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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Roadblocks to Recovery: #2. Social Anxiety Disorder

To say that being without hope is a strange feeling would be an understatement. To be without hope makes me feel hollow, that something important is missing from my soul. I feel empty. Lost. A little confused. Being without hope is not something I would recommend. It’s painful, disconcerting and altogether mystifying. Yet it’s one of those things that’s easily lost, yet interminably difficult to replace once it’s disappeared from your life.

In this series of posts I am dissecting what is preventing me from navigating further down the road to recovery; all the things that have created roadblocks and zapped the hope from my being. Hopefully, I will be able to shine a light on what I need to do to rekindle hope, and with it, myself.

Social Anxiety Disorder

anxiety

It’s not all bad. Heightened self-consciousness, apartness, an inability to join in, physical shame and self-loathing—they are not all bad. Those devils have been my angels. Without them I would never have disappeared into language, literature, the mind, laughter and all the mad intensities that made and unmade me.
~ Stephen Fry ~

It’s true that social anxiety disorder has provided me with several positives in life. My love of writing, reading and literature. My love of movies, television and the moving image. Even my love of photography, a gloriously intimate act that can be performed quite beautifully in solitude. But for the most part, social anxiety disorder has been the devil that has destroyed me.

Since it’s onset in my teenage years, it has had a profound effect on my ability to make friends and retain relationships, to the point that I now find myself an isolated individual incapable of even talking to people, let alone making friends with them. Social anxiety disorder was also instrumental in destroying my educational career, affecting my A-level choices, ability to cope with examinations and my return to college in 2007 was also hampered by social anxiety, to the point I lost that course within weeks of returning (although glandular fever and abuse also played a large role in the loss of that particular course, it would be plain wrong to suggest social anxiety had nothing to do with it). Even now, as I contemplate returning to university, I find social anxiety rearing its ugly head as it convinces me I would be unable to perform the course or survive around so many other people. Social anxiety disorder plays havoc with the view that I have of my own body, feeding into preexisting body dysmorphic issues that have plagued me my whole life. It also renders simple, day-to-day activities, almost impossible to perform. For example, going to the supermarket has become a strenuous action that shouldn’t be anywhere near as complicated as it is. I have to go at a certain time of the day (early afternoon, when the supermarket isn’t as busy) and I have to go to specific supermarkets, ones which have self-service checkouts, so I don’t have to make ‘small talk’ with the checkout operators as they scan my food.

Everything in my life is controlled around my social anxiety. From walking down the street to the actions I perform whilst there, everything is ordered so as to keep my anxiety as low as possible; no communicating with people, no socializing under any circumstances, no pushing myself into situations that I deem uncomfortable. Activities that I used to enjoy, that I used to garner so much pleasure from, have become no-go areas; for example, I can no longer go to the cinema due to the number of people present, I can no longer attend munches, which in 2013, were one of my few lifelines of social interaction. Even blogging, an activity I used to relish, has become super-difficult for me to perform. I worry continuously over people judging the words I have written, stress endlessly about commenting, even on my own blog, let alone other peoples and find myself censoring myself for the first time in eight years out of pure stress over what people may think of my output.

Although social anxiety has always played a tremendous role in my life, I’ve found that since my hospitalization earlier this year, it has only become worse. Since coming out of hospital I have been isolating myself more and more, refusing to go out unless I absolutely (unequivocally) need to. I have become, for want of a better word, a recluse. A hermit. Someone who refuses all social interaction due to the worry over panic attack, due to the worry over what other people may think of me, due to the possibility of making a complete and utter fool of myself. I don’t know why being in hospital escalated the symptoms of my abuse. Perhaps it was being forced to share a ward with other individuals. Perhaps it was the control being taken from my life. Perhaps it had nothing to do with hospital, and that’s just become a convenient excuse. All I know is that over the last few months, my social anxiety has been so out of control, so impossible to contend with, that it has become (even more so than it used to be) a serious illness that has a profound (and monumental) debilitating impact on my life.

