Self-Harm and Buddhism

At work there is a program called Illness Management and Recovery (IMR).  It was developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) and consists of 10 modules on managing mental illness.  I am not trained to teach it, but have been working through the modules myself to learn more.  Most recently, the assignment was to explain a symptom to others.  I wasn’t sure which symptom to cover, until I spent 5 nights back in the inpatient unit last week.  I’ve struggled a lot with suicidal ideation and urges to self-harm over the past three months, and reached a point where it was beyond time to take a breather from life and go somewhere safe where I could focus strictly on taking care of me.

While there, I began reading The Buddha and the Borderline by Kiera Van Gelder.  It is a memoir of her experience of Borderline Personality Disorder and her path to recovery via Dialectical Behavior Therapy (DBT) and later delving into its roots in Buddhism.  Early in the book there were some fairly graphic descriptions of self-harm, which I only felt okay with reading because I was in a safe place.  It turns out, it wasn’t entirely safe.  They do the best they can with keeping dangerous objects out, but those of us who self-harm can get pretty creative.  At one point I found something dangerous that was built into the architecture.  I showed it to a nurse and she said she would report it to the director of the unit and that I should come tell a staff member if I was feeling tempted.  One night I did.  I’d been feeling anxious during visiting hours and when my mom left I called the same nurse over and told her I felt tempted toward the thing I had shown her previously.  I also handed over my statistics folder mom had just brought for me and asked her to please remove the staples from the packets of notes.

The nurse told me to stay put, but it didn’t totally register and after a different staff member handed back my folder without even speaking to me I started to get overwhelmed by the noise in the main commons and moved to a smaller area near my room.  The nurse came rushing in and happened to see some recent scratches on my arm from before my admission, which led her to exclaim, “Did you hurt yourself?  I told you to stay put!”  I explained that the scratches were older, and she told me that they would like me to sleep in the quiet room that night so they could keep an eye on me.  The quiet room?  That’s the nice term for seclusion room, which is the nice term for restraint room.  The only furniture was a bed in the center of the room, with restraints built in.  The lights were controlled from the outside, there were cameras monitoring the room, and there was no handle on the inside of the door.  Now on the bright side, they really just were putting me there for the cameras, and the door was not fully shut.  I was allowed to get up and leave to use the bathroom or go to the water fountain or ask for sleeping medication.  It was still rather intense.

It was also completely warranted.  The dangerous item I had found wouldn’t do serious damage, but it was in a place where no one would see and stop me, and I could have hidden the marks had I acted on my urge.  So why self-harm?  It can be many things.  It can be a punishment.  It can be a release of psychological pain in physical form.  Those are the main two things for me.  If I’m hurting intensely, it’s less painful to transfer that into something physical.  I’m also usually tempted toward it when I feel shame, which unfortunately I feel frequently and for sometimes inexplicable reasons.  The important part to note is that, while many people both self-harm and feel suicidal, the act of self-harm is not a suicide attempt.  Severe acts of self-harm could result in death, but it’s different if death is not the intent.  Self-harm is a coping skill, just not a very healthy one.  Some people come home from a hard day and have a glass of wine or eat a comforting meal or go exercise intensely for an hour, and all those things reduce the pain somewhat.  Self-harm does the same thing for some of us, and therapy (such as DBT) is about replacing that with a healthier way to reach the same end result.

I finished reading The Buddha and the Borderline last night, a couple of days after my release from inpatient, and toward the end the author asked one of her Buddhist teachers if suicide was the same as killing another person.  Likewise, is self-harm the same as attacking another person?  The conclusion was that it is impossible to fully practice loving-kindness toward others if you cannot love yourself.  I can’t say that I will never slip and act on those urges again, as that’s much too simplistic to think a line from a book is going to undo decades of experience, but the book did inspire me to look more into Buddhism.  I am not a spiritual person.  I am even less a religious person.  I have, however, found myself drawn toward Buddhism over and over throughout my adult life, and have benefited immensely from DBT and the elements of Buddhism Marsha Linehan incorporated into it.  So I am steering my upcoming focus on reading toward books on the topic, to discover if it is something I want to explore further.


Expressions of Aging

My great-grand aunt died in late March.  Her funeral was held on a Monday, when I needed to be at my practicum class at college.  While on campus, I was in the student union racing past some random booths that were set up for various organizations.  I saw one that said “social work” and turned around.  The Social Work program was promoting a contest they were running for images related to aging.  The winning image will be used on materials for the Social Work program that promote aging issues.

