College and Borderline Personality Disorder

College is a time of life that is one of self-discovery and self-definition. It is a time where people make friends that last them a lifetime and oftentimes meet the person that they will one day marry. College is filled with so many new experiences from college parties, fraternities/sororities, more difficult classes, and a whole lot more independence. What usually accompanies all of these things? Stress, and lots of it. College can be the best time of someone's life.
But for someone who has Borderline Personality Disorder or BPD, college can be a tumultuous time of their life. Borderline Personality Disorder is defined in the DSM as "a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning in early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. Frantic efforts to avoid real or imagined abandonment
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
3. Identity disturbance: markedly and persistently unstable self-image or sense of self
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., substance abuse, binge eating, and reckless driving)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms"

Borderline personality disorder generally has traits that appear during adolescence but the actual diagnosis cannot be made until someone reaches the age of 18, which usually is the age of a college age student.
One thing to keep in mind with the diagnosis with BPD is that someone needs to have 5 of the 9 symptoms to be diagnosed. There are a total of 256 combinations of the symptoms that can be present for the diagnosis to be made so all of the following suggestions may not be applicable to every person with BPD.

What does this mean for a college student struggling with BPD?
1) Relationships look different. This is the hallmark of BPD. For some, it is easy to make friends while for others it is difficult to make friends. For almost all, it is extremely difficult to keep friends. Relationships are extremely rocky in nature because of the kind of thinking that comes with it and the patterns that follow the thinking. One characteristic thinking pattern is all-or-nothing thinking also known as black or white thinking. This includes the extremes of idealization and devaluation. This means that one day someone can be put on a pedestal and the moment they do something wrong, they are the worst person ever. Another way this may happen is that when someone is in the idealization stage, all faults may be overlooked until something becomes so obvious that it cannot be and the flip to devaluation occurs. It may also occur with devaluation. Someone may view someone in such a negative light that nothing positive that they do can change the way they view them. What this leads to is tumultuous relationships. Tumultuous relationships can add extra stress to those who struggle with BPD, making college even more stressful. However, they crave human connection and need it.
2) Self-image related situations. People who have BPD struggle with maintaining a stable self-image or sense of self. This can mean that college students frequently change majors as their interests change frequently as their sense of self changes. For example, one semester they may study education because they want to be a teacher. Then they decide they want to study business. Then they decide they want to be a writer. The frequent change of majors is often related to the fact that they don't know what they are truly interested in and don't have a stable sense of who they really are. Another aspect of self-image related situations is perfectionism or apathy. Again, it is usually in extremes. They can be either perfectionistic, high achievers in their studies and do exceedingly well, or be apathetic and have poor performance. They can also go back and forth between the two.
3) They have to be careful. One symptom of BPD is impulsivity. This can include substance abuse (including alcohol and drugs), over-spending, driving recklessly, or being promiscuous. While it may be okay for some to have a few drinks every now and again, some people who have BPD cannot do that. It can lead to a pattern of impulsivity that can become dangerous quickly.
4) They need extra support. This is the most important. Getting treatment for BPD is so important and the earlier the treatment begins, the better. Having support from peers is critical to making it through college and being successful. It is also sometimes a key aspect in getting treatment. Many times students with BPD are afraid to seek treatment because of the stigma out there that exists but are more inclined to go if someone goes with them.

So what can you do as a college student or a college professor who knows someone struggling with BPD?
1) Offer support. This can come in a variety of ways. This can mean going out to lunch or coffee with them. This can mean getting together to study with them. This can mean just lending a listening ear when they are struggling.
2) Offer to go with them when they do seek treatment. This can be critical to them feeling more comfortable when it comes to seeking treatment and following through with treatment.
3) Be consistent. This is probably the most important thing when connecting with someone who has BPD. Part of having BPD means intense fear of real or imagined abandonment and if someone is not consistent in their relationship, it can be mistaken as abandonment which can lead to catastrophic consequences. This does not mean it is not all on one person either. It does not mean being there every moment of every day. It just means not randomly dropping out for periods of time without letting them know what is going on.
4) Take care of yourself. There is the saying on airplanes that one must "put on your own oxygen mask before helping someone else". This applies to life in many ways. You must take care of yourself and not run yourself down into the ground to help someone else because it will only make the situation worse. So make sure your oxygen mask is on first.

Again, please note that all of these do not apply to every person with BPD as no one with BPD looks the same.
The one thing that should be kept in mind through all of this: There is hope, no matter the diagnosis or the situation and help is available after a diagnosis.
Overall, BPD can make college more difficult and more complicated, but it does not have to take away the rewarding experience that it can be. College can be a fun and exciting period in life for anybody. It can be a challenging experience for anybody. The same applies for people with BPD.

The Reality of Psychiatric Hospitals Part 1

Many people do not understand the realities of staying in a psychiatric hospital. Many do not understand what goes on inside a psychiatric hospital and how challenging those stays can be. I've even known people to refer to my hospitalizations as "vacations" because that's how they saw them when they are the furthest thing from that. This may be a long piece that I may have to break up in segments but here is a start.

Being admitted to a psychiatric hospital:
This can be done in 2 ways. The first is through the ER or medical hospital. The second is done directly through the psychiatric hospital. I have done both and have very different experiences with both.

Being admitted through the hospital directly is much simpler in the long run. This is because most of the time when you admit yourself to the hospital, you are there voluntarily which means there are many extra steps you don't have to go through to be discharged (more on that later). The process of being admitted usually follows a set of steps.
1) You research and determine which hospital you would want or need to be admitted to. This can be influenced by a number of factors. The primary one is if they take your health insurance or not. Other factors include location, availability on beds, doctors and programs available, as well as reviews. As my experience went on through my series of hospitalizations, I began to take all of these factors into consideration when looking into a hospital.
2) You call the hospital and ask for the admissions department. This is usually followed up with either making an in-person appointment for an evaluation or doing an evaluation over the phone. One hospital I went to did evaluations over the phone. Others required it to be done in person.
3) You go through an evaluation. This evaluation is used to determine the necessity of you needing hospitalization. This evaluation goes over various points in your mental state and takes all into consideration about whether a hospital stay is necessary. When doing a phone evaluation, there is a risk one takes and that is that if the admissions staff determines you need help right away, they will call 911 and send someone out to your house which will lead to you being taken to a local ER and evaluated there (more on this shortly).
4) Hospital sends your case to the doctors and the doctors will decide whether to accept you as a patient or not. This is generally the most nerve-racking part of the whole process because if you don't get accepted, the process starts all over again. Usually, the admissions staff will present your case to the psychiatrists there and one will accept you. This is usually the doctor you get assigned to for your stay there.
5) You are from there admitted into the hospital and fill out a bunch of paperwork that goes over rules and regulations, insurance stuff, contact information and emergency contact information.

The other way to being admitted to a psychiatric hospital is through the ER or medical hospital. This usually takes place when people are hospitalized after a suicide attempt or when they go to the ER reporting suicidal thoughts. This can also take place if someone calls 911 because they are worried about your safety. This includes crisis line staff, admissions staff at hospitals and friends and family. Anyone can really call 911 on you and tell them that you are suicidal and usually both police officers and EMTs will show up at your place. From there, you are asked a series of questions about your mental state and if you agree to go, you will be transported by ambulance to the closest hospital that is designated to handle psychiatric patients. (Note: This may not be the closest ER. Many places have certain hospitals that are designated to handle psychiatric patients in the ER and when you are determined to be a psych patient, that is where you are brought.) Once you arrive at the hospital a number of things take place.
1) You are evaluated in the ER by a social worker or psychiatrist. Many hospitals don't keep psychiatrists on site anymore so it is usually done by a social worker or through a video chat with a psychiatrist. This evaluation will determine if you are involuntarily committed or not. Many times there are other things added prior to being evaluated depending on the hospital. Blood work is usually taken and a medical clearance is done, especially if they anticipate putting you on commitment papers. Certain hospitals require you to change into paper scrubs to further show that you are committed and then turn in all your belongings. Security will lock up your valuables and the rest will be kept in the ER behind the nurses station. This means that you are not allowed to have your cellphone or any other personal items with you during this process.
2) If you are put on involuntary commitment, a few things take place to make this happen: the report by the person who evaluated you is used to fill out a bunch of forms explaining why you need to be committed, then you are informed that you have been committed and are no longer considered voluntary, then social workers in the hospital begin looking for a hospital to accept you as a patient.
3) When you are accepted by a hospital, you will be cleared medically and then transported by hospital cop to the designated hospital. Before leaving, your belongings will all be turned over to the hospital cop who is assigned to transport you. Sometimes you have to stop at the hospitals belongings desk to sign for some of your belongings. Depending on the cop, you may be restrained during your transport to the hospital. This can be through padded cuffs on hands and feet. It all depends on the cop, the hospital and your demeanor whether or not you are restrained during the transport. The drive itself is very uncomfortable if you are tall or a bigger person because the cars are equipped just like cop cars with protection between you and the driver. There is also a camera that the cop can use to monitor you throughout the drive. Because of all the protective equipment, there is not much leg room. Occasionally, depending on the time of day and the drive and the cop as well, you may be granted a pillow and blanket for the drive. This all depends on the cop and the situation. Other than the pillow and blanket, you are not allowed to have any personal belongings in the car with you. Sometimes the cop is nice enough to let you choose the radio station, sometimes not so much. This is one thing that made my drive even more difficult because I'm triggered by certain music so if the cop decided to listen to classic rock it was a very difficult drive. The drive is usually very quiet and you spend most of it in your thoughts, which considering the situation is usually a horrible situation to be in. I have cried during my transports, I have prayed, I have tried to do everything to keep my mind occupied during the drive, even if that means watching the GPS and road signs. It is a miserable trip. Once you arrive at the hospital, the cop escorts you to either the general entrance of the hospital or in some cases to the designated unit. From there, they hand your paperwork to staff at the hospital and you go into the admitting process. 4) The admitting process is usually the same whether you are voluntary or involuntary. You still go through a series of questions as to why you are there and have to fill out paperwork regarding general information (sometimes it is bypassed though depending on commitment paperwork) This concludes the process to getting admitted to the hospital. Next post will be what the intake process is like and examples of rules and regulations in hospitals. Please note: This is all based on my personal experiencess. However, I have been in 8 different psychiatric hospitals and multiple ER's belonging to different hospital companies.

