Hope: n. A feeling of expectation and desire for a certain thing to happen
v. Want something to happen or be the case
Hope is a very pregnant word. Pregnant with promise, with desire, with expectation. A feeling of better things to come. A small word with big meaning. When things are black and stormy in my life, I hope they get better. Sometimes I feel this hope is misplaced, especially when I’m deep in the pit; when it’s hard to reach out a hand and ask for help. It’s getting easier these days. When my therapist says to hang on, the depth of these feelings in transient, I have faith in her word, and trust and hope she’s right. And she always is. I always come through. And lately I can say I come through unscathed. Weary, oh gods, am I weary. But it’s been months now since I’ve self harmed. Even the most recent scars have faded to pale lines, no darker than the rest of them. She tells me that self injury had a place in my toolbox of survival long ago, BUT THINGS ARE DIFFERENT NOW. And she is correct in that. I’m different in my body and being. I see the urges for what they are: lying monsters.
The monsters wail
Begging to be fed
Promising light after the blood
To slumber in the post pain haze
I know the truth
Of their existence
Never sated, always begging for more
The cravings deep
Alone in the night
With the monsters in my head
In my heart
In my soul
Filling the cracks with blood
In the place of tears
I’ve been with my therapist for about three years now. One of the first things she did was put me on saftey contract. I am proud to say, in that three years, I have only intentionally violated it once. I say intentionally, because the things she considers to be self harming behaviour are myriad. Not using my seatbelt in the car, driving too fast on the highway, not eating right, even not maintaining good sleep hygiene. All of which I’m guilty of at some point. I’m finally at a point where my med compliance is no longer an issue, just a struggle. When I’m feeling good, I don’t think I need them. When I’m not feeling good, I feel what’s the point. So it’s a constant struggle. But the main focus of my contract is the obvious, direct ways I harm myself: drinking and cutting. And after yesterdays session, the struggle is real. I even reached out to her about it last night. She didn’t respond, but as I was in no real danger, I wasn’t really expecting her to.
Self harm. Two little words. The act of hurting oneself. Doesn’t really sound too bad, does it? I even managed to inflict a bit on myself while in her office yesterday, squeezing my hand too hard and leaving deep imprints of my fingernails, took a bit of skin off. She commented on how easy it is to fall back into old ways of coping. It left marks which still are there, though faint, today. It’s so deeply imbedded in my pysche as the only way out of emotional distress, be it feeling too much or too little. And right now I’m feeling too much. Way too much. I can’t even define all that I’m feeling. I tried to in her office yesterday, and last night when I was dying for a sharp to drag across my skin. Lost. Alone. Sad. Melancholic. Overwhelmed. Not present. Broken. Hurt. And a multitude more floating through my brain and body. And that’s what’s so damn hard about this. The feelings are so strong, they’re painful. My body hurts from carrying them. The release of a little blood seems a fair price to pay for the relief. But one of the last things she said to me yesterday was, “Remember your contract. A promise.” A promise to her as well as myself to stay safe. And there are days I curse that contract. That promise. If it was only with myself, it wouldn’t be so bad. I could live with that. But the shame I would feel going into her office next week, and having to say, “I fucked up,” keeps me strong. That and the fact that there are no readily available sharps that I can access. I have a disposable razor in the bathroom, one I keep for emergencies like this. However, the fact of the matter is, I would have to dig it out, dismantle it, and then carry through with the very act I have sworn not to. Many opportunities to pause and think things through. Which she would not hesitate to point out. Something I really value in her is her refusal to accept bullshit answers and provide clarity when things are muddy to me. So rather than face that, I stayed in bed, my safe zone. Except when it isn’t. I try hard to keep my bed a safe place. Injuring myself in the bath, where it’s easy to clean up, or on the floor of my bedroom. My bed is sancrosanct. Not to say I haven’t used an x-acto knife that I forgot to put away while sitting there, focusing only on the imminent relief. That pressure valve which causes immediate and tactile release. But word is my bond. So I suffer. Like Tennyson wrote in Ulysses, “All times I have… suffer’d greatly, both with those/That loved me, and alone… One equal temper of heroic hearts,/Made weak by time and fate, but strong in will/To strive, to seek, to find, and not to yield.”
