I Aced the Test! Part 4: Know thy enemy

I promised we’d take a look at the consequences of long-term stress (and, by association, trauma) on the body, didn’t I? That’s today’s topic so buckle up, Class.

Before I jump in, I want to define a few terms so we’re all speaking the same language.

The amygdala is a little almond-shaped cluster that controls your emotions–namely, fear and the fight/flight/freeze response. Memory and decision-making are also controlled by the amygdala.

The autonomic nervous system controls all unconscious processes, like breathing, blood pressure, and heart rate. Think of it like a car with automatic transmission, or being on autopilot.

Adrenal glands produce adrenaline and cortisol when the body reacts to a stressor. The inner medulla is the part that produces the hormones epinephrine and norepinephrine, which help kick off the whole fight-or-flight response.

In a nutshell:

Stressors trigger the sympathetic nervous system and hormones come rushing in full-bore. The amygdala enters the chat, which sets off a chain reaction with the adrenal glands and other endocrine systems. Your blood pressure goes up, your heart rate increases, you sweat. Without you even noticing it, your body is preparing to take one of three paths: fight, flight, or freeze.

When in crisis, our bodies and minds work in tandem to respond to the situation. The good old autonomic nervous system kicks into gear, triggering an immune response (which is designed to protect the body and fight off “intruders,” so to speak)¹. This immune response releases histamines, which are also the cause of hay fever symptoms like itchy eyes and hives. It may sound counterintuitive, but all of these unpleasant symptoms are part of your body’s fight to keep you alive. The second the stress hit that tiny little amygdala, you were no longer in the driver’s seat. Ever since that moment, you’ve been on autopilot–think of your body as a kind of gundam suit designed to protect you by any means necessary. This response is as effortless and natural as breathing. 

When most people hear the word “adrenaline,” they often imagine a scene such as a mother lifting a car off her baby. Our entire autonomic nervous system is wired to keep us alive, and the body can do incredible things when under acute stress. 

However, you can’t sustain that level of intensity forever. Think of a rubber band. You can only stretch it so much before it begins to lose some of its elasticity, and the same principle applies to stress and the body. Our bodies are not built to sprint at 84,000 miles per hour 24 hours a day, 8 days a week, and that’s precisely what long-term stress demands of you. 

Miller, Chen, and Parker (2010) describe stress as something that “accumulates” in the body’s cells. What this means for you, dear Reader, is that your body is in a constant state of inflammation because those hormones are poppin’. Even if it’s more of a wallflower than the life of the party, that inflammation is still there. 

This leads us to our next point: vulnerability for chronic illness. When your body is constantly on high-alert, it reacts to stimuli that may not bother the average bear. Many trauma survivors have at least one, if not multiple, chronic health conditions. Autoimmune disorders such as lupus are more common in adult cis female trauma survivors². Additionally, the odds of an autoimmune disorder causing an individual’s first hospitalization were higher among adults who reported two or three different types of childhood adversity, such as physical, sexual, and/or verbal abuse; parental neglect; or having a parent or caregiver who struggles with substance abuse or mental illness³. 

There is a strong behavioral component to this complex issue as well. Early trauma leads to hypervigilance and mistrust, meaning there are cognitive and emotional factors layered on top of the biological aspect. (It’s like the world’s worst sandwich, basically.)

Let’s pause for a visual aid. I wonder how many of you are familiar with our good friend Ouroboros. 

Picture the biological factors as the head of the snake, and the cognitive/emotional factors as the tail. Or reverse it. Either way, they are simultaneously feeding and devouring each other. Much like our old pal Anxiety, stress feeds itself. 

So, that probably sounds terrifying, right? It doesn’t have to be. Here are some platitudes to explain why:

• Knowledge is power.
• Know thy enemy.
• If it bleeds, we can kill it.

If we know what our own vulnerability factors are, we can find ways to counter them. If you have a chronic illness, make sure you’re keeping in touch with your doctor and taking any medications you’re prescribed. Try to eat well, stay hydrated, get enough sleep. Take at least a minutes throughout the day to do something you enjoy and celebrate being alive. A client once very astutely described living (versus surviving) as “nurturing the being as well as the human.” We exist on many levels–physical, emotional, cognitive, spiritual. Please be kind to yourselves and send love into the darkness.

