Scattered pieces

When Paul announced that the topic for both the Carnival Against Child Abuse, and Expressive Arts Carnival would be “your truth”, I was excited. I struggle with what my truth is, almost on a daily basis; so saw this as a great way to explore my reactions and issues around the concept.  Then the reality of writing about the topic hit me… literally.  I published a post about my truth last week, which received some negative feedback, and all my insecurities came out and had a party.  It became a fight about whether I would look more foolish keeping it up, or taking it down.  I decided to take it down.

I consider truth to be an amorphous concept.  What I wrote last week, was my truth at that time.  What I write today, will be different because I’ve learned from last week’s experience, and gained more understanding about the situation.  If I write another post on this topic in a week, month or year, it will be different again.  Truth isn’t set in stone.  Truth is derived from the understanding of our experiences… but that understanding comes from our perspective, bias, values, etc.

Truth also has political, economic and cultural importance.  This is where I start to get confused – not because I think I’m of any great importance, but rather because so many people seem to have a vested interest in my truth…

• The False Memory Syndrome Foundation and DID deniers are vocal in their opinion and research that they say proves you cannot repress traumatic memory in the way that many DID cases are presenting.
• Extreme supporters of DID tell you to seek out each memory and believe it as the truth.
• My family don’t know what to believe, but they are tired of having a daughter who is unwell.
• Work doesn’t care as long as they get more than my contracted hours of work, and I don’t inconvenience them with my phobias.
• ACC accepts that I have issues related to sexual abuse, but would prefer this to have been “resolved” long ago so that they didn’t need to keep funding my therapy.

I find it impossible to ignore all of these conflicting messages and theories.  In some ways, I think it’s dangerous to do so.  Each group has something to teach us… FMS helped to place a check of poor therapeutic practice; our family show us how confusing our experience can appear to the outside world; and so on.  But, I don’t think that it’s up to us as individuals, to get caught up in the debates and arguments.  I think that we owe it to ourselves to be an informed consumer; to gain power over our own healing, and to play an active part in that healing process.  But we shouldn’t hurt ourselves in the process.

I’ve read much of the FMS material.  I’ve debated with the DID deniers.  I’ve questioned the beliefs of the extreme supporters.  Each of those interactions has come at a personal cost.  I begin to doubt my truth.  I become conflicted and destabilised.  Opponents to DID, would argue that this destabilisation was due to the house of cards that I have built my life on, being threatened.  The thing is, the intellectual part of me likes this reasoning.  At times I embrace denial for all it’s worth.  Events which I know occurred are minimised, or I detach emotionally from them.

But, this doesn’t explain how I continue to react to things.  Even in the midst of my denial, I still avoid the smell of tyres on a hot summer day, I must have my back to the wall… the list goes on.  I can appear bright, happy and be super-functional; yet internally I’ve compartmentalised the turmoil, and can dangerously self injure within the hour.  This is where my intellectual/autobiographical truth, and the truth of my sensory memory collide.  For me, healing comes, not from trying to uncover every single memory, but rather in coping with what I am facing in the present – it’s about symptom management, not chasing memories.

It’s my intellectual part that needs to know what happened to me; but this has never been where my healing has occurred.  My greatest leaps in healing have always come from working through a trigger in the present.  It’s shown the wounded parts of me that it is possible to be safe.  Ironically, this safety has often led to more sharing of emotions, and yes, sometimes memories.  But these were shared from a place of strength, not chaos.  They didn’t have the power to sweep me along on an emotional tidal wave.  That’s not to say that I don’t get swept away, I do.  But I’m learning how to cope in the present in a more proactive way… a more emotional way.  It’s uncomfortable, it’s scary, but the benefits are showing.

So what is my truth?  I was hurt in the past by people who should have protected me.  That betrayal of trust now influences my life in significant ways.  I get confused, distracted and hurt by the controversy that is associated with the diagnostic label that a psychiatrist assigned me.  I am trying my best to heal from the wounds of the past, understand the controversy, and (more importantly) live a life.  Isn’t that what most of us are trying to do?

What is the truth… or are they both the truth seen from different perspectives?

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Now playing: Collective Soul – December
via FoxyTunes

Today, I saw the crisis team psychiatrist… it didn’t go well.

He showed me to the interview room, with this pleasant, eager young woman following in his wake.  I was a little puzzled about her presence, but had a sneaking suspicion that she was a training psychiatrist come to sit in on the interview.  Having had this before, I knew that they always asked if it was acceptable for the trainee to sit in, at which point I was ready to politely decline her being there.

