PTSD: Depression is not always a chemical imbalance

Introduction

I was talking with a friend of mine over dinner earlier this week, and she mentioned not wanting to take meds for depression.  Another male friend of mine said the same thing a few months ago.  Both said that the medicine makes them foggy and feel numb, so preferred not taking the psychiatric prescriptions.  And during my final visit with my dietitian yesterday, depression and stress related food issues came up.

So I thought this would be a good time to share some facts I’ve learned about depression and anorexia as related to (symptoms of) my PTSD.  You see, the complex posttraumatic stress disorder sometimes includes symptoms and side effects that can also be standalone diagnoses.  Depression, anxiety, OCD, eating disorders, self-harm, phobias, Dissociative Identity Disorder, and dissociation to name a few.

Depression

I struggle with depression often.  It comes and goes in waves depending on a schedule of personal holidays and anniversaries embedded in my mind and body.  For a long time, psychiatrists and psychiatric nurses tried to give me all kinds of pills.  Sometimes they gave me the same ones my mother was on; this made sense to them as our supposed symptoms of anxiety and depression were similar.

Then they started giving me other pills to help with the psychotic symptoms: hearing voices; hallucinations, sleep issues, and so on.  The pills were supposed to make the symptoms go away – i.e. I wouldn’t hear voices or hallucinate anymore.  The nightmares would disappear.  And I’d sleep through the night.

Well I did start sleeping a lot.  And for a few months at a time, my mind would be quiet.  But, I felt numb and spent most of my time living in a fog.  Nothing penetrated the fog.  And my coordination problems got worse.  Concentration became difficult.  I started to get sick often.

So I stopped taking medicine and tried to find other coping strategies.  But I kept wondering what was wrong with me that the medicine couldn’t fix a biological/chemical problem like depression the way it did for others.  If I had depression, then it was a chemical imbalance.  Medicine fixed chemical imbalances.  Right?

Not exactly…my last psychiatrist explained to me that people who have experienced severe trauma do have problems with depression.  But their depression is not biological or chemical based.  It comes from having been traumatized; only therapy modalities that focus on healing from trauma can help with that kind of depression.

He said that about anxiety too; the symptoms of anxiety can be masked by medicine, but the cause of the anxiety cannot.  So when the medicine wears off, I will experience all of the symptoms of anxiety and/or depression that were masked.  Sometimes, the symptoms will be worse because they were repressed (backlash).  It’s a risk I would take every time I took one of the pills.

These days, the only time I take one of those pills is if I haven’t slept for more than 24 hours and need to knock myself out.  Hence the nickname “knockout pills”.

Final Thoughts

Find a mental health provider who understands trauma (trauma-informed or trauma trained).  Not all of them understand trauma or how it affects mental health.  Then discuss symptoms and past experiences with medication with this person and see if medication is the right path.  If it’s not, ask for other suggestions and options.  If medicine does seem like a good path, keep a journal of the different symptoms and side effects that occur or not occur when on and off the pills.

I am not opposed to taking medicine or pills.  I am opposed to having my mental clarity and independence compromised.  So if ever there comes out an FDA approved pill that can help with my symptoms without making me foggy or so tired I sleep 20 hours a day for weeks or sick to my stomach, I will try it.  Until then, I am better off without the pills.

Thanks for reading

PTSD: When a safe place doesn’t feel safe anymore…and how to make it safe again

An extra post today 🙂

Background

In the last post, I wrote about a lot of what’s been taking away from “me time”.  It’s a good way of burying my head in the sand because I can’t cope with what’s happening around me as well as I want to.

One reason I’ve been avoiding “me time” is because that coping strategy only works when I feel physically and emotionally safe in my environment: home, neighborhood, work, traveling, etc.  Right now, my neighborhood and workplace do not always feel safe.  Triggers are part of it, but experiences count too.

In order to get back to the “me time” and other positive self care strategies, I have to bring back the safe feelings.

Issue 1: feeling safe in my neighborhood

Have you ever noticed people in your neighborhood who set off your instincts?  You can’t see or hear anything “wrong” from their appearance or interactions with other people, but you know there’s something “not quite right” about them?  There are a few people like that in my neighborhood; they are unsafe and dangerous.  I avoid them by crossing streets and not looking them in the eyes.  And I make sure my posture and body language say “don’t bother me; I am not vulnerable” instead of the opposite as often as possible.

Also, I’ve been known to talk to the hotline while I walk home; it helps that people hear one side of the conversation and think I’m a little crazy.  This way, they actively avoid looking me in the eye and walk around me too.  As much as I’d like to be friendlier, past experience has taught me that being friendly and chatty with neighbors or people on the street gives the appearance of an easy target.

