Change is scary…

I finished the partial hospitalization program last week. On Thursday, January 30th. I started a Trauma Focused Intensive Outpatient Program yesterday, February 3rd.

Change is scary.

I’ve pretty much been in PHP since June. There have been breaks for trips to the hospital, and one short step down to IOP for a few days before I was stepped back up to PHP because it was agreed I needed a higher level of care. So I have been in PHP since June.

I don’t even know if I’m ready for this group. The trauma focused IOP. Maybe I should be doing the dual diagnosis IOP or the DBT (Dialectical Behavior Therapy) group. I mean, DBT is THE treatment for Borderline Personality Disorder, and even though my personal therapist is adament that I do not have it, other providers who see me on shorter terms usually say I do. Simply because I self injure, in my opinion, and it makes me angry sometimes. I have done DBT groups many, many times. I know the material backwards and forewards… but, I did self injure a week ago, on Tuesday, the 28th. I also relapsed on alcohol, for 4 days each time, and showed up to PHP intoxicated 3 times. My clean date is January 29, 2020, at the moment. So the dual diagnosis IOP would make sense too, but there probably not much they could teach me that I don’t already know, having been doing the getting clean thing since 2006.

But am I ready for the trauma IOP? Can I handle it? I dissociated hard yesterday, and it was the first day of IOP…

During the first hour, we checked in. There were only three of us there yesterday, so we all had a decent amount of time. That was nice. It was awkward for me, even though I knew the therapist and one of the other group member a little. I don’t know, just saying some of the things I deal with, like the self injury (I mentioned the specific methods I use) and suicidal thoughts and I was able to say that part of the trauma relates to a loss that was too soon… saying those things was difficult in front of people that I have only really just met.

During the second hour, we discussed our goals for the week. The therapist wanted three goals: a physical, social and emotional goal. My physical goal is to not self injure this week. Social is to go to 3 meetings. And the emotional goal is to show up for IOP. As weird as this may sound, those goals are hard for me. Right now, those are pushing my limits. IOP starts in 3 1/2 hours and I have not slept. The sun is starting to come up… The sky is starting to lighten at the horizon behind the houses across from mine. People are starting to leave for work. And I have not slept. At all. Normally, my alarm would be going off in one hour, so it’s not even worth trying at this point. I’m just going to have to caffeinate, caffeinate, caffeinate. It’s the only way I will be able to make it to IOP today. And to the other things I have scheduled later.

During the third and final hour, we do mindfulness every day. Yesterday, the therapist did a self compassion guided meditation. I normally am not really that okay with guided meditation, except for breathing ones, body scans, or progressive muscle relaxation. I gave it a try. It didn’t go well for me. As I said above, I dissociated hard. Less that a minute in, I could tell I was losing my body. Then the tunnel vision started, all the way to a pinpoint. Then I lost my hearing completely. Usually, when I dissociate, I don’t lose my hearing. I am still semi-aware. I can still hear what is going on around me, I just can’t respond at all for a bit. But this time, I lost everything. I was completely gone. I don’t remember the rest of the meditation. The next thing I know, the therapist is asking me a question. I didn’t hear the question, but I could tell it was aimed at me. I couldn’t speak yet, however. I made a gesture with my hand to indicate “kind of.” It was all I could manage. I was zoned out again, when I realized she was asking me another question again, after a minute or two. I made the same gesture with my hand, because I still couldn’t manage words. At that point, she realized. She asked if I had dissociated, because I had mentioned earlier that certain guided meditations (safe space) make me dissociate. I nodded. She asked what would help bring me out of it, and I was able to squeak out a very quiet “time.”

The therapist did hold me after group for a bit, just to make sure I was okay to drive, and also check in with the level of suicidality I had marked on the check in sheet and check that I could be safe overnight and be back today. So I kind of have to go today. I can’t just not show up…

Some day, hopefully soon…

I will write about the traumatic event that has me in this mess. That led to the suicide attempts. That kept me depressed practically my entire life. That is giving me flashbacks and body memories daily. That has me still actively suicidal on a daily basis.

Don’t even know where to start…

I want to write… I have wanted to write for over a week now… I want to write the right thing. I want to make it perfect. There are things I need to write about, but I don’t know where to start.

