Scattered pieces

Today, two articles were published by the Sunday Star Times which highlight a troubling aspect regarding the recent changes in ACC guidelines (or clinical pathway)… ACC advisor silent on links to sex abusers (29 August, 2010), and Conflicting interests?

Reading these articles has left me with questions…

• How much influence have the ideologies of Bert Potter (a convicted pedophile), indirectly had on ACC Sensitive Claims Unit policies?
• If ACC commissioned research directly from Felicity Goodyear-Smith, why?  What was the motivation, considering her stance and ideologies were well known at the time of the later studies.
• Why did ACC commission research from a GP, rather than psychologists, psychiatrists or clinical psychologists?
• Why did ACC commission research from a person who was a founding member of a group dedicated to defending those accused of sexual crimes (Casualities of Sexual Allegations – COSA), and who has been used as an expert witness defending the accused?
• Why did ACC commission research from someone who could later argue “that gonorrhoea in pre-pubescent children was not necessarily an indicator of sexual abuse”? (see Conflicting interests? and What is the evidence for non-sexual transmission of gonorrhoea in children after the neonatal period? A systematic review)
• My knowledge of the tertiary sector, would indicate that the research was directly commissioned.  However, if ACC commissioned the research from The University of Auckland, and they assigned the research to her… why was it assigned to her and why did ACC commission more research without any provisos that she not be involved in further research associated with sexual abuse?
• In the research where Ethic Committee approval was needed, what was disclosed about any conflicts of interest regarding the study?  Not only of the main researcher, but also other people involved in the study.

But, the most important question…

What is ACC going to do with this information?

One step was the appointment of the review panel, who are looking at the changes in policy and their impact on claimants… but this was instigated by a Dr Nick Smith under pressure from the opposing political party and public pressure in the form of survivor rallies and news stories about the suicide of women refused ACC funded counselling (see Denied help for sexual abuse, dead days later).

It also seems hard to believe that ACC didn’t know the type of research, or outcomes that would be produced, when the book First do no harm: The sex abuse industry, was published in 1993.  So the ideologies were well known before the 2003 and 2005 ACC research was commissioned.  So, may be the more appropriate question is…

What is ACC going to do, now that this information is public?

On a personal note… One of the arguments put forth by Felicity Goodyear-Smith, is that children seek out sexual contact with adults as part of a consensual act.  I find this the greatest insult.  I initiated sexual contact with adults, I know this and carry the shame and confusion as a result.  But, well before I did this, I had been forced into sexual situations which were beyond my ability to cope or understand them.  I was abused.  I was used.  I was stripped of my humanity and treated as a plaything.  I was so sexualised by the time that I initiated the contact, that I didn’t know what the appropriate sexual boundaries were.  I thought that it was “normal” to play those games.  I also found that it was over more quickly if you acted a certain way.  It hurt less.  It was also one way to get a sense of power, in an otherwise powerless situation.  So one statement, treated as generalised fact, can hide a huge range of issues and problems.  There are no simple answers when it comes to child sexual abuse… well, there’s one simple answer – it’s wrong… morally, ethically and legally wrong.

I’d like to thank Tim Hume, Barrie Leslie and Kyle MacDonald for speaking out.  I know there are others, not named in the articles who contributed, so would like to thank them as well…

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Now playing: The Feelers – Stand Up
via FoxyTunes

I’m writing this entry from a hotel by the beach… Out one window is the view of a bay, out the other is a glimpse of the ocean…  It’s beautiful.

I wish my state of mind matched the beauty surrounding me, but it doesn’t.  Instead it’s a floating mess of past and present memories…  It’s a harsh reminder that no matter how far I run, the problems will follow me until I work them through.

I hate that.

I knew it was risky coming to the beach, but I didn’t realise the memories and issues it would throw at me.  A combination of being in a hotel; by a beach similar to the one where I grew up; and the psychiatric assessment on Tuesday, has opened old wounds.  To top it off, the free cable channels in the hotel are the Rugby ones… just typical!  Why couldn’t they be the kids, movies or arts channels… why????

