Tag Archives: Trauma

Dropping the Mask: Does it Take a Diagnosis? #TakeTheMaskOff

Today, the theme for #TakeTheMaskOff is diagnosis or self-discovery and its effects on masking. This is applied mostly to the experience of being autistic, but I can relate to it from a trauma survivor perspective too.

I haven’t yet read any of the other contributions for this week, but I assume the idea behind this challenge is that discovering you’re autistic, either through professional diagnosis or not, can help you drop a facade.

This is definitely true for me. When I was first diagnosed with autism in 2007, my staff claimed that I was using it as an excuse, because I reacted more to for example loud noises than I’d done before diagnosis. Similarly, my parents claimed that I was over-protected by the staff who felt I’m autistic and this led to my psychiatric hospitalization in November of that year.

To be honest, yes, I may’ve started to use autism more as an explanation for my behavior once I was diagnosed than I did pre-diagnosis. Note that I say “explanation”, not “excuse”. I don’t feel I need an excuse to act like myself, unless acting like myself were harming other people. Saying that we use autism as an excuse for our behavior is really saying that we should conform to non-autistic standards of behavior at any cost. Autism is an explanation for why I can’t conform to these standards, but even if I could, that doesn’t mean I should.

Then again, once my autism diagnosis was taken away in 2016, I did feel like I needed an excuse. And so did many other people. I was kicked out of autism communities that I’d been a valued part of for years. Suddenly, I’d been faking and manipulating and “acting autistic-like” all those years rather than just having been my autistic self. One Dutch autistic women’s forum’s members and admins were notorious for spinning all kinds of theories on why I’d been pretending to be autistic all those years and had finally been unmasked.

<PAnd at long last, I started to believe these people. I started to believe that self-diagnosis may be valid for other people, but it isn't for me. I started to wonder whether my parents were right after all that I'd been fooling every psychologist and psychiatrist before this one into believing I'm autistic.

This process of self-doubt and shame led to my first real episoede of depression. After all, if I’m not autistic, why did I burn out and land in a mental hospital? I’d been diagnosed with dependent personality disorder by the psychologist who removed my autism diagnosis, so were my parents right after all? I suddenly felt like I needed an excuse to act autistic-like, as if being autistic is indeed less than, not just different from being neurotypical.

I sought an independent second opinion and was rediagnosed with autism in May of 2017. I still am not cured of the idea that it takes a professional diagnosis to “excuse” a person from acting non-autistic. I don’t apply this to other people, but I do still apply it to myself and that’s hard.

I originally posted this to my other blog. I use that blog to counteract this self-stigmatizing attitude. This, after all, also applies to my status as a trauma survivor. I got my autism diagnosis back, but I never got and most likely never will get my trauma-related diagnoses back. I still mask, hiding my trauma-related symptoms when I can. And that’s not usually hepful in the long run.

How Far I’ve Come

Today, in a complex PTSD support group, a member shared her story of hope and healing to lift other members up. I was inspired to share mine. Not that I’m as successful as she is, but I’ve come a long way on my healing journey especially given how deeply troubled I was several years ago. Regular readers will know most of this already, but I’m still going to share where I’ve come from and how far I’ve come so far.

In 2007, I started university in Nijmegen. I didn’t really want to go to university, but I felt I had to because my parents expected me to. I felt I had to live up to their expectations or I wouldn’t be worth much and would not have anyone to support me. My parents had instilled in me that I wasn’t wired for relationships, so if they decided to abandon me, I’d have no-one left.

Two months in and I crashed. I was so dysregulated and suicidal that I had to be admitted to a mental hospital. The psychiatrist who admitted me felt I needed supported housing. We searched for this for many years, but no place wanted me.

Meanwhile, the other half and I started dating. This could’ve given me some hope that I may in fact be able to develop social and even romantic relationships and wouldn’t be dependent on my parents for the rest of my life. You see, despite the fact that my parents only ever visited the hospital to argue with my treatment team, I was still heavily emotionally dependent on them. I still felt I needed their approval to be able to have any sort of meaningful life.

