There is Always a Choice

TW: self-harm and suicide

I wrote this in my hospital journal towards the end of my stay. A few days ago, I published a post about self-compassion. The two seem to go together, in my mind.

drawing of landscape with tree and river and words about self-compassionThere is always a choice. Two therapists have told me this independently. It took a little while for the meaning to sink in after the first therapist said it. I had gone a few weeks without self-harm at that point, and I still felt utterly controlled by it. The question of whether to do it or not didn’t seem like a choice; it seemed like an inevitability. Over time, the less trapped by it I felt, and the more sense that statement made. Although the choice of whether to self-harm might have been stacked in favor of doing it, the choice to take steps to change that was still mine.

I relapsed and eventually ended up here, in the hospital. On the surface, I’m likely to view all of that as a failure. However, I didn’t make the wrong choice. I experienced the symptoms of wanting to self-harm and having suicidal thoughts. I made the choice to be honest and to go to the hospital. I’m making choices every day to participate in groups and to work towards stability.

Was cutting a choice? Yes, but it’s about more than that. It’s about larger choices. When my disorder makes resisting those urges and thoughts too difficult, agency over my life as a whole is still mine. I can decide to work towards taking back control in all areas, however slowly I have to do that. It’s about the choices I make to be honest with my loved ones, to go to therapy, and to take my medication, that will affect my recovery from an illness that makes me want to hurt myself, that makes me want to disappear, that tells me that I don’t matter.

I do matter. I choose to work towards self-love.

There is always a choice.

Love,

Your brain

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Acceptance, Self-Compassion, and Growth

The other day, my therapist gave me a handout on self-compassion. My “assignment” is to read through it and make some notes on what stands out to me. Since she reads my blog, (Hi, J!) why not expand my notes into an entire post?

A Definition

Self-compassion has to do with accepting that we are not infallible and treating ourselves gently when we’re suffering. Just like you’d extend understanding and compassionate support to someone else, we can strive to do the same for ourselves. As humans, we’re going to make mistakes; our imperfections are not only part of what make us unique, but their existence is also a common element shared among all humans. The handout encourages readers to stop fighting against the reality that we are imperfect beings.

Here’s my initial reaction to that bit of advice: but if I stop fighting it, I’ll stop improving. 

Growth

drawing of woman surrounded by plant growth

I worry that if I stop fighting the reality that I’m going to make mistakes, I’ll end up stagnating. If you also hold this belief, I wonder if we can change it by convincing ourselves that the components of success don’t necessarily include criticism and harsh judgment. You can like yourself and still be motivated to grow and improve. (This is what the Dialectics in DBT is all about; two seemingly opposed things can be valid at the same time. It’s about finding the middle ground.) Not to mention, you don’t need to beat yourself up for your mistakes in order to learn from them.

Acceptance vs. Resignation

At the heart of it lies another DBT concept, the difference between acceptance and resignation. Acceptance is the ability to recognize and come to terms with the reality of a situation. It leaves room for you to change it. Resignation doesn’t. When you’re resigned to something, it’s like putting blinders on. You see the reality of what’s in front of you, but not the opportunities to your left and right. With acceptance, you can understand that something is the way it is and still take steps to change it.

Depression’s Symptoms

Here’s where I run into trouble. Depression comes with behavioral symptoms that can get in the way of my productivity. When I sleep too much, for example, it somehow feels easier to be hard on myself than to accept that my illness causes these symptoms. Why? Probably because it gives me a sense of control. If I take responsibility for things that are out of my control, I don’t have to face that they are, in fact, out of my control. It scares me to feel like a victim of my illness. I’d rather be hard on myself for something that’s not my fault than relinquish my (false) sense of control over my actions. I think the key issue is that I’m not distinguishing between acceptance and resignation. I can accept that depression causes me to experience symptoms. If I accept that (not resign myself to it), then there are actions I can take to combat those symptoms, and practicing self-compassion will be easier.

Keep in mind I said “easier“. I’ll be honest, this is something I’m really struggling with. How can I hold myself accountable for working to get better without being judgmental when it’s not going to plan? It seems like a delicate balance, but my current strategy is not serving me in the way that I’d like. I guess it’s time to invest in a tightrope.

Are there times when you struggle with self-compassion? How do you remedy it? Share your tips in the comments!

College and SPD: Dealing with Overwhelm

In my last “College and SPD” post, I talked about what I wish I had known about living with Sensory Processing Disorder while in college. This time, I’m going to share what I learned about self-regulation throughout my four years at a large university.

