When Things Get Really Bad

Since I last posted on here, literally all I’ve done is survive.

After putting up last week’s post, I went to therapy, which just about wrecked me. It was really hard going. I don’t want to get too into what we talked about and what I’m currently struggling with because I’m really struggling with it and I’m still figuring out how to put all of it into words. But I think the gist of it is important to include: I’m struggling with ‘feeling’ autistic, like I’m never going to be able to function the same way as everyone else. I don’t know how to cope with a thought like that. And that has really triggered my depression, in a massive way. I feel like I say this every time, but it feels like the worst place I’ve ever been; but maybe I say it every time because each time takes more out of me.

It looks so small and simple when I write it out like that. But in reality it’s powerful enough to overwhelm everything.

I left therapy feeling absolutely drained. I didn’t know how I was going to get through the day, get through the week to the next session. But somehow I did, one minute at a time. This week has been about survival because sometimes that’s all you can manage – I feel like I’m standing on the very edge of the black hole that is my depression and it’s taking all of my focus to not get pulled in. So while I feel like I’ve achieved nothing, I’ve actually achieved everything. At least that’s what I’m trying to tell myself.

So I thought I’d write down what I do when I’m in this place, where the only thing I can do is survive:

Each day, I get up at seven and go to the gym to swim for thirty minutes. I always want to do more but through trial and error (usually error), I’ve found that this is the amount I can do and still kind of function. If I push on, I end up falling asleep during the day and screwing up my sleeping pattern or I end up in a place where everything makes me cry. So I’m trying to be sensible and build it up slowly.

I get home and head for the living room. I curl up on the sofa, turn on the TV and continue the rewatch of whatever TV show I’m watching (currently The Mentalist). I’m not really watching; it’s more about having familiar, comforting background noise so that the scary thoughts can’t get in. Then I find something that will distract me from all the overwhelmingly difficult things. The activities that work best for me are playing piano and printing, cutting, and sticking pictures from Tumblr into notebooks. And sometimes reading a book works, if I have the concentration to actually read.

And I use those things to get me through the day. I spend time with the animals in my house. I’m lucky enough to have a Mum who works from home so that I can have someone with me when I need to have someone with me. I try to eat well.

And then I go to bed not too late and start all over again.

It’s a hard thing to get my head around and I’m aware that I’m very hard on myself. Because even though I genuinely believe that sometimes all you can do is survive, I find myself getting desperately upset that I’m ‘not doing anything.’ I feel like I’m not trying hard enough – in my mental health, in my music, in my life – and that I should ‘push through it.’ And it’s so hard to think that when I feel so overwhelmed by my depression.

And, outside all of that stuff, someone I care about is in hospital and no one really knows what the outcome is going to be. So I’m trying to manage all the anxiety around that too but it’s like trying to stand on ground that’s constantly shifting.

I think that, if I keep writing, I’m going to end up going in circles: ‘it’s okay to focus on surviving’ to ‘I should be trying harder’ and back to ‘it’s okay to focus on surviving’ and round and round and round. So I’m going to stop here. But regardless of all my anxieties and negative thoughts, I know that it’s okay to focus on surviving. And I hope you know that too.

Getting A Diagnosis – The Mental Illness Edition

This is something I’ve been meaning to write about for a while but it’s such a big topic that I was very daunted by just how much I needed to include. I’d open a word document, stare at it for ten minutes, and then switch to something else. You’ll see what I mean. Getting a diagnosis is a complicated and emotional process that is so different for everyone but I had no idea how difficult it would be when we started pursuing it. So I thought I’d write out my experience just to put out into the world one version of the story. Maybe yours is similar, maybe it’s different. Hopefully you’ll get something out of it either way. And if you’re trying to get one, maybe this will give you some idea of the hurdles. I don’t want to scare anyone off; it was a brutal experience but it was absolutely life changing and life saving, both for my mental health and for who I am as a person.

I’m going to split this into two posts because although they’re linked, the processes for getting the mental health diagnoses and getting the ASD diagnosis were very different for me. I don’t know if that’s the same for everyone. This post will be about getting the mental health diagnoses.