One final note:

Take care of yourselves, Readers. Go take a safe, socially distant rainbow walk. Get some vitamin D–it’s good for you! Read a book. Plant a tree. Take a hot shower with a frozen orange. Meditate. And for the love of god, wear a mask and stop touching your face.

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1 Quas, J. A., Bauer, A., & Boyce, W. T. (2004). Physiological reactivity, social support, and memory in early childhood. Child Development, 75(3), 797-814.

2. Roberts AL, Malspeis S, Kubzansky LD, et al. Association of trauma and post-traumatic stress disorder with incident systemic lupus erythematosus in a longitudinal cohort of women. Arthritis Rheumatol. 2017 Nov;69(11):2162–2169.

3. Miller, G. E., Chen, E, & Parker, K.J. (2011). Physiological stress in childhood and susceptibility to the chronic diseases of aging: Moving toward a mdoel of behavioral and biological mechanisms. Psychological Bulletin,137(6), 959-997.

On Vulnerability

There are so many words in the English language relating to innocence and vulnerability, and most of them can bring me way down if I’m not careful. They provoke some ancient anxiety that I’ve come to realize, with the help of my excellent therapist, are linked to what she calls my “wounded younger self.” (I was incredibly skeptical of inner child work at first, but it is incredibly effective and incredibly healing.)

“Little” is an adjective that, when paired with certain words that also remind me of innocence, usually messes me up emotionally. That’s the word that got under my skin tonight.

I’ve been feeling kind of “off” the last few days. I recently blocked my mother completely on my phone–including the second number I thought she’d deleted until she used it to contact me after I blocked the first number–and was treated to some really unsettling dreams on Monday and Tuesday night.

Monday’s main feature involved me skipping my grandmother’s birthday party because my mother was going to be there and I knew she’d be drunk. Tuesday’s late-night horror show involved a healthy helping of guilt because I was hiding from her (in a Target, of all places) while she wailed and lamented that she “couldn’t believe [I] didn’t want to talk to her.”

Naturally, this put me in a pretty weird headspace today. Wednesdays are my big clinical days and I do group as well as individual client work. As such, I generally store my feelings away to deal with later and do a pretty good job of not thinking about them at all during the day because I’m 100% focused on my clients. (Side note: I adore them, and I’m bummed that I’m leaving my practicum site in a few weeks!)

On the drive home from class this evening, though, those neglected feelings reared their ugly collective heads and roared.

The anxiety and guilt were so powerful that I considered just going to bed early and sleeping it off.

Instead, I took a shower.

I focused hard on those thoughts and attempted to get a good, cathartic cry in. Nothing happened.

I turned the focus to that wounded younger self I mentioned and took the opportunity to literally hug myself while I waited for the conditioner to work its magic on my decidedly unruly hair. I decided to speak aloud because I’m home alone most days during the week and hey, I knew the cat wouldn’t judge me. (Audibly, anyway.)

I told my younger self that it’s okay. I told her I love her and that I’m sorry she felt like no one could keep her safe. I told her that I’m going to do it. This changed into me speaking to whatever hypothetical future child I’ll end up having. I promised that child to take the best care of it I can and to make sure it never feels afraid or lonely.

And I cried. Instead of stifling it or trying to be tough, I gave myself over to it completely–ugly, wracking sobs. After a while, those sobs turned into relieved laughter that I’m sure sounded like I’d finally gone completely ’round the bend.

I think there’s something to be said for having a good cry.

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On Monday, I spoke to my clients in group about the concept of “ghosts”–they had all shared some intense and profound stories about their deepest wounds, their secret shames, their most painful memories. I told them that while they can haunt you, they can’t physically hurt you. You can start to let go of them.

I led them in one of my new favorite exercises, which is “HA!” breathing. Basically, you take a deep breath and push that breath out while making a “HA!” sound. I opened the group with the exercise and invited them to imagine themselves yelling at someone or letting frustration out. I demonstrated (because I am not afraid to look silly anymore), and they loved it. After the big, intense sharing session, I led them in the exercise again, this time instructing them to imagine the “HA!” on the exhale as them blowing out part of their ghosts.

I’m glad it was a hit, and I encourage you all to try it, readers. Howling into the void or, as I called it, “therapeutic yelling,” is incredibly cathartic.

