News Day Tuesday: New treatment for PTSD?

a cure for what ails you, News Day Tuesday, personal experiences, ptsd, rapid-cycle bipolar disorder, three hopeful thoughts

Good morning, readers!

This week, I rustled up an article about some exciting developments in PTSD research.

Basically, scientists are looking at glutamate (one type of those fun little things in your brain that sends signals) and how alterations in glutamate levels affect PTSD. What this means for us is that PTSD is now being studied on a molecular level, which means that new treatments could be on the horizon!

My PTSD is generally well-controlled, as far as “controlling” it goes. I’m still mad-jumpy and don’t have a good time in crowds (the dissociation spikes, and sounds that hit my left ear first seem to make it worse, though my previous psychiatrist had no idea why). I still feel depersonalized/derealized every single day, though the level of detachment varies widely. I haven’t been able to pinpoint exactly what it is that makes it better or worse, but admittedly, I’ve been super lazy about charting it.

However, I’m sleeping soundly for the first time I can remember. I think a lot of us can relate to the hypervigilance and, by extension, light sleeping. Loud noises still startle me awake and my fiance sometime scares the bejeezus out of me by touching me–gently–to wake me up. But! and this is good news–the sounds of the cats wheezing or vomiting or fighting don’t wake me in a panic. It’s more of a “God, this again?” reaction, which, while not fun, is better than waking up with a racing pulse and momentary confusion about where I am.

As far as journaling about symptoms goes, I’m still trying to figure out a system. How many times in a day should I note what’s going on upstairs? I don’t want to become obsessive about it, as I did with my mood journal when I was first beginning treatment for bipolar disorder. At the same time, I want to make sure I have an accurate log of my symptoms and the events that may have caused an increase/decrease in the weird floaty feelings of unreality.

That being said, it’s sometimes hard to notice the changes because they’re subtle. Because this has been chronic for six years now, it often takes an absolutely massive spike before I notice anything is off. On a related note, I often don’t notice the symptoms decreasing because hey, it’s my “normal” now.

Any ideas or tips, readers? Should I follow the standard day/time/preceding events/level (on a scale of 1-10) format I’ve used in the past for mood tracking? What system(s) do you use?

I look forward to hearing from you! I’ll see you next week and as always, stay safe and remember to say one nice thing to yourself every day. Today I have two: “My new DIY manicure is bangin'” and “I am surviving my fiance’s work trip with zero negative emotions!”

It’s important to focus on the positive, especially when our emotional weather is often stormy.

News Day Tuesday: Local Mental Health Resources

a cure for what ails you, abuse, anxiety, medication, News Day Tuesday, ptsd, therapy, three hopeful thoughts

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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News Day Tuesday: Childhood Mental Illness

News Day Tuesday, ptsd, rapid-cycle bipolar disorder, relationships, stigma

Good afternoon, readers! This week, I’m featuring an article from NPR related to the early detection of mental illness in children. Child psychologist Rahil Briggs states that half of all children show signs of mental illness before age 14.

On a personal note, I began experiencing symptoms of post-traumatic stress disorder around age seven or eight. My mother had gone to prison when I was six years old, and I went twice a month to visit her at the correctional facility that was several hours from my home. By this point, nightmares were a common occurrence–I’d had them regularly since age five–so my guardian and other relatives didn’t think much of it when the frequency increased slightly after these visits began. There was some talk of finding a therapist for me, but the idea was abandoned.

One of the earliest memories I have of PTSD-related symptoms was one night when I was attempting to play chess with my aunt in the basement of my grandmother’s home, where I lived for the majority of my childhood and adolescence. I began to feel odd, detached from my own body and my surroundings. I remember saying to my aunt, “Do you ever feel like you’re in a dream?” because that was the only way I could describe it at the time.

She had no idea what I was talking about and gave me a strange look, a reaction for which I can’t exactly blame her–if I weren’t “in the know” about the symptoms of PTSD, I would have found such a statement very strange.

As a child, I was generally calm and reserved, but I did occasionally “act out.” I would get panicky and anxious, a tiny ball of pent-up energy and what I can only describe as rage at nothing in particular. That energy had nowhere to go, so it was directed inward, causing lasting damage before finally exploding outward. I would storm around the house in a dark mood, only to erupt moments later in a fit of crying so intense I felt like I couldn’t breathe.

My family was helpless to help me because they didn’t understand–or perhaps didn’t want to accept–the reality of what was happening to me. Bipolar disorder, which has spread throughout the family tree like Spanish moss, was beginning to wreak havoc on my still-developing brain.

