Self harm and me

Trigger alert – today’s post talks about self harm and it’s causes. If self harm is a problem for you please get help from a professional. This post describes my experiences and is in no way designed to encourage anyone else to self harm.

Just as an added note, I wrote the following post last weekend. I debated all week about whether to post it because the issue of self harm carries a huge amount of stigma. Many people know I have this problem because the scars are hard to hide, but no one (with the exception of my family and one other person) has ever raised the subject with me.

The shame and stigma attached to self harm are overwhelming at times and it is perhaps one of the hardest aspects of mental illness to discuss. Many people can not understand why you would want to harm yourself, particularly using the method I do which is cutting. The following post describes what leads to this behaviour and the biological reasons why.

(Sunday)

Today….today was unfortunately one of those days that is so common for me as a person with BPD. A day where my moods changed with speed of the wind outside, sweeping away all traces of what I felt previously and hammering me again and again with intense emotion.

This morning I woke feeling motivated. Little G went off to her father’s early, and then I got on with the washing and ate breakfast. I had decided to spend another hour or so in bed as it had been a long week and I was trying to take things easy so as not to get sick.

All morning my brain fought me. It was sunny outside and there was a war raging inside my head. One side telling me how lazy I was, and that I was wasting sunshine and time laying in bed reading. And the other side telling me I needed the rest, to give my body a chance to recharge and get ready for the next week. I recently found an article about boring self care and her drawings were the main reason I managed to stick to my guns this morning and try not to berate myself too much for resting and reading. She does cute little cartoons about the little things we can do to take care of ourselves, and today I knew that rest was what I needed. Didn’t stop my brain from trying to take over with my normal pattern of non stop activity to fill a long day by myself though.

After lunch I stopped feeling like I should do something, and started feeling like I didn’t want to do anything. This was particularly bad timing as this is when I’d actually planned to get moving and do chores and buy groceries. It took me several hours to force myself to have a shower and get lunch, put on shoes and go outside for a walk. My brain kept distracting me and I was having trouble focusing on what I should be doing. I wasn’t actually doing anything during this time except wandering around pausing and looking at all the stuff I should have been doing. The thoughts in my head about me being useless and lazy were pretty loud, and were drowning out anything much else at that point.

I finally got outside and did about half an hour’s walk. This week’s goal is to be consistent with my exercise, and try and do 20-30 minutes on 5 or more days. I walked yesterday and today so was reasonably pleased by the time I got home. Off to the supermarket and for some inexplicable reason, the person in front of me drove at 35 km/h the whole way (speed limit is 50 km/h, I normally do more like 60!). The frustration and anger that overtook me was incredible, I was imagining setting up a punching bag and slamming my fists in to it over and over. After 5 minutes I was in full blown rage mode, though my rational/logical mind kept trying to tell me I wasn’t in any hurry and that I should calm down.

Pull in to the supermarket car park and park the car in the far corner away from anyone else so I can have some deep breaths and calm down. Then on into the supermarket. After only a few minutes inside I start feeling really upset, then a sad song comes and I have tears in my eyes while I am picking out apples. After telling myself that I’m being ridiculous and have no reason for crying, I manage to pull myself together enough to continue with the shopping.

In the supermarket environment I’m overwhelmed by the number of people, the bright lights, tiredness and the music. My physical senses are often in overload in settings like that due to my autism.

My emotions have run the gauntlet from motivated to hyped up, to depressed, then to confused and distracted, happy after my walk, then tired, angry, full of rage, then to sad (complete with tears). I feel so overwhelmed by the large swings in my mood that my brain keeps trying to default to its standard method of taking the emotional pain away.

All I can think about is drinking alcohol and cutting myself. I’m severely triggered walking past the wine and beer aisles. The craving for a drink is so strong that I can’t stop myself from choosing a bottle of wine to take home, all the while knowing it is the first step on a disastrous path that only has one end.

I’m well aware of how destructive the drinking is, and how once I start drinking then what little control I have over my self harm urges subsides. This usually leaves me sitting in a pool of blood with a razor blade in my hand at some point.