 

It’s okay not to go home again.

For Thanksgiving, we flew back to my hometown in the Midwest to visit my remaining family–my mother, the aunt who was my legal guardian when I was a child, and another aunt who lives about an hour away from said hometown but visits regularly.

As I told my therapist this afternoon, “I don’t want to say it sucked, but…it sucked.”

I don’t want to get into any of the messy details, but I realized a few things during our brief Thanksgiving trip.

The first is that my grandmother is dead, like, for real-real. My “mom” is dead. Full stop. It’s not that I was pretending otherwise, but being in her house without seeing her there drove the point home in an unexpectedly painful way, and I had to hold it together while I was there because I knew if I lost it, so would everyone else, and then it’d be this whole terrible thing that I was just not equipped to handle.

The second is that it’s not normal to spend the week up to your flight being anxious and trying to brainstorm ways to defuse any potential arguments. It’s not normal to be five minutes from landing in your hometown and freaking out because you have no idea how many fights there will be this time or how bad they’ll get.

The third is that it’s simply not healthy for me to go “home” again. My therapist agreed with this assessment–there really is nothing there for me anymore. I’m 28 and am building my own life, my own family. If anyone wants to visit me, they know where I am. There are several large airports nearby. I never turn my phone off, though I have become more selective about when I answer calls–if I’m emotionally exhausted and have nothing left to give that day, I let the call go to voicemail.

It’s not like I’m unreachable. I just don’t want to make the effort anymore. I’m tired of throwing myself out into the wilds of my family-of-origin and hoping I come back in one piece. I’m tired of having to tell them, “Hey, I flew all the way here, can we all just get along?” I’m tired of having to put a dog into the fight. I’m tired of there even being a fight.

I went back “home,” and all I got was the flu and three days of crippling anxiety and depression.

Readers, it’s okay to set boundaries. If, like me, you’ve finally hit your breaking point, please try not to feel guilty about it. You need to take care of you first. You can’t pour from an empty cup, and life is too short to spend it with people who make you miserable.

An Audio Post!? 4-7-8 Breathing Exercise

Hey readers! I haven’t posted any sort of “There’s a real person in here!” content in a really long time, so here’s a quick clip of me walking you through an even quicker breathing exercise. Click below for the transcript and let me know what you think!

(Side note: I love transcribing stuff because it makes me uncomfortably aware of my verbal tics. Sorry ’bout that.)

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Dichotomy

Is it possible to simultaneously be the most troubled and the most well-adjusted person you know? The deeper I go into my counseling program, the more this question pops into my mind. On the one hand, my demons are legion. On the other, I keep them very well-controlled and they all have little color-coordinated leashes.

Am I well-adjusted because I have to be? Does being well-adjusted look the same, or mean the same thing, for people who have backbreaking loads of trauma and those who don’t?

I used to worry a lot about whether my personal mental health history meant that I can’t be a therapist. I still worry about that, though thankfully not as much. Tonight in class, we were discussing self-disclosure and one of my classmates brought up that exact question–how are our clients supposed to trust us if they know we have our own set of problems?

I guess it’s one of those situations where what you have doesn’t matter as much as how you handle it. I get up every day and even though I do a fair amount of yelling at the intrusive negative thoughts, I still manage to accomplish everything on my to-do list. (Well…most things, anyway. I’m human.)

This has been on my mind for most of the day today, probably because I had intake with my new therapist yesterday and was thinking about the wall between my thoughts and feelings. I depend so heavily on that wall to keep it together, and I’m a bit worried–or, okay, a lot worried–that once I start really delving into the trauma and trying to merge my thoughts and feelings that there will be this monumental change and I’ll basically fall apart. I can’t remember the last time I was able to feel an emotion on an actual deep, meaningful, emotional level for more than a flash before cognition takes over and the brain reasserts control over the “heart.”

I know that’s unrealistic and that no one can do a total 180 in terms of functioning, but the unknowns are scary. As horrible as it is to know certain emotional things but not be able to feel them…better the devil you know than the devil you don’t, right?

I haven’t had self-doubt like this in quite a while, but getting the thoughts down on this little blog has helped a bit. It’s funny how writing about your troubles takes away some of their power, isn’t it? I’m also going to hit the self-care pretty hard tonight because tomorrow I have a phone interview with another prospective internship site–yay! That search is pretty terrifying, but I have a good feeling about the last couple of sites I’ve contacted, so fingers crossed.

