Tag Archives: Attention-Seeking

A – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health. I discussed many topics related to mental health already last October for #Write31Days. As I menitoned in my theme reveal post for the #AtoZChallenge, I’m going to give short descriptions of several words for each letter (sometimes though I have only one). For today, my letter A post, I have quite a lot of words. Here goes.

Acute unit


Also called “admission unit” in the Netherlands, here is where people go if they’re in crisis. The acute unit is for short-term treatment only: up to three months. Even so, some people stay there much longer. Like, I spent sixteen months on an acute ward because the rehabilitation unit didn’t want me.

Addiction

Though addictions are typically treated in separate units or even by separate agencies than mental illnesses, many people with a mental health diagnosis also have an addiction.

Admission

The process of getting admitted to a psychiatric unit. If people are admitted to an acute unit, this is usually through the crisis service or psychiatric liaison in the emergency department. On treatment units, such as for eating disorders or personality disorders, people usually get admitted through their outpatient treatment team. An admission interview typically consists of a brief assessment of one’s symptoms and some standard questions (eg. does the patient know where they are and what date it is). Details of the patient’s initial treatment may also be discussed.

Aggression

Aggression is quite common among mentally ill people, especially those in inpatient care. This may not be a politically correct statement but it’s true. Most times, this consists of verbal aggression, but nurses and patients sometimes get attacked physically too.

Alcohol

Alcoholism is not as common among mentally ill people in inpatient treatment – they often take their addictions out on other drugs. However, still you get the occasional alcoholic on an inpatient mental health unit. Most instituttions don’t serve alcohol in the cafeteria, though near my institution is the railroad store where they do sell alcohol.

Attention-Seeking

Us mentals are supposed to crave attention more than do people without mental illness, hence the common belief that a mental illness is “attention-seeking” behavior. Well, let me tell you: mentally ill people often keep their symptoms hidden for a long time and most don’t crave attention more than do mentally healthy people.

Attitude

A similar myth about mental illness is that it’s an attitude problem. It’s not. I wrote a post on mental illness and attitude last October. The idea that mental illness is an attitude problem is very damanging to people with mental illness, who often have a lot of shame as is. There is a group of people wiht an attitude problem here and they’re the people who think they can judge another person’s attitude like this.

Histrionic Personality Disorder (HPD) #Write31Days

31 Days of Mental Health

Welcome to day 12 in the 31 Days of Mental Health. Yesterday, I was originally intending on writing a post on personality disorders. I didn’t and I didn’t even write a draft. However, since this 31-day series is raising awareness of the borad spectrum of mental illness, I thought I’d make use of the opportunity to discuss some disorders I’ve not been diagnosed with. Today, I’m writing about a disorder that my therapist at one point hinted at when discussing the possibility that I had imagined my dissociation: histrionic personality disorder. For your information: she never suggested I had this and, when my husband looked over the criteria to make his own judgment, he said I’m about the opposite of this.

Histrionic personality disorder (HPD) is a personality disorder characterized by a pattern of excessive emotionality and attention-seeking. Like all personality disorders, it sets on in early adulthood and is relatively stable across time and situations. People with HPD meet at least five of the following eight criteria:


  1. Is uncomfortable in situations in which he/she is not the center of attention.

  2. Interaction with others is often characterized by inappropriate sexually seductive or provocative behavior.

  3. Displays rapidly shifting and shallow expression of emotions.

  4. Consistently uses physical appearance to draw attention to self.

  5. Has a style of speech that is excessively impressionistic and lacking in detail.

  6. Shows self-dramatization, theatricality, and exaggerated expression of emotion.

  7. Is suggestible, i.e., easily influenced by others or circumstances.

  8. Considers relationships to be more intimate than they actually are.


People with HPD are often referred to as “drama queens”. Though this was my first online nickname and many people agreed I was a real drama queen, I only meet one criterion of HPD (suggestibility) consistently now.