I have to walk past the utility knives, don’t need those as my house is littered with them, and anyway they don’t provide the deep cuts that give me the relief. They have long since been replaced with razor blades.

I’m not buying blades today. My hands are shaking on the trolley as I walk past but I try and tell myself that if I don’t buy them then all I’ll do is drink. Unfortunately, this has not proved true in the past. I know full well how to take a razor apart when I’m drunk and in the grip of my compulsion.

In situations like this in the past I’ve gone straight home after the supermarket, opened the bottle, sat down and cried about what I’m about to do. I’m normally a spirits girl and a shot is all it takes to release the flood gates. That is when the blades come out and I promise myself it will just be one or two cuts. That I’ll see the blood and feel a bit better and then I’ll stop. However, it usually takes 8 – 10 shots with small chasers of coke before I’ve cut myself enough to be able to control it enough to stop.

It’s hard to describe the relief the cutting provides, and it can be different depending on the circumstances at the time I have the urge to self harm. For me, self harm is a compulsion. I’ve used it so many times in the past that my brain is wired up to want to complete acts of self harm to relieve my emotional pain.

Part of the reason for this is because at some stage I accidentally tapped into the brain’s ability to use it’s natural painkiller, endorphins, to relieve my emotional pain. Our human brains are wired up to sense both physical and emotional pain using the same two areas: the anterior insula and anterior cingulate cortex. When you get hurt physically, your brain registers the pain in these two areas and prompts the production of endorphins, which is the brain’s own natural morphine. Wikipedia says “The principal function of endorphins is to inhibit the transmission of pain signals; they may also produce a feeling of euphoria very similar to that produced by other opioids.^[3]

Basically this means that if you cause yourself physical pain, the body produces endorphins which then act on your emotional pain as well. In terms of self harm, this is why it can be so addictive – create enough physical pain and your emotional pain will be relieved with endorphins your body has produced to get rid of physical pain. Unfortunately there is no way to stimulate an endorphin response to emotional pain without causing yourself physical pain. And it seems (though more research is being done on this) that you can not relieve emotional pain with painkillers made for physical pain.

The upshot of all this is that every time I create physical pain in response to my emotional pain, I force my body to produce endorphins which relieves both types of pain. This creates a feedback loop – emotional pain leads to physical pain which causes endorphins which relieves the pain. And every single time I use that response to my emotions, the feedback loop is reinforced, making that connection stronger and stronger. This makes the urge to harm myself become a compulsion when faced with situations that trigger overwhelming emotions.

This is not the only reason people self harm. Sometimes for me it is about punishing myself, causing myself pain because I believe I deserve it. Sometimes it is more about the scars and pain on the outside matching the black deadness you have on the inside. Often it is a combination of things – a triggering event may cause the compulsion but may also cause me shame because I’m not living up to my own expectations. I can spiral down as thoughts about what a terrible person and waste of space I am go around and around in my head.

The therapy I’m doing, which is a combination of acceptance and commitment therapy and dialectical behavioural therapy with a few other things thrown in, is teaching me to recognise my triggers, to try and prevent them, and what to do when I am in this situation. In order to remove my self harm behaviour I have to have something to replace it with. Not only do I need to recognise when I’m having thoughts that lead to overwhelm, I have to self care skills, triggers, be able to tune in to myself and my surroundings (mindfulness), and a range of coping skills to suit all sorts of situations.

So, last Sunday, despite the fact that I brought the wine, I came home and I did not drink it. I put it away at the back of the cupboard, then I ate dinner. I had forgotten to eat much during the day and it wasn’t until I did some mindfulness on the way home from the supermarket I realised I was hungry. I switched on Netflix and watched a funny movie, with my soft sensory blanket on my knee and the cat on my lap. Then I got on here and wrote about my day. I did some other writing which was a bit of homework for my therapist and finally sat down to read. Crisis averted, till next time.

