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

BPD and me – Emotional dysregulation

It’s been a really long time since I wrote and a lot has happened in that time. I stopped writing when I ended up on the psychiatric ward twice in March, and it’s taken a while to recover.
I am planning to write about what happened and the last two months, but in the mean time here is the first part of a series of posts I have written called BPD and me.

BPD and me

BPD at it’s core is behaviour that alternates between extremes. My emotions often feel like I am stuck in the middle of a storm, being pulled this way and that. My emotions appear out of nowhere and can go from 0 to 100 in 2 seconds flat. I often don’t know what’s triggered the strong emotion in the moment, and it’s taken me a long time to figure out how to pin point the trigger. Because I have no control over my emotions I also feel like I have no control over the behaviour I have in reaction to them. The wild, angry, impulsive behaviour is an attempt to gain control over the emotion. I am aware that I can be full of rage, unpredictable and volatile. And I am ashamed by it and always vow to do better. Then I get triggered again and the same cycle repeats. I am not deliberately trying to hurt or upset anyone.

Borderline Personality Disorder basically means I exhibit a chronic pattern of behaviours based in my personality, which essentially means they affect everything: moods, actions and relationships. There are 9 main diagnostic criteria and a number of subgroups of the disorder. This means no one person with BPD is alike.

Extra sensitive and highly reactive emotions – Emotional dysregulation

I have emotional dysregulation which means I am at the mercy of my highly tuned emotional system all the time. It’s like taking a bath in boiling water that everyone else insists is lukewarm. You might feel a twinge of irritation but an emotionally dysregulated person feels instant rage. Something that might make you feel slightly embarrassed might send me off to drink shots of vodka and/or cut myself to obliterate the feeling of overwhelming shame.

People with BPD have emotions that come up quickly and change quickly. I can flip from laughing and happy to shame and then anger and then sadness in a very short space of time and those emotions are very intense.

My emotions can also last for a lot longer than other people’s do. A vivid memory for me is going to the movies to see ‘The Book Thief’. If you’ve seen it you know it is a sad movie but not probably the saddest you’ve ever seen. For me, I was so overwhelmed with emotion that I cried for two solid hours afterwards. So hard that I burst blood vessels in my eye. At one point I struggled to breathe because I was crying so hard. I ended up having to drive to my parents house and they sat one on each side of me, holding on to me while I had a big meltdown over it. I remember Dad being so baffled, he kept asking me what was wrong and I just kept repeating the movie was so sad. He said “But you’ve seen sad movies before….’. Yes, I have, and they don’t all do that to me. But on that day, that one triggered extreme emotions in me and I didn’t have the capacity to deal with it.

Shame is something I feel very strongly and is a big trigger for me. It reinforces those experiences from my childhood that taught me that there was something wrong with me. In the scenario above, I felt a huge amount of shame for over reacting so much to a movie. It wasn’t that my parents did anything wrong. But my Dad’s confusion triggered shame in me, because I felt that my reaction was wrong or bad as it was so out of proportion. I didn’t understand why I was so emotional, and neither did they. Through this misunderstanding I felt invalidated and very deeply shamed by the strength of my emotional outpouring. It took me a long time to understand that invalidating experiences can be ones like these where people I love are trying to help me and inadvertently reinforcing my negative self beliefs. And this comes back to my being extra sensitive – my emotions are dysregulated, therefore my reactions are quick, intense and out of proportion to what others would do. People’s confused reactions can invalidate my experiences (Like the bath – it’s not that hot, its only lukewarm, what is your problem?!) and cause shame, which perpetuates the cycle.

Sometimes I can appear emotionless as I have learnt to squash my emotional sensitivity in certain situations because of the disastrous consequences that it has had in the past. Subconsciously I’ve learnt “emotions are bad, I shouldn’t have them” and so when I have big emotions I try and suppress them which usually results in an eruption at a later date. Often this will happen in the context of work, where something will trigger me but I will try and not react till I am ‘safe’ at home. When my daughter was younger (and even now) I tried to avoid letting her see me cry. So I suppressed anything upsetting. For a long time (years) this meant I couldn’t cry. I’d done such a good job at suppressing upsetting emotions that they came out as anger and rage and impulsive actions rather than sadness and tears. This ultimately is what lead to my biggest major depressive episode aka ‘my breakdown’ in 2013.