Histrionic personality diosrder is more common in females than males. It occurs in about 1.8% of the general population. Like most personality disorders, the presentation of HPD tends to become less pronounced as the affected person ages.

People with HPD are quicker to seek help than those with other personality disorders. However, this may reflect a symptom of their condition, because they exaggerate their symptoms and difficulty functioning. They also may display all emotions with the same depth of expression, unaware of the subtleties of emotional experience. People with HPD are also emotionally needy. Therefore, once in therapy, it’s hard for them to terminate treatment.

Therapy for HPD should usually be supportive, relatively short-term and solution-focused. It is unlikely that a therapist will be able to “cure” a HPD sufferer, so it doesn’t make sense to invest in long-term therapy.

People with HPD may exhibit suicidal behavior or make suicidal gestures. They may also self-harm. Though this might be an expression of their need for attention, suicidality and self-harm should always be taken very seriously. Even if the person is just crying out for help, death or serious bodily harm may occur. Like with all people who are suicidal or engage in self-injury, a safety contract may help establish boundaries while keeping the patient safe.

What Blogging Has Taught Me About Myself

The first writing prompt for August on the SITS Girls website is to write about what blogging has taught you about yourself. I have been blogging for years. I started an online diayr in 2002 and kept one on about every diary site that was around. In 2007, I transferred my DiaryLand diary, which had become partly a blog, to WordPress and started a real blog. My old blog died from inactivity in like 2011 and I had some blogs on and off for a few months until I started this one in August of 2013.

Blogging has taught me many things. It’s helped me improve my English and writing skills in general, and it’s helped me develop online connections and even a few friendships. Maybe it’s even helped me meet my husband, because he was reading my blog when he decided I was an interesting girl to meet. When I think, however, of something it has taught me about myself, I have to be really honest and say I have learned that, deep down, I crave attention.

In a way, this truth should’ve been crystal clear to me by early secondary school, when I allowed new “friends” to read parts of my journals. These friendships usually didn’t last long, in part probably because I was way too clingy. But I yearned for real friendships at the time.

This continued in the age of the Internet, when I exchanged E-mails with some people I’d met on Yahoo! groups and we exchanged URLs of our online diaries. DiaryLand didn’t have a comment system for free users and I had no clue about stats, so there was no way of knowing whether anyone actually read my diary unless they told me so. At that time, I really wanted people to read my diary, but not so I was a successful writer. I wanted to communicate things I couldn’t communicate face-to-face. I didn’t care how many people read my diary, if those people I cared about did.

That changed when I got a real blog in 2007. Now on WordPress I had a comment system and stats, so I could actually view how many people were reading my writings. I was, at the time, quite a successful blogger in my niche of disability rights bloggers. I didn’t read the big lifestyle and Mommy bloggers, so I didn’t care or even know that I was only a tiny blogger in the bigger scheme of things.

When I started my current blog in 2013, however, I knew about the bigger blogging world. I don’t even know how I found out, but I learned about blog support groups on Facebook, writing prompts and link parties. I decided I wanted to spread my wings and reach out to the bigger blogging world. At first, I only wanted to teach them about disability issues and autism in particular, but of course other people’s stats stared at me.

In absolute numbers, I’m more successful a blogger now than I was with my old blog. However, now I know that you can be even more successful. I also know that there are essentials of blogging I will never master, such as including images. And the sad truth is, this makes me feel inadequate.

After all, I crave attention. There is some research my husband mentioned that asks people whether they want a car when everyone else gets a car or they want a scooter when everyone else gets a bike. Most people choose the scooter and I’m no exception. In this sense, it’s sad that I got to venture out into the larger blogging world of people with bigger cars than mine, so to speak, even though I now have a car too. If I’d stayed in my little disability rights niche, I’d have had the proverbial scooter but at least could’ve measured up to everyone else.

In this sense, there are two things blogging has taught me about myself. Firstly, indeed, I crave attention. I smile when I get a new comment even when it’s from a blog support group. But the second thing I learned about myself is, and I only realize this now that i write this post, I’m more competitive than I thought I was.

