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.

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.

 

Messy Interpersonal Situations

I didn’t have therapy last week because Sadie was off work.  It was sort of a test run for the every other week method, which we’ve tried unsuccessfully in the past.  This time around, I was finally feeling ready to try it, whereas in the past I was reluctant.  However, it was a really rough week and I don’t know anymore how it’s going to go to see her less.

I had one evening in which all the hope I had for job hunting and college and general life improvement came crashing down.  I’d done a lot of “life management” that day, and the prospect of having to deal with that sort of thing on a daily basis was overwhelming.  I was crying and thinking about how wrong Sadie and Brent are to say that I could work full-time.  I was thinking about taking too much of my medication, which was actually possible to do since I’d been feeling so much better that Sadie called mom and told her to let me have my medication back.

Then I was crying even more because I have this list of people I can supposedly contact in a crisis but I felt like there wasn’t anyone I could actually contact because they’d all just be fed up with me for intruding on their lives.  After many hours I was over the crying, but still needed to talk to someone.  Deputy Wayne had told me I could call either him or his wife if I needed anything, and I wasn’t about to call and he doesn’t reply to texts, but I did text his wife.  I was worried that she’d be irritated he volunteered her for that, but we ended up texting for a while and even made plans to get together a few days later.

Our conversation went well, but she is very religious and I am not, and although she said she wouldn’t push it on me I felt a little uncomfortable.  I wondered if I was talking with her for the right reasons.  I like her and want to get to know her, but was I really doing it because of her, or because of her husband?  If the latter, I feel like that makes me a horrible person.

In the meantime, I may have accidentally gone on a date.  I’m not sure, because I’d never been on a date before and the situation was kind of weird.  A guy I know asked me if I wanted to hang out, and although I never say yes to spontaneous plans I had a built-in end time due to a meeting for work, so I agreed to meet him at Dunkin’ Donuts.  I was thinking on the way there that it was obviously just friends hanging out, because he has a girlfriend.  Then he told me that he broke up with her.

He talked a lot, and I didn’t get to say much in return, and then some friends of his happened by and they were very dominating.  I ended up driving him home because he had walked there, and he mentioned possibly going to a movie sometime.  My panic system went off.  He’s a very nice guy, but has a lot of baggage.  We are completely opposite.  Yet I believe that people deserve to get a chance to straighten out their lives.

I spoke with my best friend about it, and although she told me what I’d already been thinking, I hated what she had to say.  She told me not to get involved until he had his life straightened out, and what that said to me was that people don’t deserve love until they have everything together.  Given that I don’t have everything together and don’t foresee when I will, I started crying over the fact that I don’t deserve love either.  The idea of overdosing was back at the front of my mind.

Someone commented in her blog recently that she gets more anxious in the evenings.  I notice that my emotions tend to go haywire in the evening as well.  All the little things that I could handle earlier in the day start piling up and bringing me down.  I have fortunately learned to use the Moment to Pause skill to stop and identify what is triggering the feelings, which lets me recognize that it will seem less overwhelming after I get some sleep.  If it’s too early for sleep, then I find a distracting activity, such as coloring or scrapbooking, to fill the time.

I had asked Sadie if we could go over the Interpersonal Effectiveness skills again because I rarely mark them down on my diary card.  I may be using them, but not consciously and I can’t name what I’ve used because they are all a big jumble in my mind.  Funny that before we even got to do this I wound up in two messy interpersonal situations.

Diffusing Stress with a Laugh

Every week in the middle of DBT group we take a break and then come back and do a Mindfulness exercise.  Today Sierra handed out sheets of paper and told us we were going to do the one where we make smaller words out of a big phrase.  I clapped excitedly.  She warned the group that this was my favorite and not to be upset when I get way more words than they do.  She gave us the phrase and said it should be easy to find words.  I said, “But there are no As or Os!”

The phrase was INTERPERSONAL EFFECTIVENESS.  Notice both an A and an O in there?  Notice how there isn’t a U?  After we all got done laughing at me, I wrote down the phrase at the top of my paper.  I started making words.  I was nearly down the first column when Rochelle said, “Have we started yet?”  Oops.  I got a little eager.  I said I’d sit out the first minute but Sierra told me to keep going.

As usual, everyone freaked out when they saw my page.  I counted it up and had 76 words, which is my new record.  Other people counted theirs and said they got distracted by the sound of my frantic pencil scratches.  I did have to volunteer to scratch out all the dirty words I used, in case they didn’t count.  (Come on, don’t tell me you didn’t immediately see “PENIS” in there.)

