Grounding Techniques

Per the new posting schedule, every Thursday is a Resource and Recovery themed post. In this series, you’ll find coping skills, tips, and tricks for coping with a mental health struggle, whether crisis or day-to-day management. The Thursday posts won’t necessarily relate to the more personal Tell-All Tuesday posts every week, but when I can tie them in, I will! My Tuesday post this week was on what it’s like to be triggered and some thoughts on the “Trigger Warning” debate. For this Recovery Thursday post, I’d like to share some grounding techniques I find helpful when I am triggered.

I explained my personal favorite grounding technique in my post Top 5 Ways to Get Through a Bad Situation (Without Making It Worse) earlier this year. Click that link to read all about the 5-5-5 grounding tool. But in mental health recovery, what works well for one person may not be as effective for another. And, honestly, sometimes success in grounding is situational. So, I wanted to make this post about multiple ways to ground yourself when triggered, so that hopefully you can find one that works best for you or one to guide a loved one through a flashback or a panic attack.

What is grounding? Grounding is getting your mind to stay in the here and now even if you are panicking or having a flashback. Often times, this is best accomplished by using something physical and tangible to “bring yourself back.”

I find physical grounding to be the most effective for me. In addition to the 5-5-5 technique, there are several other approaches you can take to physically anchor yourself to the present. Most of us do things to get “back in our bodies” already, but some of those coping skills are maladaptive and unhealthy. I’m thinking specifically of self injury: cutting, burning, punching walls, etc. Yes, these actions can keep you “here,” but “here” isn’t so great when you’re hurting yourself.

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If your go-to coping skill is self harm, I’d like to give you some alternatives that may work as well and be better for your wellness in the long run.

ICE CUBES: I like to use ice cubes over everything else. I hold the ice cube in my palm and squeeze it. When that hand is numb, I switch it to the other hand and do the same thing. Sometimes, I put the ice cube on my arm or on my neck. The cold is usually a very helpful grounding technique. You may have heard of the ice cube trick before, but just because it’s floating around out there doesn’t necessarily mean you’ve tried it. You may have heard of the next one as well.

RUBBER BANDS: Keep a rubber band around your wrist and snap it against your skin when you need to ground. It will sting a little bit, but will not have the lasting impact of more drastic forms of self harm. The rubber band trick is only suggested to those actively struggling with self harm impulses. If you don’t currently engage in self harm, it’s not recommended as it could actually build the habit of hurting yourself when you’re overwhelmed, and that’s not a habit you want to start if you don’t have it already.

FROZEN ORANGES: This one is going to sound a little weird, probably. It definitely did when I first heard it. But, I keep a frozen orange in my freezer at all times. If I really need to ground, I take it out and put it against the back of my neck. Then, I start to peel it. Fun fact, it’s really hard to peel a frozen orange. And, if you’re focusing on that task, the combination of attention and fine motor skills needed to peel it and the strong citrus smell keeps you really grounded and often the panic or dissociation will pass before you are finished with the task. And being able to “dig” into the skin of the orange can help negate the need to hurt your own skin.

Now, let’s look at grounding techniques that are not necessarily substitutes for self harm. What can you do when you are starting to have a flashback?

Again, the answer is mostly physical. If you can prove to your body that you are here and not in the past, the flashback will pass much quicker.

GET ON YOUR FEET. Taking the term “grounding” quite literally, try to stand up, Feel your feet against the floor or the ground. Walk a little. Feel your legs moving. Stomp a few times. Ask yourself “where are my feet?” and answer “On the ground.” This may seem silly, but this is something I have used both in my personal and professional life to help keep myself or my clients grounded. And it tends to work very well.

FEEL YOUR ARMS. For me, when a flashback is happening or is about to happen, my arms are usually numb. Lifting them above my head (or having a friend raise them for me), wrapping myself in a heavy blanket and feeling where my body ends, or rubbing my arms to warm them helps immensely in grounding.

MINDFULNESS. Pick something up and really focus on what it feels like, walk around and focus on your feet and the floor, if you’re sitting, focus on where the floor or chair connects with your body.

OPEN YOUR EYES. If you’re eyes are closed, it’s usually game, set, match for the flashback. It’s got you. It’s really hard to stay present if you can’t see the present. Keep your eyes open and try to look around you mindfully. Focus on every small detail you can find. (the pattern of the floor, wood grain on cabinets, decorations on walls, leaves of grass, etc.) This really helps me stay “here” or, at the very least, get back faster than I otherwise would.

OK, so those are the “external things” you can do. What about internal? What can you say to yourself to help stay grounded?

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ASK YOURSELF QUESTIONS. “Where am I? What year is it? What was I just doing? What time is it? How old am I? Where am I right now?” By thinking about and answering these questions, you will bring yourself back to the present.

HAVE A SCRIPT. “I’m having a panic attack right now. I am safe. I am not in any danger.” “I’m having a flashback right now. The worst is over. This happened in the past and is not happening now. I will come out the other side of this.”

THINK ABOUT DIFFERENT THINGS. Set your mind to a weird task. Count in 7’s, name ten different countries, think of your 5 favorite books and try to name the authors, name all of the characters in your favorite TV show, try to name 5 animals that start with the letter “M”, etc. If you can get your brain away from focusing on the trigger, you can show yourself that you are safe.

Remember that you are not powerless and at the mercy of your diagnosis. These are tangible coping skills you can implement immediately. Practice them, see which ones work best for you, and keep them fresh in your mind so that you can access them easily when you’re struggling.

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There you have it! I hope you find at least one of these coping skills helpful! As always, I’d love to hear what you think of the post! Drop a comment, Tweet me, and check out my FacebookTumblr, and Instagram! Also, be sure to check out the perks available to YOU on Patreon for becoming a Patron of this blog! (You’ll love ’em, I promise!)

