Return of the Dark Core

major depression, ptsd, rapid-cycle bipolar disorder, self-harm

About ten minutes ago, I was standing in the kitchen trying to eat a bowl of strawberry ice cream. My hands were shaking so badly, I could barely even hold the spoon, and then the dark core started its shit again. I’ve been feeling anxious, guilty, and extremely depressed lately—I shouldn’t have to add this qualifier, but I feel sad for no reason. Or rather, no reason that others can see; my brain chemistry has decided to take a dive again and I think I’m in the beginning stages of a major depressive episode.

We’re struggling financially right now and I’m still feeling a lot of guilt and self-loathing for not being able to work; I know those things don’t help. My meds aren’t quite right but I can’t go see my psychiatrist until I get my lithium checked. He fucked up the lab sheet again and the clinic I go to won’t take it without a time written on it along with the date, so I’m not sure when I can have those levels done. I’ve stopped going to therapy for the forseeable future because our deductible just reset and we can’t afford it.

In short, things are not going that well these days.

My cycles have been getting longer, which I was told is a sign that I’m getting better. But while it’s okay to have a two-week-long hypomanic, or even manic, episode, the major depressive ones frighten me, not because I don’t know what I might do but because I know exactly the sort of things I’m capable of doing.

I’ve been feeling out-of-sorts for several days, but things started their usual downward slide this afternoon. I put myself to bed for a few hours in hopes that I could sleep it off, and I did feel a little better when I woke up…but it’s back. The worst part is feeling helpless to stop it. Oh, I know some ableist scum would argue that I could do all sorts of things to “cure” it, but the fact is, it’s a simple matter of brain chemistry that’s not quite right. And unfortunately, type I bipolar tends to be very tricky to treat even if it’s not rapid-cycle (mine is).

I’m counting the time until D. gets home so we can talk about a safety plan. It’s important to discuss that before things get really bad up in my head. For now, I think I’ll indulge in my usual anti-self-harm strategy of hugging a cat and listening to music. If I fall asleep again, so much the better. Anything to get away from these thoughts.

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Informational post: panic attacks versus mixed episodes.

a cure for what ails you, explanations, medication, ptsd, rapid-cycle bipolar disorder, self-harm, stigma, suicidal ideation

In May, I woke up feeling rather odd—jittery, teary, completely unable to calm down. I’d felt this way before, but it had never been that bad. After about an hour of trying (and failing) to steady myself, I asked my husband to take me to the emergency room because I was afraid for my safety.

I thought I was having a severe panic attack and spent four and a half hours confined to a bed in the ER on suicide watch; after demonstrating that I really was okay and didn’t need to be committed to the psych ward upstairs, I was released with a prescription for lorazepam. At the time, we thought panic attacks were a reasonable explanation, given that I have C-PTSD and a couple of dissociative disorders as a result.

I continued taking lorazepam whenever I felt that way, even after I’d learned I was having mixed episodes and not panic attacks. I needed a couple of milligrams before I started feeling okay again, but that much knocked me out for a couple of hours…not really the most productive way to handle the situation. I talked to my psychiatrist and learned that benzos are pretty much the worst thing to take during a mixed episode because they heighten the feeling of detachment, which can lead to more anxiety and make things worse. He prescribed quetiapine (Seroquel) and so far, it’s worked; I usually don’t need a very high dose, about 50 mg, whenever I feel a severe mixed episode coming on.

Having learned more about panic attacks, it seems strange to me that the ER staff didn’t recognize my mixed episode for what it was. While panic attacks tend to produce more physical symptoms (racing heartbeat, shortness of breath, chills, hot flashes, nausea, trembling, sweating), mixed episodes (also called mixed mania) tend to produce more mental symptoms, such as the highs of mania with the lows and despair of major depression, urge to self-harm or attempt suicide, and uncontrollable swings between moods and thoughts.