While at this booth I met one of the professors from Social Work and briefly spoke with her about my interest in the MSW program.  When I got home I sent two e-mails: one to this professor to provide a further introduction about my background and interests, and one to enter the photo below in the contest.


I received a call today that my image had been chosen as the winner.  I had to fill out a form to get the prize, and the professor who ran the contest also wants to interview me for the department’s newsletter.  I am excited and terrified, but I think mostly excited knowing that my beautiful great-grand aunt is going to be immortalized on these brochures.

Tidying Tasks

Two weeks ago I wrote about getting Support from Coworkers and how much it was helping me adjust to the job.  I’m still not adjusted.  I thought I was doing great, and then I was texting with a coworker while at work and we had a bit of a disagreement regarding whether I need to continue therapy, and I had a bit of a meltdown over thinking that I’ll never be “well enough” to properly help others.  I completely freaked Tilly out by texting her that I couldn’t do the job.

Then the night went terribly, or well, or both.  I had two major situations with clients that I thought I had handled well, but when I talked with Tilly in the morning it seemed like I had just horribly screwed them all up.  She had asked during the night if I wanted to quit or was just upset, and I told her that I honestly didn’t know and that I would do a pros & cons sheet to try to figure it out.

I e-mailed Tilly the pros & cons sheet, which resolved nothing for me, because I felt like everything was equally important.  I made a special trip out to work on Monday so that we could talk before my next shift.  We agreed that I would write out some “what if?” scenarios and how I would respond and then we could review those and she’d make suggestions.  She was concerned about the fact that my pros & cons sheet had indicated the possibility that I might end up harming myself, and made me sign a form that ended up essentially being an administrative version of a safety contract.  I felt very uncomfortable about it despite her promises that it would stay in her desk and not go to anyone else.  It indicated a follow-up plan regarding the “what if?” scenarios and that we would meet on Thursday mornings to talk before I went home.

This week went better.  I have a client who had previously told me I had “too much philosophical education” and didn’t know how to talk to regular people like him.  I’ve worked hard to remember QTIP – quit taking it personally – but this one was definitely meant personally and I knew he was right.  This week I managed to engage him in conversation and he has become friendlier again.

I had to attend first aid and CPR training Wednesday morning after working all night.  A coworker and Tilly’s boss both indicated that I never seem tired.  I said I do get tired, but I usually perk up again quickly.  I was showing signs of tiredness during the training – fidgeting a lot and having trouble focusing – and also I ended up having to take the nausea medication I keep in my purse because the first aid video nearly made me throw up.  On the bright side, my hands-on CPR test went perfectly.

Yesterday Tilly was coming in a bit late and told me I could have her boss sign my timesheet for practicum class, but I wanted to wait for her.  We talked for a bit, and went over to look at the office to determine what needs to be done before the auditors arrive in a couple of weeks.  I apologized for my obsessive tidying over the previous two nights.  Tilly touched the baskets of supplies on the desk and said, “I saw this and thought, ‘That’s my girl.'”

We came up with a list of other cleaning and tidying tasks that I would take care of before the audit, one of which was to update a calendar markerboard with more activities for the clients.  We noticed that it still said March and had March’s dates, so I was going to fix that before leaving.  I ended up staying until 10 am to erase and rewrite the whole thing because it was too messy trying to erase tiny spots and not smear the rest.  I feel like I should be frustrated at getting all these cleaning tasks, but really I just feel needed when I have special projects.

I’ve also gotten mutual support from a coworker who is experiencing some of the same challenges at adjusting, and I got a lovely e-mail reply from Tilly’s daughter, who had a rough time starting out when she worked in the same position I’m in now.  All in all, I’m still a bit shaky about whether this is the right place for me, but feeling a lot better about it than I was last week.


Support from Coworkers

My new job is…challenging.  I’ve been there for 2 months, and I’ve had many moments (even hours at a time) when I questioned what I was thinking when I even considered working in the mental health field let alone accepting this particular position.  I am brimming with self-doubt and insecurity about whether I’m suited to work with people who have similar issues to my own.  Despite this, I am constantly grateful to be given the opportunity, delighted at what I get to do, and genuinely like the clients I’m working with.  One of them accuses us of just working for a paycheck and not caring, but I truly do care.