It is holding me back. It is preventing me from living. It is sucking the hope from my being on a daily basis. It is destroying what belief I have left.

So what can be done? What possible avenues can I explore to try to fix this particular, debilitating aspect of my mental health? Well:

Firstly, there is talk therapy. I have spent very little time in my life talking about social anxiety. Psychiatrists have been uninterested in this aspect of my mental health, preferring to focus on the (perceived) more serious illness that is bipolar affective disorder. Psychologists, equally, have ignored this part of my illness. Instead choosing to focus on my moods and blaming my ineptitude (and lack of effort) for my isolation and inability to communicate and/or make friends. What I need, more than anything, is a psychologist who understands what social anxiety is, how it impacts on someone’s life and the damage that it can cause if left unchecked. I’m hoping that the psychologist I am planning to see will have this understanding, but only time will tell on that.

Secondly, there is exposure therapy. Of all my readings on social anxiety disorder, this form of therapy seems to have a particularly positive effect. For those not in the know, exposure therapy is when someone is slowly exposed to the source of their anxiety and/or trauma in the hope it will lessen the impact and help the individual cope with what is causing the pain. In the sense of my social anxiety, this means exposing myself to situations where other people are present, where I am forced to socialize and communicate with strangers, in the hope it will lessen the control social anxiety has on my life. Perhaps this means attending psychosocial rehabilitation groups again, perhaps it means forcing myself to go to the cinema (under controlled circumstances), perhaps it means just going to the supermarket during the busiest time of the day. Whatever I decide, exposure therapy could work.

Thirdly, there is CBT and DBT, which I’ve heard can work wonders for people with anxiety disorders. As I have attempted to self-teach myself these practices, to little or no effect, I feel that I need to work through these treatments with another individual – perhaps a psychologist – who understands them better than I.

Fourthly, there is simply being more kind to myself. I am immensely hard on myself in all walks and manners of life. In fact, it would be fair to say that I hold everything I do up to intense scrutiny. From the blog posts I publish, through to the meals I cook, and the speed in which I walk, everything is criticized, analyzed and torn apart by my perfection seeking mind. I need to learn to be kinder to myself, to understand that not everything I do needs to be perfect, that nothing anyone does is ever perfect. I need to find a way to look at my body with acceptance rather than revulsion; I need to find a way to blog without tearing myself apart; I need to find a way to act without criticizing myself into oblivion. I need to be kinder to myself; for if you can’t accept yourself, how can you expect anyone else to accept you? If you can’t love yourself, then other people cannot love you. It’s as simple as that.

Fifthly, there is seeking advice from people who are either living with their own battles with social anxiety, or those people who have successfully managed to control the impact it has on their life. But for that I need to get past my own insecurities over commenting and emailing and teach myself, once again, how to communicate with strangers. For the knowledge of other people is often the greatest knowledge of all – or at least, that’s what I’m led to believe.

Sixthly, well, I can’t think of a sixthly at this time, so these five goals will have to suffice for now.

Whatever happens with my attempt to manage social anxiety disorder, I know that I will not be able to live the life I deserve (see, starting to be kind to myself already) until I have learnt to control my anxiety. It is, without question, one of the biggest (and most severe) roadblocks on my recovery journey – and one I need to tackle quickly and definitively.

Previous installments in ‘Roadblocks to Recovery’:


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31 Days of Bipolar: Day 05. Six of the best treatments for bipolar

Day 05: What treatment, therapy etc do you do?

Lucy-Therapist

Most people who I’ve spoken to that are afflicted with bipolar have a psychiatrist monitoring their progress, medication and moods. In fact, I would go so far as to say that having a psychiatrist is pretty much a prerequisite for someone suffering from an illness as serious as bipolar. However, as the last appointment I had with a psychiatrist went so badly, I no longer have any trust for people in this particular profession. Thus, I am left to navigate the ups and downs of bipolar all on my lonesome.