Grief

Grief is something that every single human being will go through at some point in their lives. Grief can be over a loss of a friend or family member, over a change in a life situation such as new house, new job, new car. There are many situations that can cause grief. Typically, once the grieving process begins there are 5 stages: Denial & Isolation, Anger, Bargaining, Depression and Acceptance. Originally, it was thought that we go through these stages in this order. However, every person's grief is different. We spend different amounts of time in different stages and we can go through the stages in any order.
But what happens when the person grieving already has a mental illness? How does that change things? Personally, I have thought so much about this recently as I have been starting the grieving process myself because of the death of my mom, and now a friend as well.
I believe having a mental illness changes grieving in the following ways:
1) People with mental illness can have more severe reactions when grieving. I say this, not to minimize other's grieving processes and experiences but rather to point out that those with mental illness already have an extra emotional struggle on their plate and thus aren't always equipped to handle emotional struggles that come their way. Many suicides attempts are fatal by people who have a mental illness. When having a mental illness, it means we have physical characteristics in our brain that make us react differently to the world around us. Those with depression are not simply sad or even really or super sad. It is something on a whole different level. Those with anxiety are not nervous or even really nervous. Those with addiction or alcoholism don't simply drink or use drugs, it's something that's an addiction to the point where they almost lose control to it. Those with borderline personality disorder are not just emotional and sensitive, they physically feel things to a completely different extent. This is what makes grief so difficult for those with mental illness. We are already prone to having over the top reactions to situations in life or even nothing at all. Add stress into the mix and things get kinda shaky. That's where I bring in the point that grief to those of us with mental illness is different. Personally, since the death of my mom, I have been more angry than I have been in a really long time. And not just angry but irritable too, like the littlest things send me over the edge. I've been dissociating more, isolating more, and suffering more severe symptoms of depression than I have in a long time. That is part of my mental illness but it is also in response to the grief. My grieving looks different because my brain acts different. Another part of the severe reactions is that there are many people who commit suicide because of grief. My grandmother did and that makes me even more at risk for doing something similar.
Relating this on a more personal level and to give a clear example, my mother passed away 2 1/2 weeks ago. Since her passing, there have been symptoms of my depression that are making their way back in. I'm not eating much, which isn't characteristic for me. I'm also going through periods of time where I don't sleep much at all during the nights and then my body gets so physically exhausted that I will sleep for 14, 15, 16 hours at a time. I'm not able to concentrate well and my motivation is out the window. I've either been extremely tearful or not able to shed a single tear. One extreme or the other. I lay in bed for hours staring at my iPad hoping that the time will pass. I'm fighting the urge to isolate more than anything right now but even still, I'm isolating when I should be reaching out. When it comes to anxiety, I'm having 2 or 3 anxiety attacks in a day, some so severe they make me feel like I'm going to throw up when they rarely reach this intensity. When it comes to my Borderline Personality Disorder, I'm showing more severe signs of anger and irritability (and I am not one to show that I'm angry or irritable, so it's an incredible struggle to fight). I'm engaging in destructive habits again. My obsessive like thoughts of suicide and self-harm are much more present than they were before. I'm severely dissociating, worse than I ever have in my life. I'm paranoid at work and home. All of this is in response to the passing of my mother. My personal grieving process looks like this and it only looks like this because I have a mental illness.
2) People with mental illness need different support when grieving. Many people with mental illness have a therapist and psychiatrist already because of their mental illness. The help they need from them continues as a person grieves. It may even become more necessary due to the more severe reactions described above. Yes, people who don't have a mental illness will often seek out counseling and therapy when dealing with grief, but it is usually not right away. It is only after a period of time of struggling with grief that people will seek out counseling to help with their grief. People with mental illness have that support often the moment the grieving starts, if they are in treatment already. Additionally, people with mental illness need friends and family just like those without mental illness. But the support looks different in many cases. Many times, it's a friend to just sit with a person so they are not alone and to help keep themselves safe, often from their own minds. Other times, it's a person to talk to about the grief. Other times, it's to talk to someone about something that has nothing to do with the grief. Personally, since the passing of my mom, I have been the one to choose who I open up to and who I tell how I'm doing. I shut out people who demand to know how I'm doing and even times people who just ask in general "how are you", I can't answer them. Because of my mental illness, I have been extremely selective in who I talk to about my mom and when I talk to them about it. It's all been my choice. And that's hard for people who want to know how I'm really doing all the time and I can't give them an answer because I can't spit out my thoughts and feelings at the moment. That's why there is the support of a therapist and a psychiatrist as well as friends and family. The support need is different.
3) People with mental illness have different physical needs when grieving. What's the most common thing people do for a family that's just lost someone? Bring them food. While that is great for many people who are grieving, for those with a mental illness that can be a difficult thing and even a triggering thing. Because of the severe reactions, there are times when they don't want to eat because the depression is so bad and other times where they want to eat everything in sight. Other times, when they only want to eat specific items. This also applies to those with eating disorders. Food can be a big trigger for those with eating disorders as they struggle on whether they should eat the food that was brought for them. The food can sometimes be eaten, sometimes not be eaten and sometimes go to waste which can lead to major guilt. People with mental illness don't always need meals brought to them. It can sometimes hurt more than help.

So what can you do to help those who have a mental illness who are grieving a loss?
1) Support them through their severe reactions. Some reactions don't make sense to them or to you and that's all part of grieving with a mental illness. Be aware that there may be severe reactions from the person and that it's not your fault that they are acting this way. Be aware that sometimes extreme anger directed towards you may not be meant for you. When a person is open for talking, ask them about their reactions and their emotions and anything you can do to help them through their severe emotions.
2) Support them as a friend/family. This includes so many things. This means being the person they need when they need it but maintaining a healthy relationship as well. Make sure you are well supported and kept healthy through the entire process. Recognize when you can't be what the person needs and help that person find someone who can. This means that you as a supporter can play many roles, You can be a shoulder to cry, an ear to talk off, or just someone to sit with. You can be someone to be normal with too. Ask the person what they need and if they don't know, that's okay too. Offer support but don't push. The biggest thing is you recognize them going downhill and beyond what you can do to help them, HELP THEM SEEK PROFESSIONAL HELP! This could mean going with them to the appointments and describing what you are witnessing. But make sure that if you can't do it, they get the support they need from someone who can. Set healthy boundaries with the person while making it clear that you are not leaving them or abandoning them in this difficult time. Remind them of their importance and your care for them.
3) Ask what they need. If they need food, bring food. If they need supplies and toiletries, a gift card is always an option. If they need a ride somewhere or help figuring out something, anything you can do to help is encouraging. Personal notes and cards are always encouraging as well, especially when it's past the usual 2 week mark of the loss and the cards have stopped coming.
4) The most important thing to do to help anyone who is grieving is just to be there and be there through the long haul. Through the dark and the light, through good days and bad days. That's what grieving people need, especially those with a mental illness.

Personally, I still need support through each day and still need people to understand the reactions I have. This is something that is just beginning and may go on for a long time as grief can be a long process. That's why it's so important to recognize that when a person is grieving, especially a person with a mental illness, that the grieving process looks different for everyone.

The War with Depression

Depression is like a war. Each day is a battle. I go through times where I easily win my battle with depression every day. I can manage work, school, and daily life stressors with ease. I can handle bumps in the road. I manage my sleep and my appetite stays fairly consistent. My emotions aren't out of control and I don't participate in self-harm. I handle any triggers using coping skills I know and choose not to engage in any risky behavior. I also go through times where it feels like depression wins the battles. Where my sleep and appetite aren't consistent, my emotions are all over the place, my mind is the battlefield, and every life stressor feels like a nuclear bomb went off inside my chest. I've gotten really good through the years at making it difficult to tell which time is which just by looking at me. If you talk to me or read my facebook posts, you may get a better feel for where I am on my relationship with my depression.

