Too Many Thoughts for a Title

Back in October, Sadie had suggested doing a Pros & Cons of Existence, which I opted not to do because it sounded too dangerous.  What would happen when I weighed the evidence and found that it was much more in favor of not existing?  Well, I’m about ready to do that pros & cons list now.

Recently I’ve come to understand how people develop Munchausen’s syndrome, in which they intentionally cause themselves illness or injury in order to get medical attention.  I found myself wanting to cut myself or overdose so that I could be sent someplace safe, where people would take care of me and I wouldn’t have to deal with my life.  As time passed I found myself reacting to every little twinge of pain or discomfort with the hope that it was a serious illness.  Every time mom and I were in the car, I would cross my fingers for us to have an accident.

I got a little taste of being taken care of when I got dizzy while Suffering for a Good Cause, but it wasn’t enough.  In my appointment with Sadie the next day, which I’d scheduled specifically to discuss these thoughts, she asked me if being taken care of was a need or a want.  I said that everyone needs to be taken care of sometimes, but I imagine her point was that I’m capable of taking care of myself at this point.  She said it was a Catch-22, that in order to form relationships with people who will take care of you when you need it, you first have to show confidence in who you are in order to attract those people.

I said I didn’t know who I am (lack of a sense of self is a symptom of Borderline Personality Disorder) and we worked on naming off some of my interests and personality traits.  She asked what I would say if I was writing an author’s bio for my book.  I was going to go with where I was born, where I live now, and that I have cats.  Somehow that didn’t seem like enough to give me an identity.  I said that identifying my values would probably help with this, and then remembered that in reading The Happiness Trap there were exercises about values.  From the website of worksheets to go with the book, there is a Life Values Questionnaire and Bull’s Eye Worksheet that can be used to identify one’s values and how far or close one is to living by them.

I had done the Bull’s Eye Worksheet but the other one looks even more specific by addressing more areas of life.  Sadie and I have to update my ANSA and treatment plan at the next appointment on Wednesday, but I will try to prepare these worksheets in case we have any time leftover.

And the pros & cons list?  Well, over the weekend I was on a spontaneous trip out of town.  Mom had asked me Wednesday evening if I’d like to go, and we made all the plans on Thursday and left at noon on Friday.  Throughout the weekend, I struggled with suicidal thoughts.  I no longer was thinking about the possibility of getting attention.  No, I was thinking about actually wanting to die.  I was crying every time mom was out of sight.

I don’t want to be dead.  The thought of dying makes me sad.  I remember back in December, when I was sure I’d be acting on a plan on January 1st, I would cry every time I did something for what would be the last time.  I saw Jean at a choir performance and tagged along behind her for the whole tour of the historic house it was held in, hoping to be able to hug her goodbye.  She never made a move to hug me, despite having done so the last several times I saw her, and I went home in tears.

Brent noted back in June last year, when I recently had started my job at the hospital and was desperately overwhelmed by it, that I had very specific suicide plans.  What I have in mind now is even more specific.  I don’t see Brent for another 3 weeks, and I don’t know if I’m going to make it that long.  Everything feels manageable early in the day, but as the hours pass and darkness falls I fall with it, spiraling into a swirl of negative thoughts and tears.  I don’t want to be dead, but I don’t have hope of things ever being better enough for life to be worth living.

Brent and Sadie tell me I could work full-time, that I’m not disabled, which would make it very difficult to actually get approved for disability if they don’t support me.  What I’m coming to realize is that I may not be too disabled to work, but I am too disabled to accomplish what I want out of life and I don’t know how to accept the idea that my dreams are unattainable.  I have some good days, but then I have some really bad ones that, if they continue, would make it impossible to follow long-term plans.

It just feels like it’s not possible to be well consistently.  I was patient in the first year of treatment, knowing that it can take a while to get the right combination of meds and have them take full effect.  Now I’m more than two years into this process and I never feel good for more than a month at a time.  Instead of manic highs alternated with the depths of despair, I have an occasional sense of peace alternated with a lingering malaise just bad enough to hinder progress.