You might think, reading what I did to cope with that overwhelming urge to self harm, that the things I did were nothing special so how could they possibly have helped if I was really that bad. The answer to that is two fold. One, the whole time I did the things I outlined above my body was craving endorphins. The thoughts don’t leave my mind, I just try and distract myself from acting on them. Two, it’s taken a lot (a lot a lot) of hard work over the last two years to get this far. I have crisis strategies like holding cubes of ice (either in my hands or against my arms), submerging my face in cold water, intense exercise (like short sprints), and paced breathing. But first I try distraction and soothing my senses with things I know work for me (a really good link explaining this is here.

Things are slowly getting better but sometimes I fail, and sometimes I fall. I am always going to have to be mindful not to fall back in to old patterns. At times the amount of work I need to do to get and remain mentally healthy looks like an enormous burden. But I have learnt that there is a time to look at the big picture and a time to look only a little way in front of you. Sometimes it’s best to try and deal with today and plan just for tomorrow rather than get too tangled up in what the future might hold.

Ka kite ano

Little G and my mental health

Thank you to all those people who commented on facebook and here about my previous post. It was amazing to get that much positive feedback as I was really apprehensive about putting that sort of information out there about myself. It’s a very humbling experience to find so many people appreciate my honesty. I had to think long and hard about whether putting my experiences online was the right thing to do, because I do have a professional job and the stigma is very real. Not from my co-workers (love you guys!) but because I work so hard to present a calm, capable front to my clients and I didn’t want to do anything that might cause any of them to doubt my abilities (if they ever find this).

I also have to be cautious on Little G’s behalf for several reasons. I am open with her about my mental health as much as I feel is age appropriate. I have to try and make sure she doesn’t feel any obligation to try and make me better, or feel happy, or to take care of me. I repeatedly explain to her that I am her Mum and I do my very best to be as stable as possible for her. It is my job to take care of her and provide for her, not the other way around. She loves to do things for me like make me breakfast and she is very aware of when I am not well. She can read the expressions on my face when I’ve had a bad day better than anyone else I know. My top priority is to make sure she feels safe and loved, every single day.

When I was in hospital in March it affected her considerably more than I expected it to. She was told that I was in hospital, and she stayed with her grandparents and auntie. I didn’t want her to come and see me, partly because I was very unwell and I thought that might scare her, and partly because I was worried about exposing her to some of the strange behaviour of the other unwell people on the ward. I had about four days in there, then I was out for a few days at my parent’s place, then I got worse and had to go back for another four or five days. She was very worried about me, and she was noticeably sad at school. Her teacher was concerned enough to mention it to me the following week, and several mums also told me she had said various things to their kids about how upset she was that I was in hospital.

It’s very awkward to explain why you are in hospital to people when your child has said ‘Mummy has something wrong with her brain’ and everyone’s minds jump to cancer or brain tumour!! I try as much as possible to be honest, especially in situations like that, because I don’t want people thinking I have cancer and I don’t want to be embarrassed because my brain was unwell instead of say my heart or my kidneys. But telling another parent or your child’s teacher you were on a psychiatric ward is not exactly my idea of fun, and it sure isn’t for them either! There’s always awkward silence while you can almost see the wheels in their brains turning, trying to work out what to say. My embarrassment is less about what they might think of me, and more about having put them in a position where they don’t know how to respond.

Then there is the inevitable variation on the theme ‘hope you are feeling better now’ and it’s difficult to know what to say to that. It’s mental illness and you don’t just recover or feel better in a few days or even weeks. I always appreciate the sentiment but if I do my default and say ‘yes, much better thanks’ it’s basically a lie, but the truth is socially inappropriate. This is where my Aspie brain gets a little tangled up in whether honesty and truth should win out over social convention…..

Little G’s support worker also reminded both of us a couple of weeks back that kids can be very cruel. She said that it is good to be open talking about mental health, but that Little G needs to respect my privacy and not tell everyone her Mummy has a mental illness. Partly because it’s my choice whether to share that, and whom to share that with, and partly because kids can and often do tease children whose parents have mental health issues, saying their parent is ‘mental’ or worse. Those are two things I hadn’t really thought about and I appreciate her reminding us of those issues.

Over the holidays Little G got to attend the holiday program put on by Family Link where she met other kids whose parents have mental illness and/or addictions. They did some fun activities and learnt about the brain and how it works. I think the best bit for her was learning that there are other kids out there living in the same situation as her. Their parent is struggling with similar issues to those I have and they are going through the same things.