That leads me to where I am now. I feel like in my war with depression, I'm losing more battles than I'm winning. I'm still able to make myself get out of bed and go to work. I'm still able to get myself to get my schoolwork done. Those battles I win. However, most other battles, I feel like I'm losing. My suicidal thoughts are getting stronger and more intense. My emotions are all over the place. I'm super sensitive to every little thing and paranoia has taken over. I feel extremely alone and like I don't have anyone to talk to. I feel like if I did reach out, I would be burdening people I've already worn out and will only continue to burn bridges. I'm mentally beating myself up and degrading myself and this only contributes to the suicidal thoughts.

I recognize that I'm on a sinking ship. Most people on a sinking ship would seek out life vests. Most people in my situation would have multiple life vests. These include: a solid support system, hospital options (whether inpatient or intensive outpatient), outpatient providers, and medications. When it comes to these life vests, few of them exist for me. I don't have a solid support system to depend on because too many bridges have been burned. I don't have medication options. That's part of what caused this issue in the first place and any anti-depressant medication takes 6-8 weeks to work and I am not sure if I will be able to continue to win enough battles to maintain this war for that long. Hospitalizations are out because hospitals flat out won't take me. They claim they can't help me but it's more of they won't help me and they don't want the liability. This leaves outpatient providers. When it comes to outpatient providers, I have an outstanding therapist who is fantastic but she is the only one I have. If I am honest with her about where I am,  I know what she will suggest. She will want me to do crisis group which is three hours of therapy groups and seeing a psychiatrist once a week. Sounds good right? Only this is the WORST possible time to do that because work needs me more than ever right now and tutoring is about to pick up because school is starting. I also can't afford to lose work hours because I need the money more than ever with my financial issues going on. I feel like I'm in a lose-lose situation. If I do the crisis group, I could lose my job. But there aren't any other options left.

I'm a wounded soldier in a war with too many battles left to fight and not enough ammunition or armor.

Is that safe?

This week I saw a nurse practitioner for my medications. I had never seen this lady before but had heard good things about her from my therapist and a psychiatrist that I had seen before he retired. I had multiple appointments scheduled before but every time I was supposed to see her, the appointment had gotten cancelled for one reason or another. So I was highly anticipating my appointment with her.
Recently, I've been having difficulties taking my medication because my gag reflex is so strong that I either feel like I'm going to throw up when I take my medications or I actually do throw up. It's not been fun. So I've been off of my medications for over a month now. I can tell the difference between me being on medications and me not being on medications and it's not a positive one. My therapist was aware of this and had sent her an email explaining the situation so she would know what was going on. So I was really looking forward to this appointment to address the issue with her.
I was really disappointed in the appointment. I left the appointment so frustrated I was almost in tears. Here is a list of reasons why I was frustrated:
1) I arrived there and she made multiple comments about my weight. I'm not bothered by my weight but if someone makes comments about it, it really bothers me. She commented that if I was having trouble with my appetite I should be losing more weight than I had, like my weight was proof that I was lying about my symptoms. She asked me why I thought I wasn't losing more weight and then proceeded to question me about my eating and drinking habits. I explained that while I do drink a lot of soda, I generally eat fairly healthy. I eat lots of fruits and vegetables as well as protein like chicken. So I didn't know why my weight was where it was. She lectured me about my eating habits which just irritated me.
2) When we began discussing me being off of my medications, she commented that I was on a lot of medications and that I seemed to be doing fine without them. She then asked if I should just stay off of medication. She made a judgment based on my appearance and wanted to keep me off medications based on that judgment. She didn't take into consideration the fact that I was on a lot of medications for a reason. She also didn't evaluate me by asking about my symptoms right away, she just assumed by the way I looked that I was okay.
3) While discussing whether I should go back on medications or not, she asked me what I was doing to help myself. I told her I was seeing my therapist twice a week and doing good work there. She asked me about attending groups and I said I couldn't because of my work schedule. She then said that I should focus on my mental health and work is just something extra. But it's not something extra for me. Work is part of my identity and not just a part but a key part. She acted like I should just drop everything to attend as many things as possible and that work wasn't important. However, if I had gone in there not working, I probably would have gotten a lecture about that. Just frustrating.
4) Probably the MOST frustrating part of the entire appointment was when she asked me what I do for work. I responded saying that I work in a daycare. Her response was "is that safe?" I was dumbfounded and shocked to say the least. I understand the need to ask if I'm at risk for harming someone else, but there are a thousand other ways that question can be asked. Additionally, the question just perpetuates stigma. Almost every job has some aspect of working with other people in it so if she was really concerned about me being homicidal, she should have asked that. However, instead, she revealed that she has an idea about people with mental illness that they shouldn't be caring for children. What about the people with mental illness who have children of their own? Why can't someone with mental illness care for children if they are safe with them? Just because someone has a mental illness doesn't mean they can't work a job and do what they love in their job. People with mental illness are no different than someone who has a physical illness. If that person can physically do their job, there should be no questions on whether or not they should be working that job. As the appointment continued she also made multiple jabs to me about my job. Anytime something came up that she disagreed with, she would make the comment "is that safe for the children?". This just bothered me even more. My job is a HUGE part of my identity and something that if anything, helps my mental health and gives me reasons to keep going. It gives me a reason to get up in the morning and something to look forward to. An attack on my job is very much a personal attack because of how important it is to me. Not only that, but my bosses are aware of the full extent of my mental illness and if they didn't feel comfortable leaving me alone with children, I wouldn't be left alone with them. Additionally, I'm freaking good at my job. Not trying to brag or anything when I say that but when you get noticed by a corporate worker on how well you do with curriculum with the kids, that's kind of a big deal. Plus, all the parents in my class love me and so do the kids. So the comment about whether it was safe or not to be around children was hurtful and frustrating. What a way to perpetuate stigma.
5) Another thing that really frustrated me was the expectation that I could choose whether or not to have symptoms. She made comments about my sleep, my appetite, and my suicidal thoughts. I had to explain the fact that I was chronically suicidal and she proceeded to ask me why. Like I could control the thoughts. I can't. I can choose whether to dwell on them or act on them or not, but I can't control the thoughts themselves. That's just something that is part of my reality and something that has to be monitored. And when it came to my sleep and my appetite, I can't control whether or not I can't sleep or sleep too much. I can't control whether or not I have an appetite. I wish I could, but I can't. That's all part of depression. If she wants that to change, maybe she should be trying to work with me on medications to help that.
6) The last thing that frustrated me was what she did with my medications. She wanted me to restart my medications on the same dosages I was on before, which isn't a good idea because it makes for an increased risk of side effects. I need to be built up to the dose I was on. And she wants me to choose what medication I start first. She doesn't want me to start all the medications at once, but gave no guidance on which ones I should start first. So frustrating and not helpful.
Overall, the appointment was a huge disappointment and so frustrating. Even when talking with my therapist, she was frustrated too. She knew I didn't like the person I saw and knew I wanted to see someone else. However, she said she would talk to the nurse practitioner first so that she didn't get in trouble. She is supposed to look into that and hopefully get back to me.

I think what is most troubling about the whole thing is that the nurse practitioner works in the mental health field yet still stigmatizes patients. How can someone with so much experience in the field still carry so many uneducated views about mental illness? This is one of the big problems with the mental health system. The people who are supposed to be the ones helping the patients and decreasing stigma, further it. So much change needs to take place to start eliminating stigma. It starts with one person at a time being willing to step up and say I will not accept the stigma anymore.

To my friends

I sat among a group of friends on Thursday night. We laughed and cried and really had a good time. But I couldn't help but feel like I was on the outs of the group. I felt my friends closeness around me yet didn't feel that to anyone around me. And I started to wonder why. I used to feel close with these people. I used to feel like I could be open and honest about what was going on in my life. So what changed? 

And that's when someone told me. People don't deal with loss well and the risk that they could lose me is scary. So they hold me at arms length to protect themselves. 

This is my response:

Dear friends,

I know this is scary for you. I know that being close to me is a risk. I have severe mental illness. I have a disability that puts me at risk of hurting myself. I won't deny that. But this is the reality of my illness. It's not something I have control over though I wish I did. My mind torments me day in and day out. 

What I need you to understand is that I need you. I need your support and your love. I don't have family support so friends are all I have. I know it's a risk for you but the closer you are to me, the less likely I am to do something serious to hurt myself. The closer I feel to people, the more likely I am to reach out and ask for help. The reason behind this is that when I don't feel close to people around me, I feel like a burden to people. This means I don't reach out when I need help and instead try to handle it on my own. That's when the risk of me hurting myself increases. 

