Musings on emotions

It feels like this huge, crushing weight (grief does).

It seems like I’m feeling it too intensely sometimes… 

For some reason, it struck me today that some people have “sensory processing disorders” around emotions rather than sights, sounds, or textures… 

The same way loud noises  (or lots of sources of noise) can be overwhelming to someone on the autism spectrum, “loud” emotions can be overwhelming to some people… 

What if that emotional overwhelm they try to always pigeonhole as “borderline” is really just an autistic glitch around emotions as opposed to one of the other senses? 

What if introducing trauma/abuse/neglect into the mix early-on intensifies the inability of a person to deal with this emotional sensory processing disorder? 

We’ve all heard the theories that borderline is better explained by c-ptsd (which I totally agree with). What if we took it one step further and explored the possibility that “borderline”was actually in part an autism-like disorder? 

If you consider that one “symptom” of borderline is “feeling too intensley”, and you understand that even trained clinicians minimize the difficulty of dealing with extremely intense emotions (as they’ve been trained to do; “know that emotions come & go, like waves”), it’s easy to see the disconnect in effective strategies for clients. It’s something along the lines of comparing a stubbed toe to a shattered foot. Sure, you can probably take over-the-counter Tylenol for the stubbed toe & it will likely help, but doing the same for the shattered foot probably won’t make a noticeable impact. For such an intense injury, you need prescription-strength stuff. We should have something more than “Tylenol” to offer people. 

What if we understand that pushing someone to sit with intense pain (physical or emotional)  will likely lead to various ways of procuring relief… so you take a kid who can’t handle loud noises, and you tell them they need to sit through a rock concert. You’re going to get a tantrum and various, inventive ways to deal with the pain from the noise (think stereotypical autistic behaviors like flapping, screaming, hitting self, or attacking others). Now take a kid who feels emotions incredibly intensely, and ask them to tolerate those emotions. You pretty much get the same acting out in search of relief: self injury, tantrums, physical and verbal outbursts…

I’m a huge proponent for dropping the borderline diagnosis from the dsm. It’s an antiquated and “cop-out” diagnosis with way too much stigma attached. While there’s a push to remove the stigma, it’s still very much taught to young clinicians. Professors and supervisors alike instill fear and disgust around the diagnosis. Myths are perpetuated. Doctors do the same. It’s quick to be diagnosed (often inaccurately), and it’s near impossible to step away from even if it’s found to be inaccurate. It follows you and colors every other interaction with every other professional that sees the dreaded diagnosis anywhere in the file…

What if, instead of just working to destigmatize the diagnosis, we came up with more accurate understandings, and got rid of it completely. It was, after all, just a catch-all category for people who didn’t quite fit any of the other categories… 

What are your thoughts on this? Does it kinda make sense? Am I way out in left field? 

thoughts on today’s therapy

It was my second-to-last session with TM today. It ended up really good.

I remembered her wanting to get the assessments out-of-the-way (TSI-II & BDI2), so after the greeting, I mentioned them. She had them waiting next to my chair, along with some journal entries and my timeline to give back to me. I was glad she remembered.

We joked a bit, and kinda chatted while I did the assessments. She busied herself looking up some more quotes for an activity she wanted to do together either today or next session. As I handed the assessments in, I told her that some questions were answered with caveats, but then I suddenly forgot any of the examples (Now I remember that the question around feeling punished on the BDI2 I answered scoring low because it’s not so much that I feel I am punished, more so that I “should” be punished simply because it’s “right”… There was also a question on violence on the TSI-II that I answered high because it was vague, and I acknowledge responding violently towards myself… That one we kinda talked about and she knew why I responded like I did. I answered the suicide/death questions honestly: that I always think about dying, but don’t always have a plan or intent)… I told her I’d be interested in comparing the scores from the first time and now. I know I have a really skewed self-assessment much of the time so I wouldn’t mind seeing it on paper… that & I’m a huge dork around this kind of stuff, so it also holds great academic interest.

I think at about this point TM told me something that blew me away… She reminded me of one of our first sessions, where I refused the descriptor of “therapist” when she had mentioned it. She said she understood where I was coming from (because I never did finish my MA or internship), but that I seemed more insightful, compassionate, and understanding of the therapeutic process than a lot of therapists she has known… ???!!!!???? I think I was in shock and trying to digest that for a good 5 minutes afterwards. I have no idea what topic we moved on to, because I was still reeling (in a good way) from that huge compliment. I was actually so shocked, I didn’t even deny what she was saying… Maybe I could then go back at some point and be a real clinician? That could be cool… It might have been just before she said this that we talked a bit more about my last hospitalization at IOL. She had mentioned the PDoc incident where he threw a stapler or hole puncher at me, and how that was something she never expected to hear happening in a hospital. I brought up that yeah, while it sucked, I’ve had time to process it more. He may have been triggered, or feeling really helpless, or scared, or frustrated (or all of the above) when he did that. It certainly does not excuse his actions, but it would make them understandable. After all, G behaved much the same way: always angry, yelling, violent, abusive… For a lot of years, I had no clue why he was so awful. Then one day we had a more in-depth conversation. He revealed some of his own abuses and traumas. He also said he did not recall being as abusive and horrible as we remember him being… It didn;t excuse his behavior, but it brought an understanding of his motivations. I could empathize. While I am trying my hardest to break that cycle, he was just repeating what he knew…

