Tag Archives: Psychotherapy

I Matter

Posted by Cate Reddell in Mental Health and tagged with , , , , , , , , , , , , ,

One of the things I battle with on a daily basis is that I matter, and whether I actually matter to anyone else.  Do I love myself enough to say I matter to me?  And does anyone else love me enough to say that I matter to them?  And will they show it by their actions?

Some of the struggle with this comes from the Christian upbringing I had which constantly told me to put others before myself.  Songs I sang in Sunday School taught me that I came last.  And I guess that’s where I always put myself.  As the youngest child in the family, my name always came last.  I’m not saying that my parents put my needs last, but that my brother’s and my parents names always came before mine.

In the school roll my name came near the end because my surname was Reddell, near the end of the alphabet.  I can remember wishing my name started with a A, so that I could be at the beginning.  But then the Christian upbringing  would no doubt have listed that as a sin.

Another thing I was taught was “pride cometh before a fall“.  That meant I couldn’t be proud of myself, I couldn’t take pride in my achievements, and actually no one else was ever going to proud of me.  It might not be what I was meant to learn from the statement, but it is what my young mind concluded.

My Christian upbringing even served to protect those who stalked me.  I was specifically told in relation to them that I should ‘love my neighbour and do good to them that hate you“.  What that meant in reality was I was supposed to be nice to them, and my needs for protection didn’t seem matter to anyone.  Christian love and compassion was what was called for.  When I was a teenager I thought that was just how life was.  My needs didn’t matter.  Now I am an adult I worry that teenagers might be taught this stuff now days.  I hope not.

Since my mental health ever became an issue (it’s interesting that it simply doesn’t matter until diagnosed with a mental illness) people have been telling me that it is okay to put myself first.  It’s okay for my needs to matter.  At this stage, after many hours of therapy I can tell you that I do matter, but I still find it hard to put it into practise.

At what point do my needs matter more than loving and accepting another person?  I still haven’t worked that out.  I still am not sure how to put this into practise in everyday situations.

I struggle with it in a number of places in my life, and still there is this little voice in the back of my head that recites ‘Jesus first, Yourself last and Others in between’.  It’s so ingrained in my head that I don’t know how to say ‘well actually my needs come first’.  Even as I type that, I’m thinking “selfish“.  I’ve done the textbook learning but I still don’t have it totally in operation in my life.  I don’t yet know how to strike the balance between me and the rest of the world.

Last week in What Matters To Me This Christmas Eve I told you about my family starting a family meal before I had arrived.  As I sat there that day my thoughts were “I don’t matter to these people“.  It seemed to me that I didn’t matter enough for them to think/say “We can’t start yet because Cate’s not here yet“.  Now I can see a number of logical reasons for why it might have happened, but it still hurts.  Not that they started lunch without me, but that I didn’t matter to them enough for them to think of me.

What makes it more painful is that I look around for people who I matter to, and actually most people have their own lives, their partners and children, and I am just me.  I know that I mattered to my father when he was alive, and so it makes his absence is more painful when something like that happens with my family.

The thing that I wonder is ‘who’s going to put me first?’  Will anyone?  Or has everyone got greater priorities than me?  I promise I’m not having some pity party for which I need huge doses of sympathy.  I don’t.  But I know that learning to matter to myself is helped when I can know that other people say to me “you matter to me“.

Maybe the psychology of that is all wrong, and I need to be able to just matter to myself.  But don’t we all want to matter to other people?  And surely knowing that I matter to someone else teaches me about mattering (Is that a word?  It is now.)  to myself.

I know I matter to some people, and yesterday I spent time with some of those people, purposely because I desperately needed to feel I matter to someone.  I knew with them, I would feel that, and I did.  It was in complete contrast to the lunch I nearly missed last week, simply because I knew without at doubt that I mattered to them and that my needs were important.

PS.  I need to say this isn’t at all a criticism of Christianity.  It’s not.  All it is, is my experience.

♦

“Wanting to be someone else is a waste of the
person you are.” 

―    Marilyn Monroe

♦

“Never be bullied into silence. Never allow yourself to be made a victim. Accept no one’s definition of your life, but define yourself.” 

―    Harvey Fierstein

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What Are The Scars All About?

Posted by Cate Reddell in Mental Health, Self harm, Stigma and tagged with , , , , , , , , , , , , , , , , , , ,

CAUTION: This post contains details of self harm (although no images) which may be disturbing to some readers.  Please take care of yourself in reading.

The sad truth for many.

“Everywhere Peter turned, he felt bombarded by misconception about self-harm. Why couldn’t anyone understand what he was going through? It was as if he had awakened to find himself on a different planet, where everyone spoke another language.  It’s not that he didn’t understand that self-harm can be scary and confusing to people who don’t harm themselves.  He did.  But the thing he couldn’t understand was why they couldn’t get beyond their misconceptions and hear what he was saying.  Just last week, he had got into an argument with an ER nurse about why he’d cut himself.  No matter how much he insisted that he had no intention of killing himself, she kept telling the other staff that he’d attempted suicide, and paged the psychiatrist on call to get him hospitalized.  Then, to make matters worse, the next day his father accused him of cutting himself to get attention, even though he’d tried to hide it from everyone.  Why couldn’t anyone understand that he was just trying to relieve some of his pain and cope with his depression?”

 - Kim Gratz & Alexander Chapman, Freedom from Self-Harm (p. 23)

As part of Mental Health Awareness Week I want to talk about self harm, because I believe that it is one of the hardest things for people to understand and get their head around.  It’s not often talked about, especially in polite company, but it’s out there happening, and literally tearing lives apart.

Perhaps one of the biggest issues in terms of it getting understood in the wider community is the shame that people who self harm carry with them.  It’s incredibly hard to talk about openly, especially if you don’t fully understand the reasons why you do it.  It’s fairly hard to avoid judgement, and even if you can, you are so fearful of what reaction you might get, that it’s simply easier to pull down your sleeves and pretend it’s not there.

This is how my self harm began, recorded in my book, Infinite Sadness:

“That night I started scratching my arms raw with my fingernails.  I would scratch and scratch with no feeling of pain.  Eventually I would look down and see the red, raw and bleeding skin.  I would realise what I had done and be horrified.  It wasn’t until I looked down at it that I would finally feel the pain.  The pain was bad, like a friction burn.