In my next post I will explore another of the subgroups of the disorder.

Until next time….

Ka kite anō

Tattoos and the Pink Panther

I’ve been thinking of getting a new tattoo. I already have two – the ironman symbol just above my ankle and the word courage written on my wrist. I did ironman in 2008 (ironman is a long distance triathlon – 3.8km swim, 180km cycle and then a full marathon 42.2km run) so that tattoo commemerated the achievement. The word Courage is a reminder to keep picking myself up and trying again and again even when things are difficult and I want to opt out. I read a quote once that said something like
“The greatest victory in living lies not in never falling, but in rising every time we fall”. So I have courage written on my wrist not just to remind myself to keep going, but also to acknowledge all the times when I have fallen and picked myself back up again.

For my next tattoo I was originally thinking of two things which are symbolic to a lot of people. A lotus flower grows and blooms in muddy water. It symbolises new beginings and the ability to rise above obstacles. The hummingbird represents overcoming difficult times and can also mean joy and hope. They are beautiful birds and I also love the colours of their feathers. Of course there are other interpretations of these two things but to me, together the lotus flower and hummingbird would mean acknowledging the difficult times I’ve been through with my mental health, the growth I’ve achieved and the hope I have for the future. However….once I started looking around at ideas I realised how many people have this same idea and started wondering whether I would be better with something more personal to me.

So what I am thinking about at the moment is the Pink Panther (cartoon character) as an artist like he appears in either The Pink Painter Show (season 1, episode 14), or The Pink Painter in the 1993 series.

The Pink Panther is pretty special to me. When I was little my godfather brought me a soft toy one back from England. I never had a teddy bear, just my Pinky as I called him. He was what I cuddled when I went to bed, and what I reached for when I was upset. Then, when I got married, I was given a large pink panther on my wedding day as a gift by my immediate family. My support crew for Ironman all wore pink t-shirts with a picture of Pink Panther on them and “Go Iron-Cat” on the back. And a few years ago when I finally had to throw my childhood Pink Panther out because the his fur had rotted and all the stuffing fell out, my daughter gave me a new posable soft toy which sits in my room.

I thought it would be pretty cool if I could somehow incorporate my past (symbolised by Pink Panther) and what I’ve learnt (being art – I had lessons when I was unable to work during the first of my major episodes) into a tattoo. Then I remembered seeing the Pink Panther as an artist several times and so that idea has been floating around in my head for a bit. Not sure where I’d put it – I’m thinking lower left leg as my ironman symbol is on my lower right leg. I still have to be careful about covering things up for work as I’m a professional and meet with clients all the time, but lower leg tends to go unnoticed and can easily be covered by pants if I have to. Might be time to go and talk to a tattoo artist and see what ideas come up…

On BPD, anger and depression

Things haven’t been going too well for me mental health wise in the last couple of weeks. Having BPD makes it hard for me to control my emotions, and my highs and lows tend to be much greater. Couple that with a tendency towards depression, and an Aspie brain, and you can see why my mental health seems to be a roller coaster ride most of the time.

I refer to my lows as episodes, much like someone with bipolar probably would do. During a low I can be extremely depressed, suicidal, indulge in various self harming behaviours, angry, emotional, belligerent, argumentative, manipulative….you get the idea. It’s not pleasant for me or for anyone around me and it does a whole lot of damage to my life which I have to try and repair when I am well again. It’s also very frustrating for me, because often I am aware I am acting badly but lack the skills to do anything but react.

