Thursday, July 12, 2018

My Battle with Food

*************TRIGGER WARNING for anyone who may have an eating disorder***********

I have officially been home 9 months. That means 9 months without a hospitalization, basically 9 months of stability. In those 9 months, I have successfully gone without self-harm which is a big accomplishment for me, especially considering that it was an addiction that began when I was 15 years old. My suicidal thoughts are gone and have not returned which is another huge victory. But with every victory, a new battle takes it place.

My battle with food began very shortly after I returned from New Orleans. I had gained a lot of weight through my 6 months of hospitalization, 60 pounds or so and most of my clothes were not fitting. I had to buy a whole new set of pants to have for work pants to begin work. Initially, I went food shopping and I filled up my freezer with meals and bought breakfast food and planned on eating normally. I don't even remember how it started. I think one day I probably just ate breakfast, a bagel was my usual breakfast and just didn't eat lunch or dinner. I started continuing this pattern. November 1st was when I started documenting what I was eating. Every day I wrote what I had eaten which for a while was just breakfast and the yogurt I use to take my medicine in the evening.

November 3rd was my first binge that I recorded (I don't remember if I did before then). I bought a pizza from Little Caesar's and ate 6 out of the 8 pieces at one time. Following the binge came my first purge. I wasn't very good at it to start so I didn't get much out but I got some out.

From there I continued my pattern of documenting what I was eating and if I binged and purged. At that point, my diet usually meant I was eating something for breakfast like a bagel or a parfait and then a yogurt at night when I took my meds and then I allowed myself to eat on weekends when I had get togethers with friends so that they wouldn't be suspicious but if possible I would purge afterward. I had bought myself a scale to monitor my weight and I had lost most of the weight I had gained and was trying to keep going.

Shortly after Christmas, I cut breakfast out of my diet. My diet then consisted of a yogurt and some random snacks at night that equated to close to nothing, except for weekends where I ate when around friends (which was usually for 1 meal) as to not raise any suspicion. I drank Dr. Pepper during the day to give me sugar to keep me going.

For most of this year, I've not eaten breakfast and when I can afford to I've had a fruit for lunch and occasionally had dinner. This has been the pattern up until just recently, in the past couple weeks.
Right now, I am consistently eating breakfast and lunch. I'm still struggling to eat dinner every single day because I'm just not used to eating 3 meals a day.

It's a work in progress. I guess this is my new battle to face.

Friday, June 22, 2018

Dissociation

Dissociation. Let's start with the word itself. It is not disAssociation. Just dissociation. Let's get that right first.

So what is dissociation?

Well the best way to describe it is it's a disconnection. It can take multiple forms but it is a disconnection. Think about driving your car and then all of a sudden you realize you have driven somewhere and don't remember the drive or how you got there. That is on the lowest end of the spectrum of dissociation. Daydreaming is also an extremely minor form of dissociation, because these are disconnections from the real world as you go into your head.

There are multiple forms of dissociation.

The first form of dissociation is called depersonalization. This is where there is an experience of reality outside of self remains relatively consistent, while the perception/experience of self is what gets distorted. Examples of this are things like an out of body experience, not being able to feel your entire body because you are disconnected from it, and regressive states (when people regress to younger ages). Many people who dissociate describe it as they feel like they are floating above themselves and watching everything going on like a movie.
The second form of dissociation is derealization. This is where the experience of reality outside of self gets distorted while the perception of self remains relatively consistent. Examples of this are things like flashbacks, when reality is heightened and when reality is diminished. Sometimes people experience times when they are more sensitive to their senses in the environment, like the sounds or smells of what is going on around them, heightening their reality. There are also times when people lose touch and things like tastes, smells and others senses are diminished and they less sensitive to them.
The third form of dissociation is cognitive disengagement. This is when there is a disconnect from both reality of self and reality itself. An example of this is when you driving down the road and don't remember getting there. This happens when people will "zone out" of the world completely and run on autopilot and not remember what they were doing. This is also where people will dissociate to different identities of themselves.

So why do people dissociate?