Friends, I need you. The more I feel like I have support, the more stable I can be. The more stable I am, the more support I can offer in return. When I have you around, I know I'm loved and cared for and it would make a difference if I decided to check out and leave the planet. I don't feel like a burden as much. I still struggle, yes. I still have bad days, some really bad days. But when I have those bad days I know I can make it. Friends, when I don't have you around, when I don't feel close to anyone, I feel like I'm fighting this battle alone. And it takes all my energy. All my strength. All my mental capacity. I can only focus on trying to keep myself from drowning. It makes me seem like a selfish person when I don't intend to be one. When I can lean on others, I can let others lean on me. 

Friends, I can see how this is scary for you. I can see how this is a risk. I can see how this would be difficult for you. I know I'm not an easy person to be around sometimes or a lot of the time. It will take time for me to stabilize out with your support. But with your help, I can grow and in turn help you out. I need you. I love you. Please give me a chance.

Sincerely, 

Kimberly

The Dichotomy

Merriam-Webster defines dichotomy as: a division into two especially mutually exclusive or contradictory groups or entities

I feel like my life, is living in a dichotomy. I have two options in life and neither are optimal.
I can either ask for help because of how I feel or actually give up because I feel I can't ask for help anymore. Now let me explain this further.

The first part of this dichotomy is that people always say to ask for help. I have been told so many times that I just need to ask people for help and reach out to them for help. But when the time comes and I reach out for help because I want to self harm or because I'm feeling suicidal, the responses I get are appalling. I get told that I'm just trying to get attention, that I'm being high maintenance, that I'm needy or clingy. And how many people are there when I legitimately ask for help? Whether it's listening, offering advice or out in one area or another. Then I get to feeling so bad that it leads to the other half of the dichotomy.

The second part of the dichotomy is giving up because I feel like I can't ask for help anymore. And then I do something to try to be done with life. Or I totally disengage from everyone and isolate completely. And when I fail at my attempt to be done, then everyone asks "why didn't you come to me for help?" and then proceed to tell me how selfish I am for trying to just give up. And how it would make a huge difference in their life if I was gone.

Is it just me or is there a disconnect here? It would make a huge difference in your life if I was gone forever, but my cries for help are just for attention? I don't understand. What's going to happen if one day I do end it all? I feel like it's the saying "you don't know what you have until it's gone". If I matter, if people matter to you, then tell them that. Make sure they know that. Treat them like that!

This isn't directed at anyone. This is an observation. I feel like no one is willing to step up and be there for me when I'm struggling through the hard times and then everyone flips out on me when something drastic happens. So I'm stuck in this dichotomy. Everyone pushes me to find other people to find other support because no one wants to deal with me on their own. I'm the last person on everyone's priority list. There is no one who would immediately come if I called. Yet I hear people claim there would be this hole if I wasn't here anymore. It doesn't make sense. Thus the dichotomy.

So there's a dichotomy. And it confuses me. Cause I can't make it reconcile.

A Letter to my Mental Illnesses

Dear mental illness,

I get so mad at you. You mess up so many things in my life. 

The first and probably the biggest thing you mess up in my life is my relationships. I can make friends, yes. Friendships start off normal. But once friends realize I have mental illness they either run away and hide from it completely making it awkward or they try to offer support and end up getting overwhelmed with everything that is you. Then they turn the other way and things are never the same again. And forget about romantic relationships. I'm too afraid to even venture into those waters. Because who wants to date someone who is emotionally unstable?

The next area you mess with is my job and livelihood. For me, I am on disability. At the age of 21. Thanks to you. I still try to work but it is so exhausting that by the time the end of the day comes I can do nothing but go home and go to bed. I can't cook dinner. I can't clean my apartment. I can barely keep up basic hygiene most days. And I struggle so badly financially. Because what pays the bills when I only have the disability money coming through cause once again I ended up in the hospital and missed 2 weeks of work? 

The next area you mess with is my dreams. I once dreamt of becoming an amazing teacher and trumpet player. Now I hardly pick up my trumpet. I imagined finishing college with the rest of my friends. Now they have all moved on to masters and I'm still struggling to get a bachelors and failing at it. I can't get my schoolwork done because you steal my motivation and my concentration. You have messed with the dreams I had. I wanted to become a foster parent. That can't happen until you become completely under control and I can handle the stress of another human being in my life. 

But probably the biggest things you have messed up are my joy, my passion and most importantly, my hope. You have stolen them. And I fight every day just to find an ounce to do my job. Just to get out of bed in the morning. And my hope that things will get better doesn't exist. I can't look more than a day or two in the future or else all becomes hopeless. Sometimes I can't even do that. Sometimes all I can do is focus on this very minute and not hope at all but just focus on surviving it and then the next one. Hope for the future is gone. Hope for now is gone. You have stolen my hope, mental illness. And I want it back. I want to be able to look forward and not see black. 

Mental illness, I want to be able to look up and see sunshine. I want to be able to have friends who are not on one end of the spectrum or the other. I want to be able to finish college and fulfill my dreams. I want to have joy and passion. I want to have hope again. 

I want my life back. I want ME back! 

Sincerely,

Kimberly

PTSD and Triggers

So in the past I have talked about Borderline Personality Disorder and Chronic Suicidality which is part of Major Depressive Disorder as well as part of BPD. But I have never really gotten around to talk about PTSD or Post Traumatic Stress Disorder.
This disorder is commonly associated with the military and veterans returning from war. They suffer because of things that they have gone through based on their experiences in the war. However, there are other categories of people who can also suffer PTSD. Those can include abuse survivors - this means all types of abuse (physical, verbal, sexual), domestic violence, rape. This can also include traumas like car accidents or natural disasters. There are a lot of things people can go through and develop PTSD from.
According to nami.org, there are 4 main symptoms of PTSD.
The first is Intrusive Memories. These include things like flashbacks and nightmares. Flashbacks and nightmares can be set off by things called triggers. This could be a smell, sound, sight, taste, or touch that causes someone to revert back to what they went through in the past and almost re-experience it.
The second is Avoidance. This means avoiding areas that remind someone of the event. This could be avoiding a road where a car accident took place. This could be avoiding a certain section of a store because a certain item sets off flashbacks. NAMI also includes this "A person may feel numb, guilty, worried or depressed, or have trouble remembering the traumatic event" as part of avoidance. Avoidance can also include avoidance of feelings related to the event.
The third symptom is Dissociation. This is a hard concept for many people to grasp or understand. The best way to explain it to people is to relate to when imagine driving somewhere and reaching a destination and not remembering the process of getting there. Except instead of driving, having episodes in life like that. People have episodes where they don't know what they are doing or they dissociate to other personalities and don't realize what they are doing and don't remember what they are doing. It's something the body does to protect itself a lot of the time so it doesn't have to deal with the pain from the trauma.
The fourth symptom is Hypervigilance. This is where someone can be easily startled or are over aware of their surroundings. One example is constantly checking the parking lot to make sure their attacker isn't there. It could also mean not sleeping well or having outbursts of anger.

Triggers are the biggest thing when it comes to PTSD. When one is triggered, the body usually does one of three things: flight, fight or freeze. Until we give ourselves a chance to heal and go through therapy and work through everything those are our three options. 

So how does this apply to my life?
Well I have PTSD from growing up with a physically, and mentally/emotionally/verbally abusive family. I have a few very specific triggers that I have a really hard time with. If I hear a belt snapping or being hit against something, that is a trigger. Seeing a paint stirrer (or paint stick as I call it) in any size is a trigger (granted, not as bad as it used to be). These types of things send me back to instant memories of growing up and they haunt me for days. I can't concentrate or think straight and have images constantly going through my head. I have nightmares with it too. Those are my main triggers when it comes to the physical abuse part of it. My response to these triggers varies. Sometimes it will end up being a combination of the three before I can get the images under control. For the other section, if I feel like I'm being targeted, ganged up on, personally attacked among other things, I will almost automatically shut down. If I am getting yelled at, or someone raises their voice at me, I will shut down. If someone raises their voice at someone else, I will probably shut down. This is the freeze part of the three options. I know there are other triggers but I can't think of them at the moment. But those are the real basic ones.

So what can you do to help me if I do get triggered and you notice it or figure it out?
The biggest thing you can do is help ground me. Bring me back to the present. When I am triggered I'm freaking out and having a lot of mixed up emotions but primarily anxiety and my head is not in the present moment and I need to be brought back to the present moment. This can be as simple as taking me outside if possible and pointing out the obvious or talking to me about what's around me and what's going on at that moment, even the littlest things. If my dog is laying on the floor, you can say that. Bringing my dog over to me is something to help me. I have a pillowcase that is comforting to me and helps ground me back into the present. Grounding is one of those things that I struggle doing on my own sometimes. Sometimes it is silly but it helps. Making me laugh or getting my mind off of whatever is going on helps as well. Getting me engaged in something else helps if I am ready for that. If I am still really anxious and shaky, then I still need to be grounded some more first. It will take me a while to be back to baseline again but any help (even if I try to fight you on it) will help in the long run. Trust me. PTSD is hard and is horrible to deal with alone. It can be crippling. Which is why the more people around who know about it the more people can help others about it. 