That changed around late 2010 to early 2011. The other half had proposed to me in June of 2010. I was diagnosed with dissociative identity disorder and PTSD in late 2010. Finally finding a treatment provider who believed me and realizing the other half was here to stick by me, gave me the strength to stick up for myself.

I still had many setbacks in the years that followed. I changed hospitals and my new psychologist didn’t believe I had DID/PTSD. The next psychologist even removed my autism diagnosis that I’d had for many years. She diagnosed me with dependent personality disorder, not because I was passive and compliant, but because I was too assertive, claiming care she felt I didn’t need.

In early 2017, I finally found the determination and courage to fight like a lioness for what I need. I sought an independent second opinion on my diagnosis. I started the process of finding suitable support, eventually enlisting the Center for Consultation and Expertise. I started to realize that I’m not just the crazy one in my family. In fact, even though no-one has a diagnosis other than me, I’m pretty sure my entire family has fallen a bit off their rocker. I finally realized (though I still don’t fully feel it) that the trauma I endured wasn’t my fault.

These strong parts of me are still a bit split off from the core of me, but that’s okay. Ultimately, I will hopefully learn to synthesize their qualities with the ones of the weaker or smaller ones. I don’t need to become “one”, but I hope I can someday live as the whole person, made up of all these parts, that I am.

#MeToo: Do My Experiences of Sexual Violation Count?

The “me too” hashtag has been floating around Facebook for a few days now. I didn’t add my “me too” myself, as I didn’t know whether my experiences counted. Also, I never told my parents even though some experiences happend when I was a child. I didn’t want to make them feel uncomfortable and I don’t want to come across like a “drama queen” who cries wolf too easily.

If you have to believe some people, any behavior from a man that makes a woman feel uncomfortable, whether the man is aware of it or not, is sexual harassment. All men are portrayed by some media responses to “me too” as potential rapists. I have to disagree here. Not because an “innocent” stare or gesture doesn’t count. It may not legally count, but to a victim in need of support, it definitely does. The reason I disagree to this logic has nothing to do with what counts and doesn’t count as sexual harassment and everything to do with the fact that men are victims too and women are perpetrators too. Focusing too much on just women as victims and men as perps, is silencing to male victims of sexual harassment/assault. It’s doing to male victims what those who made women set up “me too” do to women victims.

I happen to be a woman. For all the experiences of sexual violation I endured, the people doing it to me were male. Only one of them was a steretoypical fifty-year-old creep. The others were children or teens.

I have one experience where I was touched. The rest of my experiences involved threats and other inappropriate verbal and non-verbal communcation. The fifty-year-old creep’s actions were the most recent, when I was 23, and the ones I remember most clearly.

I have often wondered whether I can seek support for my experences of sexual violation. Because sexual violation wasn’t the worst of my traumas, I often feel left out in sexual assault survivor communities, because, well, was it “that bad”? No, in a sense, it wasn’t “that bad”. I mean, my heart goes out to the people who were actually raped or assaulted. Yet just because others have it worse, doesn’t mean my experience doesn’t count. Impact of trauma varies from individual to individual and the post-traumatic stress symptoms I endure are in fact pretty bad.

So my experiences do count, because I feel they do. Not necessarily in legal terms – I was going to write an essay on that -, but for support purposes, they do. Thanks to the author of Crazy-NOS for giving me the courage to share my experience.

Flashbacks

A few days ago, I read an article on complex PTSD symptoms. I don’t have a diagnosis of coplex or regular PTSD and I realize there’s a lot of overlap with borderline personality disorder traits, which I do have a diagnosis of. Of course, I used to have a PTSD diagnosis, but that was removed because I did not have flashbacks that often. At least, that’s what I thought. One symptom after all that I completely relate to in this list, is having emotional flashback.

I never knew emotional flashbacks are a recognized symptom. I just thought they were covered under the umbrella of emotional regulation difficulties, which is a hallmark BPD symptom. As such, I usually saw complex PTSD as BPD when the person was believed to have been seriously traumatized. If a person was believed to just have had a few negative experiences, then they’d be diagnosed BPD. In my experience at least, the BPD diagnosis was used to deny I had been traumatized.