Childhood mental illness is a tricky subject. It’s hard to recognize, and it’s terrifying, both for the sufferer and the child’s loved ones. It can strike anyone at any time, regardless of socioeconomic class or education level or how strong the family’s ties are. Therefore, it’s especially important for parents to remember and impress upon their children that it is an illness like any other and is not a moral or character judgment. It is not evidence of parental failings or proof that the child has not been loved enough. It simply is, and the earlier it is detected, the earlier treatment and healing can begin.

Did you start showing signs of mental illness in childhood, readers? How did your family/caregivers react?


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Last night, I felt dirty.

abuse, ptsd

I felt weird for most of the day yesterday, and the actual “dirty” feelings set in sometime late that afternoon. I’ve felt this way before, but not in a long time, and I’m still not sure what triggered it.

I spent an hour or so lying in bed last night feeling as though my skin was too tight for my body. I couldn’t relax and the feeling kept getting worse. This is what rape does to you.

I still have no idea whether or not I was molested as a child. As I’ve explained in previous posts, every therapist and psychiatrist I’ve seen, as well as quite a few of the people in my life, think that it’s extremely likely that something happened (based on my attitudes toward sex, my body, relationships, and my general well-being, as well as my sexual precocity and early sexual behavior).

I don’t know. I have flashes of memory, thirty-second clips of film that play inside my head at all-too-frequent intervals, but there’s nothing conclusive. I’ve recovered a few memories of my mother’s arrest, but that’s all. With that in mind, I don’t think it’s at all unreasonable to assume that there’s more lying dormant inside my head that I can’t access. I pride myself on being incredibly self-aware, which makes my inability to grasp at these memories all the more frustrating.

Sometimes, I wonder if I’ll ever feel clean again. Ages 17 to 19 were particularly horrible, and though I know that everyone makes mistakes, the abuse and my subsequent promiscuity take more of a toll on me than I’d like. I keep most of this discomfort from others and only confide in a select few people. As always, I’m extremely comfortable telling pretty much everyone about what happened, but I always conveniently neglect to discuss my feelings in the narrative. No one asks, and frankly, it’s a relief. As long as I don’t let emotion sneak into the equation, I can remain detached and objective, which is pretty much my default state anyway thanks to the dissociation.

I try very hard not to let myself get lost in my own head, but I find it happening more and more frequently these days. I know it’s my mind finally processing the sexual abuse, but I’m a little lost as to what to actually do about it. 

Rape is the ugliest word in the English language.

Some days, my need for acceptance and praise is really disturbing.

abuse, major depression, ptsd, rapid-cycle bipolar disorder, self-harm, suicidal ideation, therapy

I say this because of the things I know beyond a doubt: I am attractive, there is nothing wrong with my body. But I need reassurance about the physical things because of the most important parts I can’t accept—the thought that I am worthy and lovable and worthwhile and that I don’t ruin everything I touch.

*

I had a particularly disturbing dream last night that D. suddenly decided he didn’t love me, never had. I told him I was feeling suicidal and his response was something along the lines of, “Actually, that’s the best thing that could happen to me right now.” I woke up in a panic, convinced that it had been real. I had some terrible dream-within-a-dream-within-a-dream experience last night, and it’s left me a little rattled. I know the dream is just my subconscious vomiting out the particularly horrible bits of all the abuse I’ve taken—the dream situation is ripped almost verbatim from something that happened countless times in a past relationship—but it’s still upsetting.

It’s upsetting because after all these years and how far I’ve come, I still feel like a victim. It’s upsetting because my childhood would have fucked me up enough without the awful part in my teens where I realized that even if someone tells you they love you, they can still hurt you terribly. In some cases, they can hurt you more after they’ve said it.

*

A stranger once complimented me on my eyes and followed it with, “But there’s something unquiet about them.” It took me a long time to realize that everything I’ve gone through has turned me into a haunted house. If the eyes are windows to the soul, then the restlessness in mine is because of all the horrible memories, all the ghosts.

*

D. and I were discussing “Inception” the other day. “I wonder what my subconscious would look like,” I said. He replied, “I’m pretty sure it would be full of monsters.”

*

I’ve been reading a lot about self-harm and how it relates to prior abuse (the book I’m currently reading focuses on the theory that childhood abuse is completely to blame, but for me, it’s been more of a cumulative effect). I have to go slow because it’s very triggering for me, but it’s also hauling some useful anecdotes up from the depths and forcing me to confront a lot of hard truths about myself—about what happened to me during the first twenty years of my life and how those experiences have shaped almost everything about me.

