Contradictions (and how I suck at them)

I'm going to straight up just warn you that a) this post may be triggering due to disordered eating content, and b) I'm pretty much going to just talk about myself. Also, I'm really bad at blogging regularly, so there's that.

Unless something has radically changed in the past, say, week, the best treatment for BPD currently out there is DBT: Dialectical Behavior Therapy. Developed by a researcher named Marsha Linehan who recently "came out" as having BPD herself, this treatment method focuses on dialectics, taking contradictions and reconciling them with each other to eventually reach a middle path. This works for BPD because people with BPD often go to extremes. We are either on top of the world or feel crushed by the weight of it. People we know are either awesome or a complete and utter disappointment. I can do anything I want, but I am simultaneously a total failure.

So DBT is the therapy for borderline, and is also being used for some other mental illnesses as well, especially co-morbid disorders. But sometimes I feel like my life is made up of contradictions that I cannot reconcile.

For me, eating has always been a source of anxiety. As a child my parents were very restrictive about what we ate, probably because my father specializes in nutrition. So sweets and junk food were rare treats and food became a reward, and like many people it became a source of comfort. But I also developed a very strong sense of certain foods being good and others being intrinsically bad. There was no middle ground.

Now, this is all pretty normal in our society. It seems like every day I hear of a new fad diet, and almost all of them categorize foods as being either bad or good, allowed or forbidden, and so on. But for me this somehow translated to the food I ate determining whether I myself was bad or good. I became very exacting about what I ate at times, but at others I'd reward myself with very indulgent foods. Not bingeing, but feeling that I was only allowed to enjoy food if I'd earned it. This was basically asking for trouble.

As my self esteem worsened over the course of middle and high school I based a lot of my sense of worth on my diet. But this came to a head in the past year when, as my self esteem plummeted and I came to hate myself, I began to use food as a means of punishment. I began to feel that I did not deserve food because I did not feel deserving in general. Giving in and eating anything signaled weakness and greed, restricting and fasting a sign of strength, an indication that I was good. Purging became a punishment for eating. I knew that it wouldn't "get rid" of the calories, but it was unpleasant and it was what I felt I deserved.

This entire time I've known that my eating habits and my views of food were extremely unhealthy, but at the same time these disordered behaviors are a source of comfort, quelling my increasing anxiety around food and pretty much every other aspect of my life. But now I have once again come to an impasse, a contradiction that I cannot reconcile: I know what I'm doing is unhealthy and I want to change that and feel better about myself, but I still feel unworthy of health and of happiness and in that sense don't want to change and lack the motivation to do so. Disordered eating has become my drug of choice, but I haven't hit bottom yet and therefore lack the will to change. I am stuck in a place where I ask for people to help and then resist all efforts people make to do so.

So I guess Marsha Linehan was right. I have some contradictions I need to deal with. I just haven't figured out how to do that yet.

The trouble with inpatient psych treatment

I've seen shows before or read books about psych wards before. Generally they're portrayed as being a normal hospital floor, just with a lock on the entrance. And like a normal ward, patients generally keep to themselves, interacting only with hospital personnel, family, visitors, and getting most of their treatment from a pdoc.

That's basically bullshit. Or rather, that's nothing like what I've seen or experienced. The fact is, psych stays tend to be longer, you usually have a roommate, and you don't spend very much time with the pdoc. Most of your time is spent sitting out on the unit (aka outside your room) for groups or just for something to do. visiting hours are always restrictive, though how much so varies. But what I'm trying to get at here is that you are basically living with 14 or however many other people who you didn't choose. And as an added bonus all of them are probably mentally ill. On the one hand, you're living with a dozen or so others who have a good idea of what you're going through and who you can talk to about a lot of stuff that most people just don't get. On the other, particularly depending on the nature of the unit you're on, there can be other patients who are, to put it mildly, problematic.

I have to take a moment here and just say that the MTs are not paid anywhere near enough for the stuff they have to put up with. I've seen other patients yell, scream, kick walls, bang on windows, throw furniture, and hurl abuse at them and they still manage to keep their cool. But that behavior is what I'm referring to when I say some of the other patients are problematic. Specifically, on a general adult unit, odds are there will be a patient who behaves this way or who is in some other way threatening, and that was the case during my most recent hospitalization. I feel that now is a good moment to go into a bit more detail regarding my own specific flavors of cray.