 I was disgusted that I could do such a thing to myself.  I had never had an urge to do anything like it, but had now just found myself mutilating my arms.  How?  Why?  Questions flooded my mind.  What was happening to me?  But then how could I answer those questions, for that would entail admitting to another human being the horror of what I had done.

 By the next day, I knew I needed help.  I wondered about the 24 hour Surgery but couldn’t bear the thought of a strange doctor questioning me.  Eventually I decided I would tell my friend Amy.  I knew I had to tell someone, and I thought that through her friendship and her nursing training, she must surely know what I should do. 

 I went to Amy’s house.  We drank coffee.  We talked for an hour and a half, but I couldn’t find the words to pull up my sleeves and show her the damage of the night before.  I left having not told her.  I think that I was so disgusted by what I had done that I just could not bear to admit it.” (p. 106,7)

I was 30 years old, so note that self harm is not just a teenage fad.  It’s serious, and it affects people of all ages.  Scratching my arms was never going to be a suicide attempt.  I simply made one heck of a very painful mess.  As for attention?  That was the last thing on my mind, simply because I was so disgusted by what I had done.

I didn’t even know what self harm was.  I had never seen evidence of it on anyone else, nor had a read anything about it.  It was completely new to me.  And in case you’re wondering, by that time I had spent a lengthy time in a psychiatric hospital, and while I accept that I was very sick at the time so might not have been very observant, I didn’t notice any sign of self harm amongst other patients.  The reason I say that is because a myth that exists is that people ‘learn’ self harm behaviours from watching others.  I didn’t.

Back to the story though.  Several days later I finally plucked up the courage to confess what I had done to both my doctor (a very wise, and trusted General Practitioner) and my psychotherapist.  By that time I had also self harmed again, but still had little idea of why I was doing it, or what I was achieving.

Both these health professionals immediately (and quite separately) told me that my self harm was a good thing.  They were both pleased that I had done it because I was apparently expressing my feelings.  I admit that I had great difficulty up until this point in expressing my feelings.  I simply didn’t have the words, and expressing feelings was not something I  had ever been encouraged to do.  Tearing my arms to shreds was apparently a good thing.  Of course no one, including myself, knew what those feelings were that I had been expressing but that didn’t seem to matter.

Image credit: FB-A Mental Illness Is Hidden

Fast forward 15 years.  In that time I graduated onto more serious, and dangerous methods of self harm.  At times I was self harming while dissociated, and this was the case in the worst damage I ever did to myself.  Now though, I have fought back and found other, healthy ways to express myself (if that was what I was doing), and to reclaim control over my life.

Beyond what was suggested initially I worked out that I self harmed because I felt totally out of control, and if I cut myself then I would somehow bring everything back into control   I also self harmed sometimes because I needed to see physical blood, and experience physical pain to comprehend the emotional pain I was in.  I self harmed sometimes to punish myself.  In this respect, it was more a case of thinking that I didn’t deserve to not harm myself.

While I don’t believe this is the case for all people who self harm, the self harm became a kind of addiction for me.  It was something I needed to do, and I had to break that pattern so that I could recover.

I don’t accept that self harm is ever a good thing, and while I still have a lot of respect for those people who told me it was, I completely disagree with the stance they took.  Recently I read something (which of course I can’t find now) that suggested that self harm shouldn’t be seen as a bad thing.  The article I read suggested that by judging the behaviour of self harm as bad, then we are judging the person as bad.  I don’t agree with this either.  Anything that we do that harms us has to be a bad thing, but that is not a judgement on the person.

I also don’t accept that one form of self harm is better or worse than another.  Yes, some forms are more dangerous, and can have more lasting consequences, but any harm that we do to ourselves has to be bad.

There are a lot of myths relation to self harm, some of which include

  • it is the same as a suicide attempt
  • superficial self harm is fine, and is not dangerous
  • people use self harm behaviours to manipulate others. and to get attention
  • self harm is a female problem
  • if you self harm, you must have a mental illness (no doubt, Borderline Personality Disorder)
  • only teenagers self harm
  • self harm is a copy-cat behaviour
  • if you self harm you are a danger to others
  • self harm is a response to childhood abuse

Self harm is difficult to understand, if you’ve never felt the urge to do this.  If you haven’t, be very thankful because the fight that goes on internally is terrible.  It’s made more difficult because of the stigma related to self harm.  The inclination is to think that a person who engages in self harm is ‘completely screwed up’ and maybe even ‘beyond help’.  Nothing could be further from the truth.

There is hope.  Recovery is possible, but it takes a lot of work and unfortunately many of the people struggling with this don’t get the long term therapeutic help they need.  Because of some of the things I am involved in when I’m not blogging, I know many people (men and women) who are fighting this battle every day, and also many people who have won the battle.  It is possible.  It is a really hard battle to beat this, but it is possible.

Self harm is a dangerous activity but the people who use it in order to cope, are no different from anyone else who might use destructive behaviours.  They deserve compassion, acceptance and help… just like any other human being.

An interesting story to end with shows this isn’t always available.  It is my experience of seeking help after my worst self harm, about ten years ago.  I had cut myself badly while dissociated, so actually I felt nothing.  I went to the Accident and Emergency Department of my local hospital (it was after-hours) and the doctor who treated me refused to give me a local anaesthetic while he stitched the large wound.  He told me that I had done this to myself, so I could take a bit more pain.  And yes, it was very painful.  Whether he thought he was being smart, or teaching me a lesson, I don’t know; but there certainly wasn’t much compassion or acceptance of the struggle I was having that night.

“Do no harm & leave the world a better place than you found it.”

―    Patricia Cornwell

Related reading

Gratz,K.L. & Chapman, A. L., ( 2009). Freedom from Self harm: Overcoming Self-Injury With Skills From DBT And Other Treatments. Oakland: New Harbinger Publications.

Sutton, J. (2007). Healing the Hurt Within – Understanding Self-Injury And Self-Harm, And Heal The Emotional Wounds. Oxford: How to Books Limited.

