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.

Tweaking Meds

11 days ago I called and left a rambling message for Brent about feeling worse and fearing that I was going to screw up my job and could we please do something about this before April?  His nurse called me back and after some phone tag she interrogated me about what was going on and asked me to hold on a moment while she went to talk to Brent.  He didn’t want to change anything without seeing me, but they squeezed me in for an appointment the next morning.

10 days ago I saw Brent, for the 4th time in a month.  I repeated all the information on how I was feeling and he said we could either increase Lamictal or Wellbutrin, but that his preference would be Lamictal.  I had mentioned the persistent thoughts of self-harm, and he thought it would help with that.  So we agreed to increase my total daily dose to 75 mg, with 50 mg in the morning and 25 mg at night, because I said that it tends to give me difficulty with sleeping if I take it too close to bedtime.

I went ahead and took the extra 25 mg for that morning when I got home, so today makes the 11th day on the new dose.  For the first several days I was feeling rather agitated and irritable, and my pre-existing urge to run away from everything I attended was persisting.  I want to say there’s been a hint of improvement since then, but I can’t put my finger on what has improved.  I guess maybe that I’m really not thinking about self-harm all the time, but it’s hard to see that as improvement when I actually acted on it for the first time in 5 months.

I still have no motivation, but I’m trying to force myself to do things anyway.  Basic life necessities, like helping with the dishes or doing the laundry or taking a shower before going out in public.

It’s 11 more days until I see Brent again.  I don’t think we’re done adjusting the medication yet.

The Silent Rejection

About a month ago I woke up in the middle of the night with terrible heartburn.  I ended up having to spend the rest of the night sleeping upright on the couch.  The heartburn has been recurrent since then – never quite so bad as that first time, but then I’ve also started taking medication when it crops up, so I don’t know how bad it would really get.

At the same time, I lost my appetite.  This normally only happens when I’m manic, but I am decidedly not manic.  In fact, I fluctuate between normal and mildly depressed, with about 1/3 of days in the past month spent in a mildly depressed state.  When I’m depressed my typically healthy appetite turns into non-stop eating, but right now the exact opposite is happening.

I manage to eat half or less of most meals, if I even bother getting a meal at all instead of opting for a cup of Jell-O (which I don’t always finish).  On Thanksgiving I gave half my turkey away to my cats.  Tonight I went to a friend’s house for her belated Thanksgiving and despite taking the smallest portion imaginable of each dish I was still having to force the food down by the end of the meal.

My coworkers have been nagging me to reschedule my December 17th doctor’s appointment for an earlier date, and when I finally did give in and call the office was closed for Black Friday, which I pretty much expected when I called.  This is probably why I was willing to call then, because I knew it wouldn’t lead to anything.  It occurred to me tonight that some part of me is putting this off in the hopes that it’s serious and could be fatal if left untreated.  I can’t actively try to kill myself without jeopardizing my graduation from DBT group, but I can let a serious illness go unchecked.

I screwed up tonight.  Two people who I’ve been involved with via their professions have been in some community activities I participated in.  There is only the slimmest chance I would ever again have to deal with them as professionals, so after months of waiting and wondering if it was okay, I tried to friend them on Facebook tonight.  I’d just given them a Christmas card when I saw them at an event, and one of them even hugged me.

I don’t know what I was thinking.  I had myself convinced they were going to accept.  Not only did they reject my friend requests, but they untagged themselves in the photos I posted from tonight’s event.  There was no hesitation where they could have considered the possibility of accepting.  There was no message to say “I’m sorry, but I can’t accept.”  Just the silent rejection.

Now I’m trapped.  Not only do I have to face them for at least two, maybe three more events in the next couple of weeks, but I also can’t ever again make use of two services.  If anything ever goes wrong with my job, I can’t get help finding a new one.  If I’m ever unable to keep myself safe, I can’t be protected from myself.  And right now I don’t even want to keep myself safe.  All I can see is how I can never do the right thing and am always going to be a completely worthless failure with terrible judgment.

I’m seriously thinking about cutting myself and lying on my diary card.  I wonder how long it would take before I caved in and confessed to Sadie?  I’m counting on not going back to DBT group after this year, but I wonder if I even care that much about actually graduating?

Fear of Showing Compassion

Occasionally I bring gifts for Sadie to my appointments.  While the first one, a handmade chainmaille bracelet, was objectively the best, the most meaningful thing I’ve ever given her wasn’t a gift at all.  A few weeks ago I wanted to commit to stopping my negative actions of nicotine gum and self-harm, so I handed over all the gum and blades for disposal.

Today I’m at work alone for the 2nd day in a row.  I got called to do the one task I truly dread.  The task itself didn’t turn out that badly, but when I arrived at the patient’s room a nurse gestured for me to wait outside, because a doctor was speaking with the patient.  I couldn’t help overhearing the patient begging for more pain medication and being refused.