We entered the room, and he sat down briefly, flipped through my file, noticing that there weren’t any blank pages, so left to get some.  Saying over his shoulder to the eager young woman (who had scooted her chair up to the desk), to introduce herself.  She was incredibly polite, saying that she was a trainee nurse.  When the psychiatrist returned, I asked if she was studying at the same institution where I worked – she nodded eagerly.  I asked that she not be present as I worked there and didn’t want to discuss the issues I was facing in front of a student from the same institution.  His immediate reaction… “But, she’s here for my safety”.

Apparently I look like someone who would either physically attack this old man, or scream sexual harassment.

What was interesting, was that at no point did he consider my safety.

His compromise, was to sit the student in the corridor just outside of the office with the door wide open.  It was a busy corridor.  At one point a woman stood at the doorway for over a minute trying to close an adjoining door – while loudly talking about her inability to do so.

Then there was the interview…

“So you didn’t show up for an appointment last week with Dr X”
“No, I’ve shown up for every appointment that has been made for me”
“Accusation number 2″
“No, I took care of myself”
“Accusation number 3″
“No, that didn’t happen”

So it went on… “What’s your mood level?” “How are you sleeping?” “What drugs are you taking?” “How much and how many have you got left?” “What do you want?” “Why are you here?”

Then it got worse. “I’ll prescribe X drug”. I asked what that was… he went into a long description about how benzos are addictive and their effect diminishes over time. He didn’t actually tell me what the new drug was, just how bad my current medication is. When I asked what the new drug would do, he said it would calm me down. I asked about another drug that I’d been recommended, and he scoffed. Saying that’s an anti-psychotic and that I’m depressed; and they only give that drug as injections up at the hospital anyway.

As I’d checked about the use of the drug before going into the appointment, I knew that it was also used for PTSD symptoms – my main problem at the moment; so I knew he was wrong about it’s use.  But I didn’t correct him… he was not a person to be corrected.

We’d started the interview pretty low, but this crushed us.  We crumpled.  I asked if it was ok to leave, he said yes; so we got up, thanked him for his time and left.  As we were doing so, he flipped my file shut with a sigh and leaned back on his chair.

I know I didn’t handle the situation well… I know I should’ve taken the drugs he was offering… but I couldn’t cope.

When I got back to work, I put my things down and told my cynical friend that I thought I was going to cry… we went into a spare meeting room and it all came out.  How I dissociate, how unsafe I am, everything…  She contacted the work place therapist who sat with me for an hour talking about things.  When I described the appointment to him, his comment was… “Yes, the psychiatrist had done his job.  He’d mentioned all the right things in all the right ways; but he didn’t care what happened beyond his vision of what you were and needed”.

It was this therapist who gave me the two creative expressions that I put up here today.  I decided to remove one, as although parts of it were powerful, the potential for triggering someone outweighed those benefits.

I’m still at a loss as to what I can do.  The birthday has now past, and that seems to have eased things internally.  I’m back at work, and that has forced a level of functioning.  I also have my cat back home… that always makes life good.

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Now playing: Sarah McLachlan – I Will Remember You [Live]
via FoxyTunes

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

These are two lines from the song I will not let you down by Don McGlashan.  This song has been going through my head all day, just little snippets…

You must try to believe
That I will be coming through
…
I have carried my cross at each step
Upon my neck for you
…
There’s a tear in my eye
And an ocean of swallowed pride
…
Ties that comfort
Ties that bind
…
And I will not let you down
I will not let you down
That’s for sure
…
I will not let you down
I will not let you down
Any more

Today, these snippets mean a great deal to me.  I’ve just finished one of the worst weekends I’ve had regarding self-injury since before the ex-husband left.  I’ve done many things which I’m not proud of, or can even fathom.  I’m still shaking and trying to work through what happened.  But the lines “Ties that comfort, Ties that bind” got me thinking… wondering about how much I hold onto this self-injury, destructiveness and my mental health diagnoses.