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Be sure to check in tomorrow for ParallelDichotomy’s first ever guest post! It’s part one of a first hand account of medication induced psychosis in someone who does not live with a mental health diagnosis. I feel it’s important to honor all mental health struggles, and through the guest post series, I hope to host the voices of people living a different experience than I am. If you’d like to be a contributor to this series, please get in touch via social media or email me at Paralleldichotomyblog@gmail.com.

Being Triggered and Trigger Warnings

What’s it like to be triggered, really? We hear the terms “triggered” and “trigger warning” thrown around a lot, even used as a joke. Because people hurl the phrase so thoughtlessly, others have come to mock it, even hate it. If you’ve been anywhere near the discussion around trigger warnings in the past year, I’m willing to bet that you’ve heard someone spit out the phrases, words dripping with indignation and contempt.

Per the new blog schedule, today is “Tell All Tuesday.” (One day, I’ll have a more intriguing name, but, while I love to write, creative naming is a bit of a struggle for me.) What’s the idea behind this Tuesday series? It’s more personal. It’s not about resources and recovery as much as it’s about sharing my experiences in what I hope will be a meaningful way to help further discussions on mental health and combat stigma. In that spirit, I would like to spend the inaugural post in this series talking a little bit about what it’s like, for me, to be triggered, and what it’s like to hear these debates around trigger warnings as someone who lives with the potential of being set off by external events.

I live with complex post traumatic stress disorder. Complex trauma occurs when a person is living in a dangerous situation from which there is no obvious form of escape. For me, those traumatic experiences involve growing up in a home with abuse and domestic violence, and then living in a marriage with domestic violence myself. I am very new to “the PTSD thing.” I only became really symptomatic after my husband left in November of last year. But, I’ve learned quite a lot about being triggered.

First, and very importantly, a trigger can be anything. The word “Trigger” means different things to different people. For the purpose of this post, I am talking about triggers that relate to trauma and a traumatic reaction. They can be large and “obvious”, or subtle, sometimes seemingly coming out of no where. “Obvious” triggers would be graphic depictions of a sexual assault, domestic violence, child abuse, war, a car wreck, a hostage situation, etc. Depending on your particular trauma, any realistic reenactments of  something similar will probably get you revved up and incredibly uncomfortable. “Subtle” triggers can literally be anything related to your specific trauma. To give you an idea of how something “mundane” can really trigger someone, I cannot listen to Journey. My stepfather used to listen to it when he was drinking, and if I hear the opening notes of “Faithfully” or someone singing “Just a small town girl, living in a lonely world,” I become seriously on edge. Honestly, even thinking about those songs to type that sentence has upped my anxiety a little bit. I hear Journey and my physical, subconscious reaction is “danger is likely coming, and I need to be prepared for it.” Living with PTSD is living with your particular triggers, the known and the unknown, the avoidable and the inevitable. Hearing Journey is pretty inevitable. Talk about overplayed! It’s something I’m still working on as far as being able to ground myself and prevent a flashback or panic attack. I think of triggers like a lurking monster, always ready to jump scare you, horror movie style, when you least expect it. Much like horror movies, even when you know it’s coming, it can still make you jump.

I’m a huge fan of the movie Jaws. It’s one of my all time favorites. I watch it every fourth of July. I think of my PTSD like Jaws. Sometimes, it’s in my face, trying to rip me apart. Sometimes, it’s lurking just under the surface as feelings of suspense and concern rise. Sometimes, it’s not really on the radar, but I know in the back of my mind that the threat is always there. I no longer have the ability to enjoy a nice, relaxing swim in the ocean in this metaphor, because I know what is hiding under the waves. I have a very hard time “just chilling” and “fully relaxing.” I’m just too hyper-vigilant for it.

Being triggered, for me, is a complicated spectrum of responses. It’s not just one reaction, or one behavior. Sometimes, it’s simply heightened anxiety and being on edge. Sometimes, it’s a full blown panic attack. Sometimes, it’s a dissociation; no panic, no reaction, just shutting down for a bit. Then, there are flashbacks.

Flashbacks are brutal. They are Jaws leaping from the water and ripping flesh from my body. There’s a lot of misconception around flashbacks thanks to the media. They are not all word for word reenactments of trauma, or hallucinations that the trauma is happening again. (Though, sometimes these types of flashbacks do happen.) Occasionally, with very direct and strong triggers, I have had full blown flashbacks. I don’t usually remember much from them (even the “mild” ones) but I usually remember what brought them on. When I was in the waiting room at the hospital, a lady in the next room was screaming. She believed that the doctors were going to kill her. But the words she was screaming were “No! Stop! Please!” etc. This triggered me deeply, as it sounded very much like my mother during violent situations with my stepfather. My friend tried to keep my attention in the present, but I could not. The room faded and I was not there anymore. I don’t know what happened, but when I came out of it, I was across the room against the wall with my friend in front of me looking very concerned. That was a “full blown” flashback. But mine, at least, are nearly always what I call “half flashbacks. These experiences are not typically that dramatic. I dissociate. I can feel it coming on sometimes. I start to “drift.” First, my body gets tingly. My hands and feet get cold, but my core feels hot. My heart rate increases. I start to “zone out”. I’m half “here” and half “there.” I’ve had a few of these types of flashbacks around friends. Obviously, being friends, they tend to attempt to help me through it and find my tether back to the here and now. I can hear my friends speaking to me, but responding is very difficult. Sometimes, I do lose touch with “here” and it usually takes me a little bit to “get back.” But I don’t do a whole lot physically. I don’t really speak. I pretty much comply with whatever someone tells me to do. I’ve heard that my leg tends to shake a lot and that my muscles tense up, but that’s really it. Not nearly as “exciting” as the flashbacks you see in movies, I know.