When the doctor finally left and I was free to go in I wished I didn’t have to.  I didn’t want to speak to this unhappy patient.  When I went in, he kept asking me to ask the doctor to give him pain medication and I felt terrible as I lied and said I would ask.

I left the room shaken.  When I told my employment specialist I wanted to seek work in the health care industry I didn’t foresee the reality of doing so.  I regularly have to restock cadaver bags on the supply carts.  I’ve started mornings off by watching a gurney with a human-shaped sheet roll past on the way to the morgue (where I’ve thankfully never had to follow).  I have to check IV pump numbers in ICU rooms each day, hoping the patient is asleep and has no visitors so I can silently slip in and out.

Usually I don’t have to hold a conversation with a patient.  Sometimes they ask for their table to be pushed closer or their thermostat adjusted, which I’m able to do for them.  Sometimes I have to go to the nurse’s station and pass a request along.  Recently in ICU I was trying to slip quickly out of the room when the patient said, “Please don’t leave me!” I wasn’t sure what to do or say.  She was 91 and haltingly asked if she could have breakfast.  I told her I’d go ask the nurse and hurried out of the room.

A lot of times I leave kicking myself over the things I could have said.  I once asked a patient, who was holding a room service menu, if he was finding anything good for lunch.  He said he’d been looking at the menu for half an hour.  The rest of the day I told myself I was a total failure for not offering advice on the best food choices.

Today was my first time talking to a patient who was truly suffering and I have to say I didn’t do a very good job of it.  A friend told me that what I’ve been through probably makes me more compassionate than others, but what good does that do when I don’t have the confidence to show it?  Every time I talk to a patient I am terrified I’ll get in trouble for saying the wrong thing.

After leaving this patient’s room this morning, I wished I had those blades back.  I could have easily gotten another one, and the bandages to clean up after the fact.  I thought about calling the on-call therapist, but couldn’t guarantee I’d be available when s/he returned my call, so I used my Riding the Wave skill, and also Turning the Mind.  I was able to stop myself from acting because I don’t want Sadie to think I’m intentionally backsliding. 

I also used Crisis Survival Network, contacting a couple of friends and relatives, and the first response I got made me angry.  It was about how everyone’s job is stressful and stress is good for me.  How is it supposed to help me to tell me, in lengthier words, to just suck it up?  I considered the on-call therapist again, and again I decided to work through it on my own.

Guess who I ran into in the elevator a few hours later?  The on-call therapist.  We rode silently down to the ground floor and as we parted ways I realized I could have asked if he had a minute to talk.  I mean, that’s what he’s there for, right?

Retail Therapy

I keep a restricted journal elsewhere on the internet, where I post the contents of my paper journal. A couple of days ago, I posted one that mentioned having done something bad (no further elaboration taking place here), and promptly got a comment about it from someone who I wasn’t even aware was actively reading my journal. I had a horrible flashback to 8 years ago.

8 years ago, a friend on that same journal site had made a post where people could comment and she would tell something she admires about them. What she said to me was that she admired how honest and open I am in my journal. Fast forward a month or two, and I made an honest and open post which got a comment from her about how she couldn’t stay silent anymore about that topic and how much she hated me for it. Then she removed me from her friends list.

During the same period of time, in which I was experiencing an unrelated severe depression to the point that campus police were sent to check on me, I lost several other friends for vague reasons that boiled down to “I really haven’t liked you for a long time, but I’m just now saying it.” Is it something wrong with me that makes people silently fume about things for months or years and then abruptly cut off contact without giving me the opportunity to correct the situation? I really think that’s their issue, but it happens to me so often that I wonder why I’m defective.

At any rate, I had a flashback to that time period and had a meltdown about what an awful, worthless person I am. How I will never be able to make up for all the things I’ve done wrong. I laid in bed crying and thinking about potential medications to overdose on. I thought about cutting myself and seeing the badness bleed out of me. I managed to go to sleep after a couple of hours of this, and the next morning I awoke and cut myself for the first time in nearly 4 months.

It was a minor cut. I was too scared to press hard with that sharp, sharp blade. It still bled enough to need a bandage, but what I was really fantasizing about all that time was watching the blood run down my arm and being unable to stop it and needing stitches. The next morning, I was criticized for something that was an unintentional mistake with mitigating circumstances, but the shame overwhelmed me and I did it again. Still just a minor cut, but the rest of that day I kept receiving more and more criticisms, this time for things that weren’t even wrong to do, and I had to fight to keep my hands off that blade the rest of the day.

What did I do instead? Retail therapy. I had been thinking for a while that it was time to get a new phone (I was eligible for an upgrade 5 months ago). My phone has started to lag a lot, and I’m getting frustrated with trying to use it. By happy coincidence, I also found out there was 3x as much money in my checking account as I thought, and it seemed the perfect time to splurge a little. So I’m retiring my Droid Razr Maxx HD tomorrow and playing with a new Droid Turbo instead. I’m sure I will end up beating myself up over making a purchase to make myself feel better, but at least for a few days I’ll be distracted by installing all my apps and getting everything set up just the way I like it.