A person may also feel numb, guilty, worried or depressed or having trouble remembering the traumatic event. - See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Posttraumatic-Stress-Disorder#sthash.rhguXw31.dpufA

A person may also feel numb, guilty, worried or depressed or having trouble remembering the traumatic event. - See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Posttraumatic-Stress-Disorder#sthash.rhguXw31.dpuf

A person may also feel numb, guilty, worried or depressed or having trouble remembering the traumatic event. - See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Posttraumatic-Stress-Disorder#sthash.rhguXw31.dpuf

A person may also feel numb, guilty, worried or depressed or having trouble remembering the traumatic event. - See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Posttraumatic-Stress-Disorder#sthash.rhguXw31.dpuf

Poems and Songs I have written and kept

Over the past couple of years I have written many poems. I have posted some in various locations but never on my blog. So I have decided to try to post them in increments of 3, based on which ones I feel like posting out of my journal my my various experiences that I have been through. Some may be older. Some may be newer. It really just depends. Hope you enjoy. 

4/2/16 Song/Poem (Not quite finished)

Suicidal Thoughts
Running Through My Head
Making Me Wish
That I Was Dead

Giving me false hope
That this pain will end
But it will only pass it off
To my other friends

Die! My head screams.
Die! It's not worth it.
Die! The pain's not over.
It's a never ending pit.
Running gets you no where.
It's a brick wall that you hit.

Your tears stain your pillow
Your fight leaves your eyes
You just want to give up
And give your soul a chance to fly

Fly among the eagles
Fly among the trees
Fly into the heavens
Until you sit down at God's feet

There's a never ending battle
That you're tired of trying to fight
When you want is peace and answers
And one quiet restful night

You ask all the questions
Yet can never get any answers
To why you're stuck suffering
To why you're still here

And your fight leaves your body
You want to give up
And give your soul a chance to fly

Fly among the eagles
Fly among the trees
Fly into the Heavens
Until you sit down at God's feet
Fly above the oceans
Fly into the sky
Fly above the world
And leave it all behind
And leave it all behind.

1/24/15 Poem

I have an illness.
Its name is depression.
It paints the world black.
It feels like a dark hole.
Or a cloud that follows me everywhere.
It engulfs me.
It encompasses me.
It is like a chain around my neck.
Constantly there.
I have an illness.
Its name is depression.

I have an illness.
Its name is anxiety.
It feels like the world is spinning,
the colors blending together
The room shakes, the chest tight.
The overwhelming fear
Of anything, everything.
The inescapable sensation
of unrelenting chaos.
I have an illness.
Its name is anxiety.

I have an illness.
Its name is PTSD.
Triggered by past hurt,
betrayal, trauma
Nighttime is my enemy
Daytime is a freedom
But only a small freedom
The color is red
Like a screaming child
Who's childhood is ruined.
I have an illness.
Its name is PTSD.

I have an illness.
Its name is BPD.
Its colors are black, white and blue.
Black for the depression, and the thinking
White is for the smile before the black,
the other end of the thinking.
Blue is for the tears, for the hurt
Caused by others and by self
Nothing in the middle, just extremes.
I have an illness.
Its name is BPD.

I have an illness.
Its name is RA.
Its colors are blue and purple.
Blue for the tears caused by
the pain, pain caused by the
rain, by the ever changing weather.
Purple for the swelling and the color
of the joints inflammed.
Pain is a reminder that life is
not what it should be, a reminder
of my limitations, a reminder of the
no cure, of the pain.
I have an illness.
Its name is RA.

I have 5 illnesses.
Each one has a different name.
They paint different pictures
of pain, suffering, tears.
But they also paint a picture
of hope - hope for recovery.
Recovery is possible.
I have 5 illnesses.
Depression, anxiety, PTSD, BPD and RA
But those illnesses are NOT me!

1/29/15 Poem
This place is not a place for me
A place for me to get help
A place where meds are changed
Friends are made
Life controlled.
This place is not a place for me.

This place is not a place for me.
A place where people want to help.
A place for a new journey to start.
But mine won't.
Mine won't.
This place is not a place for me.

This life is not a life for me.
A life full of suffering and pain.
A life slowly spun out of control.
Friends lost.
Family too.
This life is not a life for me.

This life is not a life for me.
A life that doesn't give breaks.
A life that spins round and round
Rest is what I need.
What my body longs for.
Eternal Rest.
This life is not a life for me.
And soon I won't be in it.

12/08/16 Poem
Broken
Bruised
Beaten Down
Lying in a puddle on the ground

Passerbys stare on their morning stroll
Wondering why I can't get control

My mind is freaking out
Wondering how to get out
Out of where you ask
Out of this place
Out of this town
Out of this state
Out of this world
Out of it all
Permanently
Gone
Never to be seen again
By those passerbys on their morning stroll

Now there will be just a hole
Where that puddle once laid

No crosses, no flowers
No candles on the sidewalk
No teddy bears to take the place
Of the person who once took the space
Where that puddle once laid

Broken
Bruised
Beaten Down
Lying in a puddle on the ground
No more
Just a hole

When it's time to go to the hospital...

The past couple of weeks have been quite interesting. On the 25th of March, I ended up checking myself into a psychiatric hospital because I needed help and I needed help fast. It was to the point where the night before a friend had to come home with me for a couple hours so that I could stay safe and not hurt myself because I was in such rough shape. So I agreed to sign myself in and try to get some help that I needed. Let me tell you it was one of the hardest things I have ever had to do. I have been involuntarily committed multiple times before and hated it but it was still not as hard as this stay was. I had multiple opportunities where I could have signed myself out, where I could have lied to get myself out sooner or where I could have said screw it and not done the work and not cared about getting better. But I didn't. I had friends behind me, who came to visit me every and I mean EVERY chance they got and answered almost every phone call they could and spent countless times on the phone with me crying and begging them to just let me give up and let go.
One conversation I specifically remember and I hope that I will remember it the rest of my life is the conversation that changed my viewpoint on a lot of things and changed my mindset about the whole thing was the conversation we had about me just wanting to give up and end it all. She told me about her experience about losing a loved one to suicide. She told me that her and her friend (who also was constantly visiting me) could not lose another person to suicide. She told me that "Just because you are told it's not your fault and that there was nothing you could have done doesn't mean that you don't sit there and blame yourself and ask yourself how did I mess up? How did I screw up? Why wasn't I good enough to keep this person on the planet?" And it was this conversation that really hit me. Not right away. But after sitting with it and sitting with it and sitting with it, things started to change. My thinking started to change a little bit.
Luckily, with this hospital stay I was able to get a fantastic doctor who was able to switch up a couple medications which have helped a TON in managing my condition. The doctor was really helpful in challenging my thinking about my situation and how I handled my situation overall and how I handled situations that took place while I was in the hospital.
Another big thing that I learned while I was in the hospital was how crucial it is that I ask for help. I am horrible when it comes to asking for help about things like mental health or even with simpler things. I have started to learn that I need to ask for help before things get to a crisis stage and that this can help me prevent getting to that crisis stage. I have friends that can help me stay away from that point and my therapist is back now and can work with me. I have learned to ask questions when I need to ask them and reach out when I need to reach out. This has been a tremendous learning experience. I made a couple new friends through it and hope to slowly gain more friends as time goes on. I hope I can remain stable for a while and make things okay for a while as the medication begins to start to work in my system and things level out.
I started back work last week and LOVED it and got back to fostering kittens which has been an absolute blast to get back into.
Recovery is a process and this was a huge bump in the road. But it helped me move forward. And hopefully things will continue to move in an upward direction. We shall see. More details about the hospitalizations to come..........

7 Practical Ways to Help

I decided that I should create a list of practical things people can do to help me and others who are struggling with depression or who may be hospitalized for their mental illness.

1) Be there.
This would seem to be so obvious to some people but it's something so many people forget. This can be done in a variety of ways. If I am in the hospital, come visit me if you can. If you can't, call me or write me a letter or even send a card. It seems so simple but it makes such a huge difference. If I am just struggling with depression overall, don't just assume I know you are there for me. Depression clouds my thinking and my viewpoint and makes me think that I am being a burden to whoever I reach out to. So being there for me may mean reminding me that you are there if I need to talk. It may be actually calling me and asking me how I'm doing if you notice I'm struggling. It may be coming over and watching a movie with me. Just being there is what is most important. Another part of being there is staying with me if I do feel like harming myself. If the urge to harm myself is serious enough, sometimes I need someone to be in my apartment with me to keep me safe until the urge passes or until I go see a professional.

