All that I am, all that I ever was…

I am more than my mental health. I am more than my homelessness. I am more than any one aspect of me. I am Addy. And this is…


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How forgotten victims of emotional abuse are building new support networks online

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Home comfort. (Shutterstock)

Written by Ria Poole, Research Associate, School of Social Sciences, Cardiff University

Two women are murdered every week in the UK as a result of domestic violence. The issue affects one in four women and one in six men at some point in their lives. Domestic violence also has more repeat victims than any other crime and costs the public £23 billion every year. And of those victims who have received hospital treatment for domestic violence injuries, 400 will go on to commit suicide within the year.

Such statistics are shocking, but what they don’t tell us is how many additional victims suffer from emotional abuse, which is another form of domestic violence. Emotional abuse is not regarded as a criminal offence in adult relationships but it is just as destructive to victims’ mental health, as a review in The Lancet revealed. It affects their self-esteem, emotional well-being, relationships with others and personal freedom.

Emotional abuse features across the entire spectrum of domestic violence. It can take the form of destructive criticism, put-downs and name calling, but also isolation, harassment, monitoring behaviours, and lying to a victim and their friends and family. It may also go hand-in-hand with sexual abuse.

But because emotional abuse is not a “crime”, its victims find it especially difficult to receive protection or even to be taken seriously by others at all. Research suggests that this may also be because emotional abuse lacks the public and political profile of physical and sexual abuse.

Limited support

Unlike victims of these crimes, emotional abuse victims may not seek help because they are unprotected by the law. The government hopes to address this lack of support as it introduces a new domestic abuse law later this year. This will criminalise the emotional abuse which underlies many abusive relationships.

Emotional abuse is a common occurrence affecting a fifth of intimate partner relationships. Despite far-reaching effects, there is a surprising lack of research on emotional abuse in adult relationships. At present, emotional abuse does not receive the attention from researchers and health services that it needs to enable victims to be recognised and professionally supported.

So, where do people go to receive the support they so desperately need? If victims are not protected by the law, if they are misunderstood by family and friends, and support from health services is lacking, then to whom do they turn?

Call for help. (Shutterstock)

Online groups

In the digital age, one obvious place to look for support is online. Through numerous online forums, “victims” of domestic violence become “survivors” who seek the emotional support from others they lack elsewhere in their lives. As with forums for patients with long-term conditions, these websites offer common components of support. This comes in the form of sharing experiences, seeking and offering advice, comparing coping strategies, and signposting to professional resources, as well as simply letting users know they are not alone.

Another of the more interesting uses of these forums is discussion of the perceived personality disorders of abusers, such as antisocial personality disorder and narcissistic personality disorder. But rather than focusing on the perpetrator’s issues, forum advice commonly concerns the victim’s self-protection. This makes sense because these personality disorders are typically thought to be resistant to professional treatment.

Many of these forums have been created by “expert survivors”. These people have escaped and recovered from emotional abuse, and now aim to support others by sharing their experiences and creating a platform for others to discuss their own. Crucially, alongside nearly all of these forums is some form of psychological education in the form of blog posts or other websites with information about how survivors can be helped in the longer-term.

Empowering and advising

There are multiple ways these forums may help victims or survivors of emotional abuse, but further research is needed to explore these mechanisms more fully. It may be that support from an online group validates victims’ experiences and empowers them to safely confront or leave their abusers. They may feel protected by an anonymous online identity as they confide in sympathisers about the abuse, perhaps for the first time.

One way to describe these insightful and empathetic forum users is as “enlightened witnesses”, who help others understand and accept their experiences and regain their independence. And with online forums, this support is instantly available. Advice and coping strategies may help victims rebuild their confidence and increase their self-efficacy. Their self-worth may increase as they realise they are not to blame for the abuse. As well as reducing feelings of isolation, a shared perspective may also develop compassion, friendship and humour.

So how can these “survivor forums” contribute to the services provided by health professionals? As a starting point, they give victims a voice that could help highlight needs unmet by the health service. But they could also give health researchers another way to study the nature, prevalence, language and outcomes of emotional abuse, and the coping and exit strategies survivors find to be most effective.

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This article was originally published on The Conversation. Read the original article.


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Mi Recovery: Biopsychosocial Personal Treatment Plan (aka Self-Love!)

“The Biopsychosocial Personal Treatment Plan (aka Self-Love!)”