My mental health problems became very acute when I failed an exam at sixth form in March 2013. I was eighteen and it was the first time that had happened. There’s a lot of stuff behind why that was the breaking point but I’ll talk about that in a different post. Otherwise we’ll be here forever; I’m already splitting this post in half. I hadn’t been oblivious to my mental health up until that point but I hadn’t recognised the signs for what they were; my knowledge of mental health had been pretty limited. But I’d always felt like there was something wrong with me (I now know that it’s different rather than wrong but that’s how it felt and sometimes still does feel) and I know that my depression and anxiety had been building up to that moment, that critical incident.

After that, I started seeing a psychiatrist that a family member had recommended (my GP had been unhelpful at best and distressing at worse). He diagnosed me with Clinical Depression and gave me an anti-depressant called Paroxetine to try. I don’t have enough experience to judge whether he was a good psychiatrist or not but I don’t remember feeling particularly supported by him. I only saw him a few times before I switched to a psychiatrist closer to where I lived. The Paroxetine made me incredibly sleepy; it was like they put me into a waking sleep that I still don’t feel I’ve really woken up from. I switched to Sertraline but that was even worse: I felt like a zombie and that was so upsetting that I (unwisely) stopped taking it cold turkey. That was a Bad Move, such a bad one that I still capitalise the first letter of each word. For a while I was very dissociated and then my anxiety came back, even stronger than it had been before. So I was a bit put off by medication but the diagnosis was helpful and I started going to CBT.

That ended up not being the right thing for me and the energy it took was just too much so I quit, not forever necessarily but I needed a break and we wanted to explore some of the other options. I tried several other things over the next year before deciding to try medication again. Both that first psychiatrist and the CBT consultant had been private but I couldn’t get the NHS to help me. I have to say here that I have so much (SO MUCH) respect for the NHS. It has saved the lives of several of my friends and I will defend it to the death but I don’t feel it has yet got it right when it comes to mental health. In my case, my anxiety was so bad that I found it incredibly difficult to talk to people I didn’t know. My Mum would explain the situation but we were repeatedly told that if I wouldn’t talk they couldn’t help. That was very distressing. Logistically I understand that it’s more difficult to communicate if a person can’t talk but that’s not an excuse to refuse care. The not talking was a result of my anxiety, which falls under their job description. They should’ve helped me. They should’ve at least tried. But they didn’t and I was struggling so much that we were forced to go private. I am endlessly, endlessly grateful that my family have been able to make that possible. It has, without a doubt, saved my life.

We found a new psychiatrist in the summer of 2014 and after such a horrible year, I was determined to make it work. I walked into his office, sat down, and started talking. I still don’t know how I did that. I was just as anxious as I had been before but I guess that’s desperation for you. Maybe it was my survival instinct. Anyway. My psychiatrist has since told me that he couldn’t believe I had such bad social anxiety because I had been so articulate and direct. Again, I’m putting that down to desperation (and I wouldn’t be surprised if the ability to mimic ‘normal’ behaviour – something that many girls with autism have learnt to do – came into play here too). But as I told him more, he started to understand where I was coming from and what I was dealing with. He put me on Phenelzine, which made a massive difference (I’ve written more about that here) and we continued our sessions so that he could get as much information as possible.

I wanted him to give me a diagnosis. I wanted a name for the thing (or things) that had so much power over me. I wanted to know what was really me and what was this indistinct, suffocating black shadow. I thought he’d have me do a load of diagnostic tests and questionnaires and then give me his findings but it felt more like therapy, but with a focus on my past experiences (rather than strategies to move forward). He didn’t seem in a hurry to find the answers and I didn’t know how to fast track the process. Eventually we got the deadline I wanted: my university said they couldn’t help me until they had an official diagnosis. But again, it wasn’t how I’d expected it to be and again, it was incredibly slow. Throw in that I’d just started university (which came with new people, new classes, and commuting into London) and I was under a lot of stress, as you can probably imagine. How I didn’t have more autistic meltdowns, I have no idea.