The weekend of self-destruction started on Friday when I was triggered by a couple of incidences which lead to me to repeat the old patterns of needing to please people – in particular the ex-husband.  It didn’t matter that he is no longer present in my life, it was all about finding ways to repeat old behaviours and coping mechanisms.  But why did I do this?  The threat of him appearing in my life was minimal to non-existent.  I no longer want him in my life, yet he fills my flashbacks.  These flashbacks and the stress caused by the memories of him, have lead to me not being able to function at work, meant I’ve had to take an increasing amounts of medication and resulted in me losing huge chunks of time.  But I wonder how much of this I have brought on myself?  There is a certain comfort in being able to explain away my behaviour to his influence and abuse…  What if I’m using all of this as a convenient excuse to get away with inappropriate behaviours?

I read a comment recently from a fellow survivor, they said that they can’t stand those who aren’t actively working on their issues… Those that use the past as an excuse, rather than a cause for healing.  This sort of argument has always worried me – whose to say that I am doing enough in this healing journey?  What if I am wallowing in self-pity and excuses?  Whose yardstick am I being measured against?  What does the yardstick even look like?  It’s the sort of argument that I’ve heard several times, but it does my head in.  I’ve been judged all my life, now I’m healing and I’m still being judged?  When does the judging end?

Another comment that hit close to the bone, was a good friend saying to me that I wasn’t sounding like the survivor he knew.  He’s right (you usually are Paul), I wasn’t a survivor over the weekend… I was a battered victim… like an addict looking for their next fix of self-harm.  All adult knowledge of consequences went out the window.  At times I could hold it together, but these were short lived.  The nights were especially difficult… looking for the ex-husband in each shadow… looking for ways to hurt myself and undermine all the work that I had been doing.  It wasn’t a deliberate attempt by any one within the system to cause harm, it was me coping in the only way I knew…  But what if the only way I knew was perpetuating that tie that binds me to this place of being a victim?  I know the role of being a victim… there’s a comfort in fulfilling a role I know well… so how tied am I to it?  How much of my energy is spent in ensuring I stay there?  I’d like to say that it’s not a great deal, but I just don’t know.

I know that I’m bound to the past in many ways… flashbacks and other PTSD symptoms indicate that.  My healing is aimed at breaking these binds.  This weekend, I failed.  I failed myself, the dissociative system and the people around me who count on me to be a survivor.  My trust in those around me and myself has been seriously shaken.  I’ve come out of this weekend distrustful and scared of people again.  I hate that this has happened.  I hate that I’ve put a great dent in my healing.  I’ve come out questioning everything about my motivations and what I am doing…  Is this healing really working?  Why am I doing this?

I know these are all questions that I need to ask Liz… but I fear she will give me an answer that is meant to soothe, rather than be truthful.  I fear that I have become comfortable in the role of a victim and that those ties are keeping me in this place.  I worry that being a victim has become my identity and way of life… I know that my life is so restricted by the different triggers that I sometimes can’t see past it.  I know that some of the things Liz suggests to change in my life, I can’t do… or I explain that I’ve already tried them and failed.  I’m not very good at giving things a second go, if I fail once, then I’ve often failed forever… especially when it comes to my healing work.  I cut myself very little slack in that area… is that another sign that I’m tied to being a victim?  I just don’t know anymore…

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Now playing: Cat Stevens – Where Do The Children Play?
via FoxyTunes

I’m writing this from a respite care house :) Respite care is a very odd experience. I’m in a normal house on a normal street with a “normal family”. I’ve just had the most surreal evening meal with this family… They blessed the food (mild trigger, but nothing too bad), ate, talked and joked. There were no undercurrents, no tension, no unspoken hostility… It was very, very odd. I haven’t experienced that in my adult life ever. I’ve never witnessed a family who loved and joked without malice. I still don’t know what to make of it all.

My room is simple and comforting. I’m the only “client” here, and they have a capacity of three clients at any one time. There are no locks on any of the internal doors – including the bathroom, which is a little triggering, but it still feels safe! I’ve felt welcomed into the home without reservation. They don’t care about my diagnosis or what has led me here. There is just warm comforting acceptance. They’re not the Crisis Team trying to therapise me, they’re just a normal family who accept strangers into their house with basic guidelines in place.

There was a visitor for dinner who has mental health issues and is going through the DBT program, she convinced me that the program, as delivered here, wouldn’t suit me. It was interesting to talk to her though. It sounds like her world fell apart and she is now struggling on an invalids benefit. I can see how that could so easily have been me. But instead my current level of dissociation keeps me on a different level of functioning.

