Monthly Archives: February 2010

Escape and Keeping things seperate

When I tell people why I switched schools/majors I try to put a happy spin on it. ‘It was purely for academics’, I’ll say.
The reality is that after I returned from my involuntary leave, I did not feel welcome.

I was placed in freshman dorms again and harassed by roommates who’d heard rumors about me and dug through my prescriptions, running google searches. They google diagnosed me with schizophrenia and decided I was out to murder them in their sleep. If they were really so scared of me why did they yell at me so much?

I was only able to take one class in my major, because the prerequisites I needed were not offered that semester. My semester off left me a year behind. I hardly saw the classmates I’d known when I was there before. They’d moved on without me.
I avoided large sections of the campus. I couldn’t go near any of the offices involved in forcing me out. I hid when I spotted people involved.
It was not a welcome return.
I just wanted to pick up where I left off like nothing had ever happened, but it was impossible.

I felt so on edge and unwanted. I needed to escape.
I couldn’t transfer and stay the same major. I couldn’t justify that to myself.
I was enjoying my Intro Psych class and reading a lot of psychology books. I’d thought before it wasn’t an option, but as I learned more I reconsidered.
I told my therapist I was leaving to get an MBA. I refused to talk over my decision in therapy. I didn’t tell him I was switching to psychology. I felt uncomfortable telling a therapist I was going into his field. I justified this lie by telling myself I could get an MBA after I got the psychology degree, but didn’t really believe it.

I hate to make it sound like I don’t love what I’m doing now that I am a psychology major. In retrospect I realize now that I have much more enthusiasm for this than I had for my previous major, but the decision will always be tainted because it was made to escape one thing rather than pursue another.

So I escaped to a new school. Except the escape didn’t work. Changing location wasn’t enough. I can’t escape the fear of it happening again.

No matter how well I do academically I am still at risk of it happening again. My last school didn’t care that I was a good student, this one won’t either. The fear is in my head guiding every action I make.

I see a person who looks like the therapist who kicked me out. I know it’s not him, but what if it were him? What if he showed up at my new school? I run through scenarios of what I would do. I get lost in my thoughts.
It’s like I have two images layered on top of each other. One is reality and one is my fear scenario. The opacity is being adjusted up and down. I see one then I see the other. Volume alternates between the scenes. I can forget that I’m only in my thoughts.
I react as if it is happening. Fisted clenched, heart pounding, tears welling up in my eyes.
It goes until something jolts me back into the real world.

I’ve tried all sorts of reactions in my head. Sometimes I scream at him, sometimes I glare angrily, make sarcastic comments. I sometimes try explaining to someone how much he hurt me and that he needs to leave. Or maybe I quietly make an exit and other times the exit is dramatic.

I also go through scenarios where my new school tries to kick me out. Sure I’m better prepared this time because I know my legal rights, but I’d still have to fight for it. The new school becomes tainted because then they also don’t want me there. All my effort to hide things and I end up in the same situation as the old school.

There’s never a good resolution. In every imaginary situation I dig myself into a deeper mess.
I think part of it is my brain trying to find a way to deal with it. If I had a good solution, should the situation arise, maybe I wouldn’t need to fear it so much.

Another part of it that I realized recently is that part of me wants a confrontation with the therapist who kicked me out. I sent him a much too nice email awhile ago which he ignored. I want to him to see my rage. The damage that his own fear caused me.
Even in my head seeking him out for this is unacceptable. But if he invaded my territory, then I’ve every right to defend it. I could show him my anger without as much guilt.

My favorite professor has a number of things in common with the therapist who kicked me out. I’ve been through many scary stories in my head where it turns out they are friends. The rational part of me had been able to say that this was unrealistic. They have similar research interests and theoretical perspectives, but so do a lot of people who don’t know each other.
This semester has been rough. I have a class with that professor and have learned more about him. Like how he enjoys going to conferences of a organization that once named the therapist who kicked me out as their therapist of the month.
My professor recently mentioned reading a blog and recommended it to me and a few others. It was a blog I’m familiar with. This blog has repeatedly endorsed the blog belonging to the therapist who kicked me out. The therapist’s blog is one of 13 links in a recommended blogs section. That therapist’s blog has a word in it’s title that is my professor’s primary area of research interest. If he were scanning that list of blogs this one would stick out.
It is fairly likely based on this information that my professor has read/reads the blog belonging to that therapist.

This potential merging of parts of my life is terrifying.
A whole new set of fear scenarios has been launched. Even something that might seem as small as my professor mentioning the therapist’s blog is scary. How would I react to it? Am I able to hide my reaction?
What if my anger towards the blog isn’t concealed? What if he puts things together, realizing that that therapist worked at my old school?
It’s possible that the reason that therapist no longer works at my old school is at least in part due to my legal action. What if he talked to people about it, without saying my name? What if he talked to my professor about it. What if then my professor put two and two together and realized it was me who the therapist kicked out?

It’s impossible to escape fully as long as I still live in fear of being kicked out of my new school. Even once I graduate I won’t be safe. It’s not just about being kicked out of school. It’s about stigma.
There’s nothing I can do to keep myself safe from the stigma other than hiding everything. It requires large amounts of mental energy. I have to be several steps ahead of everyone. I can’t say something that would elicit a question that might lead to showing too much.
And ironically the problem causing me the most distress is the anxiety surrounding escaping stigma. If I didn’t have this worry I’d have better mental health, certainly not perfect, but better. Trying to hide my crazy is making me crazier.