*

I’m heading back to therapy on Thursday, and I’m feeling particularly anxious about it. I’m not sure what to expect; I already know my prognosis for ever coming out of the dissociative state is pretty grim, and that it’s likely I’ll be in therapy for the rest of my life. We have to move so maddeningly slow—working through the trauma without awakening my defense mechanisms is like trying to sneak past a sleeping dragon in a cave. If it shifts in its sleep or makes a sound, we have to go back and find a safe hiding place until it passes.

My therapist is wonderful. She’ll start off by prompting me to share what’s been going on in my life, and then she’s somehow able to zero in on what I need to talk about during that session. She reassures me that it’s okay if I can only handle remembering things for a minute or two—she says it’s a lot healthier than going at it too hard and making the dissociation even worse.

I’ve gotten pretty good about just accepting the way things are, the numbness and the detachment. But there are times when it makes me want to scream, when I just want to feel something other than all the pain and numbness. I want to be in the moment all the time instead of faking it. I want hearing “I love you” during sex to feel good instead of scaring the shit out of me and causing me to shut down.

I want someone to turn me off and fix me. I wish I had a factory default switch, that I could go back to being an infant and be born into a situation that wouldn’t cause so much damage. People say I’m lucky; the abuse has given me an endless source of inspiration for writing, and most people with “normal”/stable home lives have to work harder.

To that, I say: Fuck you so very, very much. If any one of those people had to live like this even for a day, they’d probably end up putting a gun to their head before sundown. No one wants to live like this. No one.

*

I know this post has jumped all over the damn place; please bear with me, as I’ve been dealing with some pretty brutal cycling as of late. I want to close this on a positive note, so let’s just appreciate that I made it through two suicide attempts, nine months of self-harm, and a lot of substance abuse—and that’s just this year.

I want to live the rest of my life without ending up in a hospital. I want to make it through this without dying by my own hand. I want to be happy, if I can’t be completely well ever again.

Capturing moods.

major depression, medication, ptsd, rapid-cycle bipolar disorder, self-harm, suicidal ideation

My psychiatrist is teaching me how to handle my episodes. Lamictal twice a day, 200 in the morning and 250 at night. Seroquel for mixed episodes; never, never take lorazepam for a mixed, because it’ll do nothing but heighten the sense of detachment. The only problem is, I find it difficult, if not impossible, to differentiate between anxiety and a mixed episode. Both make me feel jittery, anxious, prone to sobbing uncontrollably and fighting so hard to hold back the urge to self-injure or finally do myself in that it takes all of my energy. I guess the solution is to take a benzo when I feel it coming on, and if that doesn’t work, the antipsychotics might. He’s instructed me to take the Seroquel 50 mg at a time, and I can take up to 200 mg a day if necessary.

I am trying very hard to stay off the Seroquel. I’ve read terrible things about antipsychotics—uncontrollable weight gain, tardive dyskinesia—and I am terrified of having them happen to me. I know it’s just my hypochondria kicking into overdrive, but I’m so unlucky, so prone to having bad things happen to me, that my fears about the worst coming to fruition actually don’t seem that silly or off-base.

And my memory is getting worse. I’ll tell the same story three times and not remember any of it. We went to Teslacon this weekend and had a lovely time, but by the time we left on Friday night I was unable to remember any of the panels we’d gone to that morning. I can’t focus on anything for longer than perhaps 20 minutes, which is disturbing because I used to be able to read or write or play the piano for hours on end. My psychiatrist thinks it’s ADD brought on by the concussion I suffered in July, but he can’t prescribe anything to help until my cycling stops and my moods are finally under control. Considering 450 is a higher than usual dose of lamotrigine (so high that I now have to undergo blood tests periodically), it seems like the manic depression is fighting hard to keep its grip on me, just as hard as I’m fighting to get rid of it.

Relief is always just within reach, but miles away.

*

I feel guilty and hate myself every single day. My husband works 40 hours a week as the shift lead at a drug store and is taking six credits at a local community college. He hopes to transfer to a large state university within five years. My inability to work full-time so he can go to school full-time upsets me so much that sometimes I wonder if he wouldn’t be better off without me. I feel as if I’m holding him back from his dreams—having to care for an invalid wife surely isn’t what he set out to do with his life.

Meanwhile, I stay home every day, reading books and watching movies and trying not to give in to the nasty little voices that whisper to me: I’m useless, I’m a drain on everyone’s energy and resources, I’ll never amount to anything because I am so sick and seemingly unable to recover.