I don’t want to diagnose myself, of course, but the emotional flashback thing really struck a chord with me. Ever since I was a teen, I’ve experienced what I used to call “time shifting”. In a “time shifting” episode I’d have a kind of déjá vu experience. Usually, this was coupled with feelings of floatiness or unreality. The mental health term for this is depersonalization.

An emotional flashback is what it’s called when a person relives the feelings of past trauma. Boy, do I relate to this. Usually, I do have a slight inkling that I am transported back in time emotionally, but not always. I experience an intense feeling of helplessness, fear or sometimes despair.

Another type of flashbacks are visual flashbacks, when you experience the traumatic event as if you’re reliving it. I don’t have these often, although I’d readily trade an emotional flashback for a visual one. At least, with visual flashbacks, I can give words to what I’m re-experiencing and thereby desentisize myself.

Somatic flashbacks, I’m not sure I have. After all, most trauma I endured didn’t leave physical damage. I mean, I do have “weird” physical symptoms, but I’m assuming these are just from mental stress and aren’t direct relivings of a traumatic experience.

Like I said, most of my trauma was emotional or psychological. I usually think this doesn’t “count”, as most people when describing trauma, describe sexual or physical abuse. I didn’t endure much of this and, as far as I know, it didn’t leave me with major post-traumatic symptoms.

I did, however, describe the few incidents of physical and sexual trauma when I was asked about trauma by the psychologist who diagnosed me with PTSD. This is just easier to grasp. When I say a person hit me or threatened to rape me, it’s understandable it was abuse. Then agian, these incidents were few and far apart. For instance, the person threatening to rape me was practically a stranger and it was a single incident that had no connection to the ongoing trauma I endured.

This ongoing trauma left psychological wounds and I endure almost-daily emotional flashbacks of it. That being said, both the flashbacks and the traumatic experience itself are influenced by my interpretation. As such, it might be it wasn’t “real” trauma, but in my BPD mind, I interpret it as such.</P.

Just One Thing

Last week, I started a journal-style blog to explore my inner world. As usual, I didn’t write in it much at all, so I’m resorting back to this blog. The reason I wanted another blog is because of the derogatory comments I’ve gotten here regarding my dissociation. No, I don’t have a diagnosis of dissociative identity disorder anymore and no, I don’t claim to be DID. I do however have insiders, parts, alters or however you’d like to call them. I don’t care what people think of this, or at least, I try not to care. To reclaim myself and my experience, here I’m sharing a post I wrote last week.

Manyofus1980 from Therapy Bits posed an interesting question: if the world could understand just one thing about your mental health diagnosis, what would it be? In the post title, the question is about your “mental illness” rather than your “diagosis”. This is important to my answer, as my short answer is: my diagnosis does not dictate my experience.

I have had countless diagnoses over the years, some of which I agreed with and some of which I disputed. I don’t even know what my current diagnosis is according to my community treatment team. According to the university hospital where I got a second opinion last spring, it’s autism spectrum disorder, recurrent moderate depression and borderline personality disorder traits. Of this, I doubt the depression, because my default mood is low. Then again, I do seem to remember feeling much lower than low in the months that I had my assessment at this hospital. The thing is, I can’t usually connect my feelings from the past to the present if they’re very different.

We didn’t really go into my trauma experience, as my assessment was primarily focused on autism. However, the university hospital psychologist did recommend I get EMDR treatment for the negative experiences I had in the process of moving towards independence. I have not had a trauma-based diagnosis since 2013 and that’s fine by me. I don’t need a diagnosis to justify my experience.

I am who I am. We are who we are. We don’t fit in a diagnostic box, because, well, we’re we.

Sometimes, we feel upset that we don’t get recognition from our treatment team (as far as we know) for our traumatic and post-traumatic experiences. I had a lot of difficulty answering my psychiatrist’s questions about this during my intake interview. I mean, most of the trauma we endured, didn’t leave visible wounds. I know that dissociation can be caused by attachment issues, sometimes even too mild to create PTSD. However, there is still a common belief that only prolonged sexual or ritual abuse can create alter parts. I try not to care. We are we are we, so deal with it.