But that doesn’t mean I don’t undertake treatment, I do, and here are six examples to prove it:

Medication

First and foremost, there is medication, something that pretty much everyone who is diagnosed with bipolar has to contend with. I say contend with because some of the side effects of psychiatric medication can be pretty brutal, as I discovered this year, but regardless of these side effects, medication is quintessential for dealing with bipolar.

At this point in my life my medication regime is: an antidepressant (Fluoxetine, 40mg/daily), an anti-psychotic (Solian, 100mg/daily) and a second anti-psychotic (Abilify, 10mg/daily).  For those who have some knowledge of bipolar, or medication in general, you will notice something pretty obvious is missing from this chemical cocktail…and that is a mood stabiliser.

I had been taking Sodium Valproate (aka Epilim) at 1000mg/daily, but this was immediately cessated in January 2015 after it caused a particularly nasty bout of acute pancreatitis that saw me hospitalised for two and a half weeks. Since then, I have had numerous conversations with my GP about starting an alternative mood stabiliser, as my mood as been rather unstable over the last three months. He ruminated over starting me on Lithium, a drug that works exceptionally well for me, but because it negatively interacts with the Fluoxetine he decided against it. Whether or not I will ever be back on a mood stabiliser is beyond my control. Personally, I would be happy to stop the Fluoxetine in favour of Lithium, but my opinion is neither here nor there. All I do know is that without a mood stabiliser, my moods will continue to fluctuate wildly, and it’s doubtful I will be able to stabilise myself, regardless of how many anti-psychotics I’m taking.

Support Worker

My only form of real-world contact comes from the weekly appointments I have with my support worker. In all honesty we don’t do all that much, mainly because my anxiety prevents me from opening up to her. So our appointments are basically her battling to get me to say anything whilst occasionally recommending a particular course of action for me to take.

This is yet another example of how my anxiety impacts on my life. It would be wonderful to have an open and honest relationship with my support worker, but no matter how much effort I put in toward achieving this, anxiety rears its ugly head and prevents me from saying anything. It’s frustrating. It’s annoying. It’s all manner of badness. In fact, more than anything, it’s gloriously ironic. Here’s a person who could potentially help me manage my anxiety, but I can’t talk to them because of my anxiety. Grrrr!

Talking Therapy

Okay, I’m being a little cheeky here. As I write this I’m not technically undertaking any form of talking therapy. I don’t have a counselor. I don’t have a therapist. I certainly don’t have a psychiatrist. But I am hoping that I will soon have a psychologist with whom to examine the intricacies of my life.

During my last visit to my GP I informed him of how difficult it is to deal with my anxiety, to deal with my PTSD and to deal with the fluctuations of mood that bipolar causes. He suggested I see a psychologist (it’s been several years since I last saw one) and dutifully referred me to someone.

I’m still waiting to hear from them about my first appointment (if I haven’t heard by tomorrow, I’ll be calling them next week) so will keep you abreast of developments in this area of treatment.

CBT and DBT

Without someone to help me with these forms of therapy, I am left to navigate them all on my lonesome. This may sound difficult, and it is, but I have a number of books on both subjects that have helped me understand the basics of each form of therapy and allowed me to partake in them as and when I’ve been focused enough to do so.

I have to be honest, I am hoping that the psychologist I’ve been referred to will be a practitioner of DBT, as I believe it would be of tremendous value to have someone assist me in working through this particular form of treatment. Fingers crossed!

Acceptance and Commitment Therapy

This is something I’ve been practicing since I first learned of its existence in 2013. Back in that heady year of mayhem, busyness and fun I undertook an ACT based psychosocial rehabilitation group and learnt  many of the exercises and metaphors that populate this method of treatment.