The fall-out from the psychiatric assessment on Tuesday has been severe.  I made many mistakes, thereby giving ACC lots of ammunition to use as a way of apportioning away responsibility to other issues.  In fairly typical fashion, I’m beating myself up for it.

I won’t know the results of the assessment for several months.  The psychiatrist assured me that he would recommend that I continue to get ACC funded therapy.  But, I was honest about my level of dysfunction and self-injury, so ACC might decide in peer review that I need to be in the hospital system or forced into DBT.  Then there’s the issue of determining my level of impairment… this is a brutal system, and one that has been harsh for me in the past.  I’m expecting it to be just as harsh this time around…  This will have little to do with the assessing psychiatrist, and more to do with the peer reviewers at ACC.

The assessing psychiatrist understood DID, he really “got” it… One of the last questions he asked was how long we’d been talking, B had just come forward again, so thought it had just been a few minutes… it had been over an hour.  B then noticed that the sunlight had moved across the floor… she forgot to check the agreed upon marker of time before answering him…

One of the things we did to try and ease the stress of the assessment, was to produce a summary of our life.  It was harsh to see our SA experiences summarised in a dozen bullet points on half a page.  That summary was difficult to write… one line alone took 4 hours… we finally admitted in writing that the father abused us.  It is now on our ACC records.  That makes it official… scary… overwhelming… disgusting… shameful… ugly…

Sorry, I know this is disjointed…

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Now playing: Blindspott – Phlex
via FoxyTunes

You shall not pass!
You shall not know.
You will never know.
It will destroy you to know.
I will destroy you, before the secrets are told.

This message has been driving my existence for the last week (month?). D. One from my internal Basement has drawn, what can only be described as, battle lines. There’s no give, little communication and no trust. She’s said several times that she hates the rest of us, and has apparently sworn at Allison – not something that I would do.

The problem… We’re getting closer to her secrets, or the secrets in The Basement. This has been deemed as too dangerous for the system by D. One. This is a Polyvore set done last night to prove the point.

What surprises me, is that it looks rather tame in comparison to some of the other works that have involved her (for example D. One). But, it more clearly shows the dissociative wall she is protecting.

As an aside, she was associated with fire and a serpent in the last set, but now it’s birds and trees?

Last week, it became obvious what she will do to protect that wall. It wasn’t pleasant.

As a result, the mother is now staying with us. Those of you familiar with this blog, will know that the mother has a tendency to grate, annoy and trigger different parts of the system. She was psychologically abusive and neglectful during my childhood, and parts felt betrayed and hurt by her. Saying that, there are parts of the system who love, cherish and want to have a relationship with her. At the moment, for our safety, she is being tolerated by us all.

I keep on wondering what all of this activity by D. One means… Reflection is my key to healing and understanding. But yet, I find it almost impossible to reflect on the actions of the past week. I find it difficult to put them into context. If D. One was so stead fast in her rules of no more secrets being shared, why was a young one allowed to talk to Allison on Friday? It doesn’t make sense. Admittedly, there were no secrets shared, it was a very narrow flashback being described, but I’m struggling to make sense of it all.

One good thing about the mother coming up, is that she has again validated some memories, either through mentioning suspicions, or by describing vehicles that were either used, or around during my childhood. I know this is a double edged sword – if she had suspicions, why didn’t she act to protect us? Possibly this goes back to what Paul was discussing when he gave a brief overview of how societies attitude towards CSA has changed over time? Possibly, it’s because we were a white, middle class family? Possibly, it’s because the mother is a nurse who was clinical, rather than emotional and nurturing? All I know, is that it hurts that there were seemingly obvious signs and suspicions, which were ignored. I also know, that this is a similar story for thousands of other survivors.