The best news about this is that I laughed when I said something completely idiotic.  Absolutely no flush of shame and no urge to go hurt myself for looking foolish.  The same has been happening for about a week in other situations.  I went from one scheduled shift to three in one week, then a coworker called in sick the last day and I worked 8 hours alone.  I took it in stride.

I got letters from my car insurance about paying (or not paying) for medical bills that had nothing to do with my car accident anyway – an ultrasound I had for complications of surgery.  Blood tests to follow up on the ultrasound.  An ER visit to get admitted to inpatient.  I laughed at the ridiculousness of the situation and calmly went to the hospital billing department to sort it out, only to find that the car insurance had actually requested all my bills that had already been paid by my health insurance.

Then yesterday I stayed calm when my dentist was being snarky to me, and again when I was driving down a country road and the cop behind me suddenly turned on his lights.  I’d never been pulled over before but apparently did what I was supposed to do.  He told me my brake lights weren’t working and when he found out where I was headed (not far) he told me to drive carefully and get it fixed right away, then walked back to his car.  I didn’t panic at all, and drove just far enough to be parked in a lot where mom could come meet me with replacement bulbs.

As it turned out, only the left one worked, so we drove back to the auto parts store and followed the manager’s advice.  It still didn’t work so he tested the bulb, found that it was defective, and gave us a new one.  I feel super loyal to this store, as he also helped out when I needed to replace a headlight bulb and couldn’t wriggle my hands into the tight space.

I made a comment to Sadie about how well I’ve been handling things lately.  She asked what changed, and was probably perturbed when I said, “Medication.”  Well, I’ve been using the coping skills she has taught me for a long time, but they are only so helpful when the medication isn’t quite right.

Hopelessly Trapped

During my last inpatient stay I talked with the social worker about how to move out on my own.  She encouraged me to reapply for disability (I was rejected before because I didn’t have enough work credits, but I do now).  I submitted that application, and when I did my taxes I got a recommendation that I apply for SNAP so I did that too.  There was a phone interview about a week later and then I had to fax a bunch of paperwork about my finances.

Yesterday in therapy we were updating my treatment plan and added back the goal about improving my living situation, part of which involves creating a budget.  The ultimate aim is for me to be prepared to move out.  While talking about budgeting, Sadie brought up the fact that the CMHC billing department had contacted her about me, and said they were going to be sending me letters because my payments had been sporadic.  I had consistently paid $50 a month for almost two years, but the past couple of months I missed paying because I’ve been really short on money.  I wasn’t worried about it, because I’ve always been told that it was great that I was making payments since a lot of people never pay.  Panicked, I left my appointment and paid $25 that I didn’t really have to spare.

When I got home and got the mail, I had a pile of bad news.  I had a bill from the hospital, from when I went to the ER to get to inpatient.  It was only $8, but I was confused because my insurance has always paid everything 100% and I don’t know why it didn’t this time.  The next thing I opened was my approval for SNAP.  Good news, right?  Not so much.  I am approved for $23 a month, which won’t even buy me a cup of yogurt for breakfast every morning.

The last letter was also from the Family & Social Services Administration, regarding my insurance.  When I was originally approved my premium was the minimum of $1 per month.  After the first year, they reapproved me but raised my premium to $4.77 because I now had some income.  I paid the whole year’s premiums a couple of weeks ago.  Now they are raising the premium to $18.10, because they think I’m going to consistently make the amount that I’ve made in my busiest months at work.  Those months have been four days per week, but I’m only guaranteed one day per week.  Basically they gave me a paltry amount for SNAP but took it right back away.

I had to go to some unexpected hours at work because someone had called in, and on the way I started crying.  Not the safest way to drive.  I couldn’t think about anything but how I needed to follow through on one of my old suicide plans, because nothing about my life is ever going to get better.  I sent Sadie an e-mail saying that it was a waste of time to make that treatment plan because none of it will ever be accomplished and everything is too hard.  The response I got was “??” and I would not have been surprised if my work shift had been interrupted by a police visit.  It wasn’t, however.

I managed to hold it together for 4 hours at work, but when I got home I slipped back into my meltdown.  I knew I needed to use a DBT skill or two, but was struggling, so I fell back on the “easy” one – Crisis Survival Network.  I texted my best friend, and her responses back calmed me just a little.  Among other things, she was talking about her daughter’s massive meltdowns and said, “You worked your magic and got her to calm down when I couldn’t.  If you can do that you can do anything!  Including comforting and calming the negative voices in your own head.  The child in you is upset and hurting.  Help her like you helped Emily.”