Some posts I’ve written on Acceptance and Commitment Therapy (in case you were interested!):

Writing Therapy

Although my blogging isn’t as prolific as it was in 2012-2013, it is still one of the primary methods of therapy that I undertake. There is something gloriously cathartic about writing about your life, feelings, emotions, moods and thoughts before sharing them with the world. Even if no-one reads, likes or comments on a post, I am still proud of myself for having the courage to put it out there in the first place, especially as my anxiety often interferes with my blogging and works to prevent me from posting anything at all.


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I Forgot to Remember to Forget

victimblaming

For the last several weeks I have been considering ending my blog for a myriad of reasons, most notably because I am tired of being told that all I need to do to rectify over twenty-one years of mental health problems, trauma and abuse is to simply ‘get over it’.

Over the years I have done my best to describe the difficulty of living with mental illness but in recent weeks I’ve come to realize that my writing is not good enough to explain the complexities of these conditions and the challenges some people face in order to live more contributing lives.

Living with unsupported (not by choice) and un-medicated (again, not by choice) mental illness is beyond difficult – especially when that ‘living’ is done in abject poverty and isolation.

In recent weeks the ‘get over it’ mentality that has been thrown at me has caused tremendous distress and self-hate. It has fuelled my descent into alcoholism, my withdrawal from the world, increased self-harm and confirmed my belief that I am a failure; that I am simply weak because I have been unable to move past the (multiple forms of) abuse I received.

I am all too aware of what I need to do. I am not an idiot. I am not stupid. I am not lazy and I am certainly not someone who doesn’t work for a better future. If it was as simple as just ‘getting over it’ I would have done this years ago.

All I have done for six years is work myself to the bone for a better future (my years of fighting to get off the streets, my years of battling for support and mental stability, my years of trying to break free of social isolation and poverty, my years of combatting the trauma of abuse, my years of trying whatever therapy option I can get my hands on, my years of trying to improve my education and employment opportunities, my years of trying to raise awareness and help others who are suffering to realize they are not alone in this war) when it would have been all too easy to give up and drink myself to death.

But telling someone to just ‘get over’ trauma is naïve, pretentious and deeply insulting. It is akin to telling someone suffering from depression to just ‘cheer up’ or a victim of rape to ‘forget about’ what happened to them. A counselor I saw a few weeks ago described it as victim blame mentality, for it shows a complete lack of understanding of mental illness, abuse trauma and how these two issues feed into each other. It minimizes the effort someone is making to overcome their illness and blames them for not being strong enough to just ‘get over’ whatever is happening to them.

Three days ago I woke up following one of the most visceral dreams of my life. A dream so vivid I thought I had Quantum Leaped back into my July-2007 self! Upon waking, the pain I had relived was so intense – so real – I promptly vomited over my bed, bedside bookshelf and books. I haven’t slept since because I’m too scared to do so.

I cannot control my subconscious dreaming any more than the next person can, and no amount of telling me to just ‘get over’ these events is going to stop the constant parade of nightmares that constantly hurl me back into those times, especially without support or distraction.

Many people struggle to fight issues of mental illness, abuse and homelessness when surrounded by friends, family and professional support – let alone someone who has spent almost every minute of the last six years (bar six months in 2008) completely on their own.

So if this failure to just ‘get over’ my illness and trauma makes me weak, useless, pathetic, lazy, selfish, worthless and someone who isn’t working hard enough – all things people have called me for not being able to fix myself over the years – then I guess that’s who I am.

Personally, I prefer to see myself in a different way.

But I would say that, wouldn’t I?

Postscript:

I haven’t decided whether or not I will be ending my blog yet. Although the reasons are real and valid (in addition to the above: I’m a bad writer, I have nothing original to say, I’m effing tired of life, there are many people who raise awareness far better than I) with all I’ve been through over the years I am more than aware my current depression is the central voice beyond this thought. I have made irrational decisions based on my mental health in the past – such as the instigation of my suicide plan in 2006 – and do not wish to make a firm decision whilst lost in this state. Until I’ve made this decision my blog will remain and I am going to try to post more frequently than I have of late.