So where to from here? Well, in just over two weeks, I have an ACC assessment. I’ve been assured by people I trust, that the assessing psychiatrist is good. But, it means describing my dysfunction, past and struggles with someone new. The results of this assessment will determine whether we still will receive ACC funded therapy, or not. We’re expecting to get our funding withdrawn – either because we haven’t shown enough progress, or because ACC will consider us to be better off in the public health system.

This assessment is what is destabilising the system. This is what is ramping up D. One’s activities… The difficult part, is that even once the assessment is over, it could take months for the results to come through. I’m not sure whether the system can cope with that sort of delay.

On a positive note… Two of my favourite blog distractions at the moment are DogHouse Diaries and Message with a bottle. As a warning, the first is a sarcastically funny take on relationships, and the second is a photo diary by a stay at home father of post-it-notes to, and about his son. I add the warning, as I know many of us struggle with fertility issues…

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Now playing: P!nk – Trouble
via FoxyTunes

Please note that this may trigger.

It feels like I’m falling into a black hole…

Over the weekend, the dissociative fog was still hanging over me… everything very detached and unreal… Then, in acts of what I can only consider self-sabotage and self-injury, I sought out ways to break through the fog.  It wasn’t smart, it wasn’t pretty, and if it hadn’t been for a good friend, it probably would have led to some seriously stupid actions on my part.

It started off in the morning by going to the shops and buying some L&P, Salt and Vinegar chips and lollie cake… otherwise known as food triggers from my childhood.  I didn’t consciously buy these things, but they were amongst my groceries when I got home.  This stirred things up internally, but I didn’t really think much of it… the dissociative fog was still keeping everything very separate and numb.

Then, in actions that were so stupid, they’re ridiculous… I read an article about ACC’s mishandling of a clients psychological reports… I watched a 20/20 special on CSA… then one on a religious sect in America… then, to top it off, I read several blogs that talked about either consensual sex, or CSA…

Stupid, totally stupid…  That whole concept of telling others to take care and look after themselves… totally lost on me.

After reading a blog about consensual sex, I lost it…  Flashbacks came through like a freight train…  Sounds filled my head… and the smells… the smells… stomach churning, repulsive smells.

I have no idea which young one it was who carried the memories, but she was hurting so much…  The blind panic, the inability to breathe, the need to run…  The overwhelming confusion, the pain…

Too much… just too much.

What does my head in about the memories, is why didn’t I say anything about what was happening?  Why wasn’t my behaviour picked up as being odd by my teachers or doctors?  Was I that good at hiding it all?  Maybe I was, I don’t know… Maybe being part of a white middle class family meant that those sorts of things weren’t meant to happen to me?

Yesterday I remembered a new piece in the puzzle as to why I didn’t tell…  At the rugby club where the father was manager, they had regular raffles.  Each of those raffles had to be drawn in the presence of the Police.  Each time there was a draw, the father used to take me to the Police Station.  I remember that the Police used to joke with me that if I was bad, they’d have to lock me up.  They showed me the cells.  Put me in them and closed the door, so I’d know what it was like.  I know they did this in jest and teasing.  It wasn’t meant to be abusive.  The always laughed and teased the blonde haired girl tagging along with her father.

This is why I believed the implied threats that I would be locked up if I ever told.  That I wouldn’t be believed.  That I was the bad one in the equation…

We went into see Allison today, hoping to talk about all of this.  But we talked about a safety contract instead.  I know safety is important, but I’m scared… I could feel the resentment and resistance to the idea of a contract and our behaviour being “controlled” through reward and consequences.  I worry about what the backlash against the contract is going to be.  Allison says she’s expecting a reaction… which is fine for her, she won’t be the one experiencing it.

I feel like an open wound…  I feel like this…  If you close your eyes and listen, it takes you places…

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Now playing: Wilhelm Kempff plays Beethoven’s Moonlight Sonata
via FoxyTunes

Ok… so, the big stuff… the stuff I’ve been studiously avoiding for the last probably two to three weeks… maybe even that last couple of months.  I can’t analyse or reflect on them yet, but I need to write them down so that they lessen their hold over me.