First, a Story

Let me set the scene: I was a sophomore, sitting in the largest lecture hall in the Chemistry Building at my university. The class was Organic Chemistry, and the year was 2015. It was the height of popularity for Bruno Mars’s song, “Uptown Funk”, and nobody was safe from its groovy, brass beat. My 200-some classmates and I were sitting there, trying to draw the chair conformation of alpha glucose with the same finesse as Professor N., when from the back of the hall came the sharp staccato of percussion instruments. If I could describe the look of pure bewilderment on Prof. N.’s face as a group known for interrupting lectures launched into a truly impressive rendition of “Uptown Funk”, I would. But it escapes description. As for the song: it was loud, it was exhilarating, and it left the class reeling for the remaining 30 minutes. Prof. N. was commendably patient and picked up her lecture where she left off, but my peers were distracted and buzzing with excitement.

The spike of adrenaline that I get from the sound of a dropped saucepan or a vacuum being turned on is just like the feeling of having your train of thought derailed by six thespians with trumpets, a bass, and some killer vocal cords. That day in Organic Chemistry was one of the few times I haven’t felt alone in my sensitivity. It was so jarring that you couldn’t help but react, and I wasn’t the only one!

There’s Always Something

Musical interruptions are not commonplace, at least not at my alma mater. There are, however, plenty of stimuli to put you on edge.

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Why do you have to scream? Also, how is this legal?

From the hordes of students clogging the walkways to the documentary clips played at full volume during your history class, to the inebriated bachelorette party on that weird bicycle/drinking bus that passes under your window at midnight.

I quickly found that I needed more time to recharge than I did before college. I also found that it was more difficult to find time to do so. I was swamped with assignments, study groups, and exam prep, and feeling the pressure of those expectations that I should live it up.

I Did Not “Live it Up”

My sophomore-year roommate and I went to one (1) party and spent the entire time shouting over the music to help a drunk student whose friends had lost track of her. For a while, I thought there must be something that I was missing out on. Why would so many people enthusiastically subject themselves to that? The answer is that my threshold for intense stimuli is probably much, much lower than that of someone who loves to party. Parties are loud, crowded, and messy; all things that raise my nervous system’s arousal past where it’s comfortable. While a little bit is enough to overwhelm me, it’s perfect for someone who craves that kind of input. Eventually, I accepted that the party scene just isn’t my thing, and I was much happier for it.

Find What’s Soothing

While you can simply choose not to go to parties, there are some aspects of college life that are unavoidably draining. For the general stress of being a college student, I found that establishing a routine was immensely helpful. Breakfast is my favorite meal and probably my favorite time of the day. I’d wake up at the same time, head down to the dining hall with my own mug, get some coffee and food, and start my day off right (read: predictably).

Having my own space set up the way I liked it was also helpful. Many people don’t have the option of living alone in college, but even when I had roommates, I tried to make my desk and bed into little sanctuaries where I could shelter and recharge. My weighted blanket is wonderful, and I learned to never underestimate the power of changing into pajamas.

When my insomnia was at its worst, it took me two hours to fall asleep at night. I just couldn’t settle down; I’d consciously relax my body, and then ten minutes later, realize it was tense again. All the while, my mind was running through deadlines and anxieties. Taking some time in between schoolwork and bed to do something soothing helped my insomnia. I brought my favorite poetry and fiction books from home so that I could read something enjoyable but not too exciting. I also did mental word games to keep my mind occupied until I could fall asleep.

I would have done some things differently if I’d known more about SPD, but I still found ways to cope. Looking back, I suppose that means that I shouldn’t discount my intuition. Listening to it and not judging it is the hard part.

Art as an Expression of Mental Health

I’ve loved making art for as long as I can remember. I used to draw the same picture of a dog on different pieces of paper and leave them scattered around the house as a not-so-subtle hint to my parents that their 5-year-old really wanted a puppy. I like to draw images that I want to remember; memories of pleasant things and places. But I also use art as an expression of mental health.

self portrait

Feelings are hard to articulate, but colors, shapes, and textures can carry meaning without the structural constraints of sentences. Creating an image can be a cathartic way to express feelings that also lets other people in on the experience. When I don’t know exactly what to make but I have an urge to make something, I start with choosing materials and just let my hand move freely. Something usually takes shape, but even if it doesn’t, I can always just scrap it and start over.