Anyway… Oh, another thing that I was kinda blown away by from TM was her opinion that I do not fit a bpd diagnosis. She started out asking me why I had self-reported that dx when I first started therapy with her. I honestly don’t know. She is the first therapist I’ve ever volunteered that dx to. Others have either come to it on their own, or been told by a referring therapist and then decided it did not fit. Part of my reasoning was that it had been relatively soon after I had read through my disability records. Most of those had bpd as one of the diagnoses (of course, they also said I was hopeless & bound to live in residential care for the rest of my life unless of course I killed myself first. One PDoc went so far as to say I he did not expect me to survive the next 6 months… and that was oh… 5 years ago now? So I guess I have to take all of that with a grain of salt. TM reminded me that hospital records reflect the worst of my recent history. She also reminded me that they will often pad dx so that insurance companies will continue to pay (I’ve been witness to some “creative billing” in my professional experiences). I’m not sure why I was surprised that TM would say she disagrees with the bpd diagnosis, but I was. She said the “cornerstone” of a bpd dx is unstable relationships (and according to what she read to me from the DSM-V, this is accurate to their wording), which neither of us see in my life. Yes, there’s a fear of losing people, but only because I actually have lost a lot of important and close people in my life. It’s not so much a fear anymore as an expectation… It’s also something I was overtly taught while growing up. And sometimes the people closest to you will hurt you the most, so a difficulty with trust is understandable… She reminded me that while I may be able to check off some of the bpd traits, it makes a lot of sense given my history… Maybe now I can hold on to that longer. I know Dr. C is of the opinion that I do not fit a bpd diagnosis. We had talked about it a long time ago because of my experience with LKB and her insistence that I was bpd & just needed to learn to accept that fact. Aside of Dr C though, no one else had openly and pointedly spoken to me about bpd vs. trauma. I know even D eventually saddled me with that diagnosis. I’m not sure De agreed, though I never asked her. TL and I never spoke about diagnoses either. It was kinda nice to get confirmation from TM as well that my resistance to the bpd label has merit… Personally, I think the whole disorder should be removed completely. I’ve yet to meet someone with a bpd dx who does not also have a trauma history. Bpd comes with SUCH a stigma (which can also lead to an excuse for not working to change the thoughts & behaviors both on the therapist’s end and the clients… think of how you would feel if even the professionals felt you were hopeless) that it’s more a detriment to any person with the dx. I don’t see how it helps the understanding of behavior or attitudes, it simply labels them. I would much rather have an understanding and hope than a mere label… Kinda like labeling someone an alcoholic without taking into account what it’s used to cope with.

Ok, sorry, went off on a soap-box tangent there. So, yeah. Session with TM was good. We laughed and also talked about heavy stuff… Part of me wonders if TM has found me online somewhere. She sometimes brings up things that I have only ever mentioned online either here or in one of the support forums I use. I might have to ask her that next week. At this point, I don’t think I would care since I won’t be seeing her after next week anyway, but if I had found out something like that sooner, I would be censoring more. I already catch myself being careful what I post if I know someone in real life will see it. This blog is written with sensitivity to my wife and my mom having access… There’s something to be said for anonymity and honesty. I’m very careful in what I reveal to others because I have had it twisted and used against me. I’m careful what I write both online and in a physical, paper journal… I actually no longer keep a paper journal because too many have gotten their hands on them and read them without permission… But whatever. I would be interested in how TM thinks to bring some of the stuff up that she does if she hasn’t found me online. Maybe I talk around it enough, or I mention it without realizing it? It’s too much of a coincidence with a lot of the stuff in timing and wording for her to just come up with it out of the blue. Maybe I’m leaving her more messages than I realize? I know a few times I had thought of leaving her a message, but don’t recall doing it, then she mentions the next session that she got my message(s)… Hmm.

I had meant to ask her today if it would be ok if I call once I am settled after the move. It feels less needed now that I know I will be seeing Dr. C again, but I rarely get the chance to update a therapist on how something went after a termination. I get the boundaries of the relationship. I know it won’t go beyond this termination, but I’m hoping to be able to let her know that things went well, and my idea that I will do better back up north and away from the constant triggers is one founded in reality… I know I would love updates on some of my past clients, though that is me. I’m not sure if she would want one… Dunno though unless I ask.