So I’m going to make that pros & cons list.  There are some pretty big pros in favor of suicide, and I don’t know if the cons will seem like enough to balance it.  For example, I don’t really want to live to my next birthday, which is next week, but if I don’t I will never get to use the birthday gift I know I’m getting, which is something I’ve wanted for a really long time.  So I cry about the idea of not using the gift, but then I ask myself why it even matters.  If I’m dead I won’t know that I didn’t use it.

I’m trying to remind myself each evening that the next day, although it may not get me any closer to a life worth living, will possibly be just a little less painful, so I can wait one more day before acting.  If I ever feel that I can’t wait and am feeling compelled to go buy the last ingredient in my suicide recipe, then I know it’s time to call for help.

 

Imagine You’re 80 Years Old

The latest exercise in The Happiness Trap asks the reader to imagine being 80 years old and finish the following sentences:

  • I spent too much time worrying about…
  • I spent too little time doing things such as…
  • If I could go back in time, then what I would do differently from today onward is…

I must say this is challenging simply because I have never expected nor wanted to live that long.  So I’m reframing it as “imagine being near death”.

I spent too much time worrying about what other people think of me.  I spent too much time worrying about whether I would enjoy activities.  I spent too much time worrying about whether I would regret my choices.

I spent too little time doing things such as working on my hobbies.  I spent too little time doing things such as communicating with friends.  I spent too little time doing things such as visiting family.

If I could go back in time, then what I would do differently from today onward is post comments freely, build more structure into my days, and ask for what I want.

Making Space

I am currently reading two books simultaneously.  Usually when this happens I am struggling to get through a challenging book so I take a break with something quick and humorous.  This time, however, both books are challenging, I’m actively reading both, and they are intertwining in a fascinating way.

From A New Earth: Awakening to Your Life’s Purpose by Eckhart Tolle:

“I’m not asking you to do anything.  All I’m asking is that you find out whether it is possible for you to allow those feelings to be there.  In other words, and this may sound strange, if you don’t mind being unhappy, what happens to the unhappiness?  Don’t you want to find out?”

She looked puzzled briefly, and after a minute or so of sitting silently, I suddenly noticed a significant shift in her energy field.  She said, “This is weird.  I’m still unhappy, but now there is space around it.  It seems to matter less.” This was the first time I heard somebody put it like that: There is space around my unhappiness.  That space, of course, comes when there is inner acceptance of whatever you are experiencing in the present moment.

Compare to this bit on “expansion” from The Happiness Trap: How to Stop Struggling and Start Living by Russ Harris:

Step 1: Observe

Observe the sensations in your body. Take a few seconds to scan yourself from head to toe.  As you do this, you will probably notice several uncomfortable sensations.  Look for the one that bothers you the most.  For example, it may be a lump in your throat, a knot in your stomach, or a teary feeling in your eyes.  (If your entire body feels uncomfortable, then just pick the area that bothers you the most.) Now focus your attention on that sensation.  Observe it with curiosity, like a scientist who has discovered some interesting new phenomenon.  Notice where it starts and where it stops.  If you had to draw an outline around this sensation, what shape would it have?  Is it on the surface of the body, or inside you, or both?  How far inside you does it go?  Where is it most intense?  Where is it weakest?  How is it different in the center from around the edges?  Is there any pulse or vibration?  Is it light or heavy?  Moving or still?  Warm or cool?

Step 2: Breathe

Breathe into and around the sensation.  Begin with a few deep breaths (the slower the better) and make sure you fully empty your lungs as you breathe out.  Slow, deep breathing is important because it lowers the level of tension in your body.  It won’t get rid of your feelings, but it will provide a center of calm within you.  It’s like an anchor in the midst of an emotional storm: the anchor won’t get rid of the storm, but it will hold you steady until it passes.  So breathe slowly and deeply and imagine your breath flowing into and around the sensation.