Until next time, readers, remember to take good care of yourselves. I will, too.

 

News Day Tuesday: Acronyms! (Or: MDMA for PTSD)

Good morning, readers!

School started last week and there’s been a lot going on in my life on the personal side–my 93-year-old grandma, who essentially raised me as her own for most of my childhood, has been ill and I’ve once again been dealing with anticipatory grief.

Anyway, on a happier note, here’s some news for you about PTSD. (And it’s literally happy–it’s about Ecstasy!)

In a nutshell: those lovable FDA officials just granted MDMA “breakthrough therapy” status as a potential treatment for PTSD. Clinical trials will (hopefully) be easier to come by now, and I am very much looking forward to seeing how this develops.

Important distinction: MDMA isn’t FDA-approved, but this is a huge step in a very promising direction.

Right now, PTSD treatment options are super-limited. My brand is pretty wicked, but my only option for dealing with the symptoms is lorazepam/Ativan. I count myself lucky that I only have depersonalization/derealization, anxiety around crowds, and the occasional nightmare. It could be a lot worse. I’ve written extensively in the past about my experiences with dissociation (hence the name of the blog), but like most things, you get used to it.

But it’s not something anyone should have to “get used to.” None of us should have to accept the symptoms as our “new normal,” and for many, the symptoms are debilitating. That pretty much goes without saying (though of course, I decided to say it anyway).

I recently completed a research proposal for one of my summer classes, and while it was a painful process for someone who’s not a big research fan, it was definitely eye-opening. There has been shockingly little research done on depersonalization/derealization; most of what I encountered deals with “dissociation” in broader terms and the individual disorders are either not specified or are all lumped together in a mass that ultimately provides no insight about the actual conditions.

Anyway, that’s a post for another day. What I’m getting at is that PTSD is an incredibly complicated beast. While some symptoms are consistent, it never looks the same in two different people. Anecdotally, the symptoms can look different at various stages in a person’s life.

Seven years ago, I was having flashbacks (not the dramatic Hollywood kind where you’re literally in the memory–the kind where you sort of space out and the memory plays out in your mind’s eye while you’re pretty much unresponsive to the real world). Then, in 2012, the flashbacks stopped and the depersonalization/derealization got its hooks into me and has been hanging on for dear life ever since.

Like I said, you get used to it. The pain fades. You adjust to never really feeling “real,” to being in this perpetual dreamlike state. When it spikes, I try to welcome it as a new adventure and pay attention to what feels different without getting anxious or judging it as “bad.”

Still, it would be nice if there was something out there that could help just a little. I’ll be keeping my eye on the MDMA  breakthrough and keep you posted on further developments.

In the meantime, readers, what helps with your symptoms? Grounding exercises are one of my favorite things to do if I start to feel anxious. It’s less tedious than counting things.

News Day Tuesday: Election Anxiety

Good afternoon, readers! It’s that time of week again!

First of all, for those of you who don’t follow the Facebook page for The Dissociated Press (and if that’s the case, why not?), I have some exciting news to share: Last night, I found out that I’ve been accepted to Johns Hopkins’ Master of Science program for Counseling Psychology! I’ll be starting in the spring.

Now, on to the main event for this week: election anxiety. I’m sure most of us have felt it at one time or another, and for many, it’s probably coming to a head right about now. Today’s article comes from K5 in western Washington state.

Bernice Imei Hsu, a registered nurse and licensed mental health counselor, stated that around 85% of her new patients come in to discuss anxiety related to this year’s presidential election. Some of the clients began presenting with these concerns as early as May of this year.

Hsu has some great tips for helping with election anxiety:

Hsu first assesses how well her clients can handle conflict and change. She then helps them come up with a plan for how they might react to election results.

She asks clients to identify people in their lives who can help them discuss their anxieties and needs. She also encourages clients to practice “relentless self-care.”

“Maybe they need to take a little break, maybe they need to turn down the volume a bit of their social media feeds, stop screaming in all caps, or reading other people scream in all caps, turn it down, tone it down, and take care of themselves,” Hsu said.