“Rumors”

I have never been quiet about my bipolar diagnosis.  My family members know, my friends know, my coworkers (even my supervisor) know.  The one area where I’ve kept it secret is with my employer’s HR department.  Until last week.

I do a combination of inventory control and quality assurance for a fulfillment center contracted by a major national brand.  I work 3-4 days per week, spending up to 12 hours per day at work.  This was all well and good when I was manic and had boundless energy (and needed virtually no sleep so I was able to do fun things in the evening), but once I sank into depression it became torture.  Actually, the job may have contributed to the depression.  My manic episode ended and I wasn’t exactly depressed, but due to a series of unfortunate events I spent weeks working in extreme pain.  Also, my blood pressure was ridiculously high, which was not helping my stress level.

At any rate, depression + long work days = bad.  Depression + long work days where I don’t know exactly how long they’ll be and what I’ll be doing that day = extra bad.  Depression plus long work days blahblahblah in which I sometimes have to spend all day on a task I loathe = unbearable.  It actually got to the point that my therapist wrote my supervisor a letter recommending that I not do that particular type of task.  I’ve done it much less since then, but recently it has been unavoidable.

Said therapist has highly encouraged me to find a new job, and by “encouraged” I mean “pressured to the point that I asked her to please stop”.  Then I ended up in an unscheduled appointment with her the following day to tell her she was right.  It’s been a few weeks since then, maybe about a month, and I have not made much progress in the job hunt.  I managed to write my first resume though, and baby steps are better than nothing.

Last week, the secret came out when I went to the HR department to see if they could suggest an alternate position in the company that may be more suited to my skill set and scheduling needs.  The HR rep I spoke with, who we’ll call “Kara”, came up with several possibilities.  None of them were ideal, but I made a very rational decision to apply for an available job at our other local warehouse.  The hours might actually be a bit worse in some ways, but it was the biggest change out of all the options and I figured if my life’s not working I should make a radical change.

A few days later my supervisor hunted me down where I was working (on that task that causes me so much emotional distress) and said Kara wanted to speak with me.  I figured it was news about the job I applied for, but then he escorted me all the way to HR.  I was anxious, but had no idea what was about to happen.  Kara took me to the conference room, shut the door, and sat much closer to me than she did last time I was there.  She told me that the job I applied for had been filled by someone else.  I relaxed a little.

Then she dropped the bombshell.  She said that she’d heard some rumors that may or may not be true about things I was doing at work.  I knew exactly what she meant, but was terrified I was about to be fired and pretended I didn’t know what she was talking about.  She said she wouldn’t pry if I wasn’t comfortable talking to her, and handed me a brochure for the Employee Assistance Program.

It took a few rounds of her saying she wasn’t sure if it was true, but it finally sunk in that I was not going to be fired and I admitted that it was true that I injure myself, sometimes while at work.  She said she wished she knew how to help.  She went over the possible job alternatives again, including a new suggestion for one that would be available in a few months.  She told me I could come talk to her anytime.

Of course that meant I couldn’t do it.  I have a tendency to drive people away somehow, and I knew without a shadow of a doubt that I couldn’t let that happen with her.  There was something on my mind that she might be able to help with, but I kept it to myself for days.  Then this happened:

arm-writing

It’s not as bad as it looks.  Last time I made such a list (on paper) it was much longer and I actually felt what I was writing.  Now I just feel blank.  Like maybe writing this would make me feel something.  Even if it was a bad feeling, it would be better than this inability to cry, to smile, to get angry.  It only made me feel a detached sort of worry that I would take the next step in trying to feel and do it in a way that would leave a scar.

I wasn’t feeling that impulse yet, but knowing that I could led me to finally go see Kara.  I told her that one of the techniques I had learned to avoid injuring myself was to put ice on my wrists, but the only place to do that at work is in the break room, where security will come yell at me and make me leave if I walk in there outside what they think should be my break time.

In reality, my particular department is so small that we are allowed to take our breaks whenever we feel like it, as long as we spend the appropriate amount of time on break.  Also, the idea of me spending a few extra minutes “on break” is a lot better than spending those same minutes in the bathroom, crying or hurting myself.

Kara’s response to the statement that security would yell at me was, “It’s none of their business.”  It may not be, but they’ve done it in the past and I told her as much.  So we now have an agreement that if I feel a need to go ice my wrists I will come see her and she will tell security I have permission to be in the break room.

So writing all over my arm led somewhere positive in the end, and although I was terrified by the idea of HR finding out about all this I’m starting to be thankful that someone spread those “rumors” in their direction.