I think the reason the two were confused that day was because of the mental symptoms present during a panic attack—fear of loss of control and a sense of impending doom, which is how my fear of self-injuring or attempting suicide was interpreted. I was having cold sweats and my heart was racing, but as I’ve started paying closer attention to my moods and symptoms, I’ve found that those, along with an overall feeling of panic or being out of control, generally accompany my mixed states.

There are many great resources online about how to help and what not to do when someone is having a panic disorder, so I won’t touch on those. Below are a list of things that I find particularly helpful when I’m going through a mixed episode (and what to avoid doing). Feel free to chime in with your suggestions in the comment section!

  • I really dislike being touched in general, so touching me is likely to make things worse. However, I’ve found that if my husband holds me in a particularly tight embrace, the compression is soothing and helps me calm down and feel safe and loved. During a mixed episode, I tend to feel very guilty and my self-worth plummets, so the physical contact from a loved one helps reassure me that I am worthy and do not need to harm myself as “penance” (the main reason I used to self-injure) or “eliminate my own map” to relieve loved ones of the burden.
  • Obviously, confiscating my sharps prevents me from hurting myself and is very helpful.
  • If I’m too far gone to realize I have medication that will help me calm down, being brought a Seroquel (which is an antipsychotic) and a glass of water with tons of ice cubes in it (which I love) is very helpful. It takes a few minutes for it to kick in, but when it does, the noise in my head quiets down, the psychomotor agitation goes away, and I’m able to focus again. The worst case scenario is that it knocks me out for a few hours if I’m given too much, but at least I’m not in danger of harming myself.
  • Saying comforting things that are not in the form of absolutes is very helpful. For example, saying specific things such as “You are worth something because you’re spreading the word about mental illness” is much more helpful than saying “Stop it, you’re not a bad person.” If you reference specific things, my brain can recognize those as true—I am writing about mental illness in the interest of raising awareness and fighting the stigma—I will not be able to argue with it, whereas I could go in circles all day long with all the reasons I think I’m a bad person.
  • Playing music or doing something over-the-top to make me laugh has been a good way to “break” the episode in the past. It’s important to note that not everything works as a distraction, but if you can get me laughing (which is not difficult because I have an entire folder of gifs/images/text posts that have made me laugh hard enough to cry in the past; also, my sense of humor runs extremely dark, so saying something really fucked-up is likely to make me lose it), there’s a good chance it’ll shorten the duration of the episode by giving me something else to think about.
  • I cannot stress enough how important it is to avoid saying the things I mentioned above: “It’s going to be okay,” “You’re not a bad person,” “Stop getting down on yourself,” “Just try to calm down,” etc. They’re not helpful, they just make me feel worse, and they usually cause the situation to escalate.

I’ll put together a post like this on C-PTSD and what my specific triggers are, what people can do to avoid triggering me, etc. I’d really like to hear from my readers, though—I want to hear about your coping techniques and how people can avoid triggering you.

Love and antipsychotics,

J.

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.

Sick, sick, sick.

endometriosis, major depression, medication, rapid-cycle bipolar disorder, self-harm

As I write this, I am having a little bit of an episode. I got up at three in the afternoon, cleaned my tattoo, took my meds, took my morphine (to ward off the crippling pelvic pain I have every single day, will have for the foreseeable future), ate breakfast, read a book, couldn’t get dressed, dealt with racing thoughts for a few minutes, crippling anxiety because I am home alone until my husband returns from class at 4:00, cried, took an Ativan, stabbed myself in the arm with a fork because of the intense guilt I was feeling at the time.

This is my “normal.”

My sleep patterns are completely fucked at the moment because I’m working 7–2 (third shift) three days a week. I haven’t weighed myself in months, but the last time I was at the doctor (a week after I started dancing), I’d lost seven pounds. My appetite is, by turns, ravenous and nonexistent.