I couldn’t just do nothing. I spent hours searching the internet, looking for anything that might explain my experience. I examined diagnostic criteria and read medical papers; I scrolled through forums and took diagnostic tests. I’ve read a lot about the back and forth on self diagnosis (something I definitely want to discuss in more depth at some point) but for me, I needed a professional diagnosis, both to get the help I needed and to validate how much I’d struggled. Grouping my symptoms together and trying the strategies advised for whatever label fitted that group wasn’t going to be enough. So I used those test results as a starting point. Eventually I came across Borderline Personality Disorder and more specifically, the ‘quiet’ presentation of BPD. This means that they have many of the same symptoms (including mood swings, problems with self worth, unstable identity, and difficulties with relationships) but rather than ‘acting out’, they ‘act in’: they direct their negative emotions inwards, hiding them rather than projecting them onto others. Many struggle with issues around self hatred and self harm. If they lie or manipulate, it’s to protect themselves from perceived abandonment and they may avoid or distance themselves in relationships because they don’t want to be abandoned or because they feel they don’t deserve those connections. The ‘quiet’ presentation made a lot of sense to me because while I struggled with many of the problems associated with BPD, I rarely lash out so this felt like something to explore.

So, buoyed by momentum that discovery had given me, I took it to my psychiatrist. And he shut me down straight away. He said that I didn’t fit the criteria and moved on to something else. I didn’t understand: I was struggling with so many symptoms associated with BPD, almost all of them when you factor in the ‘quiet’ presentation. I couldn’t believe that it wasn’t worth, at the very least, a little bit more discussion. And at the end of the session, he said that he thought we’d done all we could do. I was devastated. And incredulous: we hadn’t achieved anything. If that was it, I was back to square one. Or minus one after everything the process had taken from me.

That session sent me into the worst place I’d been and after a particularly horrific meltdown, I spent several days in a fragile, barely responsive state. But once I recovered from that a bit, I got to work. I went back through my research and symptom by symptom, anecdote by anecdote, I wrote down everything I related to, everything I’d experienced, anything that could be relevant. It wasn’t that I was certain it was BPD, it was that I was certain it was something. This seemed as good an explanation as any and my psychiatrist wasn’t offering anything better.

When I was done, the document was seventeen pages. I’m pretty sure it was longer than my dissertation for university. And then we went back. I presented him with all my research and something very surprising happened. I’d hoped he’d accept it as something to explore and not only did he do that, he admitted he’d been wrong and apologised for dismissing it. Even now, that feels like a very important moment. In my experience, medical professionals aren’t naturally inclined to apologising, let alone admitting to being in the wrong. And I’d been ignored for a long time. When it came to my health, physical and mental, doctors had always looked at the most obvious option and then, when that didn’t fit, they’d just shrugged their shoulders and brushed me off. So this was a big deal.

And at the end of that session, I had my diagnosis. Or more accurately, my diagnoses. He pulled together everything he’d learned about me and diagnosed me with Borderline Personality Disorder, Anxiety, Social Anxiety, Depression, and OCD. It was a very strange experience. Momentous and anti-climactic at the same time. I felt light enough to float away but so exhausted and heavy that I wasn’t sure I could get out of my chair. I felt like I might burst into tears at any moment but I had this weird, hysterical urge to laugh. I felt invincible and incredibly fragile at the same time. Very strange.

Finally getting names for the monsters I’d been struggling with was incredibly validating. It was real. I wasn’t ‘crazy’ or ‘over dramatic’ or ‘too sensitive.’ It also made it real to everyone else. And although part of me was steadfast that something was wrong, I had started to doubt myself, having been dismissed by so many people. I was constantly fighting against falling into a well of despair, of fear that this was just going to be how life was for me. But the diagnosis confirmed that they were problems and most problems have solutions of some sort.

The diagnosis enabled me to get the support I needed at university and gave us some idea of what kind of talking therapy might help. Dialectical Behaviour Therapy (DBT) is recommended for people with BPD and that’s what I’m still doing, about three years later.

(I have no relevant photos for this post so here are a couple from around that time.)

Surviving Is Better Than Not Surviving

Trigger warning for self harm. Please don’t read this if it’s something that will upset you or trigger you. I only want this to be helpful, never harmful. I also want to add that, while I’m not promoting or endorsing it, I’m never going to say, “Just don’t do it.” It’s just not that simple. My hope is that more openness on this subject will make it easier for people to access support and therefore not feel the need to do it.