It’s kind of cool, at the end of the week, to look at your weekly pill box and realize that you haven’t missed a day, and it’s been a few weeks since you missed a dose. For someone like me who struggles with med complaince, this is huge. And I’m still struggling. I’ve been feeling pretty stable the last little while, so the first thing I think of is, “I can go off my meds!” Of course, my therapist,the wonderful grounding presence that she is, immediately responds with, “Maybe it’s your meds making you feel this good.” So, of course, I bring it up to my GP, who handles my meds. “I want to see you stable for a longer period of time. And back to work. Maybe once you’ve been at work for a year we can look at tapering back a bit.” Talk about feeling deflated. Stupid brain. Can’t make it’s own feel good chemicals. And I know, I know all about the comparisons to heart medicine or diabetes. The brain is just like any other organ that can, and does, malfunction. And there is nothing wrong if your brains happiness needs a boost from the wonders of modern medicine. But I have to wonder, if treated today with our vast assortment of chemical bliss, would Van Gogh have painted Starry Starry Night? Would Byron and Poe have been so eloquent and prolific if their fits of melancholy were treated with modern medicine? Would Shelley have written oh so beautifully? Byron was well aware of the connection between madness and creativity. He wrote, “We of the craft are all crazy. Some are affected by gaiety, others by melancholy, but all are more or less touched.” Sure, there are many examples of people being medicated and having successful careers. A quick google search provided me with the names of ten poets currently living with mental illnesses. I wonder how/if they’re all medicated. My medication makes me dull, and creativity is hard. When I’m unmedicated, the words fly to the page easily, too easily I’ve been told. Those words are hard to follow, syntax becomes strange. Even given the free nature of verse, mine becomes difficult to embrace. Kay Redfield Jamison writes quite freely about her battles with bipolar disorder. She knows the dangers of not being med compliant. Yet she wrote a whole book, “Excuberance”, about the very thing lacking in my life with my meds. I tried lithium, but the amount I needed in my system to keep it at therapeutic levels was too high, and the side effects too great. So I’m on the mood stabilizer aripiprazole, to help boost the anti-depressant that I’m on. And I can’t tell which one makes feeling deeply and passionately difficult. So for the sake of my mental health, my creativity suffers. Some days I have to ask myself is it worth it. Then I look at my two boys and realize a subdued mom is better than no mom.
A year ago I attended a twelve week group for survivors of sexual assault. I was hesitant to go, as my experience with groups wasn’t very positive. With a lot of encouragement from my therapist and best friend, I decided to give it a shot. I am very glad I did. A year later, and I have a group of women I now consider to be my sisters. Bonded in a way I never imagined possible. A group of women I can share both my highs and my lows with, and everything in between. An amazing group of women who are supportive, loving, and quick to both laugh and cry with you.
It goes beyond our shared traumas. We are able to share the common, everyday things, the small tragedies and the big joys. And the seemingly small thing of being understood. Unless you’ve been a situation where your whole world is shattered, you never appreciate the comfort in sharing that trauma with people who have suffered in ways similar to you. We’ve all experienced different things, and suffered differently, but we all have been broken. The Japanese have an ancient art of mending broken pottery with gold, silver, or platinum. Kintsugi. They are the gold in my healing cracks.
I’ve been thinking about diagnoses and what they mean to the one receiving them. Usually they come with a sense of relief: I’m not crazy. These symptoms do mean something. But what happens when the diagnosis means you are crazy? What does that mean? I’ve been fighting the BPD diagnosis for years. Never had a therapist agree with it, though I’ve received the diagnosis from more than one psychiatrist. Recently there has been a movement in the trauma treatment community to change it to Complex Post Traumatic Stress Disorder. My current therapist, who is a gift sent from wherever such things come from, explained it to me in a way that made me feel a lot better. It’s not that I’m not fixable, which is the prevailing feeling among most old school practitioners; it’s just that my brain needs a different way of fixing it. I’ll never be neuro-typical. But I can learn to adapt and rearrange the way I process information.
Complex post-traumatic stress disorder (C-PTSD; also known as complex trauma disorder) is a psychological disorder that can develop in response to prolonged, repeated experience of interpersonal trauma in a context in which the individual has little or no chance of escape. (wikipedia) The resulting symptoms closely mirror that of BPD. The key difference between BPD and C-PTSD is that symptoms of BPD stem from an inconsistent self-concept and C-PTSD symptoms are provoked by external triggers. The inconsistent self-concept happens as a direct result of the early childhood trauma or ongoing trauma with no escape. Combine the two, you end up with a very fractured sense of self. Typical therapies for BPD used are DBT (Dialectic Behaviour Therapy) and CBT (Cognitive Behavioural Therapy), neither of which address the underlying trauma.