I had a friend commit suicide on January 12th. I relapsed on alcohol shortly after, tried to stop again, and relapsed again yesterday. In my head, drinking is better than attempting suicide again. I tell myself that if I get suicidal to the point that I am actually going to do it, it is okay to use, even though I am an addict.

I don’t know what to say about my friend. He is the second one, recently, to commit suicide. I had one friend die in September and then now this one in January. I wish there was something I could have done, something that could have stopped them. But I know the feeling… I know how it feels to have no hope anymore. I attempted in October and December. My head keeps going into suicidal thoughts, even today.

I wish I could get past the thoughts… I wish I could never be suicidal again, but the chances of that are slim to none. That’s just what my brain does. That’s where my brain goes.

I want to not be depressed. I want to be happy. I don’t see that happening. I don’t think I will ever get past and over the mood crap. And that is the hardest part. Having no hope makes it harder to keep going.

Rough Day…

Today has been rough… just an all around hard day. I’ve had several flashbacks that kind of threw me for a loop and brought up the traumatic loss that I’ve been dealing with the most lately… and that led to the two recent suicide attempts. The memories of this loss are what really brought me to the point of wanting to die so much that I actually attempted to do just that. Then, in the last group at PHP, the nurse was discussing the difference between sadness, grieving, and depression. We only go to sadness and grieving today before we ran out of time, so we’ll get to depression tomorrow. But basically because of the topic, I left group in a not so good headspace. By an hour later, I was having serious thoughts of hurting myself.

Yesterday, I gave my self harm tools to the therapist at PHP to dispose of for me, so I don’t have my preferred method without going to the store. There are other methods, though, that would work, but I’m trying to not do anything. I haven’t self harmed since December 11th. I want to keep it that way. The thoughts I was having earlier, though, were worse than just self harm. They were scary. I was actually tempted to call the PHP therapist, but I hesitated too long and now they are closed. I haven’t gone home yet, however.

I’m meeting with my sponsor tonight. In about an hour. I “can” talk to him, but I just recently switched sponsors, because I want to try working the steps through Narcotics Anonymous instead of Alcoholics Anonymous, and I don’t want to scare or worry the new one to the point that he calls someone. He works in mental health, so he knows a little more, but he also has a little more responsibility than the normal person, if someone says that they are going to hurt themselves. I’m worried if I bring up the thoughts I had, he’ll move into work mode or something…

I’m also not sure how much I’m going to say tomorrow during check in… these thoughts were strong, but they are fading now. I don’t know what will happen with them when I leave where I am, right now, and head home… or when I get home. That kind of worries me a bit, actually. I don’t know how strong I can be when I’m on my own. I know I’m not going to drink or use anything, but self harming is a distinct possibility tonight. I hate to say that… but that is honestly how it feels. I am going to do my best to not do anything. I am going to try very hard. I just have to make it through the night. That’s it.

Typing without really thinking… hope it makes sense.

This is weird. I’m not used to this. It’s foreign.

There’s really nothing wrong… Every now and then, like once or twice a day, I’ll still have a flashback or body memory that will make me cry for a minute. But that is it. My mood isn’t horrible. The demons are there, but not awful. I have been having a few manic symptoms, but I’ve been responsible and have my mother holding on to the majority of my money for now. I’m still sober at the moment; I am having strong cravings but I have managed to not drink.

I’ve gained more insight into why I’ve been so suicidal for the last several months. And why the events of late led to me trying to take my own life, twice. I hope to eventually be able to post a blog about that, but I don’t think right now is that time. I’ve been working hard in therapy, PHP and with my individual therapist and psychiatrist. It’s draining. I often leave feeling raw and tired. I know, when I feel that way, the best thing for me is to not go home, however. I have tools that I could self harm with at home, and in that state, I am more likely to self harm, which I am actively trying to not do. I am counting the last suicide attempt as self harm, but I have not done anything to hurt myself since then, aside from some minor picking. (I have dermotillomania, which is a psychological condition that manifests as repetitive, compulsive skin picking. I also have trichotillomania, which is a mental disorder that involves recurrent, irresistible urges to pull out hair from your scalp, eyebrows or other areas of your body, despite trying to stop. (Both descriptions were pulled from Google’s front page.) So I have a tendency to pick at things like scabs and such.) So, I haven’t self harmed since the 11th of December, the day that I attempted last. Well, that turned into a tangent real quick.