It’s been on my to do list to write more about self harm ever since I posted the first piece. It’s one of those things that I will never get tired of talking about, never get tired of raising awareness for. There are so many misconceptions around it. I mean, I get it: there’s something inherently un-understandable about wanting to hurt yourself, unless you’ve gone through it. And even then, it’s massively complicated. Feelings are weird and pain is weird; it’s not surprising that people struggle to make sense of it. But I’d like to think that things will get better, hopefully sooner rather than later.

I was inspired to write this post after watching a YouTube video, ‘Living With Self Harm Scars’ by Claudia Boleyn. I’ve been watching her videos for more than a year now and I particularly love her videos about mental health. Borderline Personality Disorder (BPD) and self harm still aren’t commonly talked about so to find someone describing their experience, both positive and negative, and giving advice is invaluable. And to find someone so thoughtful and eloquent is even better. I really relate to a lot of what she says.

She’d posted a video in which she wore a short sleeve shirt that exposed some scars from self harming and had received several messages about how validating it was to see someone with visible self harm scars, without shame or drama. So, as a response, she’d decided to make a video discussing the importance of living with these types of scars, which I found both interesting and useful, even as someone with ten years of experience with self harm. She put into words so many emotions that I’ve felt but for a long time couldn’t vocalize. Had I had something like this when I was younger, life would’ve been very different.

The video isn’t necessary for the rest of the post to make sense but I really recommend watching it:

(EDIT: The video has now been made private but as I said, it’s not necessary for the rest of the post. I’ll update if this changes.)

Some of the things she says are so true it’s painful.

One of the biggest things about self harm is the release you get from doing it. My emotions get so strong sometimes that I feel like there isn’t space for anything else in my body, in my brain. There isn’t the space for my lungs to expand; I can’t breathe. It almost feels like the emotion is crushing me and the only way to survive is to open up my skin so that it can escape. It’s like a pressure valve. Once I’ve done it, I feel like everything stabilises and I can think more clearly. If there’s a problem, I can deal with it and if there isn’t and it’s just an overload of emotion, I can take care of myself a little better than I could if I hadn’t. As heavy as it sounds, Claudia describes it as ‘a way of not killing herself,’ which is a feeling I can empathise with. I’m sure many others can too. I’m not saying it’s a good thing and I’m not encouraging it. It is NOT a healthy coping mechanism. But that logic isn’t very persuasive when you’re dealing with such overwhelming emotions. Claudia also talks about this: “It’s not good for you in any sense… but it’s something. It felt like doing that at least proved that there was something there… And it just felt like this huge build up of feelings and I had to do something to get rid of it and doing that… was something.” I can completely relate to that and I think that’s a feeling that is often exacerbated by how difficult it is to get a diagnosis because having something is better than having nothing.

In my experience at least, trying to cut myself off cold from the only thing that helps me get through doesn’t help; it just makes the need worse and then there’s potential for me to do more damage. So I do my best to be safe while working on my issues in therapy so that one day, I can stop because I’m okay and not because I’m suppressing the urge. Because if that’s the case, I’ll always come back to it. To quote Claudia: “If you’re a self harmer then I think it’s always in the back of your mind as, like, a coping mechanism… The problem is: it’s always there so you always have to avoid it and avoid triggering it.” To give up self harming is a really big ask, and an even bigger one if you’re trying to do it without support. And if it’s too much for you, or for you to do all at once, that’s okay. I don’t feel ready to stop but one step at a time. The fact that my therapist supports this is a huge deal to me and it’s one of the things that told me that she was the right person. This has greatly lessened the pressure on me and has helped both me and my family to work through it a bit. I used to feel so guilty that I was hurting or upsetting them so I hid it and that was doing it’s own kind of damage. But now that we have a plan, now that we’re moving in a forwards-like direction even if it isn’t always easy, everyone seems to be coping with it better. I can’t imagine what it’s like for them to see me in that place but you can’t put that on top of the emotion that makes you want to do it; it will eat you alive. I think the only way forward is to try and talk about it with someone and do what you can to avoid it if possible.

