushed into that perspective without good cause, and determine that their situation is about abrupt mood changes rather than switching, for example.

The heart of this is that chronic denial can do terrible harm. Anxiety around accepting what is really going on for you can leave you refusing to listen to or look after yourself. It is helpful to find frameworks that fit and work, and hanging onto one that doesn’t – whether you’re a multiple hoping you’re not, or someone with something else going on who’s feeling forced into the multiple label, can be another way of denying what’s really happening with you and what you actually need. Many people, even those at the far end of the multiplicity spectrum, with taped evidence of other parts, just don’t want to know about it. It’s frightening to contemplate sharing your body, not always being in control, not being able to drug or get rid of symptoms quickly, and having to work on something as fundamental to you as your own identity.

Add to that mix fear, ignorance, and huge stigma about these issues even within the mental health community – for example, I know of many people with these concerns who have been denied treatment from mental health facilities and told they were faking their condition for attention- it’s no surprise that people want to put their head in the sand and hope it all goes away. A lot of the pain and stress about multiplicity is about how poorly it is understood and responded to by our wider community, which is an unfair extra burden on those of us trying to find the courage to deal with it. Another aspect of the pain and distress of multiplicity is that for many of us there are deeply destructive trauma histories we are struggling to deal with – and that is the case for many people whether it turns out multiplicity or something else is going on.

There’s often a misunderstanding that the choice is between “I have multiplicity” and “I’m fine”. Whatever is going on that you and your doctor are wondering about DID, it’s often happening in a context of a lot of pain and confusion. Things are going on that are causing you some troubles and for which you’re looking for support. On the other hand, I’ve also heard from people who turned up to a local counsellor for some help with a relationship issue or something else fairly common who found themselves with a question mark about multiplicity because the counsellor thought that feeling like you are younger around your parents means you are switching to child parts. Which caused a whole lot of needless confusion and stress. Everything boils down to this, really:

Whatever is going on, you deserve to have help and assistance to learn about it, work with it, and get on with your life.

So really, the whole question becomes a very simple case of asking what works. What helps you function better, what gives you greater freedom, what makes sense, what moves you forwards and helps you have a life? Hopefully, you’re not trying to work all this through by yourself, but have a good doctor of some kind on board, who isn’t afraid of or fascinated with the idea of multiplicity. Confirmation bias can feed into both over and under diagnosing conditions – this is where we look for information that supports our theory, and disregard anything that doesn’t. If you’re worried this is at play, perhaps you could try and keep two lists – one of anything that suggests you are a multiple, and one of anything that suggests you aren’t, or of alternative possible explanations for what you’re going through. See how it plays out over time and what you end up with. Or, forget about the labels and just go with the framework that’s getting you results. Good luck, whatever is going on for you, you still deserve love and support and you will still be okay!

For more information see a list of my other articles in Multiplicity Links, scroll through posts in the category of Multiplicity, or explore my Network The Dissociative Initiative.