The first time I voted in a presidential election was in 2008, and I remember being incredibly anxious. That anxiety was even worse in 2012. This time, I’m feeling oddly calm about it, though I think that’s because I’m in a better place mentally and have already set up some fun activities for tonight to keep my mind off the results (even though I’ll inevitably end up watching them roll in).

I have coloring and cross stitch on the list, as well as my ever-expanding Netflix queue, which is always a good distraction. I’ve realized that while I can vote, I ultimately can’t do anything about the results and that it’s better not to waste my energy worrying excessively about it. Whatever happens is what happens; I find this point of view very calming.

What about you, readers? Do you get election jitters? How do you combat them?

News Day Tuesday: Ohio State Mental Health Triage

Good afternoon, readers! Today, we’re tackling the concept of mental health triage for university students. Ohio State University has reported a 43% jump in the last five years in the number of students seeking mental health care. Needless to say, that’s huge.

The question of how much academic demands contribute to anxiety levels among the student body is a complicated one. Parenting styles have definitely changed over the last decade or so–I’m 27 and when I was young, “helicopter parenting” really wasn’t a thing. My peers and I were allowed to walk alone to and from school and play outside unsupervised, often late into the after-dark hours. My family placed relatively few restrictions on how I spent my free time; reading and viewing choices were left up to my own discretion, with the assumption that I would make good choices for myself. As a result, I didn’t have much trouble adapting to the freedom that comes with college life, though I did live at home for the first two years of my undergraduate program.

As a non-parent, I can’t speak personally to what parenting styles are in vogue these days. However, it seems that (for very valid reasons) parents have become much more cautious and protective. This naturally leads to students feeling anxiety over the unprecedented freedom that comes with college and living away from home for the first time. Tuition and student loans are also enormously stressful–I know I’m not the only one who had a bit of a freak-out upon receiving that first scary bill after the post-graduation grace period ended. The overall “climate” of university life, combined with the myriad of complicated developmental changes adolescents and young adults have to navigate, creates a perfect storm for the emergence of mental health issues.

This brings us back to the subject at hand: mental health triage. It’s an intriguing concept and one that’s particularly timely; with so many patients in need being turned away from psychiatric wards due to lack of beds, it’s clear that we need to figure out a way to prioritize who needs what kind of help, and how urgently they need it.

Ohio State’s triage consists of determining whether students require more intensive one-on-one therapy or more general group-based therapy and seminars. The university offers a workshop called “Beating Anxiety,” which is something that I’d love to see implemented at more schools, particularly as part of the standard first-year curriculum. During my first year of undergrad, I saw many of my peers struggle with taking full responsibility for every aspect of their lives. It can be overwhelming to navigate roommates and coursework as well as meeting daily needs for the first time. Add to that a work-study job or two to supplement financial aid, and it’s not hard to see why so many students are stressed.

Another aspect of Ohio State’s program that I love is the “Recess” event:

On a grassy lawn, there are tents where students can make balloon animals, blow bubbles and play with therapy dogs and a large colorful parachute. The event is designed to help students relieve stress and to introduce students to counseling center services and staff in a fun way.

– Students Flood College Mental Health Centers, The Wall Street Journal

You can read more about the impressive range of resources offered to students at Ohio State here.

Readers who have a college background, what kinds of programs do you think are most valuable? What was/is available to you?

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News Day Tuesday: Local Mental Health Resources

Good afternoon, readers! This time, let’s talk local resources for mental health care.

I saw a wonderful counselor through the Johns Hopkins Student Assistance Program (which I’m eligible for because my significant other is currently a student). I’ll share more of the personal details in a post later this week, but the counselor I met with gave me some information about local resources I had no idea existed, and I’d like to pass those on to you. I feel they’ll be particularly useful to anyone in the Baltimore area, but I’m sure there are similar programs throughout the country.

First is Sheppard Pratt. Being new to the area, I was unfamiliar with this hospital, but they have a program specifically designed to help people dealing with all sorts of trauma.

The Trauma Disorders program at Sheppard Pratt specializes in dissociative disorders and CPTSD, which is exciting because I had no idea these types of programs existed anywhere. They certainly weren’t a thing in the Midwest, where I’m from. It’s an inpatient program, which isn’t a good fit for me for a number of reasons, but I plan to reach out to see if they know of any good outpatient therapists who are well-versed in these issues.