But this did not deter the older man in a wheel chair who stalked and stopped me on my way home one night as I walked from the train stop to my apartment – a trek I’ve made numerous times in the 21 months I’ve lived in this city.

You might think, oh he’s a disabled old man in a wheelchair; how dangerous is that?  Disabled people do not have a monopoly on goodness and vulnerability; they can be and are predators same as people without disabilities.

Even after I crossed the street and turned away from him, he followed diagonally to cut me off from my apartment building.  With one hand outstretched, and the other hidden or resting close to the hand rest, he looked at me and asked for money.  I ignored him, and he wheeled closer.  Finally, I turned to see him within 5 feet.  So I turned around and flung my hand out like I was going to throw the container at him and yelled at him to stop.  He tried to wheel closer, but I kept yelling and waved my hand again.  His face turned cold, eyes hard and mean, but didn’t get any closer.

We stared at each other in a standoff until I walked into his space with aggression in every step.  Then I turned away to walk around and back towards my apartment.  He tried to say something, but I made a gesture that had him hesitating.  And the counselor on the phone with me that night, started speaking to me again.  When I answered her, he turned away and looked as if I hurt him.  But I kept on moving and talking to the counselor.  A few minutes later, he got picked up by a van.  They disappeared, and I continued home.

That was a Friday night.

The Monday morning afterwards, a van similar to the on from Friday slow parked/crawled along the sidewalk I walked on; same route I take every morning to get to the train station.  The van followed me down the block and beeped its horn until I crossed the street to the next block.  To say I was shaken and scared is easy.  Triggered and feeling unsafe in the neighborhood that had been safe up until that weekend?  Yes that too.

My solution: write in an anonymous tip to the police using their website form; letting friends at work know what happened so they understand if I call or text on my way home; and using the hotline to keep me company when I walk home late if I feel anxious.

Issue 2: Feeling safe in my workplace

One of my biggest issues with PTSD is hyper-vigilance.  It takes a long time for me to acclimate to changes in my workplace – especially integrating new people; different levels of noise (stimulation); and understanding boundaries.  One aspect I never thought I’d have to deal with also is sexual attraction – not me because I’m still frozen, but a man being attracted to me and treating me odd because of it – and bullying that can come from close-knit groups of people sharing information with each other.

The new people in the office have a different work culture than we do in our office.  They get together often and are friends with each other, or are friendlier than my coworkers and I are in that we go to work to work and chat infrequently during work hours.  Apparently, the man whose interest I caught started talking about me to his teammates and other people who work in my area.  Those people started off friendly enough, but soon started acting unfriendly and somewhat hostile in their body language.

That makes me very uncomfortable.  These people are in and out of the shared work space and do not modulate their voices.  That means I can hear snippets of conversation and other stuff even with my headphones on loud.  And with my headphones on loud, I am more likely to startle easily when people do come up to talk with me.  I am also more likely to feel hyper-vigilant and anxious because I can’t use my normal coping methods (listening to and recognizing the foot treads/voices/sounds of people who come and go around me) to ensure the safety of my space.

But worst of all, the negative attitude and hostile body language combined with knowing they are talking about me behind my back is triggering and reminiscent of how I lived the first 25 + years of my life.  Work felt like a battlefield I wasn’t equipped to handle; not with the neighborhood scares and all of the anniversaries/flashbacks/memories popping into visit.

So what am I doing to feel safe again?

I am going back to basics.

  • Eat, sleep, drink liquids (and maybe something alcoholic if I feel like it), treat myself with kindness and compassion to start.
  • Use my gratitude mantra as often as necessary to remind myself of the blessings in my life.
  • Use my safety mantra as I wake up in the morning, go to bed at night, wake up in a flashback, or have a nightmare.
  • Stock up on my favorite grounding foods and flavors.
  • Enjoy reading silly books and splurge on a few new ebooks
  • listen to music
  • Continue on my personal style journey
  • Fight back using what quiet strength, resilience, persistence, intelligence, and strategy instead of letting my emotions win
  • And not do anything sometimes

Thanks for reading

PTSD: Sometimes Going Forward Means Going Back

Introduction

I started this blog eleven years into my recovery.  Many of the worst symptoms were reduced to manageable levels or stopped.  It felt good because I was emotionally stable and grounded in spite of constant physical pain.  Being grounded meant being able to take a look at my life and examine the true causes of my issues with perspective.  Then I could to make concrete changes about my beliefs, thoughts, and behaviors so that my lifestyle and my personality matched my values.