Scarred

Scarred. It can mean so many things. We can have scars on our bodies and on our souls. Sometimes, the scars on our bodies reflect the scars on our souls. Such is the case with self-harm scars.

I started self-harmign when I was very young. I don’t even remember when I started, but my maternal grandma asked when I was about ten wheter I still banged my head at night. I didn’t, but apparently I’d done this for a long time when I was younger. This is seen as a typically autistic way of self-harming.

When I was older, I started biting myself. My sister and I would sometimes bite each other when in a fihgt – usually I’d bite her more than she’d bite me. I also remember using hand-biting sometimes as a way to manipulate. Hand-biting is typically autistic too, although using it to manipulate is not. This could be related to my pathological demand avoidance traits.

I started cutting when I was sixteen. I vividly remember the first incident. It never got severe – most likely because I don’t have the tools to make severe cuts -, so my scars are relatively small. My biggest self-harm scar is on my leg from an incident last year.

The first time I was confronted with my self-harm scars, was when a staff member at the independence trainign home I lived in at the time, asked me about a slight scar on my hand. I didn’t want to talk about it, fearing that if I disclosed my self-harm, I’d be kicked out of the home.

Self-harm had multiple functions for me. The manipulative function is possibly still there subconsciously, but I also use self-harm to cope with strong emotions that are common in people with borderline personality disorder. Self-harm by the way wasn’t the main reason I was diagnosed with BPD.

As I said, self-harm has many causes. It can be used to express pain, as is often the case for me, but many people also hide their self-harm. If a person does it “for attention”, as it’s commonly called when someone self-harms to express emotions, that doesn’t mean they’re fake. Their (and my!) pain is real, only they have probably learned that the only way to express it is through self-injury. Ignoring people or suspending them from help, as happens in some therapy programs, is only going to be counterproductive and especially harmful if the person hasn’t learned more effective ways of expressing their pain. They need validation especially badly, because the very reason they started self-harming “for attention” is the lack of attention they and their pain got in the past.

Even those who self-harm “for attention” may feel self-conscious about their scars. I am fortunate not to have any too obvious self-harm scars, but I do know what it is like to be questioned about your scarred body. I, after all, have a scar on my belly at one end of the shunt I have because I had hydrocephalus as an infant. Children sometimes said I had a second belly button. When I was at one point worried that my shunt had malfunctioned, my parents also offhandly asked whether I could get the scar beautified if I was going to need to see someone about my shunt anyway. My husband, fortunately, has never made a problem out of my scar. I don’t even think he’s ever commented on it except when I asked him about it.

I am not particularly proud of my scarred self, but I don’t feel bad about it either. In November, I took part in a self-harm event which was being filmed for a documentary series. I don’t have time to go to the preview and most likely won’t watch the series as it airs either, so I won’t know whether I’m in it. If I am, I don’t mind. I don’t show off my scars, but I’m open to educate people about them and their cause.

Mama’s Losin’ It

Mami 2 Five

 

Mental Illness Is Real Illness Too #BADD2014

When I signed up to participate in Blogging Against Disablism Day 2014, I originally intended to write a semi-academic post on what it means ot be disabled and who can identify as such. Then I read Kees Kooman’s Dutch book on chronic fatigue syndrome (ME/CFS), which is aimed at advocating the idea that ME/CFS is a physical rather than psychological illness. Fine with me – there is a lot of evidence that ME/CFS is a physical illness. What bothers me, however, is the idea, propagated throughout the book and in many other places within the chronic illness community, that a physical illness is somehow more real than a mental illness.

I have a mental illness. I also have largely unexplained physical symptoms, which the doctors for now call probable irritable bowel syndrome. IBS, like ME/CFS, is an illness with clear physical symptoms which however have not yet been explained. This doesn’t mean no explanation will be found – many cases of “hysteria” in Freud’s era were later found to be brain tumors, after all.