Healthcare Kiwi Style

Posted by Cate Reddell in Health, Mental Health, New Zealand and tagged with , , , , , , , , , , , , , ,

Image credit: whakaangi.co.nz
This is a kiwi. If you think a kiwi is a piece of fruit, that is actually called a kiwifruit. And to confuse matters further, New Zealanders are also known as kiwis.

A number of people have asked me about how healthcare works in New Zealand, and my friend Candida at candidaabrahamson has given me just enough (gentle) prompts to get me to answer this question.  Thanks Candida, you’re a star!

For kiwi readers (that’s people living in New Zealand and not our much-loved, but endangered national bird), you’ll know all this but I would love to hear if, and how, your experience differs from mine.  Consistency is not always available in probably any healthcare system, so I’m sure there may be some big differences in reality.

Just to clear up any more confusion that might exist, New Zealand is NOT part of Australia.  I know Australians often wish they were part of us, but we are actually two separate countries, much like the United States and Canada.   And generally we don’t like this issue of our identity to be confused or misunderstood, although I hasten to add that I love my Aussie neighbours (and readers) anyway.

I had to think about this topic because after many years in the health system here I know that my views are slightly tainted by reality.  And I guess that’s the case in whichever country you choose to look at their systems.  New Zealand has a public health care system, but a private system is also available, and in my experience it is necessary to use both.  In a promotion by the immigration service here I was told that my health care needs are in excellent hands.  Hmm.  I’m not totally convinced but…

I spent a very long time trying to insert in here an image of how our health system is supposed to work, but  I’m sorry to say my technological skills were just not up to the challenge of ‘WordPress versus the New Zealand government department responsible for such things’.  I don’t think they want me to point out that the government was firmly at the top of the diagram, and I and all the other 4.5 million kiwis were firmly at the bottom of it.  No wonder I have so much trouble.  Why do patients always come last?

Our healthcare system offers me subsidised access to a General Practitioner (GP) for my general medical needs.  I also have access to subsidised prescription medication.  Now subsidised doesn’t mean I can necessarily afford it though.  Because I am on a social security benefit and have to access both of these on a regular basis, I theoretically receive a disability allowance to meet these costs, but because I have other disability costs (there is a maximum), it actually doesn’t cover the cost of doctors and prescriptions for me. While I have never been unable to access prescription medication, I have regularly been in the situation of not being able to afford to go to the doctor, even though I needed to.

We also have a public hospital system, which involves inpatient, and specialist outpatient services.

Theoretically:

I should be seeing the following specialists through this public system.

A Psychiatrist (& social worker/nurse)   ×

An Endocrinologist for Graves’ Disease   √

A Rheumatologist for Fibromyalgia   ×

Reality:

I was dumped (my word, not theirs.  I think the word they used was ‘discharged’) from the public mental health system about five years ago.  It previously included free access for me to a psychiatrist and a social worker, as well as access to the outpatient Eating Disorders Service, which included a specialist nurse).  I was ‘dumped’ apparently because I was treatment-resistant and wouldn’t respond to the help they had provided to date.  Apparently that was my fault, but I won’t get into that now.

Now days I largely survive without these services and pay a hefty price on the occasion that I need to see a psychiatrist (mostly for medication changes) through the private health system, because sometimes my GP just doesn’t know quite what to do.  My last appointment cost NZ$345.00 (you’ll have to do your own exchange rate calculations).

I was fortunate to get into the public service for Endocrinology because at the time I was diagnosed I was considered to be ‘acute’.  Had I not been, I would have probably waited six to nine months to be seen (during which time perhaps I would have died), or again I would have had to opt for the pricey private health care.

I went directly to the private system for a rheumatologist because I would have waited at least six to nine months to be seen publicly.  That appointment cost me about NZ$350.00.  It wouldn’t have killed me to wait, but it was not long after the Endocrinology experience and I was getting a little weary of my state of health.  Sometimes it’s just not worth the wait.

Mental Health Services

I need to say that most people’s reality of the mental health system is not as checkered as mine.  There is a free outpatient service, and generally I think they do a good job.  There is also a after-hours crisis service available, and I admit in years gone by I made heavy use of it.  Those crisis service staff are always run off their feet, probably like anywhere, and sadly there are people who end up falling through the cracks because of it.

There is free access to in-patient psychiatric hospitals, and I have used my fair share of these over the years.  The problem is that again, demand exceeds supply, and the hospitals become a ‘patch up and ship out’ service, rather than any type of therapeutic path to recovery.  Unfortunately there is very little in the way of inpatient care for people with eating disorders, and I have sat on waiting lists, but have never been near being admitted for this inspite of previously being dangerously unwell.

Very few private facilities exist for mental health care.  I know of one private psychiatric hospital, which operates as a therapeutic community.  I have had two admissions there, one for three months and the other for 10 months.  It was very helpful to me and it’s a shame that most people never get this opportunity.  The first admission was paid for by a family member thankfully, and I was fortunate enough to get rare public funding for the second admission.

Most people also don’t get much opportunity of access to psychotherapy.  This is not free in most circumstances, and while there is some government funding to people on low incomes, it tends to be very limited.  For example, I was given access to six visits to a psychotherapist to deal with an experience of sexual abuse.  Most people could tell you that six visits doesn’t go far.

I pay NZ$100.00 a time to see my psychotherapist.  He has kindly lowered his fee for me, as he knows I already go without other necessities to make this a possibility for me.  But that is still a lot of money.  While it makes for a very tight budget, I consider therapy to be the thing that lead me from death’s door to life again, and so it is worth it.  But for so many, this isn’t a possibility and I personally believe that it means that the other services are overused.

New Zealand has a free health service and when I hear stories from other countries, I am grateful for what we have.  It means that there is generally something available for everyone, regardless of income and/or insurance.  I know that if I am really sick and I need help, I will get it.  It’s just that it is difficult to access sometimes, and that sometimes means people continue to go without what they need.

Hopefully that answers some questions, without boring you to tears.  If you’re wondering about anything else, ask and I will answer…

To finish, something entirely unrelated to healthcare:

“The United States invented the space shuttle, the atomic bomb and Disneyland. We have 35 times more land than New Zealand, 80 times the population, 144 times the gross national product and 220 times as many people in jail.   Many of our big cities have more kilometres of freeway than all of New Zealand, our 10 biggest metropolises each have more people than all of New Zealand, and metropolitan Detroit has more cars on the road than all of New Zealand. 