Dissociation is developed originally as a defense mechanism. It is how the brain handles things that are too difficult for it to process. These are things like trauma - physical and sexual abuse, assault, things like that. When the brain cannot process what is happening at that moment, it disconnects from reality as a defense mechanism. What ends up happening though is that dissociation continues on even after the trauma has ended. It begins to start disrupting life and becoming an issue that needs to be addressed.

So how do you address dissociation?

1. Identify and work with triggers is the first big step. Know what is a trigger and where that trigger comes from. Doing extensive trauma work is a key piece in identifying triggers and working through them to being able to lessen dissociation and being able to manage it.
2. Use grounding techniques. This is critical to managing dissociation. One of the easiest ways to practice grounding is by using 5-4-3-2-1. You list 5 things you see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing you can taste. You do this actively and engage your senses back into your present. Another big way to ground is to have a transitional object. This is an object that people can use their senses with to help ground them. This is something that a person always has with them. One example is for me, I have a special pillowcase that I have had for years. I take it everywhere with me. It helps ground me when I begin to lose touch with reality because I can use the sight, smell and feel of it to ground me back to the present. Another example would be a worry stone or for some people a necklace. There are many different ways to practice grounding but it is key when experiencing dissociation.
3. Respond effectively in the moment. Dissociation is kind of like a stoplight. Green is grounded and red is dissociation. Yellow is the warning signs. Creating pictures for what all three of those look like, especially the warning signs will help you find ways to catch yourself and choosing your response to the trigger before dissociation occurs.

So what does this look like for me?

Dissociation is a daily struggle for me and I struggle with all three forms of dissociation. I will sometimes lose touch with my body completely and not feel connected at all. I have flashbacks often, which for me are where I can still see what is going on around me but I feel all the sensory stuff plus the emotions (usually anxiety) from the flashback. So I can tell I'm having a flashback but still know what's going on. I also lose touch completely with the world. This happens a lot while I'm driving. I have been in the car and driven past where I'm going and come back from dissociating and have to figure out where I am because I don't remember driving there. I will dissociate in the middle of conversations (not intentionally) and will look like I'm listening but will be gone. The worst it's ever been happened recently when it came the end of the day and I couldn't recall most of the day because I had dissociated so much. So dissociation is a daily struggle for me.
I do my best to cope with it. I carry around my pillowcase with me, though I can't have that by my side when I'm in certain places like work. I keep essential oils in my purse, one specific blend is called Grounding and I use that when I'm dissociating to help bring me back. I use music when I'm in the car to try to help me stay in the present as much as possible. It is a daily struggle but I try my best to work with it. I am in therapy working on trauma related things and trying to maintain stability as much as possible.
Overall, it's a process. A long one. It's part of having PTSD and it will probably be a battle for the rest of my life. But it is something I will work to overcome. There is always hope.

Sunday, April 8, 2018

Living in the Dark


Trauma. We need to talk about it. It teaches us so many unhealthy ways about how to cope with life. It takes our fight, flight or freeze system and puts it into overdrive. Eventually, it becomes how we interact with the world. It determines our interactions with other people, how we handle stressful situations, how we view the world around us and so much more. When we are exposed to trauma at such a young age, our whole world is defined by it and we know nothing else. This can become problematic at any age, but especially becomes problematic as time goes on. It gets to the point where we don't know who we are without the trauma, without the interactions that come as a result of the trauma. This is living in the darkness.

Darkness. It started with abuse and neglect as a child, showing the child that the world was a dark place to live in. Then continued. It took over. Darkness means that the trauma has now defined you as a person, has taken over your identity. Darkness means healing is daunting, terrifying because it looks like nothing is there other than you with your trauma. Living in the darkness means running from healing because you are too afraid of losing your identity.

Living in the darkness can be manifested in a variety of ways. It can be someone who isn't willing to seek out therapy when they know they need it. It can be someone who is in therapy but not letting the therapist in because they aren't sure they want the help. It can be someone who purposefully keeps their distance from everyone because they are too afraid of being hurt or can be someone who lets everyone get close and gets hurt easily. It can be someone struggling with addiction, whether that be alcohol, drugs, or self-harm. Living in the darkness looks different for everyone but what it ultimately comes down to is someone is running away from healing because change is scary.