Step 3: Create Space

As your breath flows into and around the feeling, it’s as if you are somehow creating extra space within your body.  You open up and create a space around this sensation, giving it plenty of room to move.  (And if it gets bigger, you give it even more space.)

Step 4: Allow

Allow the sensation to be there, even though you don’t like it or want it.  In other words, “let it be.” When your mind starts commenting on what’s happening, just say, “Thanks, Mind!” and come back to observing.  Of course, you may find this difficult.  You may feel a strong urge to fight with this feeling or push it away.  If so, just acknowledge that urge.  (Acknowledging is like nodding your head in recognition, as if to say, “There you are, I see you.”) Then bring your attention back to the sensation itself.

Mr. Harris continues to explain that this technique of expansion is not limited to bodily sensations and encourages bringing up painful thoughts and memories in order to practice.  It actually works!  By making space around the pain, it became easier to accept and gradually dulled.

Without Fear and Thoughts of Failure

The latest exercise in The Happiness Trap asks the following questions:

  1. How would I act differently if painful thoughts and feelings were no longer an obstacle?
  2. What projects or activities would I start (or continue) if my time and energy weren’t consumed by troublesome emotions?
  3. What would I do if fear were no longer an issue?
  4. What would I attempt if thoughts of failure didn’t deter me?

The suggestion is to spend 10 minutes thinking about and writing down answers to these questions.  Since I knew I’d want to blog about it anyway, I’m just writing them directly into this blog post.

  1. If painful thoughts and feelings weren’t an obstacle I would act more carefree and more mindfully focused on current events.  I would be able to experience pain without it spiraling into depression.  I would take action on the minor chores that I tend to procrastinate on.
  2. If I had more time and energy I would be hard at work on my book.  I’d also pick up the hobbies I used to participate in – knitting, photography.
  3. If fear were no longer an issue I would travel more.  I would make plans to visit friends across the country and around the world, and I would drive to activities that I currently want to do but find out of my reach.
  4. If thoughts of failure didn’t deter me I would go back to college.  I will need quite a lot of credits, wanting to transition from the theatre degree I had in progress to a psychology degree, and at this point I don’t even feel I could successfully complete one course.  In order to take on-campus courses I would have to do a significant amount of the driving that I fear, and with online courses I don’t think I could focus well enough to complete my work from home.

Medication has helped with the completely crippling anxieties and depressive thoughts, but I’ve settled into a “life better than dying”, not actually a “life worth living”.  For that it will take a lot more hard work in therapy.

I Am A Banana

I started reading The Happiness Trap while I was in inpatient.  There are several times that the reader is asked to stop and do exercises, so I’m still in the process of reading it, but I wanted to share some of the exercises.  In inpatient I did one that asked me to complete the sentence “The thoughts/feelings I’d most like to get rid of are…” and make a list of ways I’ve tried to do that.

Then for each way, I was supposed to consider whether it worked in the long-term, what it cost me, and whether it brought me closer to a full, meaningful life.  I did not write down all the details to those last three questions, but for the first two…

“The thoughts/feelings I’d most like to get rid of are…suicidal ideation.”  There are numerous thoughts and feelings that complicate my life, but those thoughts are persistent and creep in even when I’m not feeling particularly depressed.

Ways I’ve tried to get rid of suicidal ideation:

alcohol, painkillers, Benadryl, cutting, overeating, going wandering late at night, shopping for things I don’t need, talking to friendstherapyinpatientself-soothing, pacing, reading books, watching television, solving puzzles, assembling LEGOs, playing video games, knittingsnuggling cats, thought diaries, encouragement, Ride the Wavesitting on the lawn swing, journaling, coloring

The underlined methods are those that have some success, at least in the short-term, without causing additional harm.  In the long-term?  None of them work, the thoughts keep coming back.  This is the reason for ACT’s thought defusion techniques: to accept the thoughts without trying to push them away, and to take away their power.  By contrast, DBT has a skill that’s actually called “Pushing Away”.  I’ve always found it quite ineffective, despite taking Nadia’s advice and filling that thought’s space with something else.