I tried, really I did.  I couldn’t do anything to make myself feel better about the situation last night, but managed to e-mail Sadie a less cryptic explanation and get myself to sleep, and things look a little less dim this morning.

A Series of Unfortunate Events

Last night was the third meeting of my NAMI Peer-to-Peer class.  Last night was the first time I missed the class.  I spent the day nervously looking out the window to see if snow would start up again (it had snowed heavily in the morning but instantly melted) and decided that if the weather was clear at 4:30 I’d try driving to the class.  Normally I would leave at 5, but I was allowing extra time in case there were snowy patches along the way.

At 4:30 I stared out the window and was disappointed that it looked like a blizzard.  I gave serious consideration to trying to go to class anyway, despite knowing how unsafe it was.  I felt awful about having to miss, as though I had in some way failed to follow through on a commitment even though I know no one else in the class would have driven 45 minutes to be there even in good weather.  I texted the facilitator, and he said he really appreciated that I travel so far to participate and that he’d have this week’s material for me next week.

Since I was going to be home for supper, I asked mom if we could make a pizza.  We had the crust made and I was almost done spreading the sauce on when I remembered that we didn’t have any of the Italian blend cheese.  On any other day I would have run to the store to buy some, but since it was snowing we threw on Mexican blend and hoped for the best.  The crust wasn’t done, even after putting it back in for extra time, and the cheese was disgusting.  I ate one bite of pizza and had nothing else to eat the rest of the evening.

I went to bed with a sore throat, which is always my first symptom of a cold.  I managed to sleep through the part where I shiver with fever, but woke up with my head feeling all cloudy and my nose stuffed up.

This morning I went to DBT group, planning to have lunch with a friend afterward and then go straight to therapy.  I got a text when I arrived at DBT group, cancelling my lunch.  Then the one person I despise from group decided to rejoin today.  Then Nadia announced that she is leaving at the end of the month to pursue a new career.

I’ve been trying desperately to use Radical Acceptance on this chain of events, but I’ve also been really irritable the past few days and can’t seem to stop fighting reality.  In my last appointment with Brent I mentioned irritability and he said it was normal if it was only one day a week, which it was at the time.  Now it’s been 3 or 4 days in a row and it is driving me up the wall.

The only break in the string of things going poorly has been today’s therapy appointment.  I felt like Sadie and I accomplished a lot, including making plans for Coping Ahead with the upcoming anniversaries of my grandparents’ deaths (the 13th and 21st).

Social Anxiety Hierarchy

A while back in “I can’t drink and drive!” I made a hierarchy of steps for addressing my anxiety about driving.  Due to being without a car after my accident, then in inpatient, then on vacation I didn’t have a lot of time to work on these steps before the deadline for which I needed to reach the final step: Drive to and from location of NAMI classes in the dark.

Well, as it turns out I actually drive there in the daylight and come home after dark, which was step 21, but either way I accomplished the ultimate goal last week when I drove to the class by myself.  I was ready to call this goal completed and strike it from the treatment plan, but Sadie says I need more practice on the intermediate steps and I grudgingly admit she’s right.  This week I plan to drive somewhere new in my own town to pick a friend up for lunch.  She doesn’t even have a driver’s license so I’m quite a few steps ahead of her.

Sadie and I went over my treatment plan in my last appointment because an update is due next week.  One of the aspects that we haven’t touched in the past 3 months is another hierarchy, this one addressing my social anxiety.  Sadie suggested that I spend this week working on a list of steps to include, and I sort of haven’t touched that despite the fact that my appointment is in 26 hours.  Oops.

The problem is I’m stumped.  I guess that I should probably refer back to my DBT materials where there was a section on ways to practice asking for what you want.  Those are all situations I’d find anxiety-provoking, but I also found some of them flat-out rude, like scheduling an appointment then calling back to cancel.  I also could look for example hierarchies online, such as:

http://www.socialanxietywebsite.com/example_hierarchies.html
http://www.succeedsocially.com/fearfacingexamples

I know I need to work a lot on phone anxiety.  I overcomplicate my life a lot with reluctance to make phone calls, and when I finally do bite the bullet and call it turns out to be so simple that I beat myself up over having put it off so long.