2) Help with household tasks
One thing I really struggle with when I'm in a deep depression is house cleaning. I have no energy to clean and therefore I don't so my apartment gets messy. I also have no energy to do laundry either. Another thing I have trouble doing is cooking or preparing meals for myself when I am depressed. Sometimes even putting something in the microwave is all I can do. Offering to help with my animals is another way you can help me when I am struggling with depression. When I am in the hospital, this is even more important. I need someone who can look after my animals. I need someone who can provide meals the first few days home as I may not have the energy to do it. I need someone to help me keep my apartment clean and my laundry done once I leave the hospital.

3) Prayer
This is something that those who pray can do to help me. Knowing people are praying for me is a huge comfort.

4) Logistics
One of the hardest things when it comes to being hospitalized is dealing with things like transportation to and from the hospital as well as getting me the things I need for while I'm in the hospital. This may mean I need someone to go to my apartment and pack me a suitcase if I do end up needing to be hospitalized and it's an emergency. I may need rides home from the hospital or even rides to the hospital. If something serious happens in my depression and I need to be taken to an ER to be checked out, it is much easier having someone take me there than it is going in with EMS. EMS just increases my anxiety and is an additional expense that sometimes insurance doesn't cover. This means I need people who are willing to drive me to the ER if I do something like cut myself too deep or am at a high risk of harming myself. 

5) Financially
Now I understand this is not something that everyone can do and no one can do it all the time. I totally understand that. But even if it's just a couple dollars here or there to help me cover bills I have no way to pay. I cannot say enough about how much stress has been relieved when people have offered to help financially. Life continues to move on even if I am in the hospital or so depressed I can't get out of bed to go to work and bills continue to come.

6) Random acts of kindness
Now this kind of ties in to some of the other things listed above. But this can be a letter in my mailbox, a random text or email or a Facebook message. Sometimes when I'm depressed I don't like answering the phone and texting is easier for me to communicate through than over the phone. This could also be taking me to lunch or anything outside of the house if I'm having a hard time leaving the house by myself. And if the depression is too bad for me to leave the house at all, showing up with some ice cream and a movie is an easy way to help me out and make me feel like you care.

7) Education
Now this is a HUGE one. So many people don't understand mental illness and what it's like to deal with depression and suicidal thoughts or what cutting is and why I do it and things like that. So being willing to ask questions about the disorders I struggle with to try to gain understanding and insight is one way that people show me that they care. Education could also mean doing some quick research on the web about the different things I struggle with. There are SO many articles out there that explain what it's like to live with mental illness and ways to help. I personally love it when my friends ask questions. I love it when people say "I've read this article, how is this related to what you go through?" I would much rather people ask questions then assume they know the answers and pass judgment (even when they don't realize it). Another part of education is having an open mind about the subject in general. I have met many people who are unwilling to learn about mental illness and in doing so make comments that hurt me and push me away. Having an open mind and wanting to understand is a great way to help me.

Overall, these 7 things include something that everyone can do to help those who have a mental illness during the difficult times. I know there have been times where I wouldn't have made it without the support of others around me. Many people ask me how they can help and I don't always have an answer for them because it is difficult to ask for help and admit that I'm struggling. So be willing to reach out and extend a helping hand even if it's something small. It makes a world of difference.

Self harm and the past 48 hours

******trigger warning*******
So I have had a very interesting two days to say the least. Tuesday I worked 8-5 and then I tutored 5:30-8pm. On my way home I stopped for gas and some groceries and went home after that. I didn't get home until about 9pm. I checked on my animals and made sure they were all okay and then proceeded to the bathroom. While in the bathroom, I contemplated cutting, or self harm (something I have struggled with since I was 15).
With cutting, I go through periods of time without doing it and periods of time where I do it often. There really isn't an in-between. The middle of last week was when this period of cutting started. The first time I cut it was deep, but not that deep. I did it because I had hit a car in the parking lot and felt like a horrible person about it. I was worried about paying the deductible and how things were going to work out and my emotions were running rampant. The thing with my BPD is that when I feel any negative emotion I feel it intensely, like 100 times what someone without BPD would feel. So I self-harmed. The next day, I went to minute clinic and they put steri-strips on it and it was no big deal. This past Sunday I cut again, except it was much deeper. I was exhausted and had been struggling with thoughts of self-harm and suicide throughout the day. They came on for really no reason at all. And again, when I felt the negative emotions that suddenly came over me, it was extremely intense. I felt out of control of the world around me so I self-harmed. I bandaged it but after my experience with minute clinic wasn't sure whether or not it needed stitches so I decided not to go get it checked. I thought about it but never went. I learned later that I should have.
Then Tuesday night, after I got home, I sat in the bathroom for a decent period of time. I even wrote a dark poem to try to help convince myself not to self-harm. It didn't help. So I self harmed. I did one cut across my right forearm and the moment I did it, I gasped. I had cut really deep unintentionally and it was pouring blood. I covered it with gauze and as I looked at it, I knew it needed stitches. So I called EMS. BIG MISTAKE!!!!!!!!!!! The person from EMS over the phone told me what to do to stop the bleeding and I followed his instructions and he ended the call. Then less than 2 minutes later, I got a call from the sheriff's office, or first responders. They were asking about what had happened and I told them. Their first question was "was this a suicide attempt?" and I said no. The lady asked me to stay on the phone with her until the people arrived (I guess to make sure I didn't try to hurt myself further, which wasn't even on my mind at this point). The cops arrived first. There were 3 of them. I don't understand why it was necessary to send 3 police officers to my apartment for a self-harm cut. Once the police officers arrived, one immediately recognized me from my attempt back in October. I didn't recognize him. Another guy didn't say hardly anything. The last police officer I guess was the lead guy for the 3. He took my information down (I'm not sure of the reason) and commented on my animals. He took a picture of my bunnies and was talking about my animals. I had some poop on the floor (from my dogs who are left inside all day while I'm at work) and my kitchen was a little messy and the third officer just had to make the comment that the way I am living "wasn't healthy" and that he could report my living conditions to animal control and they would take no mercy on me and would take all my animals away. Considering the circumstances, I don't think this was necessary nor appropriate. I had just harmed myself and was obviously not in the best state of mind yet he threatened me. This just showed me how untrained police officers are when it comes to handling people who have harmed themselves and who have an obvious mental illness. This is a major problem with society. They do not know or understand mental illness and therefore treat the people who are struggling poorly with no compassion. 
Once the EMS people got there, they looked at my cut and asked me what happened. I told them, they wrapped the cut in some gauze, said I would need stitches and then I followed them out of my apartment. The police officers left and I walked to the ambulance. The EMS people were all helpful, caring and compassionate. They didn't see me as someone crazy. They wanted to understand what was going on. They treated me like they would a normal patient. I enjoyed my ambulance ride to the hospital, specifically because of them. I even laughed a couple of times with them. Then we arrived at the hospital.
The hospital they had taken me to is one I have been to many many times. Greenville memorial hospital. They handle most of the psychiatric cases for Greenville county and almost all psychiatric calls are sent to them. They have the largest section of the ER designated for psych patients. The problem with this though is that many of the staff are ignorant, rude and obviously don't care about the patient. If someone is suffering so much that they end up hurting themselves or want to hurt themselves, compassion is the FIRST thing that should be offered, NOT judgment! So they wheeled me over to the section of the ER designated for psych patients, helped me off the stretcher and put me in a chair because there were no beds or rooms available. The first person to interact with me was a tech. She came to draw my blood and ask for a urine sample (this is standard procedure). She was rude and uneducated. She tried to argue with me about what I did to myself. She said things like "we take these things very seriously here" and "we consider what you did a suicide attempt" and I tried to explain to her that it was not a suicide attempt, just self harm. Self harm is used to help me survive and handle life. Suicide attempts are me trying to escape life. BIG difference. She obviously didn't know that. She just assumed I would be committed to a psych hospital on involuntary papers and that would be it. I tried to advocate for myself and she wasn't having it. The nurse on duty that night was actually fairly sweet and kind to me the entire time I was there, which I really appreciated.
As the night progressed, I was really bothered by a variety of things. Two different people were put in restraints for being un-cooperative and it seemed like that was not necessary for the situations that were occurring. Some patients were screaming and were rude to everyone and it was chaos for a period of time. Once it calmed down, the charge nurse came to me and apologized for the mess and asked if I was okay. I told her I was anxious because of what happened but was fine otherwise. She ended up making a joke that it was "free TV". Other staff repeatedly talked negatively about patients and laughed at them, in places where the patients could hear them. This really bothered me. They are people too. They didn't choose this illness. It is something that happened to them! The stigma attached to mental illness runs rampant in the one place that should be the most understanding of all, the hospital. If people are brought in by their loved ones who are concerned for them or if they bring themselves in, they should be treated with the utmost respect. Other patients in the hospital aren't made fun of for their illnesses. Staff doesn't joke about them. It's only the psych patients. This is the problem. If people are going to be laughed at and judged when they reach out for help, they are less likely to seek out help. I know for me, there are many times I have either attempted to end my life or self-harmed and not sought out help because I knew how poorly I was going to be treated and wasn't going to subject myself to that.
Anyways, the night continued on and I waited and waited and waited to be seen by a doctor. Finally, a nurse practitioner came around with a social worker and looked at my cut. They asked me a question I had already been asked at least 5 times - was this a suicide attempt? No it was not. Part of me wanted to look at them and tell them that if I had been trying to end my life, I would not be cutting myself. If I was trying to end my life and failed, I would be unconscious and would have to be dragged there. They also asked me many times who called EMS. I did. They were shocked by that. The social worker asked a couple questions further and then left. The nurse practitioner told me that I would need stitches and that she would be back soon to stitch me up. She also determined then that she would want me to be evaluated by a psychiatrist. So they found me a bed and put it in the hallway. The nurse practitioner came and stitched up my cut. 7 stitches in my arm. She also commented that my cut that I had done Sunday night should have also been stitched up but it was too old now to do that. She was nice the whole time and asked me questions and we had a good conversation. She ordered my medications and gave them to me as I would normally take them at home, which has never happened in any of my experiences at the ER or even in the hospital. Staff continued to make fun of patients into the wee hours of the night. I slept off and on but didn't get too much sleep. Thankfully they allowed me to keep my stuff which doesn't usually happen and this helped me sleep. In the morning they gave me breakfast. I saw 2 more social workers, another nurse practitioner and then was interviewed by 2 psychiatrists and a med student observed. After all of this, they determined that I could go home. I went in around 11pm Tuesday night, was not stitched up until 3:30am and did not get discharged until after 2pm.
Overall though, the sad thing is that this was my best experience with that ER to date. Most of the staff were kind and compassionate, to me at least. They got me what I needed and handled the situation appropriately. There were other patients there that weren't as lucky. Many were made fun of, laughed at and talked rudely to for no reason. I was glad to leave when I did. I was also glad they did not try to commit me to a psych hospital. It was an overall interesting experience, but one that saddens me. There needs to be more training for first responders, police and hospital staff about psychiatric illnesses and how they should be handled and how people should be treated. If this meant an extra course in college or a yearly training, it would be so worth it and would make a huge difference to the patients. Attitudes toward mental illness need to change. People deserve help and shouldn't have to go through unnecessary suffering to get it.
As of now, I'm still in a very unstable position. Thoughts of self-harm are intense and almost constant and I'm having a hard time fighting them off. I think about reopening cuts, including the one with stitches. I know it sounds horrible but it is the struggle of my life right now. I'm doing all I can to hold on, but at times it doesn't feel like there is anything to hold on to. I go to the psychiatrist next week and hope that maybe through that I can get some help and maybe some medication changes to help the thoughts in my head. It's been a rough 48 hours but I have survived. I know now what to do if that situation were ever to occur again and will hopefully be able to avoid all of this mess in the future.