One of the things I have been struggling with most during this particular low is anger. Often having a low with strong anger as the dominant feeling means a depressive episode is on the way. This is because as the anger or rage causes me to do things that I regret, I start hating myself for being like this. This begins a cycle of thought about how I am not trying hard enough, people would be better off without me, I’m not good enough, I’m a horrible parent/family member/friend/person in general. Then leads on to thoughts of death and finally suicidal ideation. Occasionally I hallucinate if I get really emotionally fraught – I have gone for bush walks and thought I have seen bodies hanging in the trees.

So the anger I have been feeling this time has scared me. I have had several severe major episodes in the last 3.5 years and every time it is a long hard journey to climb out of that hole and keep living. My daughter has been and continues to be my reason for living, for climbing out of bed every day even when things were at their worst. But returning to a place where you can see a future again and have a little hope takes a lot of hard work. Severe depression is unlike mild and moderate depression in that the traditional things that doctors recommend don’t work, at least initially. No matter how much exercise, good food, quality sleep, social connection etc you get, your whole life basically falls into a pit of doom and you become unable to do the most basic of things for yourself. At my worst I couldn’t read or watch TV because there was too much effort involved in concentrating and trying to understand the plot, and my ability to speak was severely impaired because I had trouble following conversation and forming opinion.

I think what I also find hard about anger as a dominant symptom of a low is that it makes me inclined to be extremely difficult to deal with as a patient. As much as I need help I will take offence to suggestions or instructions from my nursing case manager and my psychologist. I will feel like nothing anyone suggests is good enough and I will interpret attempts to help me as “people interfering” or them “telling me what to do”. I vocalise this opinion to the people involved and I have been effectively fired as a patient by several psychiatrists and one psychologist for becoming angry and verbally agressive in appointments (just to clarify – I’ve never hurt anyone, just damaged the patient/therapist relationship).

I am currently receiving DBT therapy for my BPD and have made huge improvement in a number of areas. But anger still remains one of the emotions I find hardest to control.

For whatever reason, this morning I woke feeling better than I have done in a while. Work was busy but not as stressful as it usually is, and after work Little G and I went to a local swimming pool. We bumped into friends and she played with their girls while I chatted to the mums, then Little G and I swam laps together. After dinner her and I walked to the dairy for an ice cream and sat in the park to eat them. Her and I sat in companionable silence and I tried to just be in the moment, enjoying the last of the evening sun and the taste of the ice cream and the company of my child. I think my peace is slowly starting to return. I am hoping that I hit the bottom of the low and because I am getting better at resisting self harming urges and limiting angry outbursts, it hasn’t lasted as long as it normally would.

I’ll leave you with the lyrics from one of my favourite Six60 songs, and in their words “Ain’t it good to be alive?” That might be a strange thing to say when I’ve just spent this post telling you the difficulties of mental illness, but I believe that I wouldn’t be the person I was if I was not forced to face these challenges.

SIX60 LYRICS

“Only To Be”

Only to be, I live in expectancy
No wonder it feels like this wasn’t meant for me
Though my mind is so confined
That there ain’t no point in reasoning,
Now that it’s clear to see,
It was all in front of me
And I’m right where I’m supposed to be

Yeah yea, I’ll live just turning pages
Yeah, well I know that it’s worth the ride
Ain’t it good to be alive?

So what will it be?
My dreams are my company
To lose what is me,
I follow the path I see.
My mind is so confined
That I don’t even know where to begin.
But it took me so long to find
That I can leave it all behind.
Cause I don’t got everything I’d ever need

Yeah yea, I’ll live just turning pages
Yeah, well I know that it’s worth the ride
Ain’t it good to be alive?

Cause only to be,
Was all that you’ve got from me
You told me it’s real,
And nothing comes easily.
Cause that was the truth, I was losing all my youth
To a world that’s fit for someone else

Yeah, I’ll live just turning pages
Yeah, well I know that it’s worth the ride
Yeah, I’ll live just turning pages, yeah
Yeah, but I know it was worth the ride
Ain’t it good to be alive?

Opening post – introductions, dementia and death

So…this is my first post. I didn’t intend to start a blog tonight. I had to sign up because Little G’s homework included her commenting on one of her classmate’s blogs. I’ve always wanted to have a go myself so here I am.