I’m afraid to go back to work until this is under control because I’ve lost two jobs this year; I can’t handle getting fired again. D. agrees that a break from it all, time off so I can rest and work on my memoir, is the best plan. I made a budget; we can easily afford it if we cut out all luxuries. But I want to spoil him, want to give him everything he wants because I feel so awful and guilty, and then I feel bad because the money’s gone faster than we expected, and the whole cycle starts all over again.

We’ve applied for food stamps. I’ve applied for disability. Each day, I commit myself to two hours of research (reading books on dissociation, manic depression, PTSD, and anything else I feel might be applicable), jotting down quotes on note cards with obsessive precision—a purple heading for dissociation, green for bipolar. Most of the time, these quotes help me remember anecdotes, pieces of the puzzle that I can use when I actually begin to write this thing. I am determined to be as organized as humanly possible, despite all the things that are going on inside my head, because I want to finish this book. I want to keep going on this project and not give up; I’ve tried to write a memoir three times before and got stuck after the first chapter. How can I not know what happened to me? I’ve realized the failures were probably because I didn’t have everything laid out just-so: and then, and then, and then.

I know the cycles will make things difficult. I need to make the most of the mania and hypomania and try not to hate myself too much when I crash and can’t do anything but lie in bed and sob.

Jesus Christ, I just want to be okay and make something of myself, be able to provide for our little family again. I want to be good and successful and not feel like I’m wasting my life, like I’m already useless and dead at 24.

I want to make it to 25, and then 30…

*

I feel like I need to give myself some credit for staying out of the hospital through all the years of misery. Two suicide attempts, eight months of intense cutting, and that’s just this year. 2013 has sucked, and I’m ready for it to be over. I want a fresh start. I want someone to turn me off and fix me.

I want to not be me. I want to feel like it’s okay to be me.

I want my husband to always see me as interesting and pretty, not as a sad, pathetic mess.

I want my family to stop seeing me as a disappointment (they probably don’t, but I worry that they do) : If only I tried harder, I could go back to work. Mind over matter, J.

I’m seeing my therapist on Thursday, and I feel like that’s a very good thing. What I need most right now is for a neutral third party to reassure me, to comfort me and tell me I’m doing exactly what I need to be doing, that I’m right where I’m supposed to be at this point in my life.

I hope I’m going to be okay.

Transition.

a cure for what ails you, major depression, medication, ptsd, rapid-cycle bipolar disorder, three hopeful thoughts

At this point, I can’t say that I’m cured or that my bipolar is in remission, but something feels different. My mood swings aren’t as intense as they were before, and “Flat/numb” has replaced “Depressed” as my default mood state. I still can’t remember the last time I felt truly happy without also feeling some underlying negative emotion, but I actually feel hopeful.

My PTSD is still pretty bad. There’s some parking lot construction going on right outside our apartment, and when I had to walk past it yesterday to get home, I flinched, jumped about a foot, and had to clamp my hands down over my ears to get through the unrelenting roar of construction equipment. I felt embarrassed and remember thinking, “Normal people don’t act like this.” But I’m trying not to judge my reactions and emotions. My therapists over the years have all encouraged me to just experience them without having a knee-jerk response and assigning a morality to everything.

My derealization/depersonalization is present, as always, and I’ve been having unnerving spikes in severity that have unusual triggers…if I have my head turned or tilted a certain way and I say something/something is said to me, for example, the detached feeling increases tenfold and sticks around until I finally go to sleep. It seems to only happen in the late afternoon/early evening, but I’m still not sure what to make of it. But in spite of this, I feel like I’m finally starting to recover. I’ll deal with the emotional bit first; then, I’ll try to tackle my dissociation.

Medications: Lorazepam, 1 mg tablets*, 37.5 mg Effexor, 400 mg lamotrigine/Lamictal.

* I think it’s important to note that I can’t remember the last time I actually needed one of these.

Breaking up is hard to do.

medication, ptsd

I’m considering “breaking up” with my current psychiatrist, and it’s a tougher decision to make than I’d anticipated.

I like her as a person, but I feel as though we’re not meshing that well on the doctor-patient front. My depression has been particularly difficult to get a handle on, and treatments that previously worked (like Cymbalta) have suddenly stopped helping for no apparent reason. Yesterday, I called and left a message for her with my third request for an increase in my Effexor dose.

The first time, I was told to be patient and give it more time. When I met with her the week after I went to the ER for my panic attack and pleaded my case (since missing a dose and having a dose that was probably too low to begin with kicked off that whole mess), she added risperidone and told me she didn’t want to increase the Effexor until we’d given the other drug a chance to work.