So I am safe! I’m writing this from my iPhone as my computer access is non-existent (as is access to a spell checker *sigh*). I’m trying not to worry about the silly things, like my crops in FarmVille and Farm Town dying while I’m here. But the little things will get to me every now and again. I’ve been told that I can stay as long as I need to get myself back to ground; as I’m somewhere out Pluto way at the moment, that could take awhile.

On a random note… Our door has a painting of Tigger on it, which pleases Aimee immensely :)

Last week I knew that I was going to talk to Liz about denial.  In many ways I see my denial as attention seeking – like I’m wanting Liz (or whomever) to say “of course it happened” or “you’re right, it didn’t happen and you’re just attention seeking”.  It feels manipulative to be in denial, like I’m playing games.  But then, when I’m in the denial, it seems as if I’m playing games when I say that the abuse happened.  It’s an awful place to be in.  You have the clarity to see your actions in the past and you judge those actions, every word or behaviour is analysed and destroyed.  As a perfectionist, I’m my own worst critic, so nothing is spared.

Liz questioned me as to why this was happening now, when 2 weeks ago I said that I needed to turn and face the past, instead of continuing to run from it.  I’m not sure of the answer to that question.  I think it is partly due to the stress that I’m faced with – wedding anniversary, disastrous visit from my mother, yearly performance review at work, etc.  Objectively I understand that I may be stressed and this is what has caused the denial/lock-down, but I don’t get any sense of being stressed.  When I’m like this I don’t feel much of anything, sort of like I’m on auto-pilot.

In order to sort through some of the issues, Liz said that I needed to try and re-frame the anniversary into a new context as a way of trying to move forward.  We were nearly out of session time, so this was very much a passing comment.  I know what she means, but this year it was impossible to do.  I’m not aware of any real reaction, other than losing great chunks of time.

I almost broke through the denial yesterday by listening to Beethoven’s Grosse Fugue, but it didn’t last.  As it’s a long weekend in New Zealand, I’m not seeing Liz this week.  Possibly the wrong time to have an interruption in sessions, but it couldn’t be avoided.

I’m dreading looking at the dissociative walls again – whether it be to knock them down, or to reinforce that they never existed to begin with.  I know that this is not a positive place to be in, but I’m not sure how to move beyond it.  I also know that living like this is full of contradictions…  How can I be losing chunks of time and not be dissociative?  How can I have no personal history beyond newspaper headlines and not be dissociative?  It’s confusing and yet meaningless all at once, for when I’m like this, I only live in the present moment with headlines as reminders of what I need to do.

It feels very odd and very normal all at once.

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Now playing: Sting – Fields of Gold
via FoxyTunes

I’ve struggled long and hard to understand what is meant by the term “healing” within a mental health context.  I’m familiar with healing that can be quantified (e.g. a broken bone mending), but how do you quantify healing from childhood abuse?  Is it possible or desirable to do so? What time-frame should we look at as reasonable when we’re considering the healing process?

I’m very aware that this is the intellectual side of me asking these questions.  The questions are born from frustration at what is seeming like a very long journey that hasn’t got us very far.  I know that many survivors experience a decrease in functioning with the start of therapy, but how long can I expect this to continue?  I do what I can to hasten the healing process – I do the homework I’m set, I try to be as open as I can within therapy, etc.  But is this enough?  I’ve been told by therapists that I’m “working hard” within therapy, but I often feels as if it’s another part of my life that I’m drifting through.  There will be a moment of clarity surrounding why I do a certain behaviour, but it’s then lost in the confusion and dissociative memory gaps.

I’ve yet to fully understand what the term “working hard” refers to within therapy.  Yet, I often come out of a session absolutely exhausted or on an adrenaline high, both signs that I have experienced something extreme for what I sometimes dismiss as “sitting in a chair for 60 minutes talking”.  I have a great deal of respect for those who are working on their healing as a full-time endeavour, it’s not something that I have the strength for.  But I have no respect or patience for my own healing.  I’m still caught in dismissing and minimising the memories.  Liz has offered to assist with this process by using her as a sounding board to test out the feelings and potential accuracy of the memories.  There is a certain attraction in doing this, we could finally prove what is real and which memories have potentially been influenced.  But there is also a fear that Liz will say nothing about the validity of the memories, but rather ask us to look at them and analyse our feelings and emotions about the events.  This is my greatest fear, having no way to prove or dis-prove the memories and still having to do the work of recovering from the toxic mess they generate.