My Written Response to many comments.....

I am writing this post not to single people out or attack people and I don't intend on naming names or organizations or books or anything like that. There is just a lot on my mind that I need to write out for others to read and see. Hopefully this will be educational and help people understand where I come from.
In the past several months, I have heard and received many comments from people, more so from Christians than anything else. These comments and remarks generally show a lack of knowledge in general about mental illness and while not intended to be are hurtful and frustrating for me to receive. So in this post I will go over a number of comments I have received and my personal responses to them that aim to educate those who may have made them in the past and those who may make them in the future. While I don't claim to be an expert on being a Christian or on mental illness in general, I am an expert on my own mental illness.
The first comment I will go over is one that can be stated in many forms. These can include things like "you just need to pray more" or "you just need to read your Bible more" or "you need to do a bible study on your problem and have God lead you to the solution". All of these ignore multiple pieces of information. The first is that mental illness is a physical disorder characterized by physical changes in the brain. Yes it is a brain disorder, a mental disorder, AKA a disease of the brain. This makes it just as real as cancer, heart disease, diabetes. I have never heard anyone go to someone who has cancer or diabetes and tell them "you just need to ______ more" as if it is a total solution to the problem. I am not discrediting the fact that bible study, bible reading and prayer can all be helpful things in the process of dealing with any illness or injury. BUT this does not mean that there are other things that are part of the process in dealing with mental illness.
The second comment I have received is that I just need to forgive and all my problems will go away. This can also be accompanied by comments like "you are holding on to the past and the hurt and by forgiving you can just move on". Again, forgiveness is something that needs to happen eventually and is part of the healing process. However, to state that forgiveness solves all problems ignores the reality that is Post Traumatic Stress Disorder. Again, this is a physical change in the brain where the brain is put on high alert constantly and is always in the flight/fight/freeze mode. This is absolutely and completely exhausting! PTSD includes hypervigilance related to the flight/fight/freeze response, flashbacks, nightmares, memories, all of which are NOT chosen. I do not choose to have this. It is a physical change in my brain due to toxic stress I went through while I was growing up. My brain developed differently because of the environment I grew up in. This is not something I chose, nor something I can control. Forgiveness can help the process but when you are reminded of the hurt over and over again not by your choice it is an ongoing and exhausting process and one that not everybody is ready to take on right away.
The third comment is related to the first. It's the comment of "just trust God and you won't have anxiety". Again anxiety is a physical response to stimuli in the environment or even to nothing at all. I cannot choose if and when I have a panic attack. I cannot choose whether my brain runs on overdrive. Sometimes my panic attacks will come out of nowhere and sometimes they have a trigger. Trusting God is something that everyone needs to do in their life. However, this does not eliminate the physical reaction that is anxiety.
The fourth comment is one that really bothers me. This is one where it says things like "suicidal thoughts are a sin" or even "mental illness is based on some sin you have in your life". This means that mental illness and suicidal thoughts are a choice. I am here to say that they are NOT. I don't choose to think the way I do. If I could choose to not have the thoughts, trust me I would. If I could choose to not have a mental illness, trust me I would. Suicidal thoughts are something I can choose to act on or choose not to act on. Sometimes the thoughts are so strong it takes everything I have in me to keep myself safe from harm. Sometimes the thoughts are just passing, needing to be acknowledged that they are there and then moved on from. I have learned how to deal with them the best I can. But this is not something I chose.
The next comment is "if you only have enough faith in God, He will heal you" or something similar. God can choose to heal me just like He has chosen to allow this in my life. I believe that God can heal me but I also believe that He is sovereign and has total control of my life and everything else in the universe and that means that He can choose to heal me or He can choose not to. He has a reason that this is in my life and He has promised He will use this for good.
Comment number 6 is something along the lines of "why don't you try God's way instead of man's way" and this comment usually refers to the use of psychiatric medications and therapy. There are many that believe that using psychiatric medications is wrong and that the only therapy that Christians should ever receive is biblical or pastoral counseling. Again this is not to discredit biblical or pastoral counseling. But people with severe mental illnesses need people with certifications and understandings of the mental illnesses and what therapies are good to treat them. These include trainings in therapies like cognitive behavioral therapy, dialectical behavioral therapy or EMDR. All of these therapies require special training and certifications and many biblical and pastoral counselors lack these certifications. God has allowed medicine to be created to be used to help people. Telling people not to take their psychiatric medication is just like telling people not to take chemo for cancer or insulin for diabetes. If it weren't for the medication I am currently on, I would not be a functional human being. I would be confined to my house, to my room, to my bed. I would have constant anxiety and depression with no relief. My medications are NOT a total fix and are not "happy pills" as many may think. My medications make my life work and make me a productive person. The therapies I go through are far from easy but are specifically designed for my mental illnesses and help me to deal with the struggles that come with the illnesses. They help me learn to cope and handle life's challenges which I can't do like people without mental illness because of the physical changes in my brain. So instead of viewing medication and therapy as man's way, let's recognize it for what it is - a provision from God that allows people with mental illness to get the help they need.
The last comment I will go over is one that isn't really related to Christianity but is one that I have heard many times. This comment is one where people state that I will "grow out of" my mental illness and that it's just a part of adolescence. Again, going back to my first point. Mental illness is a physical change in my brain and is not something I will grow out of. It is something that with the right treatment and hard work in therapy, I may be able to learn to live with and not have it be completely debilitating but it is not something I will simply grow out of.

To close this post, I am going to review what Chonda Pierce said at the event I saw her at this past Friday. She shared her experience in a psychiatric hospital in group therapy. Everyone was given their chance to share why they were there, how they were feeling and any struggles they wanted to talk about. Once they were finished, the response was "thank you for sharing". Her comment was "Isn't this what the church is supposed to look like?" where we thank people for telling us their struggles and hardships and accepting them for what they are and then thanking them for being open about it. We as Christians are to care for the brokenhearted, not fix them. So let's learn about mental illness and make sure what we say is helpful, not hurtful and takes into consideration the reality of the physical component as well as the mental, emotional and spiritual components of mental illness.