She’s still working one on one with her support worker too. At each session she learns about various mental illnesses, the symptoms of my particular one, about feelings, what makes her happy, and what to do when I am unwell. We’ve put a support plan in place so she knows what will happen if I go to hospital again, and it’s been reinforced to her that my mental health is not her responsibility. She seems much more settled and less anxious now so it seems to have paid off.

I seem completely unable to write a succinct blog post to I’ll sign off here.

Ka kite ano

Chris Cornell, suicide and major depression

The death of Chris Cornell by suicide, and the subsequent discussion of his death in various forms of media, has had me thinking about my own major episodes of depression.

When I heard about Chris Cornell I was so incredibly sad. The man was a genius, and the Temple of the Dog song Hunger Strike (sung in duet with Eddie Vetter of Pearl Jam) is my favourite song of all time. Oddly enough, though I love most of Soundgarden and Audioslave’s music, it’s this song I most identify with. It’s all about staying true to yourself and what you are doing, regardless of sucess or money. And that there is really no way of having more than you need without taking from someone else that can’t really afford to give it to you. Interestingly, Temple of the Dog was a collaboration between artists who would go on to be in Pearl Jam, and Soundgarden, and was a tribute to their friend Andrew Wood who died of a heroin overdose in 1990.

The lyrics of ‘Hunger Strike’ have been running through my head all day while I’ve been thinking about Chris and what frame of mind he must have been in. I know only too well what that pain is like, having suffered so terribly with suicidal depression myself. But I also feel so devastated for his wife, kids, family and friends, because I’ve been on that end of suicide as well. I know a number of men who have taken their lives, and I’ve witnessed what that does to people. You analyse every thought, every moment, every word spoken, to see if you can find the reason. You relentlessly ask yourself if you should have seen it, if you could have done more. Whether you would have been able to stop it.

The radio conversation I listened to this afternoon talked about how selfish Chris was to take his own life. Neither of the djs had experienced depression and had no idea how someone could feel that way and not be able to think of what it might do to the people around them. One of the djs made the comment that Chris had everything, money, talent, sucess, a family etc and how could he still be unhappy with all that going for him. That he should have used his kids as an anchor and remembered what it would do to them if he was to die that way.

Now, I know that not all people who die by suicide have depression. And maybe Chris wasn’t depressed, sometimes overdoses and accidents happen. But he has said enough in the past about the struggles of depression to imagine that it could have been that, and even if someone doesn’t look like they are struggling from the outside it doesn’t mean that they aren’t.

I have suffered from depression since the age of 10 or 11. I have had a number of major episodes, but the worst one by far started in 2013 and almost destroyed my life. By November of 2013 I was in such a mess that I couldn’t follow a TV program or read a book, I certainly couldn’t work. I sat and stared at the wall and wished I was dead. It was the most pain I’ve ever been in and I couldn’t get away from it. It was inside my head and all I could picture was that permanent solution to it, death.

The first time I remember wishing I could die I was 11. I’d been bullied on and off for several years, and something expensive of mine got broken and needed replacing. I felt ashamed and guilty and like I was a waste of space on earth who just caused hassle and cost money. I wanted to die to escape from those feelings. On and off all through my teens I had dark periods, but as I got older they got longer in length and I fell that much further.

This is one of the poems I wrote in 2000, when I was about 17:

Darkness decends

And I am sitting alone

Outside

In the cold, crisp air

The rain stings

My sodden skin

As I watch the brightly lit house

Secure people bustling

Like ants in it’s inards.

Warmth emits from it

But does not seem to

Penetrate its walls.

It stands solid, fortress like

And unreachable.

I can see in

But they do not see out.

I shout until I am hoarse

My throat raw and bleeding

And still no one throws a glance

My way.

Then there is this one from 2001:

Can’t stop the voices in my head

The demons rising up

From the firy hell in the

Dark depths of my mind,

And trying to pull me down.

I kick them off and

Avert my thoughts from the

Sweet killing pain of the knife.

Surely I can find something worth

Living for

Something the shadows can’t touch

Which gives me some purpose.