Remember how I said that triggers can be anything? I meant it. I’ve been triggered into a flashback before simply because I felt tense and panicky. Sometimes there is no trigger beyond the fact that I feel similar to the way I felt during a moment of trauma. That is how subtle a trigger can be.

So, with all that said, the question we see posed a lot is “are trigger warnings necessary or are they just ‘coddling’ those pesky, oversensitive Millennials?”

First of all, the “trigger warning debate” is typically centered around classroom settings. In an educational situation, trigger warnings are not just a good idea, I would argue that they are essential. In these instances, I’m talking about the “obvious” triggers. 1 out of every 3 girls and 1 out of every 5 boys will be sexually assaulted before they reach the age of 18. 700,000 children in the United States experience child abuse annually. 5 million children witness domestic violence each year in the United States. 1 in 3 women and 1 in 4 men will experience domestic abuse of some form in their lives. And these numbers only speak to four forms of trauma one may endure. Statistically speaking, if you’re teaching a lecture class on a college campus, a decent portion of your student body has experienced some form of trauma. Being fully triggered is an all-encompassing feeling. When  trigger blindsides you, and you have no time to prepare, the effect is often much stronger than if there is warning. There are grounding techniques and coping skills one may use to stay present and engage in their education. Without a warning, those students who have experienced trauma will not be learning anything. They will be battling with their memories, intrusive thoughts, and panic trying not to make a scene.

In college, I studied social work. Thankfully, even prior to trigger warnings becoming “mainstream,” my social work classes were full of them. Teachers would say, “Today, we’re going to be talking about working with sexual assault survivors. Do what you need to do to take care of yourself if this is a sensitive topic for you.” After an intense class, each of my teachers would always make themselves available to talk and process with students who may have reacted strongly to the topic covered in class that day. In the small sized social work classes, it was very rare for someone to leave class during such a class. There was a carefully fostered sense of trust and openness in our classrooms that allowed for very intimate conversations. When talking about trauma, it was perfectly acceptable (and honestly encouraged) to share personal connections. One teacher would always say, “What about the people in this case study and the situation presented hits a tender spot in your heart?” This would allow for engaging and supportive conversations around our own experiences, how those experiences would shape our clinical practice, and what we could each do to take care of ourselves and each other as friends and colleagues.

I recognize that most classes are not designed to facilitate such self-exploration. But having trigger warnings in place can help someone prepare for the trigger, and utilize coping skills to stay present. Anyone who has a problem with an English Lit. professor saying “The reading today contains a rape scene. Please take care of yourself.” at the beginning of a class does not properly understand the reason for trigger warnings. There seems to be a misconception that “trigger warnings” somehow means that the material is not taught. This is not the case in any college class in which I have participated.

In America, the sad fact (as demonstrated by the statistics listed above) is that a substantial amount of our population has survived some form of trauma. While it is true that not all trauma survivors develop PTSD, I don’t believe that there is any shame in shifting our standards, especially in learning environments, to something a little more trauma-informed.

It’s true that no one can predict every potential trigger. (Even don’t know all my triggers, and I sure as hell don’t expect you to know them.) Generalized trigger warnings harm no one and may substantially help a trauma survivor. As someone who has been through the hell of flashbacks and panic attacks set off by a trigger, I fully support the use of trigger warnings.

The overuse, and superfluous use of the term “triggered” is a very frustrating issue to me. When people use it as slang for “upset” or even “mildly inconvenienced”, I get very angry. It’s right up there as saying “So and so is so bipolar!” It’s stigma. It’s ignorance. Saying “I’m so triggered” flippantly is a large part of what creates this “debate” around “trigger warnings.” It shapes the conversation toward “Those kids are just too oversensitive. They need to grow up and face the real world. There are no trigger warnings there.” And that is a true statement. Life doesn’t come with trigger warnings. But to diminish the experience of being triggered, to suggest that using trigger warnings in classrooms is unnecessary, and that the people asking for them are childish and spoiled, is incredibly invalidating and demeaning to trauma survivors. It can be deadly. The shame around PTSD and being triggered is already immense. (Believe me, when you’re just doing life and all of the sudden you “come to” with a friend in front of you looking worried because you just went catatonic for ten minutes, you feel pretty damn stupid. “Why can’t I control this?” “I need to be stronger so I can make this stop.” “Oh, great. I’m crazy and now my friend knows it.” These are all thoughts I, personally, have had after being triggered.) When I say I support trigger warnings, and someone says, “You’re just being oversensitive.” my traumatized brain, which already tried to minimize my feelings and my memories and the things I’ve experienced, latches to the sentiment that I’m overreacting and that it can’t really be that bad. And that starts a vicious cycle of depression, shame, and self-loathing. I can’t wait for the day when we no longer minimize people’s lived experiences and recovery process by flippantly throwing around psychological terms like they’re nothing. Until then, I’ll keep raising my voice in opposition and speaking my truth.

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***PTSD is a lot more common than you may think. 1 out of 10 women and 1 out of 20 men will develop some form of PTSD in their lives.***

If you’re interesting in the “other side” of this debate, I’d like to aim you in the direction of my friend Elizabeth’s blog Betty’s Battle Ground for her post on why she doesn’t use trigger warnings. It’s a good read, and I respect her opinions!

Thanks for reading! As always, I love hearing your thoughts! Drop a comment or find me on FacebookTwitterTumblr, and Instagram! Also, a friendly reminder that I now have a Patreon account with some pretty cool perks! If you like my work here on ParallelDichotomy, I would love to have your support! Come back in two days for the second installment of Recover Thursday! Pop in for tips, tricks, resources, support, and understanding in mental health recovery! 