I don’t have quite the same experience as Claudia does. That’s fine. Every response to self harm is a valid response. However you feel about it is okay; it’s your struggle. She talks about feeling annoyed and upset about having self harmed and wishes she hadn’t done it whereas I’m not (yet?) in that place. She talks about how it releases all that feeling but then you wake up the next day and feel like you’ve let yourself down. But, while that is quite a negative response, the way she talks to herself is very positive: “I’m just taking it as a stepping stone and saying, ‘Okay, you took a step backwards but you can take five hundred more steps forward. It’s fine.’” She talks about having a certain pride about them because they’re proof that she got through a really tough time. She can look at them and feel compassion and forgiveness for the version of herself in those moments: “It’s a part of me and it’s a part of my past and that’s okay. And I wouldn’t erase it and in a way, I wouldn’t want to because I’ve learned so much going forward.”

For me, self harm is usually a survival strategy. It’s getting through a moment that I feel like I can’t possibly get through. Maybe it’s the worst possible way to get through it but it’s better than not. So when I look at the mark the next day, or the next month, or the next year, I remember that moment: I remember getting through. I remember feeling like I can’t survive another second and then I remember the calm afterwards. I remember that I did what I had to do to survive. I wouldn’t say I’m proud of that – or proud of the scars – but I’m certainly not ashamed of it. Maybe one day I’ll find something that gives me that feeling without doing any damage to myself. How wild and glorious would that be?! But that’s the end goal, not the next step.

My other use for self harm is to mark a traumatic event. I think one of the hardest things about struggling with your mental health is the fact that people often can’t see what you’re going through and I needed it to be seen. I felt so traumatised by the strength of the emotions and by the meltdowns and I just couldn’t process that without a physical, identifiable injury to associate it with. Again, I’m not saying that this is a good method of coping but it was all I had at the time. Now, I have other things to try. I haven’t yet found anything that works but what’s important is that I’m trying, even if I don’t want to sometimes. This is a whole other issue that I do want to talk about at some point: to someone who hasn’t ever self harmed, the idea of not wanting to stop doing something that is so bad for you is weird, but is a feeling that is often associated with self harm. That feeling can be very isolating because many people don’t understand it, and many more react badly to begin with. And feeling misunderstood can really exacerbate the feelings that lead a person to self harming. I think that discussing self harm and learning about it can only help with that. There will be people who say that bringing awareness to it will encourage people to self harm and while that may be true to a certain extent, the amount of people it could help would massively outnumber that.

People do ask about the scars. I’ve personally never had an unkind response to them; it’s usually just awkward. Even if someone doesn’t actually bring them up, I see them notice and it can get really uncomfortable because no one knows how to handle it. Claudia mentions being embarrassed about people seeing them and talks about how she has tried in the past to cover them up. Sometimes that’s just easier. It’s so complicated and it’s hard when people don’t get it or jump to conclusions. There’s the typical, “You’re asking for attention,” which has always frustrated me no end. I’m not sure when asking for attention became such a negative thing. Of course, there will always be people who abuse the compassion of others, but I would hope that our first reaction would still always be to try and help. If someone is asking for attention in some way, they probably need it, even if the reason why isn’t immediately apparent. I never tried particularly hard to hide what I was doing because I think that, subconsciously, I wanted someone to draw attention to it and see what I was going through. But at the same time I didn’t feel able to talk about it.

Sometimes people see the scars and assume that you’re ‘showing them off’ when you don’t cover them up, which is weird to me. I’m not sure why you’d want to ‘show off’ or ‘flaunt’ the evidence of a moment where you’d gotten so low that you had to physically take it out on your body. When you think about the lengths people go to to hide their scars – wearing long sleeves in a heat wave, making endless excuses as to why you can’t go swimming, hiding them with make up or bracelets or tattoos, spending every second thinking about your scars and how you’re going to make sure that no one sees them – it’s clearly not a straightforward issue. And as Claudia says, it’s not showing off; it’s a form of body positivity, of learning to be comfortable in your skin, regardless of what that skin looks like. That is a hard thing; it’s something that should be supported, not torn down.

There’s obviously a lot more to talk about when it comes to self harm but this is already a lot longer than I’d originally intended it to be! This is something that makes me really emotional and fired up so I could probably write a book on it. It’s so important to talk about and talk about openly and honestly. I wish I’d found someone writing about it or recording YouTube videos about it when I’d started struggling with all the things I talk about on this blog. Had I, and the people around me, had more knowledge and awareness about all of this stuff, my ‘mental health journey’ would’ve been very different.