Part of what I love about art as a way to express mental health is that everyone can interpret it in their own way. As the artist, there’s something that it means to you, but you don’t even have to share that meaning with the people who see your art. And even if you do share it, people will still have an immediate reaction based on their own life circumstances and interpretation style.

The therapist I saw in college believed that there were no accidents in art, and would analyze my sketchbook while sitting next to me. While I’m sure there are some elements of my art that come from my subconscious, I don’t usually see the “accidental” parts of my art as meaningful.

That said, there were always parts of my art that my therapist pointed out as meaningful that I hadn’t noticed before. I could always come away with a better understanding of myself, or at least something new to think about. For example, the window mechanism in this piece is very detailed.

Thoughts

She suggested that detail might be an indicator that there was some hope of freedom or escape from the thoughts in the drawing. Whether that’s something that ended up in the drawing because some part of me believed there was hope, I’m not sure. But I can certainly take that sense of hope away from it, into my normal life. 

Art about mental health is not just an excellent way to express feelings, but it also starts a conversation. It can make people feel less alone in their experience, and it can help your loved ones understand your symptoms and how you feel. Sometimes, it even helps me understand where I’m at in regards to my own outlook. Sometimes a piece of art will take me by surprise at its dark overtones when I thought I was feeling ok. Other times, I’m pleasantly surprised to find that drawing a whimsical picture is exactly what I want to do.

whimsical-drawing-of-yellow-blue-and-pink-shapes

If you’re interested, you can follow my art Instagram @lumpdates

Medicine

medicineIt’s nothing to be ashamed of I tell myself twice daily. What day is it? They all blend together. I open the third compartment, pour the pills into my palm, wait for a moment. Maybe this day will be the day. Maybe if I give the medicine a moment of silence; infuse it with my desperation before I let it fall down the dark well of my esophagus.

How many have I tried? Not enough that all hope is lost. How many have I tried? Enough that they call it “treatment resistant” depression. I call it drowning by degrees. Later, I open the third compartment, pour the pills into my palm, and wait a moment.

It’s nothing to be ashamed of.

Love,

Your brain

green-vine-climbing-white-wall

How I Learned to Advocate for Myself

I’ve been enjoying all of the content online for Mental Health Awareness Month, and I thought I’d contribute my own story. Here’s my own experience of why advocating for yourself is important.

I have severe psoriasis, an autoimmune skin condition that makes itchy, flaky plaques where my skin cells regenerate too quickly. During my recent hospitalization (for severe depression), I let my doctors know about this in a brief, it’s-not-that-relevant-but-you-asked kind of way. When the psychiatrist asked if I had any physical conditions, I informed him of my psoriasis.

A few days later, I was meeting with my social worker to discuss my treatment plan. Under “diagnoses”, Major Depressive Disorder and psychosis were listed. Before I even said anything, my social worker quickly brushed it off and said “don’t worry too much about the psychosis- it might just be that you were confused when you came in”.

Now, I’m the kind of person who will eat the wrong food at a restaurant rather than speak up and point out a mistake. I’m the kind of person who willingly takes the middle seat on an airplane because my neighbor explains that she has to pee a lot. Seriously. I am not assertive.

However, diagnoses are a whole ‘nother bucket of fish. When I saw that on my treatment plan and heard my social worker minimize it, I made it clear that I was confused by it and wrote my concern in the questions portion of the form. The next time I saw the psychiatrist, I steeled myself in preparation to ask about the mysterious psychosis that I definitely didn’t have. Before I could bring it up, he sat down, sighed, and said “it turns out that they couldn’t read my handwriting and thought I wrote ‘psychosis’ when really, I wrote ‘psoriasis’. It’s all fixed, now.”

I laughed about it at visiting hour that night and for many nights after. Really, we’re still laughing about it. We’re getting some serious mileage out of that one.

The important thing is that I spoke up for myself and that it got remedied. I almost had an incorrect diagnosis which could have caused more confusion down the line. So, speak up! If something doesn’t look right or feel right, let your doctor know. They’re people too, and sometimes mistakes happen.

Also, handwriting is more important than you might think.

peter-cohen-quote-wellness-and-self-care

Levels of Mental Health Care

In light of my recent posts, I thought it might be useful to elaborate on the levels of care you can find in a hospital setting (at least in the US). What are the differences between them, and what can you expect from each?