The Scarlet Label (Borderline Personality Disorder)

for later reading

Beyond Meds: Alternatives to Psychiatry

By Brent Potter PhD

The diagnosis Borderline Personality Disorder (BPD) strikes fear and loathing in the hearts of most mental health providers. It is unquestionably one of the most stigmatizing and overused diagnoses in existence. Often diagnosing someone with this label is a clinical punch in the gut to the client and also a means of communicating warning to other clinicians. It is the 21st century version of the scarlet letter.

In Borderline Personality Disorder: New Perspectives on a Stigmatizing and Overused Diagnosis, Jacqueline Simon Gunn and I outline the history of attitudes about the (perceived) feminine gone awry. We show that current diagnostic conceptions do not bespeak a psychiatric disease of chemically imbalanced brain organs, but are the logical outcome of long-standing attitudes about women through history. We do not deny that there are patterns of experience typical of emotional chaos and we demonstrate that men too suffer…

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When Doctors Discriminate

I’ve noticed that when you compound being a woman, a minority, poor, or younger with mental illness, all credibility shoots out the window. I was hospitalized (voluntarily) a few months ago and had a small stroke. I was repeatedly dismissed by the staff and doctors as complaining because I disliked the treatment I received there. While I was very put-off by their lack of concern for my confidentiality and their opinion that I was suddenly incompetent because I was on a psych unit, I was not making up the stroke. It was not until 3 days later that the doctor finally offered me a neurology consult, but said that it would likely extend my stay on the unit by a week or more. As much as I worried about the stroke, I couldn’t bare the thought of being there any longer (my discharge had been scheduled later that day and this was my exit meeting with the psychiatrist). Luckily, I have not had a repeat event. It’s sickening that you are automatically considered attention-seeking and malingering if you report any health concerns as a mental health patient. It wasn’t the first time my concerns were dismissed, not will it be the last I’m sure.

recovery network: Toronto

Juliann Garey writes in NYT Sunday Review of her experience of her experience of being discriminated against by doctors after receiving a diagnosis of serious mental illness.

Doctors do this – some recognise it and some use a fancy name for it “diagnostic overshadowing”.  If you have a diagnosis you likely have been on the receiving end of it and you’ll know it doesn’t feel like “overshadowing” -whatever that would feel like.

What it does feel like is being disregarded as a person and treated as less than human.  If it were directed at any other group of people it would be illegal.

Essentially, once we’ve been put in a diagnostic box then everything we do, everything we experience, everything we think, or say, or feel,  is taken as  evidence of that diagnosis,  registered not as important information but as another tick in the box against the list of symptoms, confirming the…

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clueless

and confused/conflicted. I suddenly feel ok to try to work. I think I can do this without falling apart. I seem to be able to reign in my depression with more ease… The walls come quicker and higher these days. I don’t want to be useless and jobless. Though I know I struggle with going volunteering even twice a week, maybe if I had the benefit of a paycheck, I could pull it together more often.

On Friday I had told De about feeling useless on disability. It still feels like a death sentence. I know my energy comes in spurts, but maybe if I HAD to function for a job, I would just force myself into it. I have always been taught that you have to keep plugging on. There’s no sick days unless you are on your death bed. Lately, all I have are “sick days”. I want to be productive and useful and have a purpose… I want to have something to say when people ask me what I do. De said I might need to grieve that productive life. It was on the way out, and I didn’t really get what she meant. The more I think of it though, the more I think I disagree on that point. If I grieve being productive and the life I had before, it feels too much like I’m giving up and will never get out of this space. I just need to keep looking at it like a stepping stone. (It’s funny that I say this all the while the little voice in my head is telling me not to worry because life won’t be that long anyway… I think only people who have battled depression and suicidal thinking can truly understand that little voice – even when things are going well, that nagging thought plays on repeat in the background. I used to think of it as an escape plan in case things got/stayed really bad. These days, it’s at once something I laugh at and something I desire with every fiber of my being. Once the little voice gets louder, it’s difficult to drown it out. Then I just have to wait it out, it has to sleep sometime).

I see De again tomorrow. I think on top of everything else I want to address (asking more about the art therapy possibilities, talking about the disability stuff, touching on my fears about the past coming to life again with this relationship, feeling overwhelmed by a lot of stuff…), I need to address the crazy mood changes and the background suicidal thinking. I can coast along just fine when distracted, but the minute the distractions stop, everything comes crashing back.

I don’t know what exactly to say. My head is all over the place even now, and I can’t hold a train of thought. I still can’t see a definite future for myself. There are things I want to accomplish, but when asked where I see myself in 5 years, the tears are triggered and my head answers: dead. The cycles are maddening. If my head will still be battling all this in 5 years, I sure-as-hell don’t want to be around for it… I love my life, but not my head. Does that make sense?