On one hand, I made myself stronger and safer.  On the other hand, the pressure to go back to what I was before got worse.   Overt actions and behaviors legitimized the thoughts and fears that I had (before) dismissed as false lies.  The actual lies were me believing my family and connections loved, protected, respected, accepted, and did not abuse me.  Denial had been a great coping strategy for many years, but not so much as I moved forward.  I needed tools to help me face my past and present then safely cope with the sensations so that my past did not control my present or future anymore.

Relapse and Circle Back

The trauma specialist helped me learn other ways to process recovered memories and keep myself safe during bad flashbacks, nightmares, and panic attacks.  One significant breakthrough was acknowledging my alters as real.  That happened after a relatively unhelpful month-long stay in a partial program.  It had been my first experience being a conscious observer when I switched personalities (even though I don’t know what I or anyone else said), and I was scared.  I thought I was truly going crazy and that my symptoms had increased again to the point of not being able to follow through on my escape plans.

2011 was the year I decided to leave my current life and disappear (as much as one can while living in the same small state).  But family and connections wouldn’t leave me alone.  They found ways to bring me back in (including death of a family member) and try to control me.  I thought I could disappear on my own.  Had planned very carefully where to move, etc.  But then I relapsed with anorexia; my nightmares increased; I stopped sleeping; lost weight; had more panic attacks and hallucinations; heard voices and lost control of my body sometimes.  And got scared every time I saw my grandmother’s name pop up on my phone screen.

Try Again

Eventually, I moved into a different space.  That apartment was exactly what I wanted except for the mice and the noise.  I tried using a self-trained service animal to help with PTSD.  They are legitimate and helpful with the right training, resources, and support network.  Mine was a disaster waiting to happen because I lacked the resources and support network.  The puppy went to a new home and is very happy now.  I learned valuable lessons about my own strengths, weaknesses, ability to trust, and symptom management.

The mice were something I just couldn’t live with.  My apartment didn’t feel safe anymore.  If mice could enter my apartment any time, who knows what else could get in or be there.  And I learned that many of my neighbors were either friends of my sibling/cousins/relations or not safe to be around; they set off my instincts in a bad way.  And so started my three years of moving as I tried to find a safe place to live that was also on public transportation.

Each new place I moved to taught me about resilience and self-reliance.  For a little while (usually a few months at a time), I felt safe enough to relax and show my real self.  It’s not a self that many people were comfortable with and refused to accept.  That taught me to examine my relationships with the rest of the people in my life and the types of people I was drawn to at the time.  I realized I sought out relationships with people who treated me like my family did.  That disturbed me a lot.  The trauma specialist understood my concern; she provided me with terms and book references so that I could learn more on my own.  Those references were handy distractions from nightmares while also teaching me new coping strategies.

I was still under weight and having panic attacks, but not relapsed anymore.  The anxiety was lessening, and I was sleeping more.  Until one day I got a message from a mutual friend or maybe my godfather (hard to remember) told me my only living grandparent was in the hospital. A few phone calls through the hospital switchboard made me feel so unsafe I stopped sleeping for days.  Then came nightmares, panic attacks, flashbacks, dissociation, a cold, and many weekends of lost time when I passed out and slept from exhaustion or overload.

Reaching Out

That’s when I realized I needed more help.  I had to face some more hard truths and then take action.  One was telling my god father that I couldn’t maintain contact with him anymore.  Another was acknowledging I was a victim of domestic violence before and am both a victim and a survivor now.  Finally, I wasn’t helping myself by keeping quiet when I felt like someone was treating me poorly.  All it did was trigger anger, flashbacks, and self-harm.  So I did what I always do in times like this: read and research information.

That is when I rediscovered the hotline and the relocation project.  Both resources helped me find emotional stability and physical safety as I started the process to change my name, move someplace in the state no one would think to look for me, and get away from the people from my past harassing me on behalf of their relationship with past connections.  That was 2014.  And I was finally safe.

My alters and I had learned to communicate and cooperate enough that daily life was more tolerable.  The nightmares and flashbacks lessened.  I was eating normally and healthy again.  Only had issues when I went to work; and most of those were because of location not the workplace.

Having a safe haven to go to at the end of the combined with asking my supervisor for help with work issues made all the difference in feeling safe.  For the last two years, I have felt happier than I can remember.  Safe, content, and only having to deal with triggering people in the city made life so much better.  Enough that I started reaching for dreams (like this website and blog) again.