I’m seeing my psychiatrist on Wednesday morning, provided I can drag myself out of bed at that ungodly hour, and then I will tell him that my meds are not enough, never enough. I have one mg tablets of Ativan and am only supposed to take one to two per day, though I can handle much, much more. 150 of Effexor, which I am not even supposed to take because with bipolar (even type two), antidepressants can make you fucking crazy, and 200 of Lamictal. My moods have been more stable, but my default state is still numb and detached. I don’t often swing to hypomania (well, more than once or twice a day, and even then I don’t want to accept that it’s hypomania—I am just not depressed), though the crippling bouts of intense depression hit so many times each day, I can’t even keep track of them. They range from twenty minutes to several hours in duration, and then I’m back to flat.

I can’t get disability because I am technically still able to work, I am too young, I don’t think my doctors will sign off on it. I’m afraid to ask. I should probably ask at my next appointment, just to see, just to confirm that I’m not sick enough to actually get the help I need to take some time off and focus on recovering.

The thought is profoundly depressing.

Obviously, I’m not doing that well these days, though I’m keeping my shit togetheras they say. What keeps me going is the knowledge that eventually this will break and I won’t have to deal with my rapid-cycle bullshit anymore, that I’ll have some reprieve from all this madness.

Trigger words.

explanations, ptsd

From what I understand, it’s not at all uncommon to have trigger words— if you spend a few seconds on Tumblr, you’re likely to see tags such as “tw: rape” or “tw: abuse.”

I feel what makes my trigger words unusual is that words with negative associations don’t set me off at all; rather, words generally associated with positive things trigger the hell out of me, provoking a wave of despair and guilt so strong that it’s sometimes hard to withstand.

For years, I wondered why certain words and objects/occurrences made me feel so horrible. The sound of an ice cream truck, for example, never fails to bring on the bad feelings. Seeing an ad in a crossword book for a personalized name poem–”A special gift for a beloved child,” the ad proclaimed–made me wish I were dead so I wouldn’t have to feel so sad and guilty. I recently had to take Wite-Out to the back of a bag of milano cookies after seeing the phrase “You deserve” printed on the packaging.

It wasn’t until just a few weeks ago that I realized what all these happy, terrible things had in common, and I’m pretty sure it stems back to my inappropriate and often overwhelming feelings of guilt. From what I understand, it’s pretty common for people with PTSD to suffer from these emotions; unfortunately, it’s not something that the mentally healthy can really understand, much like my friends who aren’t depressed can’t comprehend my indifference to my own existence.

The guilt–the “dark core,” as my therapist calls it–tells me that I am unworthy of happiness, undeserving of good things—that it’s so far beyond my grasp at this point that yearning for it is pointless, not to mention pathetic.

Love, happiness, deserve, special, beloved—all of these trigger the hell out of me. Even things like ice cream can set me off because even though I know the “dark core” is, frankly, full of shit, there’s a part of me that still believes I don’t deserve good things. Years of abuse and trauma have all but ruined innocent pleasures for me, and while I’m trying very hard to correct the negative automatic thoughts, it’s a slow process and is often frustrating. Since I haven’t nailed down every single trigger (and I doubt I ever will—there are far too many of them), it’s difficult to avoid everything that triggers me, and when I’m triggered, the rush of negative emotions is strong enough to set me back and nearly undo all the progress I’ve made.

PTSD is such a bitch. Trauma is a bitch. Feeling “out of it” all the time because my defense mechanisms are operating on high-alert 24/7 is incredibly frustrating, eclipsed only by the terrible feelings that come from being triggered. I seem to be unable to handle happiness—take a moment to imagine what that must be like. But as terrible as it is, it motivates me to fight even harder to get better. I know there are so many things I’m missing out on because years of trauma have conditioned me to shy away from happiness and positive experiences (probably because I’ve experienced time and time again how fleeting happiness is). It’s easier, my brain tells me, to avoid good things than to experience them for just a moment, only to have them snatched away and replaced with heaps of horrible shit.

Can anyone relate? I hope this makes sense—it’s surprisingly difficult to articulate what it’s like to be triggered, what it’s like to live in my reality. But my hope is, as always, that writing about it (even if the writing comes out abstract and difficult to follow) will help people understand what it’s like to have PTSD, to fight against crippling depression every day.