What has been carrying me through is the amazing support I’ve received from coworkers.  Not a single one of them will tell me I’ve horribly screwed up, instead referring to mistakes as a learning process.  I’m a thousand times harder on myself than they are on me.  Multiple people in the field have commented on my position being particularly difficult.

I appreciate that I’ve been able to be open with coworkers about how I am struggling and give them the opportunity to share their experience and knowledge.  This week I worked evenings for the first time instead of my usual night shift, which required significantly more interaction with clients.  I made 7 shopping trips within 19 work hours, teaching clients to choose a balanced diet, compare prices and shop within a budget, use self-checkouts, and other skills needed in order to successfully shop on their own.

This evening my supervisor, Tilly, let me see some of her own weaknesses.  She told me a story of a…learning process she had when she first started.  She also told me that she doesn’t like the grocery shopping appointments and that I had taken some of the most difficult clients to shop with and done it successfully.  This was precisely the conversation I needed to have tonight.  It’s one thing for people to say that the job is difficult or that they don’t always make the best choices, but quite different to hear concrete examples.

I still didn’t do everything “right” on these shopping trips.  I had clients criticizing my driving since I’m still not used to the company van, and one client had to teach me how to cash a check at the bank drive-through as I’ve always gone inside for all my banking business.  However, I felt a huge boost of confidence upon learning that these shopping trips weren’t expected to be easy and that I handled them well.

Despite the positive experiences, I’m more than happy to be returning to night shift next week.  Being constantly bombarded by clients and their needs and wants for an entire shift was draining and left me wanting to crawl under the desk and hide.

Crisis Text Line

A long time ago I discovered Crisis Text Line at a time when I was definitely in need of crisis intervention.  I was too scared to use it though, and ended up being distracted by some people making a spectacle in Steak ‘n Shake.  The number did end up on my safety plan, and Sadie recently asked if I needed to update that plan due to my job change.  She reminded me of Crisis Text Line.  A few hours later, I got a Facebook message from a friend about Crisis Text Line.  A few hours later, I used Crisis Text Line.

I’m not comfortable sharing exactly what I said, but in summary, I was working overnight and had been juggling crises had by two other people, and I was about to run away from work and never come back.  I texted “HOME” to 741741 as instructed on the website, and proceeded to explain my situation.  Here is the other side of the conversation:

CTL [automated]: Thanks for texting Crisis Text Line, where you’ll text with a compassionate Crisis Counselor.  Our terms of service:

CTL [automated]: Text STOP anytime to cancel.  We can’t receive msgs longer than 160 characters (~a couple of sentences).  What’s on your mind?

ME:  …

CTL [automated]: Thanks for sharing.  We’re getting a Crisis Counselor for you, it may take a moment.

ME: …

ME: …

CTL [counselor]: Hi, my name is [name], thanks for texting in tonight.  Do you mind if i ask your name?

ME: [name]

CTL [counselor]: Thanks [name], it sounds like you are feeling overwhelmed in this new job?

ME: …

CTL [counselor]: It is very normal to get discouraged with work, especially in a very intense role like it sounds like you have.

CTL [counselor]: Do you have any supervisors you can talk to about how the night is going?

ME: …

ME: …

CTL [counselor]: It sounds like if she works there she might know this patient and be able to help you with the specific case.  You should have that support at your job.

ME: …

ME: …

CTL [counselor]: It is normal to feel down on yourself in a high pressure job, but you are still learning.  Are your coworkers supportive of you?

ME: …

CTL [counselor]: It is good to hear there is a support system for such a high stress job.  I’m sure they are confident for a reason.

CTL [counselor]: If it gets bad like tonight again, do you think you would be able to schedule a meeting with a supervisor to voice your concerns?

ME: …

CTL [counselor]:  Ok that is good to hear, you are very strong [name]!

ME: …

CTL [counselor]: That sounds like a good plan.  Good luck!

ME: …

CTL [automated]: Thanks for texting Crisis Text Line.  The Crisis Counselor has closed the conversation.  You got this!

CTL [automated]: Please share your voice to help other texters.  Provide your anonymous feedback here: [link]

Looking back over the conversation, it feels a little cheesy, but in the moment it helped.  She said just enough to get me to talk through the issue on my own and find my own solutions.  I would definitely recommend the service.  It’s great if you are uncomfortable talking to someone aloud, although I would advise that it is a little slow-paced to get responses and if you’re feeling particularly agitated the pace might be frustrating.