T – #AtoZChallenge on Mental Health

Welcome to the letter T post in the #AtoZChallenge on mental health. I’m a little late once again to publish this post, because this was a hard letter and I have once again been very tired. Here goes.

Transition

Transition or transfer happens when a patient moves from one setting into another. This could be from an acute unit to a rehabilitation, resocialization or long-term care unit. It could also be from a psychiatric unit into supported housing or community care.

Trauma

Like I said yesterday, many psychiatric patients have endured some form of trauma. Trauma is experienced differently by different people. The diagnostic manual defines trauma for the purpose of diagnosing post-traumatic stress disorder as having endured, been confronted with or witnessed a situation that is life-threatening, threatened or actually caused physical harm, or sexual violation. Starting with DSM-5, it is made explicit that being confronted with such a situation through the media does not count. As such, people who for exampe watched the 9/11 terrorist attacks on TV (ie. virtually the whole world) cannot claim to have been traumatized by it. First responders who witnessed the events themselves, of course, can. So can people who lost loved ones in the terrorist attacks.

Please note that this definition is only used for the purpose of diagnosing PTSD. People can be diagnosed with another stressor-related disorder (eg. adjustment disorder with PTSD features) if their experience does not meet the criteria for trauma but is still distressing.

Treatment Planning

Treatment plans, like I explained when discussing care plans, describe the person’s overall treatment and diagnosis. On long-term psychiatric units, treatment plans are revised every six months or so. A patient has the right to contribute to their treatment plan and to review it, but on my unit, during the actual meeting, patients are not in attendance. I have only been asked to contribute once and am lucky if I know when my treatment plan revision is. Obviously, informal patients (and most patients on a section) must consent to their treatment plan before it can be implemented. In reality though, I’ve not seen my treatment plan in years so I think consent is automatically assumed.

S – #AtoZChallenge on Mental Health

Welcome to day 19 in the #AtoZChallenge on mental health. We’ve arrived at the letter S. Here goes.

Self-Injury

Self-injury or self-harm is the deliberate infliction of wounds upon oneself. Some scientists make a distinciton between self-injury and self-harm. Self-injury is then seen as leaving relatively minor, local wounds such as cuts or burns. Many people with depression, anxiety or emotion regulation issues such as in borderline personality disorder self-injure. Self-harm then is the infliction of grave harm onto the self, such as amputation. This is seen more often, according to these scientists, in people with psychotic disorders such as schizophrenia. In reality, of course, only a small portion of even the most severely psychotic patients engage in severe self-mutilation.

In DSM-5, non-suicidal self-injury was introduced as its own mental health diagnosis. Prior to that, many people who self-injure were misdiagnosed, often with borderline personality disorder. The DSM-IV guidelines even said that, if someone self-injured to cope with overwhelming emotions, BPD should be diagnosed, even though BPD has nine criteria, five of which must be met for a diagnosis.

Self-Medication

Self-medication refers to the abuse of alcohol or drugs with the goal to cope with mental health problems. It can also refer to the use of prescription medications that haven’t been prescribed to that specific person. Many people “self-medicate” with alcohol, even though alcohol does not have any medical benefits (except in mouthwash). In fact, it can make symptoms worse. Same for drugs. For instance, many people with psychotic symptoms use cannabis because it seems to calm them, even though it is in reality thought to worsen psychotic symptoms.

Of course, some drugs sold on the streets actually do help with certain symptoms. For example, people with undiagnosed ADHD might start using stimulant drugs to counter their symptoms. It is for this reason that self-medication needs to be taken very seriously. In my post on dual diagnosis last October, I addressed the complicated relationship between alcohol or drug use and mental illness

Survivor

Many people were and still are treated for mental illness against their will. In the antipsychiatry movement, people who come out of (forced) psychiatric care are seen as survivors. Many mentally ill people have indeed endured traumatic experiences at the hands of professionals. Many also have had other traumatic experiences, which may’ve contributed to their mental health condition. As such, they’re also survivors.