However, what if IBS and ME/CFS are actually psychological? Does this mean that we don’t want to get better, as Kooman continually suggests. In my experience, living with a diagnosed mental illness, it doesn’t.

I see this kind of ableism towards the mentally ill everywhere. I have met many autistics who resist the idea of autism as a psychiatric diagnosis. While again I am on their side, their arguments discriminate against the mentally ill. It isn’t like mentally ill people always need to be pushed into independence, while autistics and others with neurodevelopmental conditions need lifelong support.

In case you’re wondering why I care, here’s why. The Dutch Long-Term Care Act, which is due to take effect next year, originally excluded those with psychiatric conditions (which I’m assuming includes autism without intellectual disability) from care. People with mental illness needed to get care and treatment through health insurance and locally-funded social support. The mental health platform, supported housing alliance and some other stakeholders fought this exclusion and it seems now that those who’ve been in residential treatment for at least three years on end, will qualify for long-term supported housing. I would qualify under this condition, but the large number of revolving-door patients, who are constantly being admitted, discharged and readmitted, wouldn’t.

The mental illness means not wanting to get better idea also has practical implications for treatment. People with certain mental illnessses, like personality disorders, are already stigmatized for being just a pain in the butt. I have been told many times that I’m manipulative, attention-seeking, and just having behaivor problems that I need to overcome. Of course it is wrong to assume the same of ME/CFS and IBS patients, but why in the world do they need a physical cause for their illness to claim they’re truly suffering?

Let me make it very clear that I’m not saying that ME/CFS is all in your head. I’m saying that if it were, that still didn’t mean you don’t want to get better. Symptoms are real, whether they’re psychological or physical and, if physical, whether a medical cause can be found or not. As a person who has been accused of imagining a mental illness, I want to say that, unless someone is malingering (ie. faking for external gain), it doesn’t matter what the cause of the illness or disability is in terms of whether it is a real illness or disability. Whether you strive for the illness or disability to be cured, by the way, doesn’t determine whether you’re ill or disabled eihter, but that is beyond the scope of this post.

I Am Astrid’s Functioning Label

Back in 2008, Bev over at Square 8 wrote a post entitled I Am Joe’s Functioning Label. The post struck a chord with me right the first time I read it, and, over the years, it has become more relevant. For those who don’t want to hop over to read the post, it’s about what the label “high-functioning” is perceived to say about an autistic person, and how this impacts the way autistics are treated.

For clartiy’s sake: I am not saying that people with an intellectual disability have it easy. The cuts to care and the accompanying independence doctrine affect them too. What I do mean is that it is often easier to understand why a person with an intellectual disability needs care than if you have a high IQ.

It is often presumed that a person who can do a cognitively challenging task like operate a computer, can also do more basic tasks like brush their teeth. In reality, these skills have nothing to do with each other. Another assumption is that people who know how to perform a task and/or why it’s necessary, can also perform that task. I remember even years before Bev’s post reading on Autistics.org about a woman who was getting ulcers beecause social services presumed that if she knew about hygiene, she must be albe to wash herself.

There are many more assumptions about people labeled high-functioning. Here are a few that are affecting my life.


  1. Because of my functioning label, I am presumed to be safe in traffic. Since starting to learn a tiny route around the building, I am not only allowed to leave the ward alone without any purpose, but am expected to leave the ward if I’m angry.

  2. Because of my functioning label, I am presumed to be able to take care of my personal hygiene without reminders or help. This is in a way somehting I don’t want to change, because the reason I’m not able to perform some skills of personal care is because of sensory issues.

  3. Because of my functioning label, I am presumed to know how to solve problems myself even when anxious or overloaded (my fuctioning label dictates that overload is just an excuse to avoid demands). I am presumed to be able to make my needs known in very specific terms.

  4. Because of my functioning label, I am thought to be able to perform practical skills like making a bed or pouring coffee myself. Ironically, the motor deficits which cause me to be unable to perform these tass, were originally thought to be especially common in Asperger’s Syndrome.

  5. Because of my functioning label, I apparently don’t need a lot of structure. This means I am presumed to be able ot schedule activities without help.