 So how come a superpower of 270 million got routed in the America’s Cup, the world’s most technically oriented yacht race, by a country of 3.5 million that out-produces us only in sheep manure?” 

-  Eric Sharp (1995)

And apparently said of New Zealand.  I totally refute it:

“A country of inveterate, backwoods, thick-headed, egotistic philistines” 

- Vladimir Ilyich Lenin (1909)

Bad Press In Black & White

Posted by Cate Reddell in Borderline Personality Disorder (BPD), Mental Health, Stigma and tagged with , , , , , , , , , , , , ,

Image credit: wordle.net

A young woman goes from doctor to doctor asking for help.  She knows there is something terribly wrong but she has no understanding of what it is that makes her feel the way she does.  She desperately wants someone to love her, and is terrified that those around her will abandon her because she seems to have no way of reining in her emotions. 

The doctors eventually all tell her the same thing.  She has Borderline Personality Disorder (BPD).  She is told they can do nothing for her.  It’s just the way things are and she will have to live with it.

She goes home and searches ‘BPD’ on her computer, desperate for an explanation to how she feels.  The words above leap off the screen.  ‘Manipulative’, ‘attention seeker’, ‘drama queen’, ‘child-like’, ’mentally tormented’… and more.

 Some of it sounds like she feels.  Other words sound pretty cruel.  She feels hopeless.  She assumes she must be a really bad case if doctors can’t, or at least refuse to help.  She concludes if they can’t help, no one will be able to.  Life doesn’t look too good.  She is doomed to a hell of black and white.

True story.  It’s not me, although my experience wasn’t a whole lot better.  Doctors told me they could do nothing more to help me… before any diagnosed me correctly with BPD.  I had, what they assumed, was treatment-resistant ‘treatment-resistant depression’.  Does that make sense?  They couldn’t, or wouldn’t, treat my treatment-resistant depression anymore.  It was hopeless.  I was supposed to just go home and live the way I had been living for the rest of my days (quietly presumably).  The problem was that depression wasn’t the issue.  I had BPD, so I found out several years later, but meantime I assumed that this would just be my lot.  I assumed there was no hope.

I fought back eventually, thanks to encouragement from a loved one who wasn’t prepared to let me accept it as an answer.  I eventually sought yet another opinion.  Thank  goodness I did, because the previous doctors just hadn’t looked far enough, and hadn’t listened to me enough to understand what was going on.

But the woman above wasn’t so lucky.  She gave up because so many doctors had told her the same thing.  There was no hope for her apparently.  She believed she was hopeless.

If you go searching for information about BPD, it’s not a pretty picture that is painted.  There is some good stuff out there but other writers are pretty cruel.   Perhaps they have valid reasons for that, but it makes it very difficult when you want to understand yourself, or you want to help a loved one who has been diagnosed with BPD.

It’s true that there doesn’t seem to be a medication that can specifically treat BPD.  What’s more, therapy is fraught with complications when you struggle to trust the therapist (or anyone), constantly fear that they will leave you, and seem to be one thing to one person and a completely different thing to another.  Therapists do have their work cut out and so it seems that many have just chosen to either refuse to treat people with BPD, or run a mile as soon as BPD is mentioned.  Another problem is that some styles of therapy just leave the patient totally flumaxed.  It makes no sense.  A therapist can assume the patient isn’t trying hard enough and give up.  The patient can assume there is no hope for them.

I was told I wasn’t trying by staff involved in trying to treat my depression and my eating disorder.  They told me they had done everything possible to help me.  Actually they hadn’t.  It might have helped if they’d got to know me well enough to diagnose me correctly.

As for a therapist, I have been fortunate (finally), although both my therapist and I know that we are in it for the long haul.  After years of seeing him, and him never letting me down, I still constantly fear that he is going to abandon me.  Everytime he has a holiday I prepare myself for the fact (well, I think it is a fact!) that he won’t come back.  Everytime he comes back  anyway, but my fear remains.  Everytime I go to see him, I expect he won’t be there, even though he has done nothing to make me think that.  I accept that I am not the easiest patient but I very much appreciate that he has stuck with me, and not just said “I can’t help you.”

“People with BPD often have an unstable sense of who they are.  That is, their self -image or sense of self often rapidly changes.  They typically view themselves as evil or bad, and sometimes they may feel as if they don’t exist at all… Relationships are usually in turmoil.  People with BPD often experience a love-hate relationship with others.  They may idealize someone one moment and then abruptly and dramatically shift to fury and hate over perceived slights or even misunderstandings.” (1.)

All this makes it difficult to work with us, but I can not accept when relatively functioning people are told there is nothing that can be done.  I say relatively functioning because many people with BPD hold down jobs, are in relationships and have children.  Mostly people with BPD are not hallucinating or delusional, but they do need help.

Do you know that approximately 10 per cent of people diagnosed with BPD end up as suicides?  That’s a huge number and I’m not going to be one of those, nor do I want any of my BPD friends to be either.

While I was researching for this post, I read a lot of negative material about BPD and actually had to take myself away from it a few times.  I was left thinking ‘how could anyone bear to be in any sort of relationship/friendship/connection with me?’  But I also know enough to know that while I might not be the easiest person to deal with some times, I am not how I saw myself being described.  But then I know I am working hard to correct the way I think, so that makes a huge difference.  The stigma associated with this particular disorder, which isn’t even often talked about, is immense.  What gets printed doesn’t help that, all it does is add the the growing mountain of criticism, judgement and hopelessness.

Actually there are some positives to BPD, which aren’t often recognised.  I had to dig a long way to find anyone prepared to say that actually people with BPD have good points.  And I suspect I’d have to dig even deeper to find a person with BPD who had ever had this pointed out:

Image and copyright owned by Kiera Van Gelder.

If you don’t have support, and you don’t have the motivation to learn new skills for yourself, then it’s pretty impossible to function adequately, although a surprising number manage to muddle on, and just assume somehow that they are terrible people.  The ‘bad press’ circulated (not just on the internet) just makes things horrendously difficult for the some two per cent of the general population who have this disorder.