Top 5 Ways to Get Through a Bad Situation (Without Making It Worse)

There’s a lot of information out there about preventative measures for relapse into a mental health crisis. There are also great resources on what to do in a crisis situation. But what do you do when you’re just having a really hard time? What if you’re feeling completely overwhelmed, but you’re not posing any threat of serious harm to yourself or others?

I’ve learned a lot in the past few months about distress tolerance skills. These tips and tricks have been immensely helpful for me in my recovery. Tonight, I’d like to share with you my Top Five skills for dealing with negative, overwhelming emotions.

NUMBER ONE

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If you’ve been following my story, you know that I live with Complex Post Traumatic Stress Disorder. Included in the PTSD gift basket are things like dissociation, panic attacks, and flash backs. Each of these events are about as fun as getting your tooth drilled without Novocain (this happened to me once at the hands of a very incompetent dentist, so I feel justified in making the comparison). You may have heard of different variations on this particular grounding technique, but my favorite method is this: look around the room you’re in and pick a color. Now, find five different shades of that color, or, if you can’t find different shades, just find five different objects of that color. Once you’ve done this, find five things you can touch. If you can, physically reach out to objects around you. Are they hard or soft? Are they smooth or rough? Are they warmer or colder than your hand? Etc. If you cannot manage to reach out, consider things you can feel without moving. What does the fabric of your shirt feel like against your shoulders? If you’re sitting – what does the chair or couch or bench feel like against your thighs and back? If you’re standing, what does the floor feel like against the soles of your shoes? How does your hair feel against your ear or neck? And so on until you’ve hit five. Finally, what are five things you can hear? This one really helps bring me back to the present, because you have to really focus to find five unique sounds. It can be challenging, and it may take a few minutes of intense listening, but I have yet to be in a place that I could not, with concentration, find five different noises. If you are still not grounded after going through these steps, repeat. In my experience, this is nearly 100% effective when I need to get back to the present and back to my center ASAP.

NUMBER TWO

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Sometimes, you’re so overwhelmed by your emotions tolerating them feels impossible. Everything starts to close in and your anxiety or depression seems to be consuming your entire being. When I’m really overwhelmed with depression, it feels like there’s a gaping hole in the middle of my chest and everything “good” about me is seeping out. It physically hurts. When I’m overwhelmed with anxiety, it seems as though the entire world is folding in on me and it’s suffocating. How can you sit with such intense emotions? Often, the mere thought of being “in your body” anymore seems impossible. You almost wish you could just crack your rib cage open and shrug off your skin and muscles for a few minutes to get some relief. These intense feelings tempt many of us to revert to old, unhealthy, maladaptive coping techniques, such as: self injury, binge eating, or substance abuse. In these moments, sometimes the best thing you can do is remember that the discomfort is temporary and find some way to distract yourself until the intensity of the feelings decreases a bit. It’s important to note that there is a difference between distraction and avoidance. Avoidance is complete neglect of your feelings, unwillingness to get curious about the causes of your distress, and, in the long run, it is not conducive to mental wellness. Distraction, on the other hand, can provide a healthy, temporary reprieve from those feelings until the intensity has diminished enough for you to sit with them and consider what may have triggered you. I’ve found it very helpful to keep a list of easy-access distraction techniques on me at all times. I keep mine in my smartphone, but I have friends who carry theirs on actual pieces of paper in their wallets. Some people I know also have a list posted somewhere in their house. Whatever method you feel will work best for you is the one you should use. When you’re not in distress, compile a list of short distraction activities you can utilize. My list includes playing a few rounds of Galaga or Tetris on my phone (10-15 minutes maximum), doing dishes, playing the “Wikipedia game” (pick two completely unrelated topics, start at one, and click links in each article to see how few clicks you need to get from the first topic to the second), and going outside for 5 minutes of fresh air and a change of scenery. Your distraction list will be unique to you, but it’s important to choose activities that will take a short time to complete to decrease the intensity of what you’re feeling until you can face it and deal with it. Choose things that you enjoy; choose things that will help clear your head.

NUMBER THREE

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I’ve mentioned this one before, but I want to expand a little on it here, because it really is a wonderful tool! Whether you’re living with a mental health diagnosis or not, every single one of us gets overwhelmed from time to time. For some of us, it’s completing that big work project or research paper for school; for some of us, it’s getting out of bed or doing the laundry. Whatever the task at hand, if you’re feeling stuck, the 10 minute rule can help. It’s pretty self explanatory – you set a timer for ten minutes and work on whatever it is you need to work on until the timer goes off. If you’re seriously depressed and feel like you can’t get out of bed, set a timer for 10 minutes and walk around your apartment for that time. When the timer goes off, you can go back to bed if you feel so inclined. If you’re writing a paper for school, set the timer for ten minutes and write until it goes off. If you feel the need to, stop once the timer goes off. I say “if you feel the need to” because often times, I’ve found, action precedes motivation. Once you actually start moving around or start writing, you might find that you’ve gained some momentum to keep going. Or, you may be completely exhausted after the ten minutes. But either is fine! You’ve done something. In those ten minutes you are tolerating a task that you thought you absolutely could not do. And you can be proud of that!