ME_468_AcceptingSelfLove

“A trigger is a recognisable risk that can produce or stir-up symptoms. Triggers can be preventable,”

In week one of the Mi Recovery series we built a biopsychosocial model of the causes, symptoms and treatments of our mental illness(es). Now, in week three, we look at how we can use this model to identify techniques and strategies in which we can combat our triggers.

Since my breakdown in 2007 I’ve done a lot of work in understanding, analysing and identifying my triggers. The manner in which I’ve been living (homeless, socially isolated, no support structure) has forced me to educate myself on what needs to be avoided in order to prevent catastrophic collapses of my mental health. Personally, I think it’s vital that anyone dealing with mental health issues spends some time identifying their triggers; for doing so gives you knowledge – and knowledge is power!

There is no easy way to identify a trigger; sometimes they are obvious, sometimes they sneak up on you, but with time, committment and support (I can’t express how important this latter factor is when it comes to dealing with triggers!) it is possible to produce a list of things that trigger you.

For example, the smell, taste and presence of Gin and Tonic sends me right back to the night I was assaulted in Adelaide ’07, whereas articles on emotional abuse, rape or victim blame mentality have the potential to dredge up a cavalcade of unwanted memories and emotions. There are also a plethora of songs I cannot go anywhere near, as well as people, places and movies that can send my spiralling out of control.

Whenever I am confronted with a trigger my gut reaction is to avoid at all cost! But, as I recently wrote about, triggers can be preventable. Approaching triggers from the biopsychosocial approach is one such way to identify potential new strategies and wrestle back the control that triggers have on our lives.

My Biopsychosocial Personal Treatment Plan (aka Self-Love!)

“Enjoyable and healthy activities that I do for myself, that decrease stress and symptoms, help my moods and help me manage the things that trigger my symptoms.

Personal Treatment can affect all aspects of the person – the physical/biological, the psychological and the social. Personal treatment is a holistic approach. Research says that people who have included Personal Treatment activities in their lifestyle are more likely to recover than those who rely on medication,”
~ Pat Deegan ~

The first step in applying the biopsychosocial model to our triggers is to work out which categories they each fit into; are they biological, psychological or social in origin?

For example, if your trigger is a place, food or medicine – then they are biological triggers. Whereas (in my opinion) loneliness, anniversaries and television series are psychological triggers and people, boarding houses and clothing are social triggers. However, how you categorise your own triggers is entirely up to you. There are no right or wrong answers, only those that are pertinent to your lived experiences.

This – utilising ‘The A-Z of My Emotional Triggers‘ and input from Meadhbh and Audrey – is what I ended up with:

__week3__Biopsychosocial Personal Treatment Plan-vert

Once you have identified biopsychosocial nature of your triggers, you can then use the same approach to brainstorm potential new strategies and lifestyle changes that could be implemented to help you manage them.

Again, there are no right or wrong answers as to how you approach this. In creating my list I decided to take a two-pronged approach, firstly by looking at things I could implement to help fight my triggers in general:

General Strategies

And secondly, by creating ideas specific to the more difficult triggers in my life.

Given my current situation, the most obvious trigger to tackle first was the person who has been – through no fault of their own – triggering me of late:

cats After this, I decided to take a look at the issues of songs, sleep (lack of) and the isolation/loneliness that plagues me so:cats2

And, as a final experiment, I decided to brainstorm strategies I could implement next Tuesday (being the 7th May and one of my “bad days“):

Specific Strategies 2

A few notes on the above tables:

  • All text in black is specific to me.
  • All text in purple is specific to Meadhbh.
  • All text in orange is specific to Audrey.
  • Some of the ideas in the ‘Strategies & Lifestyle Changes’ table may seem extreme to others (e.g. is self-harm really a viable treatment option? is leaving Wodonga really something that would help deal with my triggers? is it really possible for me to give myself comfort?) but, like I said, they are pertinent to me.
  • Some of the ideas overlap as I believe they fit into multiple categories (e.g. ‘tell her about the person she reminds me of’ or ‘face head-on’)

How the Biopsychosocial Personal Treatment Plan could help…

In all honesty, given my current mood, I’m still processing this approach to dealing with triggers – hence why I haven’t explained it all that clearly (sorry!) – so if you have any questions about this activity or how I’ve applied my triggers and strategies, don’t be afraid to ask.

However, I do believe it is a worthwhile activity to undertake. In creating the above lists I have identified hitherto unseen strategies that could help in my ongoing battle with triggers. The exercise has also helped me realise my current coping mechanisms (flee, run away, avoid) have done little to help but a lot to hinder my recovery.