I know we can be difficult to understand, and I know it can be hard to predict what we might do next.  I know we have a strong tendency toward self-destruction but actually what we need is just the same as what others with other mental illnesses need… hope.  And yes, we are good people.

Wouldn’t it be great if we could get spreading some good press?  It does exist.  I don’t believe we just have to accept the negative things said about people with BPD.  It’s just that those people have gone to the trouble to write it.  It would be easier just to accept it as status quo, but I’m not prepared to.

Susanna: [reading from a book] “Borderline Personality Disorder. An instability of self-image, relationships and mood… uncertain about goals, impulsive in activities that are self-damaging, such as casual sex.”
Lisa: I like that.
Susanna: “Social contrariness and a generally pessimistic attitude are often observed.”
[pauses]
Susanna: Well that’s me.
Lisa: That’s everybody.”

 - Excerpt from Girl, Interrupted, Movie (1999) by Susanna Kayson

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Cate’s Crocodiles

Posted by Cate Reddell in Earthquake Recovery, Family, Health, Mental Health, New Zealand, Personal, Post Traumatic Stress Disorder (PTSD), Stigma and tagged with , , , , , , , , , , , , , , ,

Image via thefabweb.com

“But in the end one needs more courage to live than to kill himself.” 
―    Albert Camus

On the surface, everything can look calm, everything can seem okay.  But hidden under that calm there are those ever-present Cate’s crocodiles.  If you’re not sure what I’m on about this time, check out Crocodiles & Three Wise Men.  While I had never stopped to consider crocodiles much before, I find myself drawn to them (well, pictures of them) and there is always a good reason.

My last post Courage Required was a little bit cryptic, and apologise for that.  The thing is there is a calm look on my face for anyone who sees it, but my mind is racing at ninety miles an hour (144 kilometres for us kiwis) trying to work some things out.  At the time I posted I could get as far as telling you that what I needed to find a healthy dose of courage, but I was unable to do much more.  The racing mind had me stalled, flicking through websites aimlessly, not taking anything in, unable to even concentrate to catch up on reading other blogs because I just couldn’t concentrate to do anything but generally looking… calm (to anyone but my imagination).

When I started blogging,  I set myself some rules.  The biggest being that I would largely leave my immediate family out of my blog.  Why?  In my desire to do my little bit to reduce the stigma of mental illness I wanted my blog accessible to my friends and family.  That kind of changes the focus a bit because family, for most of us, have a pretty significant part to play in our lives now or in the past.

I made the decision to not write anything about my immediate family that they might be unhappy about.  This is partly because of a previous disagreement over something I had published in the past.  Some parties were not exactly happy with what I had put on the internet, and while I didn’t take it off (because after a lot of soul searching I didn’t think I’d done wrong), I did resolve to be almost over-cautious in what I published in future.  So at this point you occasionally might read of my 19 month old niece’s activities, but that is it (and I should say she seems to be quite okay with that).

Now I find myself in a situation that involves my family, but if I don’t find a way to write about it somehow, I risk those crocodiles rising up through the calm and biting me on the arse.  So I need to write about what is going on for me, without betraying their confidences.  Easy?  Not at all!  But here goes.  Forgive me if there are gaps that mean this doesn’t make sense.

On 22 February 2011 life changed forever here in my corner of the world.  It came with an almighty earthquake (that I have regularly mentioned and) that killed 185 people in my city.  I knew one of those people personally.  My family was lucky to avoid death, but incurred great loss both physically and mentally.  An earlier (and larger) earthquake on 4 September 2010, almost destroyed my brother’s business (that he had only bought one month before).  In February, my parents lost their home and about 70% of their possessions.  They walked away with the clothes they were wearing and it wasn’t until four months later that my brother and I were given a few hours to go into the destroyed apartment and retrieve what we could.  By that time, in April 2011, my father died suddenly in my home  The cause of death being heart failure caused by stress.  My home was severely damaged in February but the three of us had been living here ever since.  There was no other option.

Sixteen months on, my parents home is now demolished, and just yesterday I received the offer for my mother from their insurance company.  My home is still severely damaged and it is looking like it will be years yet before it is repaired (it seems it’s in the too hard basket and many homes are in that same basket).  My brother’s business is still badly damaged and awaiting an insurance decision.  He struggles to keep it running.  The dream he and his wife had of owning their own business hasn’t quite been what they’d bargained on.

But all these things are the relatively easy pieces of the puzzle.  These are the material pieces that can perhaps be fixed with the provision of a cheque, or a builder.  It’s what goes on in the minds of the people who live through all this, that is not so easy to fix.  We have all changed and are not the people we used to be.

For me surprisingly I think the trauma of everything actually helped me take a leap toward wellness.  Like everyone else here I struggled to sleep at night (the first and largest quake happened at 4.35am and that was one heck of a way to wake up), I became super vigilant about not just more quakes but the safety of my family.  My ‘performance’ of the past nearly 20 years would have suggested that I would completely crumble at this.  When my father died six weeks later and my effort at CPR was unsuccessful, again past ‘performance’ would have suggested that I would crumble.  My brother admitted that for a while, when the telephone rang, he would expect it would be a call to say I had been admitted to the local psych hospital… or worse.  Actually that was the furthest thing from my mind.

I think I got flung into a position where I needed to take some control, not just for myself but for my parents too.  They were never the same again and I almost swapped roles.  For years I had been the ‘sick child’ needing to be handled with care in case “she spun out and did something crazy”.  Now, from the day in their apartment when the quake struck, and I needed to clear a path for them to get out to the stairway and out of the building, to arranging to replace their necessities and find a new home for Mum.  It’s hard to put into words, but it was (and I mean them no disrespect) like we reversed roles.  They became the ‘sick children’ and I the ‘adult’.

This week I have been almost overwhelmed by some of the practical issues that this has raised, that no one really has time for but they still need attention.  It has been hard, there have been a few tears (I don’t cry that often) and there has been an enormous sense of being alone.  I have been angry with my father for dying.  He was always the person I could talk my problems through, and I knew that this time he would, again, know what I should do.  But damn it, he’s gone.  He was my voice of reason (mostly!) but now while I can rant at my memory of him, he can’t respond.  And I seem to be finding it harder in the second year since his death, than the first.  I realise just how much I, and my family have lost.  It’s not just his physical presence but the part he played in our family.