NUMBER FOUR

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Mindfulness is invaluable. Truly. I don’t care what your diagnosis is, or if you even have one – in this rushed, consumer driven, plugged in, instant gratification culture of ours, mindfulness can save your life. Mindfulness takes many forms. You can mindfully eat an apple by focusing on the texture of the fruit on your teeth and lips and tongue, the flavor, the juice, the smell, and the crisp snap of each bite. You can mindfully take a walk by considering your feet against the ground, the feel of the air on your face and hands, the sounds of traffic or nature around you, and the way the sunlight reflects off your surroundings. Mindfulness is simply being present. Not considering the future or the past. Traditional mindfulness practice involves things like deep breathing and guided meditations, but practice is definitely not limited to these things. Some people prefer traditional mindfulness practice, and that’s fantastic! If you’re moving through a busy work day and need a few minutes of guided meditation on your lunch break, I’d recommend checking out the Headspace App, if you haven’t already. As a trauma survivor living with PTSD, though, I struggle with traditional mindfulness. Focusing on my body and breath tends to trigger a panic attack, and if I’m doing it with my eyes closed, I’m in for a full-blown flashback. So, I’ve needed to get creative in my mindfulness practice. Doing the 5-5-5 technique mentioned above when I am not triggered is great mindfulness practice, and, it keeps the method fresh in my mind for easy access when I really do need it! Choosing to walk away from my phone to engage with my daughter, focusing solely on whatever game she wants to play, the details, the characters, and the inevitable laughter, is mindfulness practice. Completely devoting my attention to learning to play a new song on my guitar is mindfulness practice. Photography is mindfulness practice, as you need to really take in your surroundings, consider the person or object you’re shooting, evaluate the lighting, and position yourself in relation to that person or object to best capture the message you wish to convey with the photo. Opportunities for moments of mindfulness are everywhere. And practicing mindfulness every day can really help you access those skills when you are feeling distressed.

NUMBER FIVE

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Self soothing is intrinsic in the fabric of our beings. Self soothing skills are some of the very first things we learn as tiny, brand new humans on this planet. When things are really bad, though, we have to remind ourselves to get back to the absolute basics. We need to feel warm, safe, secure, and comforted. My favorite self-soothing techniques are wrapping up in a heavy blanket or wearing a baggy hoodie that I can burrow into and away from whatever it is in my environment that is overwhelming me. I also like to light candles or burn incense with comforting scents. Sometimes, I will put on some music, either calming or songs that bring up good memories of time spent with friends and loved ones (I have a special playlist for these moments). Occasionally, I’ll take a very warm bath. I also like to snuggle my cats. Tactile. Real. Sense-based. Basic. These are the essence of self-soothing. These techniques are for the really bad moments. I use them most when I’ve just had a flashback and I’m grounded and present but need that extra level of feeling secure and comforted. I use them when I’ve just woken up from a terrible nightmare and I’m not ready to even attempt to go back to bed yet. I use them when that gaping hole of depression in my chest feels like it’s going to swallow me up entirely. I use them when anxiety is making the world collapse on me and I feel like I’m being crushed. Self-soothing is very literally about just holding on and riding the wave of intense emotion until it passes. No goal in mind afterward. Just getting through the moment as comfortably as you can.

 

There you have it! My personal Top Five distress tolerance skills. What do you do to get through a bad situation without making it worse? Do you have any favorite grounding techniques, healthy distraction methods, motivational tricks (like the ten minute rule), mindfulness techniques, or self-soothing activities or items you like to use? If so, I’d love to hear your tips and tricks in the comment section below, on Twitter (@paradichotomy), or on Facebook!

On My Experiences With Our Screwed Up Mental Health System

This is not a jovial or lighthearted post. This is a venting post. I may even venture into ranting territory. I would like to apologize in advance for doing all of the complaining and none of the problem solving. I recognize that that can be non-productive. But I’ve got some issues with our mental health system which have been festering for months, now, and I really just need to give voice to my lived experiences. That said, should any readers have thoughts or suggestions to improve my current situation (or, what I’m sure, is the current situation of many more like me), please share them! And if anyone knows of any resources which may be helpful, send them my way and I’ll be sure to link them so that, hopefully, others in similar situations will be able to find some useful tools here. I’m feeling pretty out of options at the moment, myself.

I’ve been struggling to come up with an adequate metaphor for our mental health support system, and I still am. I can label it – consistently inconsistent, frustrating, slow, over-complicated, etc. But a really good metaphor? Maybe a maze. Yeah. A crazy-house-mirror-maze. Only the mirrors are shattered in some areas, so you’re gingerly tiptoeing on broken glass, trying to make your way out without getting lost or injured; trying to walk the line between self-advocacy and being perceived as “overly-demanding/rude/aggressive” (because these are “behaviors” which will get you put on hold, disconnected, or asked to “calm down” in a condescending, but slightly foreboding tone that promises you’ll be in trouble if you continue to “overreact” to the situation).

If you know me, you know that I’m all about being polite and patient. Sometimes to a fault. You also know that I know many case managers personally and professionally. I am currently one semester shy of my Bachelors in Social Work. I was literally studying to become a case manager. I’ve also been on the receiving end of “self-advocating clients” who were, truly, being belligerent and unreasonable more than one time. So, I am not speaking broadly about all case managers in this post. I have also carefully considered the facts of the situation and believe that my current frustration, anxiety, and general agitation are justified and valid, which is why I am sharing my thoughts and experiences with you now.

I have absolutely no desire to be disrespectful, or to make what is already an immensely difficult job harder by being a “problem client.” But I have, over the course of 5 months, been put through the wringer on several levels, and, as the Cold War Kids said, “Hang me out to dry, you’ve wrang me out too, too, too many times”.

I am currently diagnosed with Post Traumatic Stress Disorder (PTSD) and Bipolar Affective Disorder (BPAD). I take medications to manage both diagnoses, and, in a perfect world, I would also be having sessions with a regular therapist once or twice weekly for further stabilization and management of my symptoms. But this is not a perfect world.