Probably the most obvious, is the therapeutic rupture with Liz.  It destabilised me.  It re-enforced all the old messages about me being too difficult to cope with, and made me feel as if I would never heal.  I still don’t think that the new therapist will cope…  She says she’s one of the top therapists in the small city where we live; but then, Bob was one of the top clinical psychologists, and that didn’t turn out well.  We’re still not sure if ACC will fund us to see her; so until funding is established, we’re seeing her fortnightly.  I know that isn’t often enough, but we can’t afford weekly therapy.

Once you get past the obvious of therapy, there’s the other given… work.  We recently had a change to our union negotiated employment agreement.  The new agreement meant that we ended up with a negative sick leave balance.  We’d used up so much sick leave in the short time we’ve been there, that we’d used the equivalent of an extra years allowance.  This basically meant that we were going to have to go for over a year, with any sick leave being unpaid.  There’s no way we could afford that.  Our union is incredibly weak and unable to fight for the rights of the worker – if you wonder why I’m in such a weak union, librarians are traditionally left wing, socialists who believe in unions, and so there’s a great deal of pressure to join.

So, ignoring the union, we researched the law and questioned work on the validity of the negative balance, when according the the Holidays Act, each employee must have five days paid sick leave per year.  We sent through an email outlining the law, and asking what that meant in regards to our negative balance.  This resulted in a meeting with HR (hence the entry about the panic attack).  The meeting was mercifully quick and resulted in HR apologising to me for any distress caused.  They also gave me five sick days immediately, and another five in six months time.

We had been expecting a written warning about our excessive sick leave.  During the negotiations, our employer had been talking about “sick leave abusers”.  When we saw that negative balance, we immediately knew that we were one of the people being targeted.  We doubted all of the work we’ve been doing.  We don’t feel as if we’ve been performing to an even half descent standard lately.  So again, all our fears and inadequacies were thrown into the spot light.

The other obvious stress has been the divorce.  We got the papers served on the ex-husband, and immediately started to get hang up phone calls.  They were at odds times of the day and lasted for a week, ending only when we picked up the phone once and asked who was there.  This led to all sorts of flashbacks and activation of parts who used to deal with the ex-husband.

Which probably leads into the other issue I’ve been facing… increasing amounts and severity of self injury.  It’s been a really tough few weeks, lots of lost time and negative coping mechanisms being used.  I know I’m going to have to tell the new therapist about this, but it’s so shame inducing that I don’t know how.  I keep thinking that I should be “strong enough” or “healed enough” not to do those old coping mechanisms… but yet fall back into them when the going gets really bad.

Then there’s the last big thing which feels so awful and… just yuck.  I’m friends with the younger of my two brothers on FaceBook.  A few months ago, a photo was added to his profile.  It’s not an awful photo, it’s actually a really good one, which shows his body language as I remember it.  The thing that sends the system into chaos however, is that the lower half of his face is almost exactly the same as the fathers.  The mouth is the same… as is the chin.  It drives some in the system crazy.  My brother is now the age that the father would have been when we were in our early teens.  As I write this, I feel the dissociation coming.  I know this is a huge trigger.  I know that sometimes one of us looks at this photo of our brother as a punishment.

Far out… that’s all I can write… sorry, I know this doesn’t make much sense.  But I needed to get it out in some way.