For me, Darkness looked like me running from my past, trying to stay as far away as possible. It looked like me living a life defined by severe mental illness, with daily suicidal thoughts and self-harm. Darkness looked like me bouncing in and out of psychiatric hospitals, trying to tell myself that it was the hospital that was in the wrong and that I didn't need their help. I didn't listen to their advice when they told me that I needed long-term treatment that was more intense than they could offer. I didn't invest myself in the therapy I was going to. I was running away from the help that I desperately needed. This was my darkness.

But why do I tell you all this? Because I know there are people out there right now that are stuck in this pattern right now. That are stuck because they are so afraid of losing their identity because it is so wrapped up in their trauma.

And I want to tell you that there is hope on the other side. There is a beautiful fullness of life on the other side. There is the opportunity to have a full functioning enjoyable life on the other side.

How do I know? Because I lived it. When I finally submitted myself to the treatment that I needed, and spent 4 1/2 months in short term hospitals getting my medications figured out and then 6 weeks in a trauma program specifically designed to help me work through my past, my life changed. Everything changed. It was a whole new ball game. I came home with a better outlook on life, the ability to handle stress and the ability to keep myself safe for the first time in my life. I have now been home from the program for over 6 months and have still not engaged in self-harm.

Life can change and can become beautiful on the other side.

It just means taking a chance and putting your full effort into it.

Sunday, January 21, 2018

Medication

Medication plays a very important role in the treatment of mental illness. It is one part of treatment in the battle versus mental illness and a very important part as well. Medication is not something that is uncommon. One in six people in the United States are on some form of a psychiatric medication.

However, medication in and of itself carries a big stigma. People still refer to them as "happy pills" and don't see them as being necessary for productive living. People are repeatedly shamed for having to take medication for their mental illness. Many times they are told to do things like change their diet to this plan or that plan or make sure their getting enough sleep or just exercise more and while these things are good things they do not solve the issue that depression and anxiety create inside the body. Mental illnesses are caused by real physical deficiencies in the brain and that is why medication is so important to recovery. Mental illnesses are medical illnesses in nature and this is something that needs to be recognized. Pill shaming should be a thing of the past and peer acceptance should be a thing of today. Only then will we move forward, away from the stigma.

My experience with medication began when I was a teenager. At the age of 15, I was put on an antidepressant and an anti-anxiety medication. I didn't have steady mental health professionals throughout the end of my teen years so I took those medications for a couple years and eventually went off of them on my own. At the age of 19, I realized that I needed help again and sought out to see a psychiatrist. This started out the new medication trials which eventually led to an overdose on those medications which once the psychiatrist found out about the overdose, led to a psychiatric hospitalization. From that point until now, I was put on so many different medications and medication combinations it is impossible to count them. I have been on almost every SSRI and SNRI that exist (SSRI and SNRI are classes of antidepressants). I have been on mood stabilizers, anti-psychotics, multiple different types of sleep medications and many different kinds of anti-anxiety medications. I am the person the black box warnings were created for. I have had medicines make me more depressed and more suicidal. We also just recently learned that medicines can make me more suicidal for a period of a couple days as my body adjusts to them and then everything will calm down and I'll be okay. My body is just super sensitive to medication and medication changes and it is super important that I keep my medications the same in my system. In the year 2017, I spent 6 months in a hospital setting. The first 4 1/2 of those months were basically used to figure out which medication combination would work best for me. It literally took 4 1/2 months of changing medications on sometimes a daily basis to figure out what I needed and what would actually work for me. But finally I am on a regimen that works and I am grateful for that. Because of all I have gone through with medication, I feel like I have the ability to share my knowledge with others because I know what medications do what and what they can help with and I have a basic knowledge of most medications that are out there. I hope to use my experience to help others.