Part of my anxiety is generated from the proposed changes to the ACC scheme (check out the ACC category at Gudrun Frerich’s site for some of the issues surrounding the changes).  As an ACC client, the changes will mean more reporting, increasing need to measure the healing progress and the threat of my cover being stopped at any time.  There is no way that I would be able to afford therapy without ACC assistance, so this is  a huge issue.  This is not because we are attached to, or reliant on Liz; but rather I have a fear that if we can’t release the thoughts within a therapeutic framework, we will self-destruct.  Yes, I realise that I’m contradicting myself – how can therapy be “sitting in a chair talking for 60 minutes” as well as one of the things that keep us sane…

In totally other news, B entered us into a photo competition which we have absolutely no chance of winning or even placing in.  This goes against every single strand of perfectionism that runs through our body.  I do realise however, that it’s going to be an great deal of fun for them deciding how to photograph 100′s and 1000′s creatively.

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Now playing: The Feelers – Stand Up
via FoxyTunes

It was an interesting session with Liz today.  I had gone there with a plan of what to talk about – boundaries (especially around religion), our diagnosis, what that diagnosis means and her cell phone.  This agenda probably indicates that a fair amount of M went into the planning – it was a little optimistic that we would be able to get through all of that without dissociating badly and losing the entire session.

We went in prepared… or so we thought.  In our usual fashion we walked into the office, sat down and became unable to look anywhere apart from the floor, her beanbags, stuffed toys and tissues.  Sophie fronted while a major discussion happening internally about how to broach the subjects.  Liz has this habit of waiting for us to talk first; we have this habit of sitting there, unable to talk.  Today she asked how we should start each session – waiting for us to talk, or for her to start asking questions.  We said unless she wants to spend an hour in silence, she’s best to ask a few questions first :)

Sophie started off saying that religion shouldn’t be mentioned unless W raises it first.  W will raise it, but Liz needs to wait for that to occur.  W is consistently curious about why other people believe in whichever religion they follow and has asked all our previous therapists about their beliefs.  Liz just has to be ready for the grilling that she will face when W does ask.  W has heard many of the reasons behind why a God would “allow” abuse to occur, so Liz needs to have some solid arguments to present or else W will dismiss or destroy her logic.

Then things went a little haywire as Liz again brought in issues which really shouldn’t be raised mid session regarding ACC funding further sessions.  As neither of us had been notified of any decision, she called them during the session – she asked if that would be OK with us and we’re incapable of saying “No”.  This then led onto a discussion where ACC are going through new guidelines where clients who haven’t met their goals will be referred to a psychologist.  Liz wasn’t sure if this meant existing clients as well, but it was something to be aware of.  This triggered all our self-hatred for not being “cured” yet, and being a problem client for not being “cured”.  Does it mean we’ll have to go see someone like Bob again?  What will ACC do with us?  We rarely meet our goals as we don’t fit into a definable goal framework – we show gradual change over time rather than a “cured food issues” sort of thing.

All of this triggering brought forward someone I’ve never met before.  They were male and from either Ellie’s floor or The Basement.  They communicated with Liz and asked what had happened to trigger them coming forward.  They were actually pretty polite, but the whole time they talked he continually ran the sharp keys across palm of the left hand.  He didn’t break the skin and kept talking in a non-threatening way, but kept on hurting the body.  Liz tried to distract him with the soft toys that he could squeeze instead, but that idea was rejected.

When Sophie returned, she could tell something had happened with the hand, as it felt hot.  We don’t feel pain very much, but could feel the heat radiating from the hand.  Liz explained what had happened and Sophie tried to explain that it wasn’t attention seeking.  It may look like it as we were sitting in front of someone hurting the body, but it wasn’t for attention.  It was purely to punish.  At this point Liz stunned us, and agreed.  She knew it wasn’t for attention.  I don’t know how she came to this conclusion, as we’ve always been told that any sort of self-injury was for negative, attention seeking purposes.  Also the undeniable fact that, we were sort of doing self-injury in front of her – surely that means we were attention seeking.  But according to Liz we weren’t.  I think the reason she saw it this way was because she was totally irrelevant in the self-injury.  It wasn’t being done to manipulate her or modify her behaviour in any way, it was just what that one needed or wanted to do.  It wasn’t really a big deal in the scheme of things.  But for us, it was another indication that we are crazy and losing our ability to act “normal”.