Victim to Survivor to Thriver

Last week, one of the Friday Reflections prompts was about being a victim or a survivor. I didn’t have time to write about it then, so I will write about the topic now. I’m pretty fatigued and quite emotional today, so I hope my words make sense.

About ten years ago, I wrote on a mailing list for former preemies asking whether those born prematurely are survivors in the way that abuse survivors are. I mean, literally speaking of course we are survivors, because we survived against all odds. I was at the time still in a very early stage of figuring out my childhood and why I have always felt like a lot of my experiences were traumatic. I was beginning to discover the fact that I dissociate and learning about attachment and its dfficulties. The group owner, herself also a trauma survivor, replied that to survive means to endure hardship, so that in this sense, of course preemies – and most people with disabilities – are survivors.

As a child, I considered myself a victim of many of the experiences I endured. They were still happening, so how could I see myself as a survivor? In the same way, I can now see myself as a victim of mental illness. I don’t, of course, because no-one inflicted my mental illness on me and, besides, I don’t consider my craziness an altogether bad thing. It sucks sometimes, of course – well, most of the time it sucks. My point in saying I could now consider myself a victim of mental illness, is that it’s not over yet – I haven’t survived it as it’s ongoing.

I did survive my childhood trauma and do consider myself a survivor. Being a survivor does not mean having completely healed from your experiences, but it means having come out the other side alive literally and figuratively.

When describing the recovery process for people who endured trauma, we generally use three steps so to speak: victim, survivor and thriver. A victim is still in the midst of an experience. For instance, someone enduring domestic violence who hasn’t left the relationship yet, can be considered a victim. A survivor has escaped the direct effects of the trauma but is stil suffering from post-traumatic symptoms. A thriver has moved beyond their trauma and is living as healthy as possible a life.

The steps are not rigidly divided. For example, if a domestic abuse survivor has left their abuser but has not gone “no contact”, they can be both a victim and a survivor. Thrivership is also a continuum, where some people have no post-traumatic symptoms at all anymore and others can manage in spite of them. I will most likely always have borderline personalty disorder, which is in a way a post-traumatic condition. However, I want to someday have a meaningful life in spite of it.

Mental Health and Art Therapy #Write31Days

31 Days of Mental Health

Welcome to day 15 in the #Write31Days challenge on mental health. I will resume writing about personality disorders soon, but today, I don’t have the energy to do my research. Instead, I will write about art therapy, which is a form of therapy that can be particularly helpful to people with mental health issues.

Art therapy is a creative method whereby art mediums are used in the therapeutic process. It obviously originated at the crossroads of art and psychotherapy. Sometimes art therapy is focused on the creative process itself. For example, today while in art therapy, I made polymer clay beads. Sometimes, art therapy focuses on analyzing the interaction between therapist and client while engaging in creative arts.

Many people use art therpay to express feelings they can’t express in words. For example, trauma survivors, especially children, may use art to express their feelings about their life and the trauma they endured. An example of this was mentioned to my high school class when we got an educational session on giftedness. (My school was a grammar school, where about 30% of pupils were gifted.) A gifted boy, when drawing the human face, always drew an angry face. Another example perhaps comes from myself. In high school, I often drew blue-eyed figures in cages. This was an expression of how I felt trapped by my blindness.

Art can also serve a symbolic step in the healing process. For example, sometime in 2014, I created a baby self out of clay. I put it in a box lined with soft textures to express that she was safe now.

Art therapy can also serve the purpose of having the client explore new creative media. In this way, it can be used to encourage people with anxiety or sensory issues to try out new things. For instance, I sometimes get to try new materials to explore the boundaries of my sensory and emotional tolerance.

The creative process can also be used to have patients step out of their comfort zones. For example, my art therapist and I have used a drawing exercise by which I’d draw a random pattern (I don’t have enough vision to draw anything meaningful anymore). My therapist would first stay at a safe distance with her felt tip, but would try to gradually move into my drawing space.

Lastly, art therapy can simply be a form of leisure or recreational therapy. The polymer clay bead making didn’t have much of a purpose, other than perhaps having me try to handle the feel of polymer clay. Then again, I came up with the idea of doing this. It is more just a way to learn new techniques to use in my free time.