Going Back

After three months of documenting different coping challenges and experiences here on the blog, I realized that I wasn’t just “sick with a cold”.  The symptoms I felt: chest pain, sinus pain and stuffiness, sleep deprivation, ears clogged, headaches and migraines were exactly what I lived with until 2009/2010 when I went to my first partial program and then started seeing a trauma specialist.

It was caused by what I call a cascade of stressful and triggering events or experiences that cause adrenaline rushes and crashes without leaving any recovery time to process what happened (or a cascade).

On the good side, I know this will go away.  My alters know this will go away too.  On the bad side, none of us remember or know how to cope with this unless we use negative coping.  And that is not an option.  So here I am with my alters in a relatively happy and safe place full of positive changes and experiences suffering from physical reactions to stress again.

Conclusion

Judith Herman, author of Trauma and Recovery, reminds the reader of this throughout her book.  Neither I nor my alters are sure how to cope.  We do the best we can and are transparent with each other when one is having more difficulty than others.  The ones who work are transparent with the supervisor and co-workers, letting them know that symptoms have increased and we might need some temporary accommodations until they pass.  Best we can do is practice self-care, self-soothing, reclaim our personal time, and try to re-establish emotional/physical/spiritual safety on the inside and outside.

Anniversary Post: thoughts about anniversaries, memories, and triggers

Anniversaries Coming Up

  • Labor Day: In the US almost everyone has Monday off to celebrate the holiday.  Except for retail, transportation, and a few other jobs where employees get a half day or reduced hours day instead.  For me, it means barbecues with family; going out to activities and events; getting bullied by cousins and shamed or ignored by everyone else; sometimes abusers found me and did stuff too.
  • Sperm Donor’s Birthday: He is 30 years older than me and does not like to celebrate his birthday.  My memories as a little girl are warm and fuzzy – I was the quintessential Daddy’s girl until I started school.  Probably because I filled two important roles: 1) kept the egg donor occupied and out of trouble; and 2) easily controlled and dominated (never physical abuse, but everything else for sure).  Then I started school.  The egg donor was left alone to her own devices.  And he started sexually abusing me.  But once I hit puberty, I was persona non grata.
  • School Starts: Every year, I looked forward to escaping my home life by going to school; even if that meant I would get bullied by my peers and teachers.  At least they weren’t physically or sexually abusing me.  Except for the principal, but that’s another story.  And at school, the other abusers (not related by blood or marriage) couldn’t get to me either.  But being ridiculed, bullied, the victim of racism and prejudice, etc. wasn’t easy either.  And then came middle school/high school with all that angst on top of everything else.  By then, everyone ignored me because I was “rude and annoying” to many, but also set up by the egg donor who worked in the juniors department at a department store and told my female classmates stories about me.
  • Moving to College and/or Apartments: September 1st is the most popular moving day for everyone where I live.  The first few moves, my donors coordinated and organized everything.  Then I had the responsibility of doing it myself.  They hated my going to college.  They hated more when I moved out and took every chance to bash me about those choices.  Then they complained enough to have the rest of the blood relatives and other connections harass me about it too.

Weekend Coping Strategies

This year is different in a lot of ways.  Here are a few:

  • I am safe – living in a place where they can’t find me that is all mine
  • I can stay home or go out on my terms
  • I do not have to move this year
  • My mental and emotional self is in a healthier, happier place than it was before
  • I have weekend projects to keep me busy
    • My favorite is making shades for hard-to-fit windows
    • Cooking and baking at home
    • Laundry and dying some of my white t-shirts a less bright white
    • Knitting – finish a scar for my friend
    • Write Monday’s blog post
  • I have movies to listen to in the background
  • Three days means I can make my own hours and not have to worry about lack of sleep and having to work on Monday

My goal is to not sleep the weekend away.  I might not be able to leave home – that gets difficult because of the fear and anxiety that comes from going out (all of us feel this way) – but at least there is plenty to do at home.

Here are my coping strategies that utilize the list above.  I am using them starting end of work today:

  • Redirect thoughts by stating facts about the present, future plans, solving problems or getting answers to questions
  • Go shopping and have everything in place for the weekend
  • Practice emotion regulation and distraction by doing the activities on my list
  • Making sure I also stop and take regular breaks – either by doing something fun and relaxing or by not doing anything at all (includes naps)
  • Use my self-care compulsion rituals to help relieve the OCD stress that comes from triggers sometimes
  • And if I don’t end up doing anything on my “Want to do” list, then that’s okay too.