In all the craziness, I’m reminded of the lines from Hymn to Her…

She will always carry on
Something is lost
But something is found

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Now playing: The Pretenders – Hymn To Her
via FoxyTunes

On Tuesday, the New Zealand Herald ran the story of a woman who died (read committed suicide) four days after being declined counselling assistance by ACC (see the whole article here).  It could be argued that there is no link between these two events, but it’s hard not to draw conclusions.  Having been on the receiving end of insensitive letters and shoddy reports from ACC, I know how easy it is to get that last knock which sets off the final downward spiral.  We’ll never know whether this tragedy could have been averted or not.  People within therapy do commit suicide, so there is a possibility, that even with counselling, this would have happened.  But there will always be that… “What if… ?”  I know her children will always wonder and question…

The reason why her claim had been denied, was that ACC determined that she hadn’t suffered a “significant mental injury” due to sexual abuse.  Yet, the counsellor initiating the claim, clearly stated that she was suicidal because of the abuse.  If you’re wondering how this can happen, ACC look at other factors in your life, to see if the symptoms you are suffering from can be attributed elsewhere.  As an example, I am deemed to have grown up in a “challenging” home environment due to having an alcoholic father (among other factors).  When someone grows up in such an environment, it is statistically expected for them to be impaired in some way, for example, children of alcoholic parents are more likely to suffer from depression.  So it would seem that ACC decided in this woman’s case, that her current issues were not due to the sexual abuse.

As an outsider, it’s easy to cite other resources for help that she could have approached instead of the ACC funded therapy – LifeLine, Mental Health Crisis Teams etc.  But in reality, it’s not always that simple.  Speaking from my experiences, when I’ve reached out to the Crisis Lines, their goal is to talk you through that moment and to suggest options for assistance long term.  Often, those options are under-funded and over-stretched.  As an example, if I wanted to see someone through the Mental Health Team, I’d be looking at a six month waiting period – just to be assessed.  When you’re in that pit of hopelessness, six months may as well be 20 years, it seems like an eternity and beyond hope.  This is the reason why the recent changes to the ACC pathways have been so damaging.  The options for someone who doesn’t receive assistance from ACC are limited and often cost prohibitive.  Not many people can afford the cost of therapy; and as it would be considered a pre-existing condition, no private health insurer would accept coverage.

In the same newspaper article that told of this woman’s death, it was announced that there would be a review of the new ACC pathways.  I hope the reviewers seriously look at the Massey Guidelines – the original work, not the slanted way in which ACC has adopted them.  As Kyle MacDonald pointed out, the way ACC have used the Guidelines, is to pretty much ignore them in favour of Goodyear-Smith, Lobb and Mansell (2005).

I also hope that this woman’s death isn’t used for political gain…  She, like so many others who didn’t make it, deserve some dignity.

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Now playing: The Pretenders – Hymn To Her
via FoxyTunes

Do you choose these therapists yourself?

This was a question posed by Missing in Sight to my last entry.  Hmmm… Do I choose these therapists?  Do I really?  With each new therapist, I’ve appeared to go through the motions of choosing a new therapist… I’ve called around, asked whether they’re taking new clients and mentioned my dissociative disorder as a flag.  But that’s really been the extent of my search.  Because in all honesty, I become so grateful that someone is willing to work with such a dysfunctional impossible case as myself, that I go with the first person who will take me on.

This ties into Katie’s comment about rejection and also my fear of ending relationships…  Some part of me sees an initial meeting with a therapist as a binding agreement… almost like, if we stop seeing them, we’ve failed again.  I’m not sure if it’s tied to our need to stay invisible (look, we’re so normal we can fit in anywhere), or our need to not make trouble.  I know this is all tied to the dysfunctional messages and patterns of behaviour that I learned growing up.

It seems as if I become so fearful of being rejected by a therapist, that I do almost everything possible to ensure that they won’t want to see me.  A prime example of this, was an email I sent to a potential therapist…

Hi potential therapist no.1,

Possibly before you agree to see me, I should outline the diagnoses I’ve been given over the years, so you can decide if you want to go any further.  I label myself a difficult client… yes, my dysfunction is showing already :) I’ve been diagnosed with Dissociative Identity Disorder, Depression, Borderline traits (I’ve been tested, but fail to meet the criteria for Borderline Personality Disorder), Anxiety Disorder, and have chronic sleep issues.  I’ve seen four therapists in the last five years – two which were poor therapeutic fits for about 8 months each, a clinical psychologist on a short term contract through ACC and another therapist for about 3.5 years (who helped me through my abusive marriage, but didn’t have the skills to help with the dissociative and trauma issues).

