Tag Archives: stigma

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? 


it’s hard to admit…

why is an abuse history so hard to admit? the shame should not belong to me. it was not something I did to someone else. it was done to me, so why is it still hard to say “this happened to me”?

a few co-workers and I were commiserating on insurance quality when I was asked where I get mine. I was able to admit being on disability for ptsd, but when asked what it was from, I couldn’t utter the words… I said “other stuff” (I was asked if I had served, since this is still the first thing people think of when ptsd is mentioned)… they didn’t ask for more details. I wouldn’t have been able to give any even if they had.

at the dentist the other night, I couldn’t check the box that would have disclosed my ptsd diagnosis to them… granted, the office tends to be pretty inappropriate in their banter around patients, so I have reason to hold back, but still. I doubt I would have disclosed even if I didn’t know they talked about their patients freely in front of other patients. it feels like a character flaw. it feels like something that deserves the shame it carries…

stigma, ignorance, judgement… our society oozes it. compassion and understanding are severely lacking on all fronts (see the articles about Charlie Sheen being forced to disclose his HIV+ status because a tabloid believed the public had a right to know his private medical information, or any of the stories on the plight of Syrian refugees). it feels like more and more people I used to peg as understanding are spewing their judgement at every turn… ignorance and hatred are running rampant. it makes me sad, and it fuels the fear that keeps me from admitting my own struggles to the people in my life.


It’s all they see

Went to a doctor’s appointment today. I normally really like this doctor. she’s normally really cool, but today I felt like all she could see was my m.i. diagnosis… I’m trying to tell myself it probably has more to do with my anxiety and being one of her last patients for the day (the one after me was probably due to deliver this week from the part of the conversation I overheard while checking out) than it does with me as a person. I’m still having trouble feeling the validity of that though.

I felt like she rushed me and didn’t give me a chance to explain why I was there… again, likely due to the time of my appointment, and the nature of the appointment after me.

Whatever. I’m going to keep reminding myself that she is generally an awesome doctor.

On a slightly related note, I want to talk to L more about what is going on for me lately, but I don’t know how to do it. I doubt the validity of my memories too much to be able to talk to her about them. She kinda guessed about it tonight, but I couldn’t bring myself to confirm it. How do you tell someone about something you are not even sure is real? I mean, it certainly impacts our relationship significantly, so I owe it to her to talk about it… but I don’t know how to do that when I can’t even say for sure they are real memories. I keep faltering and being convinced I made them up for some weird reason. I go through periods of questioning everything I remember. I think it’s all a lie. I think I just need the attention having that history brings me. I don’t know how to come to terms with some other disturbing stuff, so I weave stories around it to allow it to make sense. It’s all a lie…

And then I can physically feel it again. The sensations of it play on or in my body and I know it’s real, but only while I can feel it happening. Once the sensations quiet, I doubt it all over again.

Why didn’t I remember it till now?
What if I’m just putting the wrong face to the body?
What if I’m talking about the wrong person?
What if it’s just all something I saw on TV and somehow translated into a “memory”?

Memory is a shift thing after all…


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.


Thoughts on self harm

I recently posted on a support forum about my reasons for self harm. One reason was again pointed out as “eye opening” (when I had mentioned it to De, she had admitted that she never thought of it that way, and it helped the whole thing make more sense to her), so I thought I would share it here also.

“people will help with profuse bleeding, but I am expected to handle intense and unbearable emotions on my own”

Regardless of your skill-level in dealing with physical injury, there is no expectation of figuring out how to heal the wound on your own if you are bleeding badly. People will not look at you with an incredulous stare and tell you that you should be able to stitch yourself up and get on with your day. Even doctors are expected to seek medical help with physical illness or injury.

With emotional hurt however, a person is expected to develop the skills necessary to carry them through even the darkest times alone. The emotional equivalent of evisceration or amputation is expected to he handled with grace and poise and completely on your own. Yes, you are allowed to seek help, but you are not allowed to expect hand-holding or much support outside of a quick check-in. You are expected to “take a deep breath and use your coping skills”. Would you tell me to use my coping skills until I found one that worked if I got into an accident and became trapped in my car? Would you tell me to use my coping skills to try to cure cancer? Then why tell me to use my coping skills again and again and again in response to flashbacks or depression or anxiety?

Sometimes, when you ask for help over and over again only to be met with dismissal, you find the help any way you can get it.

I’m writing this not to invalidate the usefulness of healthy coping skills, but to offer another perspective to the concept of self harm being “done for attention”… sometimes it’s the only way to start to get the level of help you need, or the only way to allow people to understand the extent of the hurt.

When the intensity of my self harm had gotten dangerous in the past, it was always directly proportionate to the level of emotional hurt. People stopped saying “go deal with that shit on your own” and finally started asking “how can I help?”

I guess I had hoped to have this post speak more to the stigma of mental illness than it is actually doing. My frustration with the way mental illness is treated comes not so much from the general public, but from the standard of functioning treatment providers set up for clients. While they often acknowledge that it is “difficult to overcome,” and “issues that have been with you your whole life should not be expected to change overnight,” they still are expected to change and improve in relatively short order with relatively little intervention.

A cancer patient has support in so many forms, but a person with depression gets ostracized for “not trying hard enough” when they can’t get out of bed, or told they are being resistant to treatment when the medication side effects prove too taxing (or they report the medication not working)… we need to keep examining the way we treat mental illness. We need to keep looking at the expectations placed on individuals who deal with this day in and day out. When you are exhausted from fighting with the world inside your head, you shouldn’t be expected to fight the world outside alone, yet we do it every day…


Suicide Stories

another really good blog on telling stories, being heard, and the stigma of suicide… I will need to look further into the study mentioned, because I would really like to be able to connect with others who have tried. There are parts of my experience I rarely speak about (even with a therapist) simply because no one wants to talk to me about it… in treatment circles, you are discouraged from talking about specifics and emotions during the act, but before and after are ok to talk about… they are missing a huge part of that story.

recovery network: Toronto

Slowly waking from a science-induced slumber, clinical and academic practice is slowly reawakening to the importance of story in a human life. There is much talk these days of the importance of “narrative”. Narrative is just a fancy word for story. Who among us  sits round a campfire telling “narratives”? People tell stories: their own story, old stories new stories, made up stories, true stories and everything in between stories. Telling stories is what humans have done since, well, since there have been humans. So how come its taken so long for medicine and clinical practice to wake up to the usefulness? Well, it seems that someone had to come up with a fancy word for “story” : “narrative and,  someone else had to append [fancy word for stick on the end of]  that other fancy word required to legitimize any thing in medicine – therapy. As Robin Mckenzie…

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Conflicted (and clearly not sleeping yet)

I don’t know what to say about World Suicide Prevention Day.  All this week is dedicated to suicide prevention. I’m totally conflicted by it.  While my training and my compassion triggers an automatic “don’t do it, lets figure things out” response, my personal experiences say “it’s ok to let go and move on from the torture”.  It is torture.  While I do definitely love my life (pterapotemous), I also definitely hate being in my head. Nothing makes it better for long.  The battle is always and will always be as long as I’m alive… so that tired part of me says “ok, just be gentle with yourself.  You deserve that much”… I would take away your pain of I could.  I would make life easier for you if I could.  But don’t force me to keep fighting when I’m just so tired…

So yeah, suicide prevention gets me all sorts of conflicted…