So far I’ve read about defusion techniques for verbalized thoughts and those for disturbing images.  I have a favorite technique in each category.  For the verbalized thoughts, I take the negative thought (ie. “I am worthless.”) and repeat it over and over, alternated with “I am a banana!” (or some equally ridiculous statement).  I end up giggling over how I’m clearly not a banana and slowly come to realize that I am not the other descriptor either.

For disturbing images, one technique is to superimpose the image in a variety of scenes, such as on a postage stamp on a letter, on the t-shirt of a jogger running by, or on a movie poster.  Or, my favorite, on a banner trailing an airplane.  Seeing the image out of context tends to separate it from the painful feelings it triggers.

Acceptance and Commitment Therapy

Last week, Sadie said she had been reading about Acceptance and Commitment Therapy (ACT).  She noted that she’s not trained in it, but there are other people at CMHC who are.  My mind was screaming, “No, don’t abandon me!”  I worry about this often.  I worry that she will move or change jobs, or worse, that she’ll stay right where she is but pass me off to someone else because I’m too much work and not worth the trouble.

I need to learn to hear everything a person has to say before spiraling into panic mode.  She had no intention of abandoning me, and said that she’d do some more reading and we could try out some elements of ACT.  She had me fill out a questionnaire from a book called The Happiness Trap.  It’s pretty obvious after the first couple of questions that you are supposed to be choosing option B for everything.  Out of 15 questions, I chose option B for 5 of them, which Sadie thought was pretty good starting out.  A couple of examples of the questions:

A. Negative thoughts and feelings will harm you if you don’t control or get rid of them.
B. Negative thoughts and feelings won’t harm you even if they feel unpleasant.

A. In order for me to do something important, I have to get rid of all my doubts.
B. I can do something important, even when doubts are present.

I answered the first one “wrong” and the second one “right”.  My answers came from past experience.  My negative thoughts have harmed me…or at least, the actions I’ve taken in response to those thoughts have harmed me.  On a happier note, I know I can accomplish things even when I have doubts, because I always have doubts and have apparently accomplished at least a few things in my life.

ACT, like Dialectical Behavior Therapy (DBT) is mindfulness-based.  It appears to have a lot in common with the Mindfulness and Emotion Regulation modules of DBT.  Allowing thoughts to come and go, observing them non-judgmentally, living in the present moment, viewing emotions as neither good nor bad.  They share the concept that dwelling on pain creates suffering.

The difference is that ACT discourages avoidance techniques.  DBT’s Distress Tolerance module is filled with ways to use distraction and relaxation to alleviate discomfort, and ACT focuses more on facing the thoughts head-on.  Some avoidance techniques are considered acceptable, in moderation, but they aren’t the focus of the therapy.

According to the article “Embracing Your Demons: an Overview of Acceptance and Commitment Therapy”, the six core principles of ACT are:

  • defusion
  • acceptance
  • contact with the present moment
  • the Oberving Self
  • values
  • committed action

Sadie proposed trying the thought defusion techniques, such as repeating the thought aloud until it becomes meaningless noise, or saying “Thanks, mind” for the interesting thought.  A few days after this appointment, I e-mailed her about some lingering suicidal ideation despite the vast improvement in my life circumstances.  She asked if I’d tried these techniques.  I actually had tried those two, and found that “Thanks, mind” made me laugh…so I suppose that was effective?  Repeating the thought over and over was not so successful, as it never became meaningless and just left me feeling increasingly agitated.

I’ve ordered a copy of The Happiness Trap and will be bumping it to the top of my 100-book reading queue.  I’m eager to move on and try something new, but there are certain elements of DBT I’ll be holding onto.  I carried my textured Tangle Jr. at work today and it helped quite a lot with some inexplicable sadness and agitation that I felt.