I am the youngest in my family and the only girl, so I always assumed responsibility would fall on my brothers shoulders, particularly my oldest brother.  He does not live nearby and circumstances have meant that it is me on the spot, and I find myself having to take on things I never expected.  This week it has been hard (as I said) and while I know I have come a long way in my recovery in the last 16 months, I have yet again found myself really struggling with the same old doubts and fears arising.  Yet this time, it’s not just me I have to consider.  In some ways that’s really difficult, and leaves me in deeper distress, but in other ways it, yet again, saves me.  What I need though right now, is a whole heap of patience, and that sure doesn’t come easy with Borderline Personality Disorder (BPD).  I can be incredibly patient with people I don’t know but with my family, it is a whole other ball game.

It’s totally understandable that the rest of the country, and the world, would think we have just picked up our lives and moved on.  Unfortunately that’s not true.  We live with the aftermath of the quakes everyday, both practically (you should see the state of our roads) but more importantly, mentally and emotionally.  We have all changed, and while some of us will pick up our lives and move on, particularly for older people, life will never be the same again.  My mother (at 83) lost her husband, her home, most of her possessions, her church (it completely collapsed) and many other friends who have also died in the last year.  Again, I mean no disrespect but she is not the woman she used to be… and how could she not be different having lost so much in practically 50 seconds of the quake?

At this stage I have no idea whether my home, and my brother’s business, will be restored in her lifetime.  Certainly it is unlikely that she will be alive to see the city restored (80% of all buildings in the central business district have been, or are still being demolished).  Mum grew up in this city and, as she knew it, it is largely gone or certainly cordoned off.

It makes me laugh (a slightly skeptical laugh) when I hear that our Government has made provision for five counselling sessions for each resident of the Canterbury area (my guess is that is about 500,000 people).  It’s a good start, but five sessions doesn’t give you much when so many have been through such enormous trauma.  I suspect every one of my family (that lives in this region) could do with that counselling, but I know it’s not going to happen for most of them.  Aside from the ‘stiff upper lip’ mindset, there is also just the enormous need to just keep going, one step at a time.  People don’t have time, because the basic necessities of life are what still matters right now.  And I can’t imagine that the city has enough suitably qualified people to meet the need anyway.

Image via FB/Soul Speaking

I was lucky to already be in psychotherapy and be able to talk about a lot of this with a therapist I knew and trust.  [Unfortunately I am in the middle of a month of my therapist's holiday.  Nice for him... but damn him, for having his holiday!]  I think many more people will just let the crocodile slide back under the surface and hope it never rises again.  I know my mother will.  But all you need to do is watch the face of a Cantabrians when another quake (they’re happening all the time) strikes.  People are living in fear, because it’s what they’ve come to know.  What does that do to their on-going mental health?

PS.

I can’t help wonder how other places that have survived such terrible disasters fair.  Japan was hit by a much deadlier quake (and tsunami) just three weeks later (March 2011) and I wonder what happens to the emotional and mental needs of all those survivors.  Other places like Haiti, Chile and Italy raise the same wondering in me.  Actually we were really quite lucky, but still, lives will never be the same.  There was an amazing outpouring of support here from other countries, and other parts of this country, but the scale of the distress is so much more than what was seen in the first couple of weeks.

And one final thought?  No, I have yet to summon up that courage I need.  I guess I am procrastinating, which unfortunately that means the problem does go away.

.

“No one can tell what goes on in between the person you were and the person you become.  No one can chart that blue and lonely section of hell.  There are no maps of the change.  You just come out the other side.
Or you don’t.” 

―    Stephen King,    The Stand

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Borrowed Hope

Posted by Cate Reddell in Borderline Personality Disorder (BPD), Depression, Family, Mental Health, Personal, Self harm and tagged with , , , , , , ,

Image courtesy of FreeDigitalPhotos.net

“I am a success today because I had a friend who believed in me and
I didn’t have the heart to let him down”

 - Abraham Lincoln

A few years back I was really depressed.  I was very despondent and lacking all hope for any sort of recovery of my mental illness.  It was before my diagnosis of Borderline Personality Disorder (BPD) and I had been dumped in the ‘treatment-resistant depression’ box.  I hate that box because it’s like ‘they’ decide I am not doing my bit to recover and so am just left to founder for myself.  The public Mental Health System had ceremoniously dumped me off their books because I didn’t respond to the Cognitive Behavioural Therapy (CBT) they offered and they simply didn’t know what else to do with me.  And yes, they told me all this.  The public Eating Disorders Service also dumped me off their books at about the same time because they couldn’t work me out or figure why I did the things I did, and didn’t respond to what they tried to get me to do.

I was seeing the therapist I still see, and thankfully he held out hope for me.  But it wasn’t enough.  I thought at that time that the only reason he held out any hope for me was that I paid his bill at the end of the month.  No matter what he said or how super-therapist he proved to be, I could only imagine that he just saw me for the money.

You name it, I’d tried it.  I’d had years of therapy (from several different therapists),I had tried masses of different medications, I had tried Electro Convulsive Therapy (ECT) three separate times, I had two lengthy stays in a therapeutic community and had many hospitalisations (which really never did much except maybe keeping me alive.), oh and did I mention that I left my marriage on the expectation that doing so would cure me (many doctors told me this would happen).  It didn’t… although it did bring an end to my suicide attempts and alcohol abuse so I guess that was a good thing.

I had sunk to a new low.  I thought I had tried everything and nothing worked.  It seemed like nothing was going to help and while I hadn’t acted on suicidal ideation for some years, the thoughts were constant.  I started to realise that this was going to be my lot.  I was always going to be depressed (because that’s what everyone still thought I was).  Another 50 years of this was not a good prospect.  Life as a depressed person did not look like a good prospect and actually I really couldn’t see the point.

I stepped up the self harm, cut down the eating and tried to come to terms with the fact (or what I assumed was a fact) that this would be my lot.  I kept telling my therapist that he was only in this for the money and actually no one really cared about me.  For some reason he kept on seeing me regardless of my attitude about his apparent money-hungry ways.