So I come with baggage… I am motivated to change and will work hard at doing so, but I often don’t know how to change or what that change should look like.  I’m often stumped for words in therapy, and will sometimes get lost in the dissociation to the point where I lose most of the session.

You may wonder why I’m writing this out for you… and I know it would make most people turn the other way.  But, I’m hoping to give you an idea of the challenges I may present so you can decide whether you are able or willing to work with those.

If you are, please name a time and place and I will ensure that I am there.

Kind regards
CG

How many people would want to work with someone who emailed that to them?  Not many.  It could be seen as me trying to weed out the people who wouldn’t be able to cope with the challenges that I know I present in a therapeutic environment… but I don’t think it’s that.  It’s about setting myself up for failure and preventing the need to build up trust with yet another person.

But, potential therapist no.1 responded that she is experienced in dealing with what I present, and is willing to try and get my claim accepted under ACC.  Two other therapists have also said that they’re willing to meet with me to see if it would work.  Suddenly I have options!  I’m still a little unsure of how to do this process of therapist selection, but I’m trying to be mindful… trying to check out internally what happens when I read their emails or listen to their voice on the phone.

Today we met with potential therapist no. 2.  We talked for about 90 minutes and went over a great deal… It was scary, but also validating.  We talked about the care I’ve received in the past – what worked and what didn’t; what help I was currently receiving from the Mental Health Team and also what her approach to therapy was.  She doesn’t have any specialist DID experience, this showed with some of the wording that she used (a little clumsy).  But when I talked to her about our Polyvore work and this blog, she was interested in how we could incorporate these aspects of my healing into the therapy work she would do with me…  She talked about how I appeared to have been sort of shuffled around, and put in the “too hard” basket by many people…

It was all going really well, until she mentioned where she works as her full time job… She’s a lecturer at the same tertiary institution I work at…  There was a huge internal reaction to this news.  The whole system jolted… we’d just told this person we were DID and she worked at the same place we do.  If we went and saw her, we’d at some point have to talk about the secrets and then potentially run the risk of seeing her at work.  I’m not sure we can do that.  I don’t know if I can tell someone about my history and then smile at them over the counter later in the week as if nothing had happened.  When she found out where we work, she talked about how we could manage that, if we still wanted to see her.  She was really open and up-front about the issue, and reassured me that if we couldn’t cope with it, that deciding not to see her was not our fault…  We agreed that we’d think it over for awhile and see how it sat within the system…

We see potential therapist no.1. on Wednesday, and will call potential therapist no.3 on Monday morning to arrange a time to meet.  Since we’ve started getting people willing to work with us, it’s been interesting noticing the changes in the system… there’s anxiety about having to meet new people, but there’s also hope.  Yes, I think I’m actually feeling some hope for the first time in a long time…

Maybe I’m not such a hopeless case after all?

In New Zealand, in order to receive ACC assistance, you need to have a diagnosed mental illness directly related to the abusive injury. I know from reading other blogs, that health insurers around the world, often require a recognised diagnosis in order to provide (or exclude) coverage. Depending on where you’re from, that diagnosis is determined by either the DSM (Diagnostic and Statistical Manual) or the ICD (International Statistical Classification of Diseases and Related Health Problems). In New Zealand, we use the DSM, and this is currently being substantially revised – some say rewritten, and is due for release in 2013.  If you’re wondering why I’m worried about something that is so far away, well, this manual determines whether I will receive ongoing assistance, what that assistance will look like, I enjoy being an informed consumer, and I’m curious how mental health professionals perceive my various reactions to life.