Here are the facts of the past five months of my life and my interactions with my primary doctor, the PHP and IOP programs I attended, the State of Vermont, and the crisis case manager I’ve been seeing at a local mental health organization until my insurance kicks in:

  • In early November, my life circumstances changed drastically, resulting in me living truly abuse free for the first time in…well… ever. And I was essentially hit in the face with 28 years of trauma and abuse. I developed severe PTSD symptoms.
  • In Mid-November, I did not sleep for 10 days straight. I did not eat. I lost 12 pounds in those 10 days. I was wired. I was having flashbacks and dissociative episodes like it was my job. I was depressed, but it was agitated depression. I could not sit still. I could not focus. I was making reckless and unhealthy choices. I was a complete and utter wreck. I went to Urgent Care on day 5 of no sleep, which happened to be a Friday. The PA I saw there was wonderful. She called the local mental health organization and was told by their crisis response that I’d be able to see the psychiatrist on Monday. She gave me a small RX of Lorazepam to help me sleep. Even with the Benzo, I did not sleep. I was doped up, but I was still wired and jittery.
  • Monday came. I was told I did not have an appointment with the psychiatrist, but the referral was in. All they could do for me was get me in to see a crisis counselor. The extent of the crisis counselor’s advice? “I get insomnia sometimes, too, and I count backward from 100 to sleep.” (I think I showed immense restraint in not yelling at her.)
  • I went back to Urgent Care that night. They told me if the Lorazepam wasn’t allowing me to sleep, there was nothing else they could do. They established an appointment with my PCP for mid-week.
  • I finally crashed on Wednesday night and slept. I crashed hard. I became very depressed, very low energy. This depression continued for a month. 
  • My PCP started me on a very low dose of Zoloft, and made another referral to the same psychiatrist.
  • I’ve been trying to get in to see this psychiatrist for 5 months, and I’m told it’s pretty much the only option available to me as psychiatrists in Vermont are difficult to come by.
  • Waiting on referrals, going to appointments only to be told I needed to wait longer, having my PCP assure me the referral was in and active while the mental health agency insisted it was not – these were all major contributing factors to me spending a week at inpatient.
  • After discharge from the inpatient unit, I spent the next month and a half in PHP and IOP. The case managers there promised me, up and down, that there was no way in hell they’d discharge me without adequate aftercare established, including therapy and psychiatry. Not only was I discharged without those appointments established, I was also discharged with no insurance and no means to maintain my medications.  
  • We only discovered that my insurance had lapsed on my second to last day of IOP. That was a Friday. I applied online for State insurance first thing Saturday morning. I called on Monday. I set up an appointment with Community Action to try to help get my application expedited. I tried so hard to be on top of my game and not be discouraged. The person I spoke to at Community Action, whose entire job is literally to help people get State Insurance, told me over the phone, “You’d be better off calling them directly. But have a book. And a phone that won’t run out of charge, because you’ll be on hold for a long time. I can’t see you in person until Friday, but I’ll set that appointment and if you don’t come, honestly, I’ll just be happy to get a break.” Verbatim. To me. Over the phone. I get burn-out, but how far past “done” do you need to be to say that to someone calling you for help? 
  • I called the State people, and I’m very pleased to report that that phone call was not nearly the hell the Community Action person made it sound like. I only read three sentences of my book before a real person answered. That real person, though, told me I was looking at an up to 30 day wait. Running out of medications with no money to get the final refills, no appointment to get further refills written, no therapy appointments set up, and nothing with the psychiatrist, either.
  • All of the back and forth and the apparent inability to communicate among my primary care doctor, the physician’s assistant I saw at Urgent Care, and the mental health agency for a referral to psychiatric services ended up costing me my career (and with it, my health insurance, which is creating the current stressors I’m facing) and my schooling, because, let’s be honest here:  if I had just been able to see someone back when all of this started, the more intensive interventions would have very likely been unnecessary and I would probably be writing this blog in my spare time between work and homework and mom-ing. (Ok, really, I probably wouldn’t have time for this blog. So, maybe that’s the silver lining.)
  • Today, the crisis coordination case manager I’ve been seeing in the interim until I can get established insurance and regular therapy sessions calmly told me I’m in serious jeopardy of not being able to maintain my medication routine until insurance kicks in, because of the out of pocket cost and because my primary doctor is unwilling to fill the types of psychiatric ‘scripts one needs to manage BPAD. In addition, insurance and all that aside, I can’t even get on the calendar to meet with the psychiatrist until I’ve met with my PCP and received a referral. A referral to the psychiatrist. You know, the very same referral that has, according to my PCP, been sent no less than three times already.
  • Today, I mentioned to my interim crisis case manager my concern that there may be a mixed-state episode in my near future based on what that’s looked like in the past (those 10 days without sleep, et. al.) and some current symptoms I’m experiencing: Screenshot_20170313-192328She responded by asking, “How did you even get a Bipolar diagnosis? That’s not Bipolar. I’ve worked with a lot of people with Bipolar and what you’re explaining isn’t Bipolar.” (How did I get diagnosed? By sitting down with a fucking psychiatrist and telling her exactly what I’m telling you, that’s how!)    
  • This interim counselor is not aware of this fact, but it took me a solid three weeks to even accept the Bipolar diagnosis. I was very resistant to it at first and did my fair share of pushing back against it before actually accepting the fact that the psychiatrist I was seeing through the PHP knew what she was talking about and was there to help me get well and stay well. So hearing the case manager (who, by the way, is NOT an MD and has spent a grand total of 75 minutes face-to-face time with me in the last 2 weeks) not only question the diagnosis, but essentially state flat out that I do not have BPAD was not only infuriating, but also incredibly invalidating of all of the work I’ve been doing toward accepting and attempting to manage the diagnosis.