I am trying to stay alive. That takes up most of my energy on a day-to-day basis, and trying to overcome the triggers and seek out happiness and positivity in my life is sometimes exhausting. But I’ve never been one to shy away from a challenge or give up on something just because it’s hard.

Even though I’ve never thought I’d live a particularly long time (another thing that’s pretty common among PTSD sufferers), statistics say I’m going to be here for a while—I might as well try to make my world a brighter, better place. I don’t want to be miserable forever.

Is happiness a struggle for you? Please let me know I’m not alone.

Lamictal.

medication, ptsd, stigma, three hopeful thoughts

Supposedly, this is the drug that is going to make everything okay.

I met with my psychiatrist yesterday and learned that while it’s usually used as an anti-seizure medication, it works very well for the depressive portion of bipolar disorder. She’s hopeful that this will stabilize my moods and make everything feel less dismal, though I have to build up to the maintenance dosage slower than other patients because it can cause a nasty rash (I had a terrible full-body rash as a reaction to amoxicillin when I was a child, so she wants to be extra-careful).

She warned me that there’s a chance it could trigger a manic episode if I do, in fact, have undiagnosed bipolar disorder. I’m young, and it could be lying dormant for now–she said it wouldn’t be at all unusual if I remained in a depressive state for decades before experiencing mania for the first time.

I feel that, as an advocate for mental illness who tries to do something to fight the stigma every single day, it’s not great for me to say this…but I am secretly afraid that I’m bipolar. My mother is bipolar and when I was young, “You’re just like your mother!” was thrown at me whenever I was being difficult or acting out.

I’ve been educating myself on the disease, though, mostly through memoirs written by women with bipolar mothers. I know that it’s just another chemical imbalance and that I have nothing to fear, but at the same time, it seems like the proverbial big black dog, looming just out of sight. And there is a tremendous stigma surrounding bipolar individuals, which is awful. I am taking comfort in the knowledge that if I do indeed have the illness, I can do a lot of good work to help fight that stigma, too.

But is it so wrong for me to be terrified of being “just like my mother”? It’s not just the possibility of being bipolar that scares me–I was conditioned to fear and avoid any behavior that was even remotely reminiscent of the woman, though now I’m beginning to “take it back” by trying to take the positive aspects of her personality into myself–her carefree, fun-loving nature that I remember so well from her “good” days.

My relationship with my mother is a complicated one, so I’ll refrain from discussing it further in this post; I feel it deserves at least one post of its own, if not a series.

Did anyone else grow up with a mentally ill parent? How has it affected you?

Sending love into the darkness.

major depression, ptsd, self-harm, therapy, three hopeful thoughts

I met with my therapist last night after work, and she had some very good advice for me. I told her how I’m trying to make myself believe that my body is not the only thing worthwhile about me, the only good thing I have to offer other people. She countered that statement by saying it’s the “dark core” we all have that’s sending me those messages.

“But I want to fight it,” I protested. “I want to believe that I’m smart and pretty and funny and that those things, like the depression, are just a part of who I am. Right now, I feel like sex is the only way I can atone for being so fucked-up.”

She made me sit with those feelings for a while and over the course of the hour, we broke the false beliefs down in a less judgmental way. Instead of “fucked-up,” we said I was “sick but trying to get better,” which is a lot more than most people do. She told me how brave I am for making the effort.

She also advised me to stop fighting–fighting comes from a place of violence and hatred, and the darkness will always win. Instead, when the dark place tells me that I’m useless and a burden, I should look at it and say, with open arms, “I’m so sorry you’re feeling that way.” If I try to counter it by saying, “Well, I’m good at X, Y, and Z,” the automatic thoughts will come back with, “No, you’re really not.” But if I offer the pain compassion, I might be able to reduce the hold the thoughts have on me in the long run.