In creating this list I have acquired knowledge over my triggers. Thus – once I’ve implemented some (or all) of these strategies – I will have power over them to.

Like I said, knowledge is power.

And power…is strength.


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Mi Recovery: A picture of me, in a strong fame

“The importance of maintaining a sense of self,”

whatareyouworth

“Our stories and relationships change when we learn to value our whole self,”

As many who suffer from mental illnesses may attest, mental health problems do not exactly lend themselves to an over-flow of self-esteem. When a person becomes unwell with mental illness, they exert a lot of time and energy finding ways to treat their symptoms and manage their illness. So much so that it’s common for the individual – as well as family, friends and medical professionals – to focus entirely on the illness, forgetting that there is an actual, unique and whole human being beneath it.

This renders the person with a mental illness almost unable to see themselves as someone worthy of love or attention. In fact, in some extreme circumstances (and I speak from personal experience) the focus solely on the illness(es) can lead to someone completely losing their sense of self, their worth as an individual and their necessity as a member of the human race. They can see none of the skills, talents or values they possess as their illness (and/or trauma) causes them to focus solely on the negative aspects of their personality; aspects which are often unfavourably exaggerated out of all proportion.

A good example of this was a post I wrote yesterday in which I questioned whether or not I actually had any positive skills or values. A statement that immediately returned the comment:

You are a very caring person and very aware of other people’s needs. You have very good computer skills, you are a good artist, you are a talented photographer (if you had a camera that is), You have great taste in music with a wide variety of styles, You are also a very skilled writer when your illness allows you to be.

You seem to have got yourself in a rut of running yourself down and not seeing what is good about yourself, I know this is due to your past experiences but somehow you must break through this and see yourself for how good you are, not how useless you are.

This rut is something many who suffer from mental illness fall into, especially those who have had their sense-of-self destroyed by an abusive relationship.

Stephanie, for example, was a talented artist and photographer, someone who could work in a myriad of styles and produce work that was both multi-layered and truly inspiring. Whenever I would tell her this, however I would tell her this, she would instantly disregard my comments as a “complete lie” or that I was just saying that because I “had to” as her friend. The years of abuse she’d suffered (in combination with her mental illness) had made it impossible for her to see what everyone else could.

My thinking follows the same pattern of negative reinforcement that the exercise we undertook in the Mi Recovery group seeks to change.

A picture of me, in a strong frame

“I respect my limitations. I know my strengths. I compare myself with myself,
not with others who have different challenges and attributes to mine,”

The premise behind this exercise is to build a picture of who we are; the things we value, the things we like to do, our strengths and skills, how someone who knows us well would describe our abilities and successes, what aspects of our illness fit into the picture and what knowledge, resources and strategies strengthen this picture.

Once this picture has been formed, we then need to ask ourselves what internal and external resources we need to draw on to maintain this picture. For example, support groups, counselling, asking for help (external) or resilience, determination, insight (internal). This I could do easily…it was the actual strengths that I struggled with.

However – partly because I had to, partly because I needed to – I did (finally) create a portrait of myself:

A Picture of Me in a Strong Frame (2)

~ Key ~
BROWN TEXT (HAT) are three things I value in a relationship
RED TEXT (HEAD) are things I value in life
ORANGE TEXT (ARMS) are aspects of my illness I believe fit into the picture of me
PURPLE TEXT (BODY I) are things I am skillful in
BLUE TEXT (BODY II) are some of my strengths
GREEN TEXT (RIGHT LEG) are external resources I need to maintain the picture
PALE GREEN TEXT (LEFT LEG) are internal resources I need to maintain the picture
YELLOW TEXT (GROUND) is something I really (really) need to learn how to do to maintain this picture!
GREY TEXT (ANNOTATIONS) are things I like about my body (I chose to add these due to my body image issues)

Given the negative view I hold of myself it’s safe to say I do not yet believe everything I’ve included in the picture of myself. Some of them are things other people have recognised in me (e.g. Samantha saw my kinkiness as a strength, my family see my compassion as a strength and many people have noted my intense survival instinct and determination) whilst others are things only I believe (Zelda games are a skill? Really?)

But I believe it’s important to include these things in my picture, purely because they are all things I need to start believing rather than dismissing about myself.

It may be a long time before I do believe in this portrait, but for now I shall just celebrate the fact I’ve created one!