As for other areas of my ‘life’:

  • I have made efforts to begin dealing with my current alcoholism (however much I hate to use that word, I can no longer deny it, for I have consumed more alcohol in 2013 than I have in the five years between 2008-2012 combined! Hmmmm? Does that mean people will now begin accepting me as ‘Australian’? :p)
  • I am also trying to seek psychiatric care but have been told an appointment will not be available until March/April at the earliest as I’m not in ‘crisis’. Yay the mental health system in Australia!
  • I have also begun working with a new therapy called ‘Mindmapping’, which I will explain in a post later this week (hopefully).
  • My internet connectivity is still buggered. I humbly apologise to people who have emailed me over my lack of reply. I am not deliberately avoiding doing so. Sorry.
  • This is the first time I’ve logged into my blog for weeks, so more apologies for not responding to comments that have been left. I will endeavor to get to them soon.
  • Current 2013 smile count = 3½  (upon receiving a Christmas card, listening to Amy MacDonald, upon waking following a dream about Stephanie and whilst watching the Doctor Who episode ‘School Reunion’ – although this was a bittersweet sad smile upon seeing Elisabeth Sladen (RIP), hence the ½.)

Here’s hoping you’ve all had a better start to the year than me :)


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Cognitive and Dialectical Behavior Therapy

Over the years, my posts have tended to be about:

(a) incidents of my life that have been analysed beyond all reason
(b) subjects that I have researched and/or lived through so I feel I have some understanding of them
or
(c) random insanity.

Rarely (if ever) do I sit down to write about something I know little about, mostly because doing so fills me with embarrassment over my ignorance and naivity, both of which play into my social anxiety quite severely.

However, for today’s entry in the Mental Health Month Challenge, I must battle through this anxiety to admit my lack of knowledge over two rather well known areas of psychotherapy as the prompt is: I don’t know much about this, but I’d like to.

So please forgive my lack of knowledge on these subjects :)

Cognitive behavioral therapy (CBT)

CBT-Triangle1

“Cognitive behavioral therapy (CBT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to behavior therapy, cognitive therapy, and to therapy based upon a combination of basic behavioral and cognitive principles and research.” [from Wikipedia]

For several years, virtually every psychiatrist, therapist or counselor I saw raised the CBT acronym within a matter of minutes.

Of all the therapies available I’ve always believed that this could have the greatest impact in changing my thought patterns and emotional responses toward my anxiety, mood swings and self-hate, but given my nomadic homeless life, I’ve never been in a position to undertake the treatment nor fully research what this psychotherapeutic approach entails.

Now that I’m in a better position to push forward with my life, this is certainly something I’m planning to look into further, even if it means going it alone via books and/or the internet because of my distrust of psychiatrists and the mental health system.

Dialectical behavior therapy (DBT)

DBT Model Of The Mind

“Dialectical behavior therapy (DBT) is a system of therapy originally developed by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat people with borderline personality disorder (BPD).DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. DBT may be the first therapy that has been experimentally demonstrated to be generally effective in treating BPD.A meta-analysis found that DBT reached moderate effects. Research indicates that DBT is also effective in treating patients who present varied symptoms and behaviors associated with spectrum mood disorders, including self-injury.Recent work suggests its effectiveness with sexual abuse survivorsand chemical dependency.” [from Wikipedia]

Although I know even less about DBT than CBT, over the last few years I’ve been hearing more and more about this psychotherapy and the possible gains it can bring to someone’s life.

Unlike CBT this has never been raised by any of the MH professionals I’ve seen, which leads me to question just how beneficial it would be in helping me deal with the issues I face? Thus, I would need a lot more information about this subject (and talk to a professional about it’s possible benefits) before I put any thought into whether this could be helpful or not, but it’s certainly something I’m interested in pursuing in my quest to become a better version of myself.

So if anyone wiser than I has any links or book recommendations for someone wishing to research CBT or DBT, please let me know in the comments section, Twitter or email as your help would be greatly appreciated. Thank you kindly :)