I’m trying to commit to writing on my blog more regularly.  Obviously today is not Sunday but for the future I am aiming to schedule a time on Sunday to post.  After this week, if Sunday has passed and I haven’t posted, I encourage you to call me out on it.

Rolling Smash Book Tote

I collected items for my college Smash Book all through fall semester and never worked on putting things in because I was so disorganized.  I’d also like to be able to take it on the go in case I have a lot of free time somewhere or visit a friend who has tons of stamps and punches and will need my other supplies in order to use them.  I looked at rolling scrapbook totes in the various craft stores and couldn’t convince myself to buy one, but then I got home and watched YouTube videos of how people organized theirs and fell in love with one of the ones I had seen at Hobby Lobby.  I also saw a clever idea in a different video about using plastic photo boxes for organization, so I ordered the tote and the boxes and eagerly awaited my chance to fill them.

Warning: This will be a very image-heavy post.


This is the grey chevron rolling tote from The Paper Studio.  I ordered it online from Hobby Lobby when they were offering a 50% off sale.  I definitely wouldn’t recommend paying full-price.  The exterior has a plastic coating that makes it waterproof and easy to wipe clean.

The left and right sides each have a zipper pocket and a mesh pocket.  The back has a tiny mesh pocket to the side of the handle.  I’ve filled the zipper pockets with washi tape and the side pockets with roller stamps and ink pads.

Interiors of the front pocket and two side pockets.  The side pockets each contain a 5×7 Iris photo case full of washi tape.  One is thin tape in a variety of colors.  The other is standard size tape in school colors, plus a Smash Book tape and one from a Messy Box.

Contents of front pocket and side net pockets.  6×6 scrapbook paper, index cards, Mod Podge, and metal ruler.  Stamp pads from Messy Box and Let’s Color, Smash stamp, phrase roller stamp and date roller stamp from Messy Box, and a very old date roller stamp from my childhood.


Here’s a view inside the main compartment.  It has an adjustable divider (which is held in place by Velcro) that contains various pockets and elastic bands for holding small items.  I’ve placed mine far forward with just the Smash Book in front of it, so that there would be plenty of room to fit in all the photo cases.

The front and back sides of the divider.  The back is holding Sharpie pens and metallic Sharpies, paintbrushes, Prismacolor accessories, and a few random writing utensils, plus some rubber bands and pencil grips in a clear pocket.  I haven’t come up with anything to put in the other clear pocket yet.  The front side has a lot of tools that will be shown in a separate picture.


Here are the contents of the front of the divider.  Fiskars edging scissors, regular scissors, glue dot runner, stapler, tape dispenser, bone folder, rotary cutter, Prismacolor pencil sharpener, tiny sticky notes, erasers, Prismacolor blending pen, Smash scissors, corner rounder and hole punches, extra tape and staples.

Organizers inside main compartment.  Top left shows a marker board that I use as a surface for spreading glue and two Iris project boxes.  One contains large sticker sheets and some Smash Book inserts.  The other contains all the papers and brochures I’ve collected from college that might go in the Smash Book.  Bottom left shows my smaller set of Prismacolor pencils (48 count), watercolor pencils, and gel pens.  Right shows eight of the 5×7 Iris photo boxes with various supplies in them.

All the 5×7 photo boxes from the main compartment.  Top left ones contain small sticker sheets and small ephemera from college.  Top right ones contain chalkboard postcards, Tattered Tangles coloring sheets, and Smash Book smash pads.  Bottom left ones contain various pockets and a set of Smash Book ephemera that is school-themed.  Bottom right ones contain Project Life cards from the Kraft Edition core kit and the Childhood Edition-Wellington mini kit.

I worried a little in the back of my mind that I’d buy this tote and do all this organizing and then just sigh and say “So pretty!” and still not work on the Smash Book.  As it turns out, I’ve done 7 pages since I got organized.  I have completed pages about admissions and my goals, my first visit to campus for an advising appointment, and my orientation day.


Job Adjustment Struggles

Nearly a month ago I posted about my upcoming new job.  I’ve been there for 3 weeks now.  The first week I spent about 5 hours in orientation before going in the next day for the start of training.  I ended up smiling for the entire 40-minute drive home, so pleased to have taken the job.  The next day I trained with my boss, Tilly, on day shift again, then with a coworker on night shift over the weekend, then back with Tilly on Monday.  At this point she encouraged me to dive right in and work alone on nights.  At least she let me do a little training…her boss, Brice, was pushing for solo work before my first day even ended.