I grew up always afraid of my father. I don’t remember a time when I wasn’t. That’s how early the abuse started. He was never physically violent to my mother, but he was very much emotionally and verbally abusive. In typical abuser fashion, he never started until after they were married and she was “trapped” with a baby. My therapist explained to me that babies can pick up what’s going on around them, so if my mother was anxious, sad, or afraid, I would’ve understood something was wrong. When asked why she stayed, she recently told me she couldn’t admit to her mother that her mother was right. So her pride ruined my life. Well, my life up to this point. I’m taking charge of it now, and learning to say no to the shit I don’t have to put up with.
Add to the mix a cousin who taught me things no six year old should ever be aware of, a very abusive relationship at a young age with a much older man, and a more recent sexual assault, is it any wonder that my sense of self is fractured? I’m now learning that I matter, that what I want and feel are valid. Novel concepts to be learning at 45. I wish I had the confidence of my young sons. They know they’re important, they understand body autonomy, and while they may not yet know what it is, they live their lives with a purpose.
I long for the day when I can live beyond the day to day, minute to minute, second to second it takes to survive sometimes. But everyday I’m getting stronger. A solid therapist with strong boundaries is key. I’m very fortunate to have found one. She holds the space while I try to feel whatever emotions are coming up. She holds it without judgement and without forcing it. Which is what someone who has suffered much trauma needs. I am doing EMDR, (Eye Movement Desensitization and Reprocessing) along with a combination of other modalities. I take a mood stabilizer to boost the effect of my anti-depressant, and I take an alpha blocker, which helps prevent the nightmares. Being taught coping mechanisms (Babette Rothschilde is an amazing source for this), I can even manage my panic attacks and flashbacks. I’m in a stable relationship, I’m a pretty decent parent, and a damn good friend. None of which should be possible if I was truly only suffering from BPD.
So what does the diagnosis mean to the one receiving it? In my case, nothing at all. It bothered me at first, and if I had received it years ago, before I started working with my current therapist, it might have destroyed me; taking away any hope of ever getting better. Now, it’s a label that might help my disability claim, but that’s all it is. It doesn’t define who I am as a person. It changes nothing. My trauma work is the most important thing I can do for myself, and in doing it, I will free myself from the bindings of a difficult diagnosis with a less than helpful prognosis.
Last year my doctor sent me to see a psychiatrist for an assessment and med adjustment. He’s generally a decent general practitioner, but we’ve been struggling for years to get me stable. I have a history of needed to take three months or so off of whatever job I’m doing because of stress. My previous therapist thought I might have a type of bipolar. No one was sure, so off for an assessment I go. PTSD, depression, anxiety, borderline personality disorder, and cyclothymia. Which I didn’t understand. I get depressed enough that I’m suicidal, and I’ve made an attempt in the past. That being said, a mood stabilizer in conjunction with my anti-depressant has made all the difference. That, and I’m now working with a trauma specialist. Doing EMDR. This year, I went for another assessment. A different psychiatrist this time, who read the notes of the previous one. Saw me three times, instead of just forty minutes. No bipolar diagnosis this time. PTSD, persistent depressive disorder, borderline personality disorder, and general anxiety. Says my symptoms of BPD overlap a lot with the BP, and that the meds often work in tandem together when the antidepressant isn’t enough even without the presence of bipolar. We talked about the BPD diagnosis, and the main reason for the diagnosis is history: self injury, suicide attempts, and, most telling, the feelings of self-loathing and feeling empty and numb. She said with the amount of trauma I’ve experienced, it was inevitable that I would wind up with BPD. So now I’m struggling with yet another identity, one that I have avoided for years. I remember my ex yelling at me, at one point, “I’m not the only borderline here”, yet I was the only one actively seeking help. My therapist told me not to worry about the diagnosis. It basically means I have C-PTSD, (Complex Post Traumatic Syndrome Disorder) and I’m doing the hard work to get better. So that’s something at least. It explains these long, empty nights where I feel so numb and the siren call of self-injury is so strong, even though I’m not feeling depressed. Just numb.