I have been diagnosed with Major Depressive Disorder, Borderline Personality Disorder, and social anxiety. On various occasions the possibilities of PTSD and some sort of eating disorder have also been discussed. The PTSD would be due to either childhood physical and verbal abuse or due to a shooting that occurred in a hospital I was a patient at last year. So when a patient became agitated and said that I, specifically, was rude and annoying and that he did not want me to speak to him, I was alarmed, particularly since this same patient had on several occasions behaved violently. I did my best to avoid him, but again, we were on a very small, locked unit. I ended up in a vicious downward spiral where I felt I had to avoid the communal area where we watched TV and had groups so as to avoid him and then feeling that everyone else was siding with him because they all happened to be sitting with him and chatting.

I felt isolated, frightened, confused, and angry, and ended up spending the night sobbing and terrified because I had been very, very triggered. And this isn't a rare occurrence. I have been triggered in the hospital several times and have seen others triggered on plenty of occasions. It is enough to make me question how helpful inpatient stays really are in the long run. Yes, they can keep you safe when you can't do that on your own, but is there a better way? I honestly don't know.

It isn't all bad

Sometimes, when I'm doing something I like and I'm have a good time, it occurs to me that BPD isn't all bad. Well, maybe it is, but I don't know what life is like without it, so I'm deciding it isn't all bad. What I mean is that since BPD results in emotional extremes, even though that means that bad times get really bad, it also means that I jump into things headfirst with endless enthusiasm when I'm doing fun things. And I have a great time.

In the interests of full disclosure, I may currently have a kitchen being taken over by baked goods that I spent the past 3 hours making. Also I am now the proud owner of two sourdough starters, Carl the white starter and Carol the whole wheat starter (names are subject to change).

ER doctors, this means you

Hi, I’m back. Just wanted to fill whoever happens to be following this in on what’s been going on. On Tuesday last week I had a pretty severe intentional overdose. I was hospitalized for a few days and had a stay in a psych hospital, but I’m pretty much fine right now. But that isn’t what I really wanted to talk about. What I’m more interested in talking about is how I was treated by ER staff and hospital personnel. Now, I’m going to put in a disclaimer here that no, I don’t think that people who OD should be coddled by hospital employees. However, I do think that, despite the fact that it was my own actions that brought me to the hospital, I still am deserving of respect, access to my own medical information, and some measure of dignity.

There is no excuse for me to be completely ignored by nurses and doctors when I asked questions about my own treatment. I was still deserving of a thorough explanation of how and why I was being treated, and I certainly did not appreciate being treated as if I wasn’t intelligent enough to warrant explanations of medical procedures.

Anyway, I'm hoping to be posting a bit more frequently in the future, so I'll see all of you soon. Metaphorically of course. Physical creeping is just too much effort, what with the climbing and the hiding and the smoldering eyes that I'm told are a necessity. None of that Edward Cullen bullshit.

On asking for help

I don't know about anyone else's experiences with BPD or depression, but I know for me it can take me surprise, even after months of almost daily therapy. Just yesterday I was reading a study that referred to people with "serious mental illness," and I thought to myself, "would I fit in that category?" And my immediate response was "oh course not, I mean yeah, things get bad sometimes, but I'm largely functional and relatively well adjusted and blah de blah." But by the time I went to bed I realized that maybe I'm not as well adjusted as I'd thought. All of a sudden things were "that bad" again, and all it took was feeling slightly overwhelmed by things, feeling a little worse than usual about myself, guilty about how much I've been eating, guilty that I don't study enough, shame about some of the more self destructive things that have been going on, and I can go from feeling pretty okay to actively suicidal in a matter of hours.
Now, I know that this has probably been building up for a few days if not longer and that emotional lability is one of the symptoms of BPD, but it still shocks me how quickly things can implode in my life. And despite all the therapy I've had in the past year or two I still don't know what to do when this happens.
Even more alarming is how hard it becomes to ask for help when I feel my life start to collapse. It's really counterproductive because when things are going relatively well I find it easy to open up in therapy or to friends, but as soon as I become suicidal I retreat, desperately hoping someone will notice and help but completely unwilling to risk someone knowing because I half hope that this is the day I manage to go through with it, that this time I will be better at suicide than I've been in the past. But  even though I can't bring myself to tell someone when I know they will stop me, I hope someone does.
It occurs to me that maybe what makes BPD so serious is that most of the time it's easy for me to seem okay. I can fake it just well enough that no one knows when I most need help.
Now, I have no idea if anyone actually reads this, but if anyone is reading I'd love if you'd leave a comment about how you ask for help when you need it. Who do you talk to, what do you say, and how do you know to ask?

Hey, I'm back!