This then led into the final big issue regarding our diagnosis and what that means.  This has always been a sore issue for us – DID is not widely recognised in New Zealand and is seen in a negative light.  Liz’ experience with other dissociative clients means that she can compare our behaviour to theirs.  This comparison will mean that she can state with some certainty that we do, or don’t have DID.  We’re stuck between the options which could describe our behaviour and thinking:

• Believe that the childhood was perfect and we’re now attention seeking.
• Believe that the childhood wasn’t perfect and we have an undiagnosed personality disorder.
• Believe that the childhood was traumatic and we have a trauma or dissociative disorder of some sort.

The problem is that the parallel truths about the childhood are so vivid.  On one side there is the perfect childhood where we feel loved and safe; on the other side is abuse, pain and fear.  A previous therapist has stated that these two truths don’t necessarily have to be mutually exclusive, but it’s hard to see where they would meet or co-exist.  Liz responded that each of us play roles within this life – how we present at work is different from how we present at home, in parties, out shopping etc.  I accept this is true, so it seems to be that Liz is saying that we’re not dissociative, but rather are doing a bit of hysterical attention seeking through exaggerating what is nothing major.  The session ended before we could fully talk through the implications of what she was saying.

Sorry for the rambling waffle, I’m trying to make sense of what happened in the session and failing.  I’m not sure if this is a continuation of my ability to appear higher functioning than I feel, or whether Liz is seeing me accurately and I need to just get over myself.

I’ve seen 4 therapists in the last 5 years.  That seems a high number.  M was told by Liz that we have very high expectations of therapists, maybe they are too high?  Here’s a brief run-down of what happened with each -

Debra seen for 6-8 months.
Worked part-time from home.  Her methods were based on Mindfulness and Cognitive Behavioural Therapy.  She was intelligent and studying towards her masters.  Reason why we stopped seeing her was because of boundary issues and she was stopping therapy work to concentrate on her masters.

Carol seen for 2.5 years.
Worked part-time from offices.  Her methods were based on Cognitive Behavioural Therapy with some influence from other methodologies including Dialectical Behavioural Therapy. Reason why we stopped seeing her was because of boundary issues and her fascination with our dissociation. She loved playing with Aimee. She wasn’t helping us move forward in any meaningful way and we’d started to become convinced that she had planted the whole idea of DID in our head.

Bob seen for 6-8 months.
Worked full-time from her extremely busy offices. She came highly recommended and we saw her to try and find out if we were making this dissociation thing up. She had extensive experience with abused teens and children. Things went a bit haywire with Bob when she was trying to force an integration of personality states to counter what she described as a “fragile personality structure”. We stopped seeing her when the short term contract was up with ACC.

Liz seen for about 6 months.
Works part-time from offices. She was the only therapist willing to take on a client that came with warnings about dissociative issues. She has other dissociative clients and came recommended from another therapist. We don’t know if we can go back to see her.

Earlier this week we posted a rant that was fairly quickly deleted.  It covered the issues we’d had when seeing Liz on Monday and problems we’d seen throughout the time we’d been seeing her.  Some of these include:

• Turning her cell phone volume down during sessions.  It has rung during session, so you get the noise of a vibrating cell phone dancing across the desk as you’re trying to talk about something important.  She has also looked at the cell phone to see who is calling while in session.
• She has a habit of clearing her throat when being asked something difficult or is faced with challenging ones within the system.  Mickie is generally silent during sessions when fronting, which prompted much throat clearing and a conversation about us living alone meaning that we don’t know how to socialise and make conversation.
• On Monday there was a discussion about our night-time photography trips and the reason why we’re doing them – to get hurt.  Liz suggested that the reason why we hadn’t been hurt was because of someone or something looking out for us.  She was meaning a higher power of some sort.  Any talk of religion is a huge trigger for us.  It felt more like the focus of the discussion had moved from helping us, to preaching to us.
• She is unable to remember our basic biographical information – we’re the youngest of four, get on alright with the oldest brother and have minimal contact with the entire family.  This is the sort of information that she has asked several times, including constructing a sociogram with us.  If the information was important enough to ask several times, it’s important enough for her to remember or to write on the front page of our file for easy reference.

Monday’s session was particularly bad.  The religion trigger set off a negative reaction with W.  M came forward to protect W when she realised what was going on, but it was too late.  This meant that M came forward annoyed that Liz was talking religion without checking out who was present and their beliefs about the subject.