Here are some guidelines and suggestions I have come up with when it comes to medication:
1) Know what you are taking. And by know I mean really know. Know the name of it, know the dosage, know what time you take it, etc. Also do a little research on it. This is helpful if you start to experience side effects especially since no medication doesn't come without a side effect. It's important to know what the side effects are so you can discuss them with your doctor. Additionally, you should know how to take the medication. This includes knowing when you should take the medication as some should be taken in the morning and some at night. This also includes whether it should be taken with food or not. Some medications also have interactions with other medications that you should be aware about. Many psychiatric medications interact with grapefruit so it is important to know if you medication has that interaction. All of this is basic information that can be found on the internet. Know your medication so you know what to expect.
2) Keep a schedule. Try to take medications around the same time each day. One helpful reminder is setting a timer on your phone or using a phone app that can help remind you. The phone app I use to remind me is called RoundHealth. Another thing I use to help me is weekly pill containers. This is really helpful if you take multiple medications.
3) Be an active participant. What I mean by this is start researching. If a medication doesn't work for you, start researching and see what an alternative option would be. Being an active participant can mean coming to your appointments and telling your doctor "Well I read this and wanted to know your opinion". Doctors want you to be an active participant in your care. They can always disagree with you and you can discuss going a different route but having knowledge of what is out there is very powerful in your appointments with your psychiatrist. One example I will use is that there is a medication they are just starting to use for nightmares that works better than the current one and I brought research to my doctor and he researched and we agreed to put me on it and it has worked so much better. I would have never been put on that medication if I had not researched it in the first place. It is important to be involved in your care. Active participants tend to get better quicker because they are advocating for themselves and what they feel they need.
4) Do NOT go off medication without doctor's orders. I repeat do NOT go off medication without a doctor leading you through it, even if you are starting to feel better. You are probably starting to feel better because of the medication. Additionally, going off of medications suddenly can have dangerous symptoms including things known as "brain zaps". Going off of medications without a doctor's order is very dangerous and can put you in a worse state than you were in before. I know this because I've done this, twice with dangerous results both times. Both times I ended up in a hospital shortly after because of going off the medication. Stay on your medication as prescribed until your doctor tells you otherwise.

Medication is something that can be very useful in our battle with mental illness. It is something that is often necessary for people to function and there should be no shame in that. We should move forward to live in a world of acceptance, not shame so that everybody can achieve a healthy functional state of being whether that includes the use of medication or not.

(If you have any questions, feel free to ask. NOTE: I am NOT a doctor, just someone who has been through the ringer with this.)

Monday, January 15, 2018

PTSD

Trauma.
What comes to your mind when you see that word? A bad high school experience? Bullying? Parents' divorce? Or do things like war, 9/11, abuse come to mind?
The reality of it is that all these things are traumas. Webster Dictionary defines trauma as "a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury." Traumas can be a one time occurrence or something that lasts every day for years on end.
Traumas affect every person differently. What one person may see as traumatic another person may not. What deeply affects some people may only minorly affect someone else. 70% of the population will experience some type of trauma. 20% of those people will go on to develop Post Traumatic Stress Disorder or PTSD.

Post Traumatic Stress Disorder is defined as when the reaction from the trauma becomes life-interfering. Post Traumatic Stress Disorder has been found recently to develop specifically because of changes in the brains of those who have it. Generally those who have it have been living on edge for such a period of time that their body has learned to stay in that mode and therefore adjusted to it and it never stops. Living in that mode changes the brain and makes it more susceptible to developing PTSD.

PTSD is diagnosed when someone exhibits symptoms from three categories.
The first symptom is re-living of the event. This can happen in multiple ways. This can happen when someone has a nightmare, an intrusive memory, or a flashback. A flashback is when the mind sends the body back to a specific time in the past and one feels like they are back in that moment. This is usually done through the senses. Flashbacks are experienced in different ways depending on the person. A person can still be present in the world and understand what is going on or they can be completely disconnected with what is going on around them. It varies from person to person.
The second symptom is avoiding reminders of the event. This can include people, places, thoughts or anything that may be connected to the trauma. Additionally, they may withdraw from people that they are close to and feel detached emotionally from their friends and family. They may also lose interest in their activities.
The third symptom is being on guard of hyper-aroused. This means that people are on the edge all the time, worried about what may come next. This can lead to bursts of anger, anxiety, jumpiness, difficulty sleeping, and an inability to focus.
The combination of these three symptoms lead to a diagnosis of Post Traumatic Stress Disorder.