But I can’t say that. I can’t say any of it. I have to hold it back, because if I start to say these things, I’ll likely end up yelling them at this point and getting myself in trouble. Because when you’re meeting with or talking to these particular caseworkers, you’re not allowed to be upset. “Upset” is for Therapists. “Medication concerns” are for Psychiatrists. “Referral requests” are for Primary Doctors. Polite acceptance, it seems, is all the Case Managers with whom I’ve been working have room for. And I am so far beyond “polite acceptance”. I am frustrated. I am angry. I am saddened by the stated of things.

You’ve heard of jumping through hoops? I’m bouncing around among five different agencies/offices and perpetually being told to talk to someone at one of the other phone numbers. It’s like a line of people holding the hoops through which I must jump, but every time I jump through one, the fucking person holding that hoop just moves to the back of the line and waits for me to jump through again.

It feels, in many ways, like this system is designed to allow people to fall through the cracks. If I wasn’t a stubborn, persistent, determined, sometimes pain-in-the-ass person, I would have completely given up on this by now. As I write this, I am discouraged, yes. But I am also genuinely scared. I’m scared that I’m going to have to taper off the medications which are still not even at full theraputic value in my system yet. I’m scared about all of this waiting leading to a destabilization and possibly another hospitalization for me. I’m scared of the implications of all of this. I see the “cracks” for what they actually are: gaping holes. And I’m terrified of the fall.

And, to end, I’d like to acknowledge a few things about privilege. In some ways, yes, I am in a position of disadvantage in our society: I am a woman, I am currently a single mother with no income, I’m an abuse survivor, and I have substantial mental health diagnoses.

But, in many other ways, I am very privileged. I am white. I am a Natural Born U.S. Citizen. English is my primary (and only) language. I am perceived as a cis-gendered, straight person. I am educated. I have access the internet. I am literate. I have some knowledge of and familiarity with the system which I am attempting to navigate. I have a steady work history. I have a car and a license. Despite being unemployed, I am not at risk of homelessness. I have family and friends supporting me in many different ways.

All of these factors place me at a great advantage over others who are attempting to gain support and services through this same system, and if I’m having so much difficulty with it, please take a moment to consider how hard it must be for those who do not possess the same privileges.

Our system is broken. And with the current administration’s plans for the future state of health care in this country, it is at risk of becoming irreparable. We need to fix it. We need to fix it before it’s too late.

On the “Moments of Suck”

This post directly contradicts a rule with which I was raised – an implicit rule, a common rule, I think, in Irish American households (and maybe in other household, too.) “Don’t air your dirty laundry.” Well, I’m tossing that rule out the window tonight along with my “dirty laundry,” wheeling out the clothes line full of shirts and pants and underwear, stained and smelly, for all to see. I want to make a little note that if mentions of domestic violence trigger you, you may not want to read this.

I have had a lot of shitty moments in my life. The moment when I was a child and found out my father wasn’t in my life because he was struggling with heroin addiction and in and out of jail. The moment my mom divorced my first step father. The moment I decided not to go on the every-other-weekend visits with my first step father because I felt out of place knowing that my brother was his biological kid and I wasn’t. The moment right after my mom married my second stepfather and he went outside on the porch for a cigarette and I followed him out and said, “So, you’re married to my mom now. Do I call you dad? Or do we stick with Tom?” and he replied, “I think Tom is good.” The moment I first realized I needed to take care of my younger brothers. The moments (and there were many) that I saw my mother sobbing in the kitchen and tried to comfort her. The moment I had a friend spend the night and I spent time before we were picked up from school explaining that my parents fought sometimes (every weekend, really) and that sometimes it was really intense, and she replied “I get it, my parents fight too.” The moment the relief from hearing that vanished as we sat playing up in my room and they screamed downstairs and her face turned white and she couldn’t even look at me as she said, “My parents don’t fight like that.” The moments that I sneaked into the kitchen when my mom and Tom were fighting to grab the knife block to make sure he couldn’t stab her if he got too mad. The moment I watched Tom tackle my mother to a sidewalk and beat her while holding my toddler brother and trying to prevent him from seeing what was happening. The moments right after that happened when we went to our church. The moments and days following that. (That event is a whole separate post, probably, we’ll leave it there for now.) The moments I sat in my room listening to every crash of dishes and every word screamed to figure out whether or not the police needed to be called. The moments I gave my brothers headphones and videos so that they didn’t have to listen to those fights. The moments neighbors did call the police and I heard my mom and Tom both insist that everything was fine. The moment my pediatrician pulled a social worker into my physical to ask me if I ever felt afraid or threatened in my home or if I ever saw anyone else afraid or threatened, and the ensuing moment in which I made a conscious decision to lie because I didn’t want to be taken away. The moment my lie didn’t matter and DCF said Tom needed to leave the house or else we would be taken away. The moment I angrily paced my living room telling my mom “They can’t break up our family. I’m 16. They can’t take me anywhere. I won’t let them. I’ll get emancipated if I need to.” The moments in time where my mom would decide to leave Tom and it would be my job to help get things packed up and keep the secret until we moved out. The moments they would reconcile and I would finally feel like “everything is good, we have a stable family” and almost immediately, it would seem, a huge fight would erupt and a separation would ensue again. The moment I returned from a weekend long Ultimate tournament in my senior year of high school to find a broken clothes rack and  a few shattered plates and I asked my little brother what had happened and he said, “Dad got mad.” The moment I told my Ultimate coach that I had to quit the team because it was too much to do weekend tournaments with all my senior year homework load, when really, it was because I knew I couldn’t leave my brothers alone to deal with Tom each weekend if he got pissed off. The moment I went to my paternal grandfather’s funeral having just recently connected with my father and his side of the family and the cruelty of only getting to meet Papa Tom when he was already in the late stages of Alzheimer’s and MS . The moment I realized I had an older brother who had known me as his baby sister for 3 years until I just disappeared when he was eight. The moment I realized I had a younger brother who didn’t even know I existed until he was much older.  The moment my mom truly decided, once and for all, to end her marriage and was on the phone asking me to support my brothers through the divorce and telling me all her fears and concerns and how she thought he was stalking her while I was at college 2 hours away and completely helpless and, honestly, dealing with my own conflicting feelings on the topic. The moment my husband intentionally slammed frying pans off the kitchen counter because he knew it would trigger me and then stood over me, a sobbing blob on the floor, screaming at me for being a weak bitch. The moment my husband shoved me against a wall and then told me I was “too sensitive” because of the environment in which I grew up and I “didn’t know what abuse was” due to that “over-sensitivity.” The moment I found out my Nana and Papa died. The moment I learned it was a murder-suicide and that my Papa, the man I loved and admired more than anyone on this entire planet had put a gun to my Nana’s head while she was eating a muffin and killed her before sitting down and turning the gun on himself and leaving it to my Uncle to find the bodies the next morning. The day I told my husband to leave. The moment I admitted myself to Dartmouth. The moment I was diagnosed Bipolar. The moment I learned I couldn’t keep my job…