  6. If I get overloaded, my functioning label dictates that it was my own choice and I’m depriving other people of the right to make noise.

  7. If I have a meltdown because my routine is interrupted, again, my functioning label dictates that I’m just spoiled and trying to always get my way.

  8. Because of my functioning label, I am presumed not to engage in aggressive or self-injurious behavior. If I do, it’s obviously because of BPD-related attention-seeking.


Yes, I see that a lot of these assumptions are not just based on my functioning label, but also on my co-occurring diagnosis of BPD. Before I had this diagnosis, not only was I not presumed to be unwilling to act normally, but my autism was presumed not to be as mild as it is now. Hence, an additional diagnosis makes it seem as though I’m less severely affected. Isn’t that ironic? By the way, if instead of Asperger’s and BPD, my diagnosis had been multiple complex developmental disorder (McDD), which is characterized by practically the same symptoms, I would likely have been seen as quite severely autistic.

The BPD Behavior Double Bind

Attention-seeking, manipulation. Many borderline personality disorder patients are accused of these, and I struggle as I come to terms with the fact that, indeed, a lot of my behavior at least comes across like this. For example, a few weeks ago, my crisis prevention plan was changed to the effect that staff no longer need to make me come back if I run off. It’s up to me to decide whether to run off and, if I do, what to do about it. After trying to communicate my discomfort with this change and being told off with references to choices and responsibility a few times, I ran off and wandered for about an hour until the staff eventually decided to find me.

I can see in a way how this can be interpreted as manipulative. The staff also said I have tremendous power when deciding to run off, because there is no way the staff can responsibly not take care of me eventually.

To my defense, I find myself in situations many times where I communicate in a normal way that I need support and am not being heard because other patiets, with different diagnoses, are acting out more. For example, today I asked the staff to take me on a walk because I was feeling irritable. They couldn’t, because there are several patients in a psychotic break right now. I rationally understand that my needs need to go on the back burner when people are in more severe conditions, but at the same time, this feels like a double bind. If I act out, I’m attention-seeking, manipulating and it’s my responsibility, but if I ask for support in a normal way, I’m obviously not sick enough to need it. In this situation, how am I supposed to show that I’m genuinely not coping?

“You Got Enough Attention Already.”

Last Sunday, I asked a nurse if I could speak with her. She said I could, but not then. A while later, she went on a walk with some other clients and I went along. Then was coffee break and I, some other clients and the nurse were chatting. All evening, the nurse was busy with other duties, so even though I periodically asked whether she had time for a talk, she never did. Then at 9:00 PM, I burst out into anger over her not being clear whether or when she could talk to me. This was when she said that we’d gone on a walk and had coffee together. “You got enough attention.”

Now let’s get the facts straight. There were other clients being attended to too whilst we were going for a walk and having coffee. Not a problem with me, but I can’t see how I was supposed to talk over my relatively private issue with the nurse at that point. I know that in legal terms, care is defined in minutes of attention, not needs being met. Then again, suppose I didn’t go for the walk or attend coffee break. Then the nurse would still have taken the other clients on a walk and had cofee with them. Would she have been any less busy then, had any more time to have a talk with me? Most likely not. Would I have been any more entitled to time with her to talk over my issue? I don’t think so, but her commetn about me having gotten enough attention, suggests I would.</P

Now let me get this real clear: I wasn’t freaking asking for attention per se, I was asking for a talk about a specific subject. If all I needed in my mental health care was enough attention, why would we hire expensive nurses, social workers and psychologists for it? Couldn’t a high school student meet the same needs? The thing is, in reality sometimes all people need is attention, and this is all understandable given that most mental health inpatients are rather isolated. That’s why I advocate volunteers or inexpensive workers being hired by mental health agencies to provide activities or a simple chat about the weather with the patients. That walk and coffee break didn’t require nursing supervision. Then again, that talk I wanted to have surely did.