One, or actually two, things I wanted to talk about in this blog was a couple questions the PHP therapist brought up Thursday that really made me think.

Question 1: How will you know you are okay?

The answer I gave in group was when I’m not having flashbacks and body memories every day. When they are only happening once or twice a month or so… I feel like I am underestimating what “okay” can be, though. “Okay” could be no flashbacks/body memories, could be that I don’t have the trauma of my past creeping in and making me want to hurt myself in a myriad of ways, could be not feeling depression at all and feeling happiness, joy, optimism and excitement everyday. That, however, seems unreachable. It seems impossible. Even though my mood is better and I’m not really depressed like I was, I still have crying spells every day or every other day. I still think about what it would be like to not be here, on occasion. Thoughts of suicide creep in, stick around for a bit, and then leave, on a daily basis. There is no real want to die or be dead anymore. That is gone. At least for now. But my brain is not normal. My brain may never be normal. My brain may never be able to get rid of the obsession with death and dying. I may always have these thoughts. Because of the things that have happened to me… because of the things that come up from years ago that lead me to attempt suicide twice in the course of three months. For some reason, I feel like I will be okay when my depression is manageable, when the flashbacks and body memories are farther apart, when I’m able to simply stay out of the hospital and finish PHP and move into IOP (intensive outpatient), and when it’s not so hard to get out of the house and face people daily. To a mental health professional, that wouldn’t be considered okay. That would still be “having symptoms.” But to me, that is so much better than a month ago and even now. Why don’t I want something more than the bare minimum? Why must okay still be just okay instead of good or great? Is it that I think that is all I deserve, all I’m worth? This may require coming back to, later…

Question 2: Ask yourself… why are you feeling the way you are feeling?

Basically, when you are having an uncomfortable emotion, whatever it is, as why. What in you life, past or present, is causing you to feel this particular emotion at this particular time? There is always a reason we feel the way we do about certain things, and why different people feel differently about the same situation. Example… you and I are in line at the grocery store. The customer in front of us is upset about something and starts screaming, like all out screaming, at the cashier. Your reaction: look around for another employee or manager and make sure that someone is coming to help the cashier. My reaction: step back, shrink down a little, and become silent and not move. You became the protector, and I reacted like the victim. The difference between us… you never experienced any traumatic events in you life and I did. The screaming was not a trigger for you, like it was for me. That’s just an example, and a simple on at that. Usually, it’s more complex than that. Feelings are very complex. There are many reasons we feel the way we do, and often, we don’t take a step back to ask ourselves “why am I feeling this way?” “What in my past is contributing to me feeling this way?” Take the time, step back, and ask the question. Explore your feelings and emotions. Doing this will help you (and me) know and see more clearly what we need to work on with our treatment team or while we are journaling.

I hope these questions make you think, like they did me. I hope you take the time to explore some of these ideas yourself. And I hope to see you again, soon.

Going Catatonic and Other Recent Events

According to the DSM-5, at least three out of twelve symptoms must be present for a diagnosis of catatonia. These symptoms include:

  • Stupor (oblivious inability to move or respond to stimuli), catalepsy (rigid body posture)
  • Mutism (little to no verbal communication)
  • Waxy flexibility (body remains in whatever position it is placed by another)
  • Negativism (lack of verbal response)
  • Posturing (holding a posture or position that goes against gravity)
  • Mannerisms (extreme or odd movements and mannerisms)
  • Stereotypy (frequent repetitive movements for no reason)
  • Agitation (for no reason), grimacing (distorted facial expressions)
  • Echolalia (repeating others’ words)
  • Echopraxia (repeating others’ movements)

Retrieved from Here


 

I was in IOP, until Friday. Tuesday night, I ended up in the emergency room for stitches around 3 am. When I told the therapist at IOP on Thursday, she was extremely concerned. We agreed at that point, however, that IOP was still working. Thursday night, I had a massive crying fit and was obsessing over suicide for hours before I was finally able to fall asleep. At the end of group on Friday, I told the IOP therapist that I thought it was time to step up to PHP… Don’t get me wrong, I don’t want to be in PHP. It makes my schedule extremely cramped and I had to take a break from physical therapy just to make it work. I already have to leave early two days a week for school.