It was after Liz again asked M about our basic biographical information that things got particularly tense.  M asked why Liz had to keep asking about this information, Liz responded that she might get a different answer one day.  M pointed out that we would always be the youngest of four children and unless something major happened, we’d still feel the same about the family as we do now.  Liz said our expectation that she would manage this information was too high, M asked what a reasonable expectation would be…

To be fair, M was defensive as Liz had challenged one of the young ones she protects.  But Liz was helpless to find us all a way through that defensive mechanism.  We left without making a further appointment.  If this has been a one off bad session we would have had a cool-off period and made another appointment.  But it isn’t, it’s the latest in a series of unusual sessions.

Now we’re stuck.  We don’t trust Liz and don’t know if we can go back to see her.  But if we don’t, are we doing so because our expectations are too high?  Are we being unreasonable with our expectations that a therapist will manage basic information, silence their cell phone and not talk about sensitive issues without checking who is present?  Maybe our reaction is off the scale because of our dysfunctional thinking and reactions?

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In the town where we grew up, there was a psychiatric hospital.  It was spoken about in hushed whispers as a scary place where crazy people were fenced in and tortured.  In reality, the hospital catered predominantly for those who were institutionalised during a time in our history when those with even minor problems were often hidden away.  We were told as part of our abuse, that if we told the secrets we would be sent to prison or this hospital forever.  So our early contact with psychiatric hospitals was negative.

If you place these experiences within the context of our rather traumatic experiences with the medical profession, you get a picture of someone who has deep seeded issues and fears about all things medical.  The young ones especially react with terror even when driving by a hospital.  We avoid dentists, doctors and nurses where at all possible.  In many ways this fear enabled us to appear high functioning for many years – if there was a threat of having to ask for help through therapy or medication, well that just wasn’t acceptable.  Time to stamp it all back down into The Basement and carry on being invisible.

Then arrives the dissociative train wreck we experienced when about 34.  Our coping mechanisms fell apart.  Then there was the final straw – we were teaching a group of 40 students when something about the interactive whiteboard markers caused Angel to come forward.  So there you have a 5 year old drawing pictures of flowers on the whiteboard while a group of adult students look on.  M comes back to find half the board covered…

So back to therapy we went.  We were in the throes of an abusive marriage and suddenly facing a childhood that wasn’t as perfect as we’d convinced ourselves it was.  These factors led to constant suicidal ideation and intent, which in turn resulted in us needing to find some support to keep safe.

In New Zealand there are a few support lines for suicide help – Lifeline, Samaritans, Youthline, the emergency number or the local mental health hotline.  Lifeline, Samaritans and Youthline are confidential – unless they feel you are in danger, in which case they will try to get your details and send around the Police.  Emergency services transfer you through to the mental health hotline, unless you are already need emergency care.  Once you’re in the mental health system, you are told to call the mental health hotline.  Usually you wait for 5-10 minutes on hold before the phone is answered – ever been suicidal during the Christmas season and had to listen to Christmas carols for 20 minutes while waiting to see if someone can help you stop killing yourself?  You can at least double the waiting time if you call after midnight, as that’s when they go down to one or two operators.

If you do manage to get through to a human, you’re asked for your details – name, phone, address, caseworker and then why you’ve called.  If they consider you to be at risk, they will send around the local mental health workers to assess you.  If they consider that you aren’t at risk, they will discuss grounding skills you can use before sending you on your way.  The problem with this is that at any one time we can have up to 5 suicide plans – apparently that means we don’t really mean to die as we’re not focused on one plan (we consider it covering our bases in case one doesn’t work).  We can also begin the phone call with one who wants to reach out for help; but by the time we get to actually talk to someone, we’ve switched to one who either won’t talk or says that everything is fine.  So in many ways the service doesn’t suit us (and a majority of the population).