I didn’t touch here on the connotations of the attention-seeking presumption, which are that mental health patients, and especially those with a certain diagnosis, like BPD, have an excessive craving for attention. Well, I for one don’t. I probably spend less time interacting with people than most currently mentally healhty individuals. I may sometimes draw attention to me in a negative way, but that still doesnt’mean I do it for attention. Let me just say I hate that attention paradigm that keeps floating around in mentnal health and especially personality disorder care.

The Attention-Seeking Theory of BPD

There is lots of stigma surrouding mental illness. Borderline personality disorder is no exception. In fact, it is among the more stigmatized illnesses. Particularly, people believe borderlines act out to gain attention, while there’s evidence they do it out of a need to regulate emotions.

I am very thankful that I didn’t have the BPD diagnosis when I was first hospitalized in 2007. I had done something that can with good reason be seen as attention-seeking – made a suicidal threat in public -, but I was realy not thinking of the attention I’d get with this. Besides, the kind of attention I got, did matter quite a bit. It is not purely for attention, even though my threat had a signaling function.

In like 2006, before any mental condition had been diagnosed, I was talking to my named support worker at an idependence training facility about my recurrent meltdowns. At one point she concluded that I did it for attention. “So we won’t give you attention anymore. Don’t think you can do this for attention.” In reality, the majority of my meltdowns and acting-out behaviors have the function of either regulating emotions or overwhelming stimuli.

Another thing with the attention-seeking theory is that nothing really is wrong with attention-seeking. Of course, having a meltdown for attention is not appropriate, but it is not like ignoring the person is going to make them better. It will just lead to them giving up and developing learned helplessness. Rather, professionals and others need to help the borderline by providing the right kind of attention before behavior escalates. I strongly disagree with the ida that borderlines need to be left to solve their own problems. We lack skills in emotion regulation, and need to actually be taught these skills. When other conditions, like autism, come into the equation, it gets more complicated, because we truly do not have the ability to process ordinaryy stimuli. I, for one, have a hard time communicating when overwhelmed, so I can’t get across my needs in an appropriate manner. It is further reinforcing learned helplnessness to just ignore me in such a state.

Ramblings on Self-Image and Diagnosis

This afternoon, I was discussing y treatment plan with my psychologist. I heard her saying something about diagnosis and treatment being complicated by a combination of autism with axis II symptomatology. “Axis II,” I thought, “that’s personality disorders. Have they finally gotten to diagnose me as BPD?” And yes, they have. And instantly the DID and PTSD diagnoses went out the window. Not only that, but BPD, not Asperger’s, is my “main diagnosis” now.

What does this mean? I anticipated it for a long time. In fact, I’ve always doubted the diagnosis of DID. When initially diagnosed, I was too overwhelmed by some of the consulting psychologist’s questions to answer them with the nuance they required. Like, the psychologist asked whether we are aware of what happens when another alter is out. I said no, but the real truth is that we could not have known, since if we lost time, we would only find evidence later and not know that an alter had been out unless we’d had soome awareness of that alter.

I have a very unstable self-image, which goes with both DID and BPD. In addition, I need concrete qualifiers for myself, which I theorize could be an autistic feature. This gets me to identify myself not with abstract characteristics like creative, intelligent or whatever, but with the labels I’ve been given. I’ve gotten better over the past year or so at identifying myself with neutral labels like crafter and blogger.

At the same time, I still do have characteristics that are more abstract. I am not just an autistic, a crafter and a woman. I am not just a dissociator or a borderline. Yet what I am in terms of these labels, fundamentally impacts how people see my characteristics. Like, borderlines are generally assumed to be manipulative attention-seekers. If I’m seen as manipulative when a vulnerable alter is out, for example, that means my needs won’t be listened to. In contrast if I’m seen as vulnerable when I’m manipulating, I won’t unlearn to manipulate. Furthermore, my poor self-image may not alter the core of my mental problems – whether that be a drive to manipulate or emotional vulnerability or both or soomething else entirely -, but it sure alters the way I perceive this core.