Inpatient Treatment

Entering a hospital as an inpatient for mental health concerns can be incredibly nerve-wracking. If you don’t know what to expect, the experience is overwhelming. The important thing to remember is that the system is designed to keep you and the other patients safe.

In an inpatient setting, you sleep at the hospital and spend your days on the unit. You might have a roommate; they’re probably just as overwhelmed as you are. The staff will likely elaborate on the expectations for patients, but you may be expected to spend the majority of your time in a common area, interacting with other patients and staff. Your nurses and doctors will want to see that you’re participating in group therapy, willingly spending time outside of your room, and eating meals with the unit. You’ll meet with your doctor and a social worker, and have a chance to discuss your treatment goals and any concerns you have. Different hospitals have different timeframes for this; you could meet with your doctor as often as every day, although it may happen less frequently.

Before you’re discharged, the staff will probably want to be sure that you have a support system, safety plan, and aftercare set up. Continuing care might look like a partial hospitalization program, intensive outpatient program, or outpatient therapy with your own mental health counselor.

Partial Hospitalization Program (PHP)

The next level down from inpatient care is a partial hospitalization program. In a PHP, patients typically attend therapy for most of the day, sleep at home, then return for the next day of programming. For example, the PHP I did was from 9 am to 3 pm, Monday through Friday for ten days.

Programming usually focuses on teaching skills and information you can use to manage your illness. The PHP I was in took content mainly from DBT, although we also touched on ACT and CBT. You’ll meet with a psychiatrist and your case manager, who is usually one of the therapists who leads group discussions and teaches content. Your case manager will probably set up a treatment plan with you, and meet with you periodically to check in on your progress.

Many people come to a PHP through inpatient hospitalization. After spending time isolated from your normal, day-to-day life, it can be overwhelming to be tossed back into it. A PHP can serve as a helpful step-down to ease you back into your routine. Other people come straight from their outpatient treatment. They may not need the level of care you get with inpatient treatment, but the support of a PHP can give them the structure they need to stay safe.

Intensive Outpatient Program (IOP)

In the same way that a PHP offers a transition from inpatient back into your normal life, an IOP does the same. It’s the next level down from a PHP, but is still, well, intensive. An IOP is similar to a PHP in the content that’s taught, but you meet less frequently and for a shorter amount of time each session, but for a longer overall duration. Many IOPs meet three times per week for three hours. The program might run for as many as eight weeks. The IOP at the hospital where I did my partial hospitalization had a more independent treatment; you didn’t get to meet with a psychiatrist or a case manager. That meant you would need to have outside medication management set up for your time in the IOP.

Many people go straight from inpatient treatment to an IOP, although others may need the structure of a PHP. Some people continue on from partial hospitalization to intensive outpatient, but sometimes that’s not feasible with work or family obligations. I decided not to do an IOP, but rather to return to my regular schedule and leave IOP as an option should I need it down the road. It’s all very individual, and which program you choose depends on your specific needs and constraints.

 

 

prairie-with-blue-sky-and-clouds

What I Gained in Partial Hospitalization

Two or three days into my partial hospitalization program, it became clear to me that my peers were seeing positive results. At check-in, those closest to leaving would report feeling “good”, or “light”- two sensations that are unfamiliar to my depressed brain. I was glad that they were feeling better, and initially, it gave me a glimmer of hope for myself.

As the days passed, that hope dimmed; I wasn’t feeling much better at all. In fact, as my last day approached, I started feeling lower and lower. My thoughts about self-harm came back in full force, and when I tried to use the skills we’d been taught to combat them, I was unsuccessful. Morning check-in was even more excruciating than usual because I had to admit that I wasn’t doing well. The people who had come before me had felt better, so what was I doing wrong?

For one thing, I wasn’t doing anything “wrong”. The psychiatrist and both therapists for the program all agreed that the root cause of my depression is chemical. This doesn’t mean that coping skills are useless. They can help keep me safe and offer healthier alternatives to my go-to, maladaptive coping mechanisms. Over time, I can retrain my brain to help me get out of negative thought patterns or habits. However, coping skills are unlikely to do much to address the causative problem.

Secondly, there is no right pace for recovery. Comparing myself to others was only making me feel worse. That said, it’s only natural that we look to others to find out what to expect when we’re in an unfamiliar situation. I wish I had been able to temper my expectations when comparing myself to others.

Just because I didn’t leave partial walking on air doesn’t mean I “failed”. I still got a lot out of the experience.