A letter to medical professionals from someone with mental illness

Dear Doctors, Nurses and ER Workers,

While there are times I may come to you because I'm in some sort of a mental crisis, there are also times where I will come because something physically is wrong. And when something is physically wrong please treat me without viewing me through the lens of my mental illness and psychiatric history. When you have to draw blood or take my blood pressure and you manage to see one of my scars from my serious struggle with self-harm in the past, please do not ask about them unless you absolutely have to. And if you do ask and I answer that the scars are old, please don't argue with me. Yes I have scars and lots of them. Yes I have self harmed in the past. Yes I have an extensive psychiatric history. But am I here because I'm at risk for hurting myself? No. I'm here for a legitimate medical issue and would like to be treated as such and not through the filter of my psychiatric diagnosis. Please don't brush my legitimate medical concerns off for anxiety simply because I have a diagnosed anxiety disorder. I've had anxiety long enough to know what is anxiety and what is not. If it was anxiety, I would know what to do and wouldn't be here right now. Please treat me equally and look past the mental health portion of my history just so that you can give me the proper care and treatment I deserve.

Medical professionals, I see it when you look at me like you think I'm doing this for attention. I hear your voices change when you find out about my mental illness. I see you whispering to other staff about how I'm just another nutcase looking for attention. I see it. I hear it. And I'm not okay with it. Mental illness does not erase or minimize the physical suffering I am experiencing. Just because someone is suffering with cancer or diabetes, doesn't lead you to ignore or minimize their health issues, so why should it minimize mine?

My scars are my past. My scars are reminders of where I've been and how far I've come. My scars are a part of me I will probably have forever. And that's okay with me. I understand it and hope that you will too. Please take the time to educate yourself about mental illness and how it presents and please realize that while I do have a lot of emotional pain, I experience physical pain too.

Please do not include the suicide hotline on every one of my discharge summaries because I have a history of mental health disorders. Please do not consider me to be a threat to myself or anyone else just because I may have been in the past. When you do this, it makes me feel that my suffering is less or not as important as someone who doesn't have the mental health past like I do. I understand that you may think this is your way to help, but it doesn't help. If you are truly concerned about my mental state and my mental health, ask about my current treatment and if I'm seeing a therapist or psychiatrist. Treat me like a real person, not just a diagnosis. Because that is what I am..... a person. A person who has a mental health diagnosis but is NOT the diagnosis. Just like a person with cancer is not cancer.

I am a human being with value and worth. I deserve to be treated fairly and for my concerns to be treated seriously. Please be sure to remember this the next time you see me or any other person with a mental health condition.

Sincerely,
Kimberly

The Slippery Slope

For me, my breakdowns can happen either very suddenly or gradually. There can be one event that sends me in a tailspin and I'm struggling just to stay alive moment to moment. But those don't happen too often. The event has to be extremely hurtful and unexpected for it to really knock me down quick. This happened in October when I was sent an email saying I was no longer allowed to attend a support group. The day after I got the email was the day of my 5th suicide attempt and the decision was made and acted on quickly.
However, looking back, most of the time my breakdowns occur gradually. On what I call a slippery slope. One I start down it, it feels almost impossible to stop sliding down. It will start with signs like a difference in my appetite and my sleep schedule. Then it will start to affect my enjoyment of things and my energy level. Then I will begin isolating. From isolating, the internal thoughts start going about how I'm this horrible person who doesn't deserve friends and will always be alone and so on and so forth. This slippery slope takes weeks for me to slide down and out of all the times I've been hospitalized, I've managed to fight it once. Out of 16 hospitalization and 5 suicide attempts. That's a lot of breakdowns and there is only one breakdown that I've had that didn't lead me to go into the hospital. And that was only because the hospitals I wanted to go to wouldn't take me as a patient and I was terrified of being sent to a hospital that will hurt me rather than help me (which has happened multiple times). I still spent weeks in a complete depression with suicidal thoughts every day and self-harming behavior. Eventually I was starting to pull myself out of it when I got hit with the big event in October that started my last breakdown.
I've been out of the hospital since the end of October. Almost 4 months. That's a long time for me. The longest I've been out in over a year. And I don't want to go back in the hospital. I'm afraid to go back in the hospital. Because going in the hospital means one of two things: I will either end up in a hospital I have been in before that hasn't helped me or I will end up in a new hospital that I'm not familiar with and could end up in a good or bad situation. But there is the fear of the unknown. I've had multiple hospitals not let me wear my wrist and ankle braces, simply because they have strings (which by the way can't be removed so there really isn't any risk of me hurting myself with them), which has led to a lot of physical pain in dealing with my arthritis. I've had some hospitals that have allowed me to keep my braces. It really depends on the hospital. Another big thing for me is whether or not I'm allowed to have my biggest comfort and self-soothe item - my pillowcase (it has it's own back story which I will write about another time). Essentially this pillowcase is a security blanket for me and I carry it everywhere. It's easy to tote in my purse and keep with me at all times when I need it. It helps calm me down during anxiety attacks. It comforts me to help me sleep and is a very meaningful possession to me though there are many people who can't understand why (because it's very tattered). Some hospitals let me have it. Some do not. Again, really depends on the hospital.
However, I have noticed that I am once again on the slippery slope. This means my energy level is lacking, I'm making impulsive and rash decisions, I'm irritable, extremely anxious (which is usually controlled with medication), my suicidal thoughts are getting worse and I'm avoiding people like the plague. I feel guilty for doing it but it's hard to explain to people what's going on when you don't even know yourself. Last night, I made a big decision very stupidly and on impulse and it has been haunting me ever since. Making me slide farther down the slippery slope. A big decision that once I told a friend about, that friend called me three times in the middle of the night to make sure I was okay. And today I started out feeling okay and have just gotten worse and worse since.
The thing I'm noticing though with this slippery slope is that even though I recognize I'm on it, I'm still trying to isolate and not talk to people. I'm still trying to act like I have everything together. And I surely don't plan on talking to my therapist about this either (mainly because this is only the second time she will be seeing me). So I don't really feel like I have a team behind me. I have a couple friends who I know care and would do anything to help me but I know I need more and I just don't have it.
So will I continue down the slippery slope and end my streak of staying out of the hospital? Or will I manage to somehow pull myself together and make it through? I'm not really sure at this point. 

A letter to my parents

Dear Mom and Dad,

When you held your baby girl for the first time, what dreams did you have for her? That she would become a doctor? Or change the world? That she would be an overachiever in sports and academics? That she would love her life and her family? Did you dream she would be beautiful? Did you dream that she would be successful?
Were you disappointed when she chose music and academics over sports? When her weight ballooned and she was diagnosed with juvenile rheumatoid arthritis, ending any hopes you had of her being what you wanted her to be? Did you ever think you would cast her aside for your other child, the one who fulfilled the dream that you had for her but she couldn't execute?
Did you ever think that that baby girl you held in your arms would be cursed with the genes that caused mental illness? That ended up taking the life of your baby girl's grandmother and aunt and that affected many other family members lives?  Did you ever think your baby girl would become depressed at the age of 14 and turn to self harm? Did you ever think you would need to be aware of the signs that she needed your help? Or did you know the signs because you experienced things very similar and you didn't want to see them in your child so you overlooked them? Did you ever think you would push the issue under the rug once you knew? Did you ever think your baby girl would end up in the psychiatric hospital for the first time at age 15? Or that she would have 15 more hospitalizations in the years after? Did you ever think that your baby girl would try to end her life 5 times?
Did you ever think your baby girl would be on disability at the age of 21? That she would be diagnosed with 4 mental illnesses: major depressive disorder that is severe and treatment resistant, generalized anxiety disorder, post traumatic stress disorder, and borderline personality disorder? Did you ever think she would struggle with panic attacks, nightmares, flashbacks, mood swings, and chronic suicidal thoughts? Did you ever think that the genes you passed on to your child combined with the environment she grew up in would lead her having to fight mental illness every day? That she wouldn't find a treatment that would work even after years and years of trying medications? Medications like Celexa, Zoloft, Lexapro, Cymbalta, Effexor, Prozac, Wellbutrin, Abilify, Seroquel, Lithium with no relief? Did you ever think that she would even have to try electroconvulsive therapy also known as shock therapy with still no real relief?
Did you ever think that your baby girl would have to fight to get out of bed everyday and try to function? That she would have to fight to get a college education? That she would have to fight the pain inside every day so much that it exhausted her? Did you ever think that that baby girl that you held in your arms that day would end up with a life like this?
Did you think she would cut off communication with you for years at a time, hoping that she could heal and find a way to manage her mental illnesses?
When you saw your little girl for the first time, did you see her becoming a wife and a mother of her own some day? Did you dream of having grandbabies? Did you ever think that she would choose not to have children of her own so that no human would enter the world and have to suffer like she did?
When you held your baby girl for the first time, did you ever see her becoming a person who advocates for those that need to be advocated for? Did you ever dream that she would love those that are helpless, like animals and young children? Did you ever see her becoming strong in spite of adversity, independent without support, and self-sufficient without guidance?
Mom and Dad, could you ever picture what your baby girl would become? With or without you?