Sorry about how long it's taken for me to get around to blogging again. I'm not entirely sure who I'm apologizing to since I doubt anyone is waiting with baited breath or anything. Anyway.

I wanted to add a bit to my earlier post (tirade?) about mental illness and guns. I know, it's already really long, but I care about this a lot. Probably too much. Stop judging me, sheesh!

I was thinking today about how so many advocates of gun rights say that they need guns for self defense. They want guns to protect themselves, and this is understandable. Really! I don't fault that perfectly reasonable desire to feel safe. But as I thought on it, something about this did not sit well with me, and I finally figured out what it was.

I keep hearing from old white men that they want guns for self defense. But they are incredibly privileged. In all likelihood, they will never need to protect themselves from bodily harm. Whereas people who lack that level of privilege are much more likely to need protection. Case in point, mentally ill individuals are a lot more likely than the general population to be victims of a crime. But these are the exact people that are being barred from having weapons. I agree with restricting access to guns, but it pisses me off that the people who already have insane levels of privilege are fighting to get weapons that will only serve to drastically increase the power imbalance that already exists between them and underprivileged groups. And then these underprivileged groups are the ones being denied access.

And so I wonder: what makes their need for a sense of security more important than mine? If I am not supposed to have a gun so that they can feel safe, doesn't it follow that we should restrict everyone's access to assault weapons so that I, too, can feel safe? Because as long as the people who already have the upper hand in our society have weapons that are designed specifically to kill other people, I don't.

Shootings, the Media, and Mental Illness

(Content Note: violence, othering of mental illness, threats)

I doubt it will surprise anyone to learn that these things are all connected, but the hows of it may not be as obvious. Contrary to what the media seems to be indicating, it is not mental illness that is hostile to society, it is the media that is hostile to those who are mentally ill. Never is this more true than in the immediate aftermath of a violent tragedy such as the recent shooting at Newtown.

To start with the glaringly obvious, most mentions of mental illness in the news recently have suggested a correlation between mental illness and crime. The resulting impression is that those with mental illness are frightening, dangerous, and very much "other." In and of itself, this concept is counterproductive. By perpetuating the stigma associated with it, these statements make it harder to seek treatment and build a support system for dealing with mental illness. Obviously, someone who is mentally ill and prone to violence is far more dangerous when not being treated appropriately by mental health experts. 

Worse still is the conclusion that, because they are inherently violent, individuals with mental illness do not have the same right to privacy as "normal" people do. Today's New York Times had an article titled "New York Has Gun Deal, With Focus on Mental Ills; Obama's Plan to Be Broad" which described new measures being discussed to try to prevent gun violence. One of the suggestions that is repeated throughout the article is that of improved, stricter background checks. Now, I am all for screening people who wish to own guns. Hell, I'm in favor of most gun control laws. But they lost my support when they suggested that Obama may issue executive orders that "force states to feed all relevant data into the background check system so those with criminal convictions and the mentally ill could be flagged." Once again, mental illness is categorized with criminal tendencies, but worse is the unprecedented invasion of privacy that would result. 

I know that this has been stated many, many times recently, but people who suffer from mental illness are far more likely to be victims of violence than to be perpetrators of it. It makes far more sense to put provisions in place to better protect those diagnosed with mental illness than to subject them to invasions of privacy like this. I was outraged when the president of the NRA suggested a "database of the mentally ill" in their press conference a week after the Sandy Hook massacre, but I never expected that the concept would be seriously considered.

The second major concern I have with the media's treatment of mental illness recently is that no regard is being shown for victims of violence. Melissa McEwan over at shakesville explained this problem far more eloquently than I could, but suffice it to say, some mental illness results from trauma and violence, and the constant, graphic descriptions of violence we have been bombarded with recently have been triggering, at least for me. So not only are we blaming mentally ill individuals for violence, but we are now using that same violence to further contribute to mental illness. Awesome. This sounds like a great plan. What could possibly go wrong?

But I think the thing that has been most disturbing to me in the media recently is that while there has been lots of talk of focusing on mental illness as a risk factor for future violence, I've seen very little mention of actually implementing resources for effectively treating mental illness. The barriers that impede access to mental health services are not being adequately addressed. No one seems to be talking about how difficult it is to find affordable treatment, or how hard it is to find treatment providers who have space for new patients, or any of the other things that could be immensely helpful for those who are currently living with untreated mental illness. 

So basically what is being advocated is ignoring privacy rights for those who are mentally ill, further victimizing them, and not even making any attempt to make treatment more readily available. Stop the world, I want off.