Why not make one of your own…you may be surprised by what you come up with! :)

 


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Mi Recovery: The Biopsychosocial Model

At the culmination of the first week of Mi Recovery we played the warm-down ball game I have become so familiar with courtesy of the Hearing Voices Support Group. The moment Meadhbh suspected this was about to happen she squealed in girlish glee and prepared to intercept the rolled up Velcro (apparently the budget wouldn’t stretch to an actual ball) whilst I sighed in apprehension about having to say something worthy and meaningful about what I’d taken from the group; which was plentiful!

In approaching this series, I have decided to focus my weekly review around whatever I say during this warm-down game. Yesterday – and this is a direct quote – it was…

“…the biopsychosocial model.”

__Biopsychosocial Model

For those unfamiliar with the biopsychosocial model (BPS), it is a model that was created by psychiatrist George L. Engel in 1977 that posited a combination of biological, psychological and social factors play a significant role in human development. Which is in contrast to the traditional model of medicine that suggests every disease can be explained in terms of an underlying deviation from normal function; such as a pathogen, developmental abnormality or injury.

It was this model that we used to examine the theory of mental illness, and the causes, symptoms and treatments we (as individuals) have experienced on our life’s journeys.

As everyone’s experiences of mental illness are unique, our diagnoses (whether that is a Mood or Anxiety Disorder, a Psychotic Illness, a disorder resulting from alcohol/drug use or a combination of all four) are largely irrelevant. It is our life experiences that determine the course of our mental illness and the symptoms/treatments thereof.

The biopsychosocial model allows us to look at our lives from three perspectives in order to determine what events have been most relevant and, in turn, how we can use this knowledge to take control of our lives and find new paths on our road to recovery.

My Biopsychosocial Model

The core component of the biopsychosocial model is how it allows us to see how experiences through our lives our linked. As such, the model is approached from three viewpoints:

1. Causes

These are all the elements that can be/have been attributed to be the cause of our illness. For example, some people believe mental illness is genetic (which would be a biological cause) whereas others believe some of the root causes of mental illness are isolation (which would be social) and trauma (which could be considered psychological).

The following is my own personal BPS model of the causes of my mental illnesses. Yours, should you wish to write one, may look very different:

__Biopsychosocial Model (CAUSES)

Notes on my model:

  • Some may argue with my overlapping of homelessness as being biological, psychological and social. But having spent a large period of my life homeless, it was the only place that fit for me.
  • I have placed sexual minority in the overlap of psychological/biological because it has both a biological (I was born with it!) and psychological (if you have the password, I’ve explained this here) component.
  • The most contentious placement would probably be “abuse” which many at the group believed should be placed solely in psychological; I however believe it has a HUGE social component, hence my placement of it in the overlap.
  • If you have any questions regarding the items and their placements, don’t be afraid to ask! :)

2. Symptoms

The second viewpoint is ‘symptoms’, which are all of the symptoms we experience as a result of our mental illnesses. For example, the butterflies in the stomach or sweaty palms of anxiety (which would be biological), an increase in destructive voices (which would be psychological) or isolating behavior (which could be seen as a social symptom).

As with both the causes and treatment of our illness(es), these symptoms are unique to the individual. This is what I came up with when approaching my symptoms via the BPS model:

__Biopsychosocial Model (SYMPTOMS)

Notes on my model:

  • I have placed victim-blaming in the social/psychological overlap as I believe it has both of these components. The victim blaming we receive from others (social) and the blaming abuse victims place on themselves (psychological).
  • Over-indulgence relates to me as: excess alcohol consumption and over/comfort spending.
  • Personally, I believe self-harm begins as a psychological symptom that becomes a biological one, hence the overlap between these two factors.
  • The most contentious placement (and one which I mulled over for nearly two hours) was hypersexuality. Although many may see this as predominantly a social or psychological symptom, based on my own experiences of this state, it can become a biological one.
  • If you have any questions regarding the items and their placements, don’t be afraid to ask! :)

3. Treatments

One of my biggest (and longest standing) issues with the mental health and psychiatric industries is the “one-size fits all” approach to mental illness treatment. Everyone’s experiences of mental illness is unique, so why do people persist in believing that a singular course of action (be it medication, talking therapy etc.) will have the same effect on everyone?