Fortunately I had someone who believed in me.  My Dad believed in me, believed I was a good person and believed that one day I would be healed and restored to health.  I have to admit that I was very clear that Dad felt that way, but I really just thought it was him being him.  He was very much a ‘glass half-full’ positive person to the extent that it drove me to anger at times.  I thought it wasn’t really real and that one day I would do something to smash that glass and he would realise that the hope he held for me was just thin air.

With a lot of patience and perseverance Dad kept on at me.  Somehow (and I can’t remember exactly how it happened) I slowly started to think that maybe I should hold onto his hope for me.  I had no hope for myself but I kept hearing his belief.  Somehow he convinced me that his hope for me would be enough.  His hope for me would get me through this.  I had no idea how that could be possible but I decided to hang onto life, because he believed it would get better (even though I still had no hope myself).

It worked.  Not overnight by any means but it kept me going day to day, without choosing to opt out of life.  Actually making that decision to hang onto his hope also helped me stop self harming.  The urges were still strong but I could see that if what he said was right and my life was going to be restored, then I didn’t want more scars on my body.  And that was somehow enough for me.

Dad died suddenly last year.  It was a huge shock and one thing that really worried me is what I would do now that he was gone.  What would happen to his hope that was keeping me alive?  I’ve realised though (with time) that his hope can still keep me alive.  He’s not here (physically) anymore but I believe he is somewhere watching over me, and as such he probably still holds that hope for me.

More than that though, I’ve realised that I have a little bit of hope for me now too.  I’m not expecting a total cure from the difficulties I face but I can see that it is possible to live a satisfying life in spite those things.  So with Dad’s hope, and my own new hope I can keep going.

Borrowed hope really works.  I am living proof of that.  So I want to say if you don’t have any hope for yourself, look around and see who does have hope for you.  Pick someone who you trust and can believe that something could be so because they think it is.  Then hang onto it tight.  You don’t have to understand it, just give it a go.  What have you got to lose?

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Self Harm & Me

Posted by Cate Reddell in Borderline Personality Disorder (BPD), Depression, Family, Health, Mental Health, New Zealand, Personal, Self harm and tagged with , , , , , , , , ,

WARNING: This post addresses a disturbing issue and should
be read with caution.


“My head was full of wild ambitious urges to hurt myself. I tasted the ambrosia
of maddened impulse. I wanted my interior pain out in my body somehow.
I wanted this vague pain to be specific. That’s how I explain it.”
–Charles Baxter, The Feast of Love

While I’m talking about stigma, what about self harm?  Maybe you call it self-injury, self-mutilation, or maybe you don’t even dare to give it a name.  Whatever name you give it, there is huge stigma attached to it, which simply makes it harder to talk about so harder to help people address.

A news report in New Zealand last week said that up to half of all teenagers will harm themselves deliberately and the researchers claiming this are starting to ask why.  It made me think, because while I didn’t self-harm as a teenager and actually I doubt I even knew it existed, I have self harmed for a long time.  Thankfully now, I can say that I haven’t for a long time.  But you need to know just how this issue can have a grip on you, because even now there are times I still get the urge to self harm.  I’m not free of it yet.

It’s not an easy topic to discuss and when my blogger friend Kevin from Resonate Freedom came up with this image recently, I knew it was time to use the image (thanks, Kevin) and to talk about me and self harm.

There are a range of views about what self harm is, so I want to start with my understanding of it.

“Any deliberate, non suicidal behaviour that inflicts physical harm on your body and is aimed at relieving emotional distress, without a conscious intent to commit suicide. Physical pain is often easier to deal with than emotional pain. Individuals may consider that injuries can prove to themselves that their emotional pain is real and valid. Self-injurious behaviour may calm or awaken a person. Yet self-harm only provides temporary relief, it does not deal with the underlying issues. Self-harm can become a natural response to the stresses of day to day life and can escalate infrequency and severity.  The types of behaviours considered as self harm are wide and vary according to the person, and therefore are not listed here.  To determine whether what you are doing is self harm you need to consider the reasons for what you are doing.  What are you doing it to achieve?”

It’s not straightforward.  If you thinking it is just about cutting, you’re wrong.  There are many forms of self harm which really only can be determined as self harm, by looking at the motivation behind the action.  I think that any harm to your body is bad, but you will find that some websites recommend that you use a lesser harm in place of a worse harm.  For example, they suggest flicking your wrist with a rubber band rather than something more serious than cutting.  The problem with this is that it is all a matter of degrees, and it is far too easy to take a ‘lesser’ harm to the extreme very quickly.  Because of this, I don’t accept any harm (even the rubber band) to my body as okay.  That said, I know some people find that helpful and if it works for them, that is what matters.

The thing is, I realise that I am writing about self harm rather than what I said I’d do: me and self harm.  Actually it’s really hard to do.  Self harm is not something that is talked about openly, so I guess I am fairly used to keeping it to myself.  To turn around and put it out here is hard.  I am also conscious that self harmers often pick up ideas from others, and I don’t want to give anyone ideas.  Recently I had to ‘un-follow’ a blog because the person was regularly including pictures of her self harm.  I really didn’t need that.  It’s not that it gave me ideas, but just reminded me of a place I don’t want to return to.

Self harm began for me one weekend (at the age of 29) when my husband went away.  He needed a break from my battle with depression and suicidality, so I was on my own.  I was fairly anxious about being alone, and about where I was at generally.  I was dissociating often in an effort to manage my feelings and found myself scratching my arm (with my fingernail).  The skin was raw and bleeding before I realised what I had done.

I knew nothing of self harm.  I had been sick for about two years and had one lengthy spell in a private hospital, but I hadn’t encountered it there probably because I was confined to bed rest, thanks to my anorexia.  Actually the whole thing completely freaked me out but I wasn’t able to admit it to anyone for some time.  Instead I began the routine of wearing long sleeves, regardless of the weather.

When I confessed to my doctor, and then to my therapist, they both told me that my self harm was a good thing.  Good?  Yes, really… they saw it as me expressing my feelings, and I hadn’t been doing too much of that.  The self harm continued but there wasn’t much good about it.  Eventually it extended to other means of self harm, not necessarily more painful but definitely more dangerous.  Thankfully I found other workers who didn’t think it was a good thing.  I have heard this theory since, that self harm is a form of expression of feelings and so is good, but I don’t buy it at all.  It’s too destructive and it’s too dangerous.