At the moment, proposed revisions are being made to the DSM-5.  There had been all sorts of rumours circulating that there would be a whole plethora of new diagnoses, and the removal of others – including DID.  Based on my rather uneducated eye, the changes are “interesting” rather than sweeping.  Running through the disorders that I’ve been labelled with over the years, there’s an interesting mix of tightening of the definitions, and what seems a desire to create a “catch-all” diagnosis.  Here’s my take on a couple of them…

300.14 Dissociative Identity Disorder
My first concern is that they are now going to allow the disruption of identity states to be reported by the patient.  Call me cynical and a worry wort, but if you’ve read tales of caution about the “attractiveness” of having DID (for example Tempy’s entry Lemme just say it), then this may open the way for some misguided people who have problems, but not necessarily DID, to “seek” the diagnosis.

Then we get onto the “experience of possession”… I think they need to clarify this wording somewhat.  To me, it sounds like something associated with spiritual or religious possession.  That again, could just be my cynical take on it.  This could be saved by the wording of the last criteria, where the disturbance is not part of “accepted cultural or religious practice”.  But still, the word “possession” conjures a certain image that isn’t positive!

There now seems to be some acknowledgement that abusive events can be repressed – “Inability to recall important personal information, for everyday events or traumatic events, that is inconsistent with ordinary forgetfulness.” I know this won’t eliminate the False Memory Syndrome (FMS doesn’t appear in the DSM as far as I can tell) supporters, but it gives an official nod to the research supported indications that traumatic events can be suppressed, or forgotten as part of a coping mechanism (and the crowd goes wild – insert by Mickie).

According to the rationale behind the changes, this new wording is aimed at reducing the use of DDNOS, the understanding that forgetting everyday events is common (i.e. mild dissociation is common) and an indication that conversion and somatic conditions need to be looked at when making any diagnosis.  Personally, I think the wording could benefit from some further work.  I rather like having DDNOS as a “fall-back” diagnosis when I’m faced with a mental health professional who doesn’t believe in DID.  But overall, I can see some benefits to the changes – the big one for me is the inclusion of the inability to recall traumatic events.

309.81 Post Traumatic Stress Disorder
There seems to be further indication that dissociation is a normal response to trauma – something that the research has shown for years, with the wording “Dissociative reactions (e.g., flashbacks) in which the individual feels or acts as if the traumatic event(s) were recurring (Such reactions may occur on a continuum, with the most extreme expression being a complete loss of awareness of present surroundings.)”

Persistent distorted blame of self or others about the cause or consequences of the traumatic event(s)” – they’ve acknowledged that self-blame is an issue for survivors!

Irritable, angry, or aggressive behavior” – added aggressive behaviour, which is a great inclusion – I’m thinking in particular about my ex-husband with this one.

According to the rationale behind the changes, there appears to have been a great deal of input into this diagnosis, but little actually changed.  The changes that have been made appear positive in broadening the scope of the reactions that those with PTSD can have, as well as defining the time frame associated with the onset and continuation of symptoms.  I admit not to having as much of a vested interest in this diagnosis, as I think pretty much any survivor will fit this diagnosis.  It’s more about how far reaching it goes.  I appreciate that they’ve indicated the dissociative experiences that can occur – but it begs the question as to why DID is not on the PTSD spectrum?

301.83 Borderline Personality Disorder
I’ve heard of BPD being a diagnosis given when they don’t know what else to label you…  Overall, I think that those with the diagnosis have an incredibly bad reputation which is undeserved.  I’ve been labelled as having “Borderline traits”, but when reviewing the PTSD criteria, the behaviours that they describe as “borderline” could be PTSD.  In many ways, the revisions still allow BPD to be a “catch all” diagnosis for when they’re not sure what else to do with you.  It has aspects of PTSD, dissociation, psychosis, low self-esteem, impulsivity, etc.  When you look at the different aspects on the surface, it is easy to see how many survivors could meet the criteria; it’s only when you do the diagnostic tests that you realise that the severity needed to meet the diagnostic criteria.