It’s been a few weeks and the only thing the antipsychotic has done is make me even more drowsy than usual–I’m like the goddamn Dormouse to begin with, and the only change is that now I’m really sleepy on top of being really depressed. And in my desperation, I’ve found myself turning to some pretty unhealthy methods of coping with the low-mood-negative-thoughts-constantly-wanting-to-cry thing.

I called the office again today to see if my message had gotten through; after I gave the doctor filling in a quick (probably 30 second) summary of what’s been going on, she agreed to call in a small increase to see if it helps. It might not; I might need to try another drug. But at least I felt like my concerns were being heard.

I feel like my regular doctor and I have had this disconnect for a while now, and I plan to address it at our next appointment. She’s not a bad doctor by any stretch of the imagination, though there’s a pretty clear class divide between us (she suggested Weight Watchers, which is too expensive to even contemplate, when I expressed concern/anxiety over my weight, and has recommended name-brand drugs and alternative medicine that I can’t afford multiple times, despite me repeatedly telling her that our budget’s tight as it is–therapy is expensive) and I think that’s causing some issues.

I tend to avoid conflict at all costs, so it’s going to be tough for me to broach the subject. But I feel like she really knows her stuff, so I don’t want to just “dump” her. I want to make sure we’re on the same wavelength and see if things improve from there first. On the other hand, I’ve been stuck with doctors who aren’t willing to listen to my concerns and give me what I need, and I don’t want to fall into that trap again (ask me about the thyroid debacle that went down last year).

Are you avoidant? Have you ever had to break up with a doctor? Tell me about it in the comments!

PTSD, part I.

ptsd, self-harm, stigma

I was looking up some signs of unresolved trauma (mostly relating to dissociation) and came across this awesome list. The ones that apply to me are in bold (and there are way more than I thought).

1. Addictive behaviors – excessively turning to drugs, alcohol, sex, shopping, gambling as a way to push difficult emotions and upsetting trauma content further away.

2. An inability to tolerate conflicts with others – having a fear of conflict, running from conflict, avoiding conflict, maintaining skewed perceptions of conflict

3. An inability to tolerate intense feelings, preferring to avoid feeling by any number of ways

4. An innate belief that they are bad, worthless, without value or importance

5. Black and white thinking, all or nothing thinking, even if this approach ends up harming themselves

6. Chronic and repeated suicidal thoughts and feelings

7. Disorganized attachment patterns – having a variety of short but intense relationships, refusing to have any relationships, dysfunctional relationships, frequent love/hate relationships

8. Dissociation, spacing out, losing time, missing time, feeling like you are two completely different people (or more than two) *

9. Eating disorders – anorexia, bulimia, obesity, etc

10. Excessive sense of self-blame – taking on inappropriate responsibility as if everything is their fault, making excessive apologies

11. Inappropriate attachments to mother figures or father figures, even with dysfunctional or unhealthy people

12. Intense anxiety and repeated panic attacks

13. Intrusive thoughts, upsetting visual images, flashbacks, body memories / unexplained body pain, or distressing nightmares

14. Ongoing, chronic depression

15. Repeatedly acting from a victim role in current day relationships

16. Repeatedly taking on the rescuer role, even when inappropriate to do so

17. Self-harm, self-mutilation, self-injury, self-destruction

18. Suicidal actions and behaviors, failed attempts to suicide

19. Taking the perpetrator role / angry aggressor in relationships

20. Unexplained but intense fears of people, places, things

* My most frequent dissociative symptoms are derealization and depersonalization.

Depersonalization is characterized by a feeling of detachment or estrangement from one’s self.  During an episode of depersonalization, the sense of ‘self’ is disturbed.  There is an overall feeling of estrangement and detachment from the self.  …Depersonalization can be very distressing because it seems like one is losing their grip on reality, losing control, or ‘going insane.'”

Derealization – During the experience of derealization, the perception of reality feels distorted and there is a sense of being detached from the outside world.  It can feel like living in a dream.”

(Source)

In the next post on PTSD, I’ll get into some of the messier stuff–mainly, how I ended up with PTSD and how it affects my life. It’s something that is going to require a lot of effort on my part because (as anyone who knows me well can tell you) I don’t really like to talk about it. Joke about it? God, yes, I’ll do that all day long. I’m also able to write about it, to some extent–just the facts, ma’am. But really getting into the heart of it is something I still find incredibly difficult and try to avoid as much as possible.