Self harm is different for everyone, but for me it I eventually learned that it was about control, and was often tied into dissociation.  Somehow it provided a sense of relief, and the feeling pain that I could explain enabled me to feel a sense of control that was otherwise missing.  It also became an addiction for me, and while this isn’t the case for everyone, it was a difficult addiction to break.  If there was undamaged skin, I needed to harm.  I also needed to harm everyday in order to gain that sense of control over what I was feeling.  More so, if someone hurt me, then I hurt myself.

It was never a suicidal action for me, but there were a couple of times where I was lucky I didn’t kill myself.  And that’s the problem.  It’s too easy to just go a bit deeper, and before you know it, you’ve gone too far.  It is on that basis that I don’t accept any harm as okay for me.  I know myself well enough that I just can’t go there.  I know that if I give myself the opportunity, I could just push it too far.

So now… it is some time since I have self harmed, but as I said earlier I still get the urges to do it again.  It’s really like giving an alcoholic a bottle of vodka.  It’s dangerous and you just wouldn’t do it.  The thing about self harm though is that it is a personal thing that I have to monitor myself.  I have to make sure I don’t give myself that bottle (or a blade).  Unfortunately there are many ways of self harming.  It’s not just about cutting.  I need to continue to watch myself carefully.

And meantime I have scars all over my body that I regret.  Most of them aren’t where anyone can see, but you wouldn’t catch me naked with anyone.  They hold great shame for me.  I have moved on, but the scars will always remind me of the extreme emotional pain I felt, and expressed, through physical harm to my body.

“It didn’t occur to me that there was something decidedly odd in
finding a box of razor blades aesthetically appealing. I wonder if
a heroin addict loves the elegant simplicity of the needle, if a
drinker romances the curve and shape of the bottle.”
–Caroline Kettlewell, Skin Game

“Give light, and the darkness will disappear of itself.”
- Desiderius  Erasmus

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All or Nothing Kind of Girl

Posted by Cate Reddell in Borderline Personality Disorder (BPD), Fibromyalgia, Health, Mental Health, New Zealand and tagged with , , , , , , , , , , ,

If only I truly believed what the picture says!

Yup!  I’m an all or nothing kind of girl.  All or nothing thinking, or black and white thinking or splitting is widely recognised as being a trait associated with Borderline Personality Disorder (BPD).  I’m not about to give a lecture of BPD but you too can learn all you want with the touch of a few keys.  A good place to start is here.  For as long as I can remember I’ve been thinking this way, and even years before I got my BPD diagnosis I could see that there was something in that style of thinking that worked for me.  Everything was black or white.  There was absolutely no grey.  I remember years ago having a discussion with my psychotherapist about my marriage.  He was trying to help me to see that there were more than two options available to me.  All I could see what either I leave, or I stay and get used to what I had.  There literally wasn’t a bit of me that could see there were other options.  And sure enough some months later I opted to leave the marriage.  It hindsight it was probably the best thing for both of us, but my point is that it was totally beyond me to see that other alternatives existed.

Now days with the benefit of a whole lot more therapy I am starting to see that grey exists.  Frankly I still don’t like it.  It’s far too wishy-washy for my liking.  I actually like thinking I only have two options but it does leave me kind of limited.

I have spent the last five days in what I think is known as a fibro flare-up.  I’m new to fibromyalgia but if that wasn’t a flare-up then I dare not think what one will be like.  I have been in a great deal of pain, as opposed to the everyday, usual pain, and I have slept a lot.  No matter how much sleep I got, I still needed more.  But now I’ve got to the stage where I hate my bed and I hate sleeping.  Actually I’ll correct that I don’t hate sleeping, but I DO hate waking up.  That is agony.  As an example yesterday I slept in the afternoon and when I woke my legs felt like they were double their size and had been burnt raw.  It really felt like the skin had been burnt off my legs, and if I, or anyone dared touch them or move them, I would be sent through the roof with horrific pain.  This is a regular occurrence.  That’s how they felt but I knew this wasn’t the case, and so eventually I dared to move them.  I was back to the ‘great deal of pain’ but not the agony I thought it would be.  Still it was enough to put me off going to sleep again.  I can’t decide.  Do I curl up and go to sleep like I think will help?  Or do I avoid it at all costs because of the perceived pain and of course the real pain I wake up with purely because I haven’t moved recently?  I’m fighting with myself right now because what I want to do is the old ‘all or nothing’, and not go to sleep at all.  But I know I can’t not sleep.  I can’t work out how to have grey.  Any ideas???

Again I fight with my ‘all of nothing’ thinking as today it’s cold and wet.  Actually it’s the first day this year (and remember it’s autumn – fall here) when I have considered turning the heating on.  This is another battle I have every year, and right through winter.  In New Zealand we don’t have the extremes in temperatures that other countries have.  Yet it is cold enough that we need heating in our homes.  For most people that’s fine, and I should point out that I have perfectly adequate heating here.  It’s just that I struggle to let myself use it.  All or nothing comes in because I either decide I won’t have any heating (unless I know someone is coming to visit) or I’ll put it on and to hell with it – too bad about the electricity bill.  Why am I talking to you about my power bill?  Because it’s a good example of BPD thinking.  I live on my own, and I’d like to think that if I lived with other people I would accept the heating being on.  But for me I think I don’t need it.  It’s just me so it doesn’t matter if it’s cold.  I can just go to bed or I can put another layer on.  I just can’t allow myself to have the luxury of being warm.  I can’t just say I am worth it.  It’s sounds ridiculous and maybe it is, but I go through this conversation with myself daily right through the colder part of the year.  It’s all or nothing.  I can’t just turn the heater off when the room gets warm, or use the thermostat.  I have to deny myself warmth.

That said, all is not lost and last year I finally began to let myself have heating.  It didn’t help that my house is badly damaged thanks to earthquakes, so is fairly draughty.  The power bill was horrendous.  But hey, I guess at least I was warm.  As for today, I’ve decided (optimistically) that this is a one-off and warmth will return tomorrow.  I still can’t bring myself to just put it on when I’m cold.  It’s time my therapist came back from his Easter break!

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