Connection

Similar to my experience of being an inpatient at a mental hospital, one of the most valuable takeaways for me was the sense of connection I had with other patients. Hearing about other people’s perspectives on a shared experience helped me gain insight into my own thoughts and behaviors. Plus, it feels good to talk to people who understand your suffering and can empathize. I definitely came away from the ten-day program feeling less alone.

A sense of my own value

The first few days of my participation in the PHP, I was there for my family. I was there because other people wanted me to be, and I was willing to commit my time to a program like that in order to ease my family’s fears. A few days ago, though, I realized that I felt more like I was there for myself. It was a subtle shift, but it feels like a big step.

Acceptance

Throughout my inpatient hospitalization and partial hospitalization, I had several moments that stopped me in my tracks. The fact that I was at that level of care for my mental illness seemed surreal, and I couldn’t wrap my mind around the situation. I think that I have a better grasp on my symptoms and what I need to do to keep them under control. I also have a sense of acceptance that once I feel better, I’ll still need to manage my illness; I won’t be able to push returning symptoms under the rug. That’s how I ended up in the hospital.

Greater understanding of my patterns and behaviors

While the skills I learned may not address the root of my depression, they certainly help me shift my behavior towards healthy responses and actions. Perhaps the biggest behavioral takeaway for me is greater awareness of how I withdraw, isolate, and avoid addressing the issue of my depression with my loved ones.

Patience

No, I didn’t leave the program feeling like my peers who had left before me. Everyone goes at their own pace, and everyone has unique circumstances and factors involved in their symptoms. All we can do is go day by day.

My Secret Fear about Depression

I have a secret fear that maybe this is what life is like for everyone. Maybe I’m expecting too much. Maybe other people can cope with life’s stressors better than I can. Maybe I should try harder. Maybe my depression is fake.

Spoiler alert: it’s not.

Part of what makes depression so terrible is that, by its very nature, it keeps you from getting help. It tells you you’re worthless, it makes you ashamed, and it robs you of motivation and energy. My depression tells me that I’m ungrateful and burdensome and that I should keep quiet about the things I’m struggling with. Well, y’know what? I’m sick of taking orders from The Lump.

I’m going to PHP group therapy, individual therapy, and I’m talking to my family and friends about my illness. I’ve even told a few acquaintances about my hospitalization. And, guess what? Everyone has responded with compassion and support. Not one person has said “You’re faking it. Just stop being sad.” The only time I ever hear that phrase is when it’s inside my own mind.

It’s time I show myself a little of the understanding and reassurance I receive from others. After all, I have a biochemical imbalance in my brain. It’s not my fault.

Mindfulness and Emotions

If you’ve been keeping up with my posts lately, you know that I’ve been having a rough time of things. I’m waiting for my new medication to kick in and doing my best to implement skills I’m learning in partial hospitalization. Whether it’s the meds, the skills, or just the ebb and flow of emotion, I’m finding myself…feeling….feelings. Wild, right?! The numbness is retreating and being replaced with actual emotions. Which, is good. I think. I’m no longer feeling crushing sadness through a thick haze of nothingness; I’m feeling crushing sadness in a pure, unadulterated manner. But, that’s okay- because it passes. The sadness checks in, I sit with it and do my best not to catastrophize that it will stay forever, then my dog does something funny and amusement bumps the sadness out of the way. Later, I’m outside, enjoying the sunshine when sadness saunters up again and says “Hey. Really sucks that you missed out on all of this pleasantness when you were in bed for days on end, doesn’t it?” Yeah. Yeah, it does. Thanks for that reminder, brain. So then I’m sad about being sad. I’m meta sad. Immediately, worry and despair pop in to let me know that a moment of enjoyment doesn’t fix everything and that I still have a long way to go. Oops, now I’m crying, and maybe I’ve ruined the moment entirely. Quick, focus on the sunshine! Focus. On the. Dandelions! 

Forcing yourself to be mindful is kind of the opposite of mindfulness. Clearly, I have some work to do, which is why this weekend I’m trying to embrace the “non-judgmental” part of mindfulness. Emotions are healthy, and although I’m still feeling more negative ones than I’d like to, it’s ok that they’re there. When I start to feel sad about the past or anxious about the future, the best way to not get trapped in it is to just notice it and then redirect my thoughts. The weather is beautiful, I’m fortunate in more ways than I can count, and it’s ok to take time to heal.