Over the weekend, I ended up in the ER again for more stitches…

I started PHP again on Monday. That day went okay, nothing really out of the ordinary or strange. Yesterday, however, there were issues. During the last part of the morning, the discussion turned to suicide and I found myself unable to move or speak or respond with more than a movement of my head. And even that was difficult. I was aware, I wasn’t dissociated. I could hear everything that was being said, I just couldn’t participate in any way and was just staring off into space at nothing. The therapist asked if I was okay, and I was able to kind of snap out of it for a moment and nod yes. He asked if there was anything they could do to help, and I shook my head. At that point, I just wanted the attention off of me. He eventually went back to the discussion, and I went back to being catatonic. At some point, he asked me a question, trying to pull me into the discussion. I just kinda sat there and stared at him. He asked me if the topic of the discussion was causing me to go catatonic, and I shook my head no, even though it technically was the topic.

At the end of group every day, the therapist checks in with each of us about suicidality and homicidality. When he got to me, I struggled to give an answer… I just nodded at the question. He knows I never have homicidal thoughts, that my harmful thoughts are always aimed at myself. He asked me if the catatonia is often related to an increase in suicidal thoughts, and I nodded.

It is.

When I obsess over suicide or self harm, I am usually in a catatonic state of some degree. And when I was catatonic in group, I was obsessing… a lot. I didn’t want to tell him that, though. I didn’t want to admit that I was imagining being at the top of the cliff next to the Pennybacker Bridge, standing at the edge. Knowing that I had sent my goodbyes to my friends and that none of them knew where I was and none of them could figure out where I was in time.  Imagining how the wind would feel up that high, and how the wind would feel as I started to fall. The image in my mind goes the entire way, all the way to the end. Even the graphic image of hitting the rocks… and what my body would look like when I was found and pulled back up to the road. What my friends and family would think and feel, and how they would react. I know it would hurt them, but there are times that even that is not enough to keep the images from coming forefront in my mind. Even that is not enough to keep me from counting pills and seeing if I have enough for the backup plan.

At this point, though, it is just obsessing. There is no intent to do anything. And that is the difference between being allowed to leave PHP for the day and not. The therapist would still let me leave if I had mild intent, but I could contract for safety and agree to be there the next day of group. He has in the past. He has always said that he will not force me to go to the hospital. He wants it to be my decision, not his. He doesn’t want to take that power from me. He knows my history of trauma and being controlled, and does not want to perpetuate that trauma by taking away my ability to control whether I go to the hospital or not.

I have been committed once, and trust me, it was not a pleasant experience. Being put on a 72-hour police order of emergency protection was humiliating. It was like being told I couldn’t take care of myself, that I wasn’t an adult with the free will to make choices, that I needed someone to make choices for me because I was literally incapable of knowing what was best for me. After the hold was over, and I was no longer angry about being forced to be in the hospital in the first place, I agreed to sign the paperwork to be there voluntarily. That didn’t take away that fact that I was forced to be there in the first place and had no choice about when I could leave. If I asked to leave, they would have just taken me to court. It wasn’t worth it.

So, since yesterday’s events in PHP and going catatonic while in group, I have been in and out of catatonia. In and out of obsessing. I haven’t slept. I had to go to the ER again, this time they gave me staples. So now I have two sets of stitches and one set of staples. I have been to the ER on the 4th, then the 8th, and the 11th. All in the early morning hours. The stitches I can take out on my own when their 10 days are up, but the staples I have to make an appointment with my primary care physician to get them out. I am not looking forward to that, at all. He worries… and he isn’t shy about letting me know he is concerned.

Another part of this whole situation that is bothering me is that the PHP therapist and I went over my treatment plan yesterday… one of the goals on it is to go two full weeks without going to the emergency room for self harm. He made sure to say that he didn’t want that to keep me from going if I needed to go, just because I wanted to complete the goal. But we just went over it yesterday, and I have already failed. The night after we talked about it, I ended up in the ER… again… I wish I could just stop. I wish I could just not do it. But it’s not that easy. It’s never been that easy.

It’s about 6 am now, and I’m planning on going to the morning AA meeting and then heading to PHP. I need to grab something to eat for breakfast. When I was leaving the ER, I had to decide between Waffle House or a 24-hour coffee shop in town. I went to the coffee shop, so I haven’t had food yet. So, I’m gonna call it, and go find food. Thanks for reading and I hope you come back again!