If you are considered at risk, you get the joyful experience of being escorted up to the psychiatric ward of the local hospital.  Where you begin the wait for some poor registrar who has been working for at least 10 hours and is surviving on a combination of adrenaline, coffee and sugar.  This person then has to assess your level of danger.  Most registrars haven’t dealt with anyone with a dissociative disorder, let alone tried to understand if there really is a risk.  They have a thankless job of walking a tightrope – is the patient telling the truth?  To make this job more complicated, during our experiences with registrars they’ve encountered -

• Aimee (9 yrs old and carefree) who smilingly told the nice young registrar that she was too young to drink.  Quite forgetting that the body she shares is in it’s mid 30′s and sitting cross-legged on a hospital bed while drips are hanging from each arm to pump us full of drugs to counter the drugs we’d OD’d on.
• Sophie (16 yrs old) who is our safest bet for these assessments – no one would section Sophie.  The main problem is getting close enough to hear her as she talks very quietly when scared or worried.
• M who is the other safe bet.  She’s confident and knows how to work the mental health system to ensure that we are released.  Release is always her goal as the young ones she protects are violently triggered by hospitals.
• Ellie who won’t be sectioned as long as she can keep her swearing and scorn for the medical profession under control.
• Frank who is the worst one to front for an assessment.  He doesn’t get suicidal, but doesn’t understand what constitutes aggressive behaviour as seen in the eyes of a psychiatrist.  He doesn’t actually get aggressive, but his anger at being in a hospital is seen as aggression.

It’s at this point where we’ve usually been sent home.  But on two occasions we’ve been admitted or sectioned under the Mental Health Act.

Event 1:  Sectioning with two nights in hospital.

1. Night of admission, put into art therapy room with triggering artwork around the walls.
2. Given a single room across from an alcoholic man in his 40′s (the father is an alcoholic).
3. As punishment for being admitted W used all of her strength to try and break the arms by bashing them against the storage unit in the room.
4. A miracle was there in the form of a part-time night nurse.  She realised we wouldn’t sleep so asked if we wanted art supplies and then she sat and talked to us.  She didn’t care who she talked to, she just sat on the floor and let us talk and draw.  She got us Arnica cream for the bruised, swollen mess that was now our arms without a fuss.
5. Then there was the daytime registrar.  We had asked to be released as the hospital was too triggering.  He went through the whole assessment again.  He asked why our symptoms made us special.  We tried to explain that we weren’t special, just sometimes experienced dissociation.  He dismissed the dissociation saying it wasn’t important.  Then when returning after talking to the consultant, said that the dissociation made us too unpredictable to release.  Yes, the one symptom that he totally dismissed, became the thing he used to keep us in.
6. That night the same part-time nurse told us how to get out – say the words “I have no intent”.
7. The following day a different registrar got the consultant to come in and talk to us.  He was going to let us out for the day, but M came forward and dazzled him with a veil of sanity.  We were outta there.

Event 2:  Admitted to the secure unit with one night stay.

1. Saturday afternoon attempted suicide through an overdose and was taken to ER by the husband.
2. Put on a drip and was overwhelmed by the dissociation.
3. Overheard the nurses say that we hadn’t really overdosed, but were just attention seeking – our bed was right beside the nurses station and strangely enough the curtains aren’t sound proof.
4. As soon as we were coherant, we asked to leave.
5. After a 5 hour wait, we were assessed by the same psychiatrist who once picked up the phone while we were in the room and told the DBT specialist that “the borderline actually turned up, do you want to come meet her?”
6. Because of all the triggers, Ellie and Frank weren’t able to control the anger very well.  We were escorted to the secure unit by the Police.  We didn’t threaten anyone or even raise our voice, but we were considered to be irrational and dangerous because of the barely contained rage.
7. We were released the next morning.

If we are ever sectioned again, we’ll request to go to the secure unit.  It was comparatively peaceful and safe.  If any of the half a dozen patients even raise their voice, they are immediately surrounded by about four staff and taken away to be calmed down.  The only downside was that the cups of tea were lukewarm – hot water being a dangerous weapon.

This is a very light hearted look at our experiences.  In reality, during the sectioning Sophie was nearly destroyed when her twin came from The Basement to tell her why they were created.  The day after we were released from the secure unit, the ex-husband tried to kill us.  Other incidents have occurred while we’ve been waiting to be assessed, including one I’d like to forget where a patient masturbated while looking through the window at us.

We sit in wonder when people say that they voluntarily go to hospital.  It’s a concept that we don’t understand – why would you volunteer for torture, ridicule and scorn?  We know our perception is warped and that hospitals help people every day.  But it’s not something we identify with.  It was once recommended that we go to Ashburn Hospital for a minimum of six months to try and break our cycle of destructive thinking.  Just the thought of that was terrifying.  I wonder if part of the reason is that in New Zealand the focus within the psychiatric ward seems to be on holding you in a safe place until the suicidal intent goes, rather than helping you in a long term way.  It’s reactive rather than proactive.

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