So what options are there to treat PTSD?
There are generally two options: medication and therapy.
Medication can be used to help with things like mood, anxiety and any co-occurring disorders. Additionally, doctors have been using a blood pressure medication to help with nightmares and that has worked well for many.
For therapy, there are many different types of therapy that can be used to help someone with PTSD. One type of therapy is called EMDR or Eye Movement Desensitization Reprocessing. It is when a specific eye motion is used to help your mind reprocess some memories so that when they resurface they don't carry the emotional weight that they did before.
Another type of therapy that is used is exposure therapy. This type of therapy is what a person is slowly introduced to things that trigger them in order to help them to not become so triggering.
Another therapy that is generally used in all spectrums is cognitive behavioral therapy which works with thoughts and thinking errors and things like that.
The combination of therapy and medication can help life become more manageable.

Post Traumatic Stress Disorder is challenging to deal with. It can even be debilitating if not dealt with. However, with the right treatment, there is hope. There is always hope.


Post Traumatic Stress Disorder Fact Sheet. (1995). Retrieved January 09, 2018, from https://www.sidran.org/resources/for-survivors-and-loved-ones/post-traumatic-stress-disorder-fact-sheet/

Monday, January 8, 2018

The First Episode

My first major depressive episode happened when I was 14 years old. It was the summer after my freshman year of high school. I believe multiple factors helped bring the depression on. The first one was simply the fact that it was summer time and that meant no school, so there was very little to do. Both my parents worked so there were no opportunities to join things like summer camps or different activities, my brother and I were stuck at home during the day. The second factor was the news that two important people in my life were moving which was devastating news to me at the time. The third factor was the fact that I was living with Juvenile Rheumatoid Arthritis and struggling with a lot of pain due to that. The fourth thing that I believe brought it on was the environment I was living in. My parents were verbally attacking me at various times for various things and nothing I ever did was right. There were extremely high expectations and long to-do lists. The combination of these four things plus a genetic predisposition brought on my first depressive episode. I remember displaying all the classic symptoms. I would sleep late into the day and stay up until 2 or 3 in the morning. I lost my appetite and would eat maybe one meal a day. I holed myself up in my room for most of the day and only came out when I had to. I still communicated with my friends through text and Facebook and still went to church like usual but I was more standoffish than usual. I also had multiple crying spells and was very sensitive. I was sad most of the time. Many things began changing during the first few weeks of the summer.

When my friends began noticing all the changes that were occurring in me, they started mentioning depression to me. I denied it immediately saying there was no way. It took a couple weeks of them mentioning it before I finally began to admit that I actually was experiencing depression. From there, they were trying to figure out what they could do to help me. My parents were very much still in the dark about what was going on with and had not picked up on any of the signs or the fact that I was struggling in anyway and going to them was not an option. It was a difficult task and there really were no options out there for help without parental involvement. I was stuck in a horrible situation.

Not too long after, things came to a head. I started experiencing suicidal thoughts and posted something on Facebook about wanting to die. The youth pastor's wife saw it and messaged me asking if I was suicidal. I said yes. Next thing I knew, our doorbell was ringing and my dad was coming to get my mom and I out of our rooms and there were cops standing in the opening between the kitchen and living room of our house. They had me come down and asked me if I was suicidal. I said yes. They asked me if I had a plan. I said no. My mom began to freak out and cry. My dad then told the cops that my mom's mom had killed herself. The cops called back in to their headquarters about the situation and it was decided that a mental health tech would come to the house and evaluate me to determine if I was safe or if I needed further treatment. The evaluator came and he asked me a lot of questions and eventually decided that I was safe. At this point the cops left and it was just me, my parents and the mental health evaluator. The man told my parents that they needed to get me into counseling and told them some of the stressors in the environment that could be worked on, which my parents were close minded to. He left and things were very tense from then on.