The demons claw at my legs

Whisper thoughts of pain in my ears

And promise to free me from the

Burdens of living life.

I can’t make them stop.

Don’t even know if I want to.

Maybe I should just give up

And refuse to live.

I don’t think anyone would even notice.

And that’s the thing about depression. It makes you feel like you are in this black cloud. You can’t see anything but the bleakness. Life feels pointless and futile and I find myself questioning why humans crawled out of the sea and evolved from chimps and what we were we supposed to gain from that? And why I am I here, in this house, marking time?

I try so hard to think positively and be kind to myself but sometimes depression is not something you can tackle just by doing those things or getting more sleep/exercise/eating better etc. I am on meds and have been since my breakdown in 2013. I resisted them for so long, feeling like if I took them it would be like I’d failed or I was admitting I needed help. But they do help, even if sometimes all that means is that the edge is taken off things a bit so I can ask for help.

Asking for help can seem like scaling a very high mountain. You know you need to climb it to be able to move forward. But saying the words “I’m scared and I need you” can be incredibly difficult. How do you tell someone you care about that you are thinking of taking your own life? It’s like saying them and their feelings don’t matter to you – that you are prepared to hurt them in the most final way possible to end your own pain. But I’ve also been in the position where I’ve told a professional and been lectured about “how can you even consider doing that?”, and “think of your child and your family”. It took several years not to feel violently ill every time I thought of that conversation. When I opened up to someone and was honest about how dark my thoughts were they were more freaked out by them than I was. Once that’s happened once or twice you learn not to be totally honest about what’s in your head for fear of upsetting them or causing them to reject you completely.

There’s been a number of times the pain in my head has been overwhelming and I’ve wanted to end my life. Sometimes I don’t sleep properly for weeks, I can’t go to sleep or I wake in the middle of the night and can’t get back to sleep. Or I have terrible nightmares which make me fear closing my eyes at night. I’ve had hallucinations where I’ve been out walking and seen bodies hanging from the branches of trees. Some days everything looks grey and all the colour and happiness and goodness has been sucked out of life. I can go for weeks being tormented by thoughts of being a terrible person, a bad parent, a fat lazy ugly bitch, remembering everthing people have said to me about looking or acting strange and the times in my life when I’ve been bullied. Sometimes the demands of working and the house and being a parent get on top of me and the smallest thing can send me spiralling into despair. At times like these the thoughts can be so loud in my brain that I can’t follow the plot of a TV program or movie, or read anything, because I can’t concentrate. Occasionally the only thing that’s stopped me from taking a handful of pills is imagining the horror of Little G finding me. I couldn’t do that to her. Not that I didn’t want to, but that I couldn’t ruin her life like that.

Its really hard to explain what goes through my head in that position – its kind of like ‘whats the point. I don’t want to live my life but I can’t leave, I can’t do that to my girl and to my family. I really don’t want to be here. All I can see is the struggle – the depression in my past and the struggle to dig myself out of the current episode. My life is never going to change, no body will ever love me. Can I face being alone forever. What the hell am I doing with my life’. And on and on and on it goes.

You can see how I got to the point of self harming. When you mix underdeveloped coping skills with significant emotional disturbance like this, self harm by cutting relieved my pain without the final ‘solution’ of death that I craved. I was less conflicted by it. It released endorphins which helped ease emotional pain, allowing me to keep living. Not a healthy coping strategy at all but one which becomes slightly more understandable when you have some idea of the pain which causes the action.

And I guess this is the same type of behaviour that causes some people to drink and do drugs and engage in all sorts of other self harming behaviours. The trouble is that the more you use these ‘strategies’ to cope, the more you become addicted to them, and the stronger those pathways become in your brain.

Whatever killed Chris, whether it was depression or drugs or something else, the world is a slightly darker place without his musical genius in it. RIP Chris. May you find your peace.

Just as an added note, if you are in crisis please please please tell someone

Lifeline – 0800 543 354

Suicide Crisis Helpline – 0508 828 865

Healthline – 0800 611 116

Samaritans – 0800 726 666

Go here and read it right to the end.