A little bit about myself and my life would probably be in order right now I guess. I’m a single mother in my 30’s with one daughter (Little G) age 8, who is the light of my life. I have a busy professional job and I work full time. I also have severe recurrent major depressive disorder, Borderline Personality Disorder (BPD), and Aspergers. Little G has multiple diagnoses including ASD (the modern term for Aspergers), auditory processing disorder, anxiety, hypermobility of almost all her joints, mild low muscle tone, and sensory processing disorder. She’s also gifted, with an IQ in the range of 145 – 150.

As well as my professional job I dabble in art when I have the time. I am current trying arcrylic and coloured pencil, but prefer detailed pencil portraits. I’ve also worked in watercolour. Tonight I am working on an arcrylic of a river scene. The painting’s got to that awkward stage where it looks ugly and I want to give up so I’ve put it down for a bit. Usually that just means the detail needs to go on and it will start looking a bit more like what it’s meant to.

On a different topic entirely, my grandmother died in December and Little G and I went down (travelled about 5 hours in the car) to the internment of the ashes in the weekend just been. Unlike her death and funeral it was just so hard for me to feel any emotion. The plaque is nice, and its nice to have something in memorial to her and my granddad, but I couldn’t really feel attached to it at all. Once the body is ashes it loses its meaning for me. I think maybe because it’s so at odds with my memories of her that my brain can’t really process that the box of ashes is what’s left of her.

My gran died of dementia which is such a cruel illness. Last year wasn’t a great year for my family. January my Dad’s Dad died of Alzheimer’s and December my Mum’s Mum died of dementia. Poppa had been going downhill for a long time and suffered several bouts of pneumonia, and then he lost the ability to form words and speak. After that it wasn’t that long before he couldn’t swallow and he had no control over most of his muscles. It was pretty horrifying sitting there watching his eyes roll back up in his head constantly and his mouth hang open and then keep snapping shut. His mouth had to be swabbed regularly to keep getting some moisture into him because he couldn’t swallow. And of course all his dignity was long gone as bowel and bladder control was one of the first things to go, after his memory. It’s just such a sad thing to sit there with someone who once commanded troops, ran a thriving business, had a dairy farm and five boys, and all the rest, and watch him essentially lose every function he’d gained since the day he was conceived.

My Gran’s demise was just as horrifying but in slightly different ways. She had been in secure dementia care for about 3 years (my Poppa was also in secure care), and fell and broke her hip back in about July/August. From there she gave up the will to live. Going into hospital frightened her and she refused to take pain relief or even to eat or drink. She would not do the physio or get up out of bed and try to walk. The pain confused her because she could not understand that’s what the feeling was, or associate taking pain relief medication with expecting to feel better. She just knew there were feelings, she didn’t like them, so she wanted to be left alone because she was scared and confused. Once back at her care home she never really left her bed. She refused food and drink and her insides started basically breaking down. She took sips of water after a bit, and the odd teaspoon of icecream, but she could go days without anything. She started hallucinating. Sometimes her speech was clear and her legs would move around involuntarily (something to do with twitching because of the minerals leeching from her system). Sometimes she barely opened her eyes and her speech was garbled and unintelligible.

I never realised how long you could go without food and water if you are taking a few sips and mouthfuls here and there. Gran lasted roughly 2 -2.5 months of just a little food and water, and then about a week of none.

The end was so sad. We were chatting to her and each other around her bedside. The whole family were there – her 3 kids, her son-in-law & daughter-in-law, grandchildren and greatgrandchildren. We took turns sitting by her and stroking her hand. Then her breathing changed and stopped. Just like that she was gone. Suddenly there is just a body and no person in it. It’s a bizzare feeling, knowing that even though they are right there in front of you they will never open their eyes or say anything to you again.

Anyway, enough about death. I didn’t start writing tonight with the intention of telling my grandparents’ stories but it feels cathartic. There is plenty of other things I’d like to say about dementia, death and my grandparents but I’ll leave it with this little picture.