To me, this diagnosis seems to have been fleshed out substantially.  This worries me when you consider the poor reputation and often poor treatment that those with BPD receive…  When I was initially given a diagnosis of DID, I was told there were no treatment plans for that diagnosis in New Zealand, so they sent me through the system with a diagnosis of BPD… I was shocked, dismayed and victimised by some of the mental health professionals who treated me as “another borderline”.  It’s taken many years for the public health system to remove BPD from my records.  I can see with this revision, that many more people may receive the diagnosis and associated poor treatment.  Mental health professionals really need to change their attitude to those with BPD.

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Overall, the revisions seem intent on minimising the use of the “NOS” diagnosis.  But in some areas it won’t be possible – from my understanding of the criteria, I will still meet the EDNOS diagnosis.  I’d encourage you to check out the proposed changes… it’s an interesting process they are undertaking.  There has been criticism that the work is being rushed, so that means we have more of an obligation to check it out – especially mental health professionals!

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Now playing: Sarah McLachlan – Angel
via FoxyTunes

A good friend recently mentioned that she felt like she was going to fall, and fall deeply.  Part of her was expecting, and almost wanting the fall to happen.  Thankfully, her fall hasn’t happened, and I hope it doesn’t; but what she describes is a feeling I know all to well.  It’s like standing on an edge, waiting for that last push to send you over into a mental health free-fall.  The scary bit about standing there, is that you have an awareness about where you are.  You know that one more negative thing is going to push you over, and part of you wishes that it would come so that it’s over with; but another part of you hopes that you can still claw your way back to safer ground.  It becomes a tug of war between different parts of you…  This alone is so tiring that it can be enough to tip you over…

I know I’m also moving closer to the edge.  The stressors in my life have kicked into high gear and I can feel the pressure building.  At the moment, I’m far enough away to know that I’m in danger without being too close to it.  A part of me niggles that I’m thinking myself into moving towards the edge – why do I think of my ex-husband, why worry about the ACC assessments etc.  But the rational part of my brain knows that I’m experiencing PTSD flashbacks and my worry is justified based on past assessments.  This is the beginning of the tug of war that intensifies over time.  Soon other issues will come in to muddy the waters – denial, and a need for validation have already started to appear.  All of this increases my anxiety levels.  I’ve experienced this often enough in the last few years to notice the pattern…  It becomes like a dance, to and fro… ever closer to the edge…

The problem becomes, how do you stop the dance?  If I called a crisis line, they would take me through the individual stressors I am facing and encourage me to break them down into solvable chunks.  This would work for some of the issues I’m facing, but they can’t help with the PTSD symptoms.  I saw Jo today, and she was recommending trying to ground in the present, and while I agree with her reasoning, I also know that I can be very grounded in 2010 and still keep on dancing towards the edge.  Some of the grounding work can make the situation worse – repeating “it’s the 26th of January, 2010 and they are just memories” can morph into a denial statement about the memories all being made up.  The most effective way of keeping the anxiety at bay is to consciously breathe deeply – this also tends to by one of the first things I forget to do.  Like many survivors who experience anxiety, I have a form of hyperventilation syndrome, with my breathing being short and shallow.  It takes a conscious effort to alter my breathing pattern to a healthier depth and pace.  Changing my breathing will temporarily ease the anxiety, but often this isn’t enough to stop the dance towards the edge.  I’m not always sure what moves me away from the edge, I think this time it will be the formal dissolution of my marriage and completing the ACC assessment.  If this is the case, I’ve got about another three weeks of doing the dance around the edge.  I don’t think I’ll fall, but a part of me thinks I will…  A part of me wants to fall, because they think that this is what I deserve…

And so the dance continues…

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Now playing: The Feelers – Stand Up
via FoxyTunes

We have to do another ACC assessment to continue getting assistance…  As a result we’ve been playing “angry” music.  This song in particular, fits nicely…