Once my parents found out that it was the youth pastor and his wife who had called the cops, they immediately had a phone call with them where my dad yelled at them and demanded that they no longer communicate with me. My parents also contacted the lead pastor at the church to make a complaint against the youth pastor. It was an extremely difficult time for me because those people were really important to me.

As far as counseling went, my parents took me one time. The first part of it the therapist asked what everyone hoped to get out of it and my dad took that moment and ran with it as he used it to tell the therapist how horrible of a daughter I was. My mom tried to pacify him but it didn't do anything. My mom's response was more of a wanting to stop of the suicidal stuff. I didn't say much. Eventually the therapist sent my parents out of the room and that's when I was given the chance to talk and I talked to the therapist. The therapist even mentioned going on medication. When I mentioned that to my mom after the fact, she scoffed at the idea. I never went back to see the therapist.

Grief and Mental Illness

Grief. The process you go through after you have had a major loss in your life. This can be the death of an important person, loss of a job, loss of a pet, loss of a house when moving and so on. Generally the basics of the grief process include that there are five stages and everyone goes through them in different ways. Those five stages include denial, anger, bargaining, depression and eventually acceptance. One can move through this process quickly or one can take years to work through it depending on the loss.

Mental illness brings about many changes when it begins. For example, the onset of depression is determined by the symptoms of depressed mood, sleep changes (sleeping too much or too little), appetite changes (eating too much or too little), loss of interest in activities and others. This can look like someone who is usually very motivated to go to work and spend time with friends to someone who struggles to get to work on time and isolates by laying in bed when not at work.

When mental illness strikes, it can take many things from a person. The first thing it takes is the reality of having a good mental health. This can be devastating to many people.  It can ruin relationships, take jobs, take away aspirations and dreams and ultimately the reality that someone will be able to function the same way ever again. This reality leads one into the grieving process.

I have severe mental illness. I do not hide that fact. I have struggled with mental illness since I was a child and it has only progressively gotten worse since then until coming to a final climax this year where I spent 6 months in hospitals before finally receiving the treatment that I needed all along. When my mental illness began to grow in severity, there were things that I couldn't do anymore. I could no longer hold down a full time job. I could no longer maintain a full time student status at school. I had to give these things up. When I gave up these things, I entered the grieving process, the process you go through after you have experienced a major loss. Mental illness took away my first career dream. Mental illness took away the opportunity for me to have a normal college experience. Mental illness took away many friendships that I have had. Mental illness took away my ability to work full time. Mental illness took away my ability to do a full time online college experience for a period of time. Mental illness made me unstable in every aspect of my life for a good period of time and I only made it through because others had my back.

The thing that one has to know is that with mental illness, while it does take away many things, it does give back some things. Mental illness has given me a few things through my experiences with it. The first thing it gave me was that it taught me was that I have more in common with people than I ever thought that I did. Spending lots of time in hospitals meant spending lots of time with people I would have never spent time with outside of the hospital. I made so many friendships throughout my stays in the hospital and many of the people I met in hospitals I am still in contact with and have very strong friendships with. The second thing it gave me was a ton of knowledge that I can now use to help others. The fact that I've been through as much as I have with hospitals, doctors, therapists and medications means I know a thing or two about how the system works and am able to give advice to other people based on my experiences. This is at least one of the things I have hoped would come out of all my negative experiences. The third thing I have gained is some knowledge about myself.  One thing I have learned is just how strong I really am and how much I have to contribute to the world. I also learned how much I matter to the people around me. I have learned how to have strong legitimate friendships again.

Overall, mental illness has taken a lot from me. But I have gained a lot through my experiences with it. I may have lost one dream. But I have gained a new one, and I am pursuing that one. Mental illness will not define my life and it is important to understand that while grieving is a normal process to go through after a mental illness diagnosis, it can not be the end there. Mental illness cannot be the defining factor in someone's life. It is important to learn to manage it and learn to overcome it as difficult as that may be. We define our own lives, mental illness does not.