Perhaps this is because I have (obvious) issues and grievances over how I’ve been treated by mental health services, perhaps not. Either way, treatments that may find their way onto your BPS are medication (being biological), talking therapies (being psychological) or support from family/friends (social).

In my personal opinion, one of the most important treatments (and one that is noticeably lacking from my own BPS) is nurture; the physical love we receive from those around us can have a significant impact on our ability to deal with the stressors and pain of mental illness.

I hope one day to be able to add it to my own biopsychosocial model:

__Biopsychosocial Model (TREATMENTS)

Notes on my model:

  • Given the MASSIVE overloading of psychological treatments, is it any wonder I am teetering on the verge of a massive psychological breakdown?!?
  • I believe distraction comes primarily from the distraction we can find on our own (psychological) and the distraction our friends/family can offer (social); hence the overlap.
  • HVSG stands for the Hearing Voices Support Group I attend (I was being lazy!)
  • I have included Meadhbh (and occasionally Audrey) as psychological treatments because when they’re behaving themselves, they can be a source of great comfort, support and love.
  • Mindmapping is a self-help therapy designed to interrupt and sooth triggers. I’ve been working with it for a couple of months now.
  • I’ve long believed endorphins can have a massively beneficial effect on managing mental illness.
  • The all-overlapping kimnyk is something I have discussed in my password protected pages and relates to a part of my sexual-personality that I’m not comfortable sharing in detail with the world due to the abusive, ignorant and damaging comments I’ve regularly received about it in the past.
  • Once again, if you have any questions regarding the items and their placements, don’t be afraid to ask! :)

Once you have written your own biopsychosocial model, how can you use it to assist in managing your condition and working toward recovery? By comparing the three viewpoints and identifying the wheres, whats and wherefores of your life, you can begin to see links between the symptoms, causes or treatments you may wish to explore further.

Personally, I have already realized the immediate need to begin balancing  how I treat my illnesses as the overload of psychological treatments is already becoming a cause – and, if a breakdown occurs – a symptom.

I’ve also noted (as I have in the past) the enormous detrimental effect my tendency to isolate myself during periods of distress has had on my mental wellbeing and recovery. I need to allow myself to believe that asking for help is not only acceptable but doesn’t mean I’m weak, worthless or not trying hard enough. This was hammered home yesterday afternoon, following the worst reaction to a trigger I’ve experienced in months!

As I continue with the Mi Recovery group and learn more about myself and my illnesses, I fully expect to refer back to my biopsychosocial model on a regular basis. Not only to add any new items but to use the connections I’ve highlighted to assist in my journey toward recovery, forgiveness and acceptance.

Perhaps you should try writing one of your own (in a supportive environment, of course) as you may be surprised by the things you discover.


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Mi Recovery: Introduction

mi recovery

Following Acting Up, another group I have begun this year is called “Mi Recovery”. Of all the groups I have begun this term, this is the one I am most looking forward to undertaking.

Mi Recovery is a peer education program for people living with mental illness, offering a peer based approach to the complex issues faced by people with mental illness by combining challenges faced through the lived experience with up to date best practice research. The program adopts a holistic approach where a person can acknowledge their whole self rather than living ‘as their illness(es).’

As with some of my other groups, I have decided to share my experiences of the group on this blog, not merely to chronicle my progress but to share any information or strategies I learn in the hope that others may find them useful in their own journeys.

Given confidentiality is paramount, these posts will focus only on my personal experiences and journey, as discussing the health and wellbeing of others without their permission can have a devastating effect on recovery, trust and health.

Over the following ten weeks I am hoping that Mi Recovery will assist in the creation of new coping strategies, further refine existing coping skills and help remind me who I am and my place in the world.

Only time will tell whether I’m successful in these goals but, as always, I will be giving it my best! :)

“Recovery does not mean that one is ‘cured’ nor does it mean that one is simply stabilized or maintained in the community. Recovery often involves a transformation of the self, wherein one both accepts one’s limitations and discovers a new world of possibility.”
~ Patricia Deegan~

Week 01: Theory on mental illness and factors that enable recovery.
Week 02: Reframing my Whole Self and Understanding Stigma.
Week 03: Treating myself.
Week 04: Planning for Recovery.
Week 05: Working with Relapse.
Week 06: Communication Skills and Strategies.
Week 07: Stigma, Discrimination, Rights and Advocacy.
Week 08: Making the most of the National Disability Insurance Scheme.
Week 09: Motivating purposeful activity.
Week 10: Review of recovery aspirations and program conclusion.