It’s comforting to know that there are facilities that offer support specifically tailored to complex post-traumatic stress disorder, which can present challenges to many therapists. I found one therapist during my time in Madison who seemed to know quite a bit about PTSD, including my dissociative symptoms, but she went on maternity leave shortly after I began seeing her. My subsequent searches for therapists was largely unsuccessful, which is not a negative reflection on any particular counselor–as I said, it can be a tricky affliction to effectively treat. I’ve been told that because of the depth of my dissociative symptoms, I’m not a great candidate for EMDR, which eliminates one of the most widely-used techniques for treating PTSD.

The second resource I learned about last Friday is the Baltimore County Crisis Response, which offers not only crisis intervention (as the name suggests), but also a 24-hour hotline and–this is the most exciting part–one-time psychologist and psychiatrist consults, which are particularly useful for people who are in a transitional period and looking for providers in the area but need refills of medication or therapy. That’s right, readers; there’s actually a place you can go for those all-important refills you can’t get anywhere else, which means no more rationing of medication to make it through.

The counselor at JHSAP was also kind enough to email me a long list of references for therapists in the area. Admittedly, I’ve been procrastinating a bit and haven’t gotten around to checking them out, but it’s on the list for this week.

Are you aware of resources and programs in your area, readers? Are they easy to locate, or do they require a bit of digging?

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The illusion of control.

Last night was, admittedly, a little rough for me. I’m getting over a nasty cold, which always plays hell with my moods, but the day as a whole went pretty well. But around bedtime, I sort of…crumbled. Those old feelings of guilt and worry and nonspecific “bad” began to surface and I lost it for a while.

It should come as no surprise, especially to long-time readers of this blog, that I tend to be a worrier. But here’s the kicker–I don’t worry about bad things happening to me; rather, I worry incessantly about bad things happening to the people I care about.

So, after allowing myself an hour or so to cry and attempt to calm down on my own (I’m finding that the Cross Stitch World app on Facebook is particularly calming) to no avail, I took some lorazepam and settled in for some good old-fashioned Googling. It took a while to find what I was looking for, mostly because I was too jittery and anxious to think clearly enough to come up with the proper search terms, but once I did (“anxiety about bad things happening to loved ones” was particularly fruitful), I stumbled upon a treasure trove of forum posts written by people just like me. And they all had one thing in common: early loss of a loved one, usually a parent, very early in life.

Without revealing too much out of respect for her privacy, my mother was absent from my life from the time I was six years old until I was nineteen. We had contact through letters and the occasional phone call, but the sense of loss I felt was intense. Instead, I was raised by one aunt, my grandmother, and my grandmother’s sister.

I was particularly close to my great-aunt, Muriel (whose name I took as my middle name during my recent name change), and she passed away in 2010 after a long struggle with dementia and congestive heart failure. She moved in with us when I was fourteen after she had a valve replacement and her mental state began to decline; therefore, I witnessed the brutality of dementia over the next six years, when she was moved into a nursing home following my grandmother’s stroke.

I had never lost anyone so close to me in such a final way before. And because of the PTSD, I have an extremely hard time getting close to others on a meaningful, truly intimate level. I’ve discovered that this is the root of my excessive worry.

After giving myself ample time to process what I had read on the forums, comforted by the knowledge that I’m not alone in my struggle, I checked out a few Buddhist-oriented websites that also came up during my search. Most of what I read dealt with giving up the “illusion of control,” something that didn’t particularly make me feel better but did provide some good food for thought. As someone living with C-PTSD, I don’t do well with the unknown because the main reason I’ve survived as long as I have is because I am constantly planning five, six, seven steps in advance. I need to have a plan. I need to know what is going to happen and if I don’t, extreme discomfort sets in. If this discomfort is ignored, it builds into outright anxiety and, well, I end up in situations like the one I was in last night.

The good news about all of this is that I’ve made a note to myself to be more mindful and to really try to stay “in the moment” and enjoy the present instead of worrying so much about the future. I have also identified one of the main things I need to address in therapy–I’m currently in-between therapists since I’m moving in about a month and a half, but plan on finding one as soon as we’re in the Baltimore area.

Readers, can any of you relate? What has worked for you, either in terms of distraction or realizations?