That’s a snap-shot. There are more events, but I think I’ve successfully established that I’ve had my fair share of “Moments of Suck.” That’s what I like to call them. I’m not sure how else to classify them. They suck. They all suck. Plain and simple. Why list them out like this? Because I have been taught implicitly, and occasionally told explicitly, my entire life, to keep them to myself, and because of that, I have felt immense shame. I’ve been ashamed of myself and of my family. I’ve felt, inherently, that I am broken and worthless. I convinced myself very early on that all of this was a part of God’s plan and that I had no right to question it or to be angry about it. I’d been taught in school and church that God either allows things to happen to teach us a lesson or as a punishment for sin, and therefore, as a child, naturally assumed that that meant I deserved each and every one of these moments and had absolutely no right to complain about any of them: fertile ground for shame to grow.

These “Moments of Suck” are where developmental trauma comes from, my friend. It’s not a singular event. It’s not a moment in time. It’s a compilation of moments. Some scarier than others, but all, decidedly, Moments of SUCK. What do you do with these Moments of Suck? I’ve tried to do quite a bit  with them – I’ve tried to ignore them, I’ve tried to minimize them (“lots of people have endured much worse”), I’ve tried to trivialize them (“hey, shit happens, right?”), I’ve tried to numb them with alcohol (many, many nights with many, many bottles), I’ve tried to say, “Hey! I can use this shit to help other people! And if I can help enough of them, then maybe I can be ‘good’ enough to warrant an end to my own suffering.” I’ve rationalized it. I’ve written shitty poems about it thinking maybe I’d be the next Bukowski. I’ve justified it – remember the Barenaked Ladies song “The Old Apartment” and that one line “Why did you plaster over the hole I punched in the door?” That line was a lifesaver for me when I was a kid, because it normalized people getting angry and putting holes in the things and that made me feel a little less alone.

The only thing I haven’t truly done is felt it. In truth, I’ve spent my whole life pushing it all away, shoving it so deep down that any anger I feel is automatically labeled “bad” and “dangerous” because, in my experience, anger is dangerous. Hell, mild irritation is dangerous because it can lead to anger at the flip of a switch and anger and violence are synonyms in my fucked up brain. Any sadness I felt was automatically pathetic and unjustified – evidence of what a “weak bitch” I really was. I’ve overcompensated, taking a job in a difficult group home with clients prone to violent outbursts to prove to myself that I was not weak, to prove to everyone else that I could handle threats without breaking, and because it was familiar to me. I was feeding that inner child that needed to be around dangerous situations so that she could make them safe. Abuse is, and has been, my comfort zone. For as long as I can remember, managing a crisis has been my strength. Detach, be cool, do what needs to be done. That’s been my MO my entire life. But no more.

Now, I’m in a situation where I literally am incapable of detaching. I get hit with flashbacks and panic attacks almost daily. (This is improving slowly, but it’s still a fairly frequent issue.) I still have nightmares almost every night. My brain is screaming at me “We have to deal with this. You have to feel this. It’s eating you alive and we have to get ahead of it!” 

And that’s a huge part of what I’m working on now. What do you do with the Moments of Suck? You’ve got to dig in deep. Because they fester. They get infected. And that infection spreads and contaminates every aspect of your life. Until you cut away the rotten flesh and flush the wound and let the air hit it, it can’t even begin to heal. But I’ll tell you what, that surgery is a painful one. There’s no anesthetic; there’s no quick fix. And sometimes, it’s just you staring at the gauze trying to build up the courage to take the bandage off, and re-flush, and re-tape this gaping hole in your body. And you have to take careful steps not to get it infected again. This can mean pulling away from some people that you really care about, it can mean setting boundaries you’ve never set in your life, it can mean doing things that make you feel like a terrible human being. But it has to be done if you ever want to heal – no, really, if you want to survive. Because one way or another, that infection will kill you if you don’t get it take care of it.  But you can get it take care of it. You can heal. It’s work – it’s a lot of hard work. But it can happen. This is what I am learning, and slowly but surely, I am healing. If you’ve endured trauma, I hope that there is a little kernel of something resembling encouragement and hope in this post. I know that sometimes the Moments of Suck can seem to pile so high you can’t see past them, but there is something beyond them. I promise.