I’m ending this post with one of my favorite Lin Yutang quotes

Coping Challenge: Kitchen Triggers

Introduction

My kitchen is a scary place.  I go there and remember all of the times I had to deal with family and friends and strangers either with cooking, baking, preparing food, cleaning, or doing something not at all related to food.  Traditional cookware is a trigger.  Bakeware is a trigger.  Knife blocks, cutlery, utensils, tools, silverware, dishes, etc.  All are triggers.

And as I contemplate what to keep and what to get rid of, I realize that brands, types, styles, even materials the cookware, etc. are made of are more triggering than the memories.  I love the idea of having a wok again.  Cooking with a wok means I can make traditional Chinese food I grew up with.  But every time I look at a wok I feel anxiety.  Every time I try to choose one to buy, I feel anger and other negative feelings.  At home, I have a small/medium stainless steel sauce pan with a cover.  Every time I use it, I feel shame.  After I use it, I can’t bring myself to clean it right away.

I used to have a knife set that I got for my first apartment.  If was one of my first purchases for the rental because I wanted a good set of knves to cook with.  And because knives are expensive, I kept it even after I left my family.  Two weeks ago, I realized that looking at the knives made me feel scared and angry.  It was one of the main reasons I had been avoiding my kitchen.  The same thing happened with the set of cooking utensils I bought around the same time.  Getting rid of them was the best decision I ever made.
What Happens Now

Now, when I look for anything kitchen related (whether it’s dish towels or cake pans), I have to ask all of us, is this item something that will trigger us once we bring it home?  Will buying it make us feel good or anxious?  Will we use it or hide it?  Will having this item at home cause anxiety or excitement?  Will a part of us come out during its use and break it because the anxiety and other emotions got so overwhelming the need to destroy the trigger overcame everything else?  Because yeah, that’s happened to us in the past too.  broken cups & plates; tarnished silverware; rusted cast iron, etc.

And buying what I like, what I choose for myself is a trigger in itself.  The fear that someone will come and take what is mine away from me exists in some of my parts.  The urge to destroy what I like as punishment exists in other parts.  And the need to hurt the self because of the rule breaking drives me and some parts to not buy anything out of paralyzing fear.  The triggers start thoughts ruminating; the rumination feeds into obsessions; obsessions trigger compulsions until one or all of us finds relief by giving in to those compulsions or having a panic attack because the coping strategies aren’t working so well.

The Trigger Cycle

Which brings me back to my original feelings of:

Why buy cooking utensils?  Why bother trying to cook?  Is the enjoyment that comes from cooking and baking worth this hassle?  Why not continue to avoid it?  Eating isn’t necessary, and you don’t deserve to be healthy anyways.  It’s not like you’re an important person who does important work.  No one will miss you.  But if you go out and get (insert item here), you will (insert threat here).

This cycle happens whenever I try to do something good for myself.  Examples:

  • Buying clothes that fit
  • Sticking to a budget
  • Deciding to replace my cookware/bakeware/etc
  • Cleaning my apartment
  • Buying garbage bags
  • Wearing accessories and looking stylish
  • Eating food I enjoy

How do you handle your triggers?

The OCD and Rumination Cycle

I’ve been avoiding buying what I need – not exactly the best coping strategy, but it works for now because I am trying to avoid buying too much stuff right now.  Where I live now is great.  All of us enjoy it and are relatively happy.  We feel safe.  But we also know that this place is where we grew up; full of triggers just walking around outside or going to work; and often end up encountering people from the past.

So the decision has been made (by all of us) to move to another state as far away as possible from this one where no one from our family or past that we know of resides.  This will happen around the end of next summer.  And since the price of moving a lot of stuff cross country is ridiculously expensive, why not take the opportunity to sell/get rid of everything unnecessary and use the savings to buy after moving in?

Makes sense right?  But is this another case of avoiding self-care or of being practical?  Am I hurting myself by not nesting where I’ve lived for a year and plan to spend another year?  Or am I being smart by only buying what’s necessary to facilitate self care and then selling it before I move.  I can always re-buy later or give my self a limit of boxes to ship to my new place rather than move everything.

As you can read here, examples of ruminating thoughts, obsessive thoughts, and inability to make choices.

How the Cycle Is Broken

I break the cycle by using CBT and DBT with a judicious dose of meditation most of the time.  When that doesn’t work, self-soothing and sensory grounding usually do the trick.  And when all else fails, a text message or call to someone I trust for some support will help me clear my head.

I hope the quote helps you remember the importance of self-care the way it does for me.