The first night alone was a nightmare.  Two different clients managed to manipulate me and by the end of the shift I had spent two hours sobbing and nearly called the on-call therapist.  Tilly and Brice were both there to check in that morning, and both reassured me that every new employee gets manipulated at first and what I did wasn’t going to harm the clients.

I’ve worked three more nights since then and each one has been better.  I’m struggling a bit with the paperwork I have to fill out.  Rochelle kept sending them back for revision and Tilly and I got into a debate about the clients’ abilities.

Less specific to the job, I’ve been struggling because working night shift has left me filling in all those daytime blanks on my schedule and not sleeping.  This past week I was up for 63 hours with only two brief naps in between.  I’d been skipping one of my medications while not sleeping, as it’s one I must sleep immediately after, and then I was starting to skip other medications as well.  I’m seeing the start of some manic symptoms, but also having prolonged sobbing fits where I have to freeze in place because I’m convinced that if I move I’ll kill myself.

I’ve been struggling with the feeling that all of us are too many different people as I try to balance my life as an employee and a client and a CIT volunteer and a student.  I felt like I couldn’t ask anyone at all for help.  I did schedule an earlier appointment with Sadie, coming up on Wednesday, but there were things I couldn’t discuss with her.  I scheduled an appointment with Rochelle, which isn’t until Thursday after I’ve worked both days next week.  I definitely was sure I couldn’t say anything to Tilly, because I know there should be a boundary for things I cannot disclose at work and I had no idea where that boundary would be.

I finally went on Friday to see the new on-call therapist, Kallie.  I had been reluctant to ever use that service again, despite Sadie’s reassurances about Kallie being nice.  Then I met her at CIT when she was a presenter and that made me just comfortable enough to try talking with her.  I told her that I didn’t need to be in inpatient right at that moment, but I was headed in that direction and needed help developing a plan to prevent it.  We talked about the disruptions to my sleep and I agreed that I would schedule sleep onto my calendar so I could see not to schedule other activities during that time.

As for the issue of medications, she brought Dr. Flanders in to consult.  I said that Latuda has been good for me, but I absolutely must go to sleep after I take it which is causing me to take it on an irregular schedule.  So I was hoping for an alternative that I could take at the same time of day regardless of my sleep.  I asked if we could just increase Lamictal and drop the Latuda, but he said that was a weak move.  I told him what other medications I’d tried and what the effects were.  He was pushing Risperdal, with Zyprexa as an alternate option that he didn’t really recommend because of weight gain.

I asked about the Zyprexa Zydis that is available in inpatient and he said having that PRN might be an option.  Then he threw out the possibility of retrying Abilify.  I said I’d be more comfortable with that than the Risperdal, because I’m still adjusting to a new job and don’t want to deal with potential unfamiliar side effects.  I had been on 5 mg of Abilify before and tried 10 mg but experienced akathisia.  Dr. Flanders prescribed it as 2 mg twice a day, but told me to deliberately be noncompliant.  I’m supposed to take one of them on a schedule and only take the other if I’m struggling with symptoms.

Kallie asked him to clarify whether we were trying the Zyprexa or not and he decided against it.  I took the prescription to the pharmacy and couldn’t fill it because it was Friday evening and required prior authorization from insurance, which can’t happen until Monday.  I was stressed about the delay, and happened to be back at the store for other reasons that evening so I inquired about the out-of-pocket cost.  $1,694.  For a generic.  The pharmacy tech did not seem at all concerned when she said, “Well, it should be approved Monday” so I ended up very irritable the rest of the night.

Dr. Flanders, upon finding out what my new job was, strongly advised me to not say anything to anyone at work.  I think that’s what made me decide that I disagreed.  So I was texting with Tilly yesterday and explained the situation.  She asked if I wanted to quit, saying she doesn’t want me to but my health is more important.  I absolutely don’t want to quit!  I said she could help me by reminding me before I leave that sleep is absolutely not negotiable.  Also that just the fact that I was able to share this with her helped a lot, because I’d been feeling there was no one I could ask for help anymore.

I’m feeling better, but still very anxious about the medication issue.  I don’t know if it’s going to help and I don’t know if I’ll still be having a hard time when I work this week since the medication change was delayed by 3 days.