I cried a lot during our session. I think that’s going to be a recurring pattern, but I don’t see it as a bad thing–maybe it’s a sign that I’m starting to connect to my baggage and heal.

Could have gone mad.

major depression, medication, ptsd, rapid-cycle bipolar disorder, stigma

The depression has felt different the last week or so; now that I’m off the risperidone, my hands aren’t shaking anymore but I’m not sleeping as well. I sleep too much, but it’s fitful, and I’ve found myself prone to hysterical crying the last couple of days. But hey, at least my mood isn’t any worse.

I’m worrying, as I frequently do when I go through these periods of agitation (without the depression lifting one bit, mind you) that I’m popping manic symptoms. My mother is bipolar, so I’ve always been vigilant about monitoring myself for signs that I’m swinging from major depression to bipolar disorder as well. I don’t think that’s the case, but thankfully, I see my psychiatrist on Wednesday.

I know one thing for sure: this medication is not working. Not one bit. But even though I’m clearly ill and not doing that well, at least others tell me I’m still fun to be around. When I’m around others, I try extra-hard to be vivacious and entertaining because you know who likes being around me when all I can do is lie on the floor and cry? Nobody, that’s who. Not even the cats.

I’m beginning to wonder if the forced gaiety is doing more harm than good.

The worst part is the emotions. I seem to have so many of them, and yet I can’t put anything into words effectively, which is frustrating because goddamnit, I’m a writer.

All I can do is hope that therapy tonight helps a little and that I will finally, finally, finally discover the magical combination on Wednesday that will make me feel okay. In the meantime, I’m doing more of that charming but potentially destructive “Whatever gets you through the night” living.

How have you guys been lately?

Flashback: Resilient.

major depression, ptsd, rapid-cycle bipolar disorder, self-harm, stigma, suicidal ideation, three hopeful thoughts

Flashback: Resilient

Text and photo from January 5, 2013:

“This is my new wrist tattoo!

I chose the word “resilient” because my very first therapist, who I started seeing when I was 18, frequently used it to refer to me. It is the frank acknowledgement of a hard and often brutal life and a symbol of everything I have endured (an abusive alcoholic mother who wound up in prison when I was seven years old, years of bullying after that, a relationship in my teens that was abusive in every sense of the word, and my struggle with PTSD and MDD that began when I was very young).

I’d had suicidal thoughts for years, starting in my teens, but they were more abstract in the sense that I wanted to have an “escape plan” for if life somehow got messed up beyond repair–I never really intended to use it. When another major depressive episode began last July, I began to have the thoughts more and more often until dying was, more often than not, the first thing I thought of in the morning. My casual indifference to my own existence turned into a full-blown death urge, and the knowledge that I would hurt people if I “eliminated my own map” no longer mattered to me–all I could see was the pain, and I was tired of fighting it.

On September 10, 2012 (Suicide Awareness and Prevention Day), I actually decided to participate and wrote “LOVE” in tall, thin caps on my left wrist. I did so ironically, not believing it would actually raise awareness or prevent anything, but that night I got low enough again that I was considering going into the bathroom and quietly opening a vein while my husband slept in the next room.

But then I saw the word on my wrist and thought, “No, you can’t do it tonight, it’s way too fucked up (even for you) to finally do yourself in today.” From that moment, I decided to find a “motivator” each day to stay alive–one thing that made me feel, at least for the moment, that being alive was still worth it and that I should keep fighting the darkness in my head.

There have been countless days where just getting out of bed and staying alive has taken everything I have, and I have no doubt that there will be countless more. But this tattoo is a promise to myself that when I do die, it will not be by my own hand. I have survived being hurt by almost everyone I have cared about. I have endured some pretty unspeakable acts of abuse. I have fought against some of most hideously dark thoughts imaginable. When I have another dark night of the soul, I need to look at this tattoo on my wrist, inked right over the veins I’ve considered slicing into more times than I’d care to say, and remember that it would be a filthy goddamn shame to give up now.

This is a physical symbol of my commitment to getting well and staying well.”