Non-Suicidal Self Injury in the DSM 5

As you likely already know, a draft of the DSM 5 came out Wednesday.
There’s a lot of interesting stuff to look through, but the part I had the biggest reaction to was the addition of Non-Suicidal Self Injury. Funny that this is what interested me, because in general research on self-injury bores me.

My initial reaction was entirely positive, but after some more thought I realized some potential problems. So, here’s a list of pros and cons.

Pros:
Too often people who self injure get stuck with the borderline personality disorder diagnosis who don’t meet the criteria only because they self injure. In the paper explaining the rationale for this addition (It’s a quick read. I recommend skimming through it if you’re at all interested) the authors mention that self injury occurs in many different disorders.

The specific wording in the title differentiates self injury from a suicide attempt. Hopefully this can help to cut down on some of the overreaction from practitioners about self injury.

Cons:
Does self injury really belong as its own disorder? Are there people who self injure on multiple occasions without any other diagnosis? Is there research on this? Seems strange to add a disorder that might only rarely be seen in isolation, increasing problems of co-morbidity.
But I understand that the way the DSM is set up, it has to be its own disorder or nothing at all. Possibly the benefits outweigh the negatives of added co-morbidity.
In the article (page 10-11) the authors justify self-injury as a separate phenomena by mentioning a longitudinal study showing that self injury decreased independent of other symptoms. This study was done only on patients with borderline diagnoses, not sure it is fair to generalize this to other patients especially because this new disorder plays a role to separate self injury away from only borderline personality disorder.

My largest problem is with section B: “The behavior and its consequences cause clinically significant distress or impairment in interpersonal, academic, or other important areas of functioning.”
This seems like a benign thing to add. Similar qualifiers are in every disorder.

Here’s the problem: The way it is written right now, I don’t meet the criteria for this disorder. I don’t have impairment or distress from the self injury, but I have a lot of that from the feelings leading up to the self injury.

Seems silly. No one would try to argue with me that what I do is self injury. I’ve even participated in a number of studies researching non-suicidal self injury. Those studies could easily be used to support inclusion of this diagnosis, wouldn’t make sense for their participants to not all qualify.

Instead, I feel section B should be written something like this: “The behavior, its consequences and/or feelings precipitating the behavior cause clinically significant distress or impairment in interpersonal, academic, or other important areas of functioning.”

The current writing reflects an unfortunate trend to treat self-injury as the problem rather than the reasons for self injury. Certainly many people feel guilt over their self injury, but this is not the case with everyone.
The authors touched upon a similar idea in their section, “Placement in the system: A Mood or a Behavior Disorder?” (Pages 8-9). Much of their argument leads towards placing it in mood disorders, with a side note of similarity towards impulse control disorders, so it seems strange for the mood component to be omitted from the impairment part of the diagnostic criteria.

Partial Hospitalization #1

A partial hospital program is sometimes also called a day program. You spend the day at the hospital, but then go home to sleep.

My first partial hospital program was right after my first hospitalization. I lasted two days there.
This is the program that I mentioned in my post about how they sent me someone else’s records.

The social worker in my hospitalization set up the intake at the partial hospital program for me.
I told her two requirements I had for it:
1. It needed to be an adolescent program
2. I did not want to do DBT

When the social worker informed me it was set up, she told me my requirements had been met.

When I arrived on the first day, I quickly learned neither request had been fulfilled.

I realize now that avoiding DBT in this type of program is likely an impossibility, but I’d have appreciated her being upfront with me about this. To be fair she probably didn’t know the program contained DBT. But the reason for this is probably because she didn’t put any effort to find out.

My request for an adolescent program was reasonable. I was 19. My inpatient hospitalization had been with adolescents (their cut off was age 21).

There was a group of about 6 others in the program. I was by far the youngest. Most were old enough to be my parents.
I was very uncomfortable. I listened to people complain about their children and spouses. I couldn’t relate.

At my intake meeting a ‘No Harm Contract’ was presented.
‘No way’, I said ‘I will self injure if I want to and forcing me to sign that just will force me to lie. I’d rather not need to lie.’
The contract was pushed aside to be reevaluated in the future.
I left that meeting with the understanding that I had in no way suggested I would refrain from self-injuring.

I was very angry and aggressive (verbally, not physically). Largely because I was stuck at this partial hospital program because I’d been kicked out of school and possibly also in a small part because of a bad reaction I was having to Celexa.

I was under the impression that successful completion of this program was necessary to help my return to school. Despite despising the program, I felt I needed to stick it out.

The first day was a Friday. That weekend I returned to the school to move everything out of my dorm room.
Most was removed Saturday. Sunday morning I came to retrieve the last few items and discovered another person sleeping in what had been my bed and a large bong in the bathroom.

Monday I returned to the partial hospital program. The first day I had left my sharp items at home. I wasn’t sure what I was getting into (would my items be searched?) and decided it was in my best interests to leave them at home. Monday, the second day, I came prepared with a swiss army knife in my pocket. This seemed fine based on my experience the first day.

Inpatient hospitalizations are under-structured. Too much time with nothing to do. Partial hospital programs are over-structured. One group after another. Spending the entire day dwelling on problems, because the structure prevents one from going out and doing anything enjoyable.

I was frustrated with the way the people leading the groups spoke down to us, as if the depression meant we were cognitively challenged.

During the lunch break I made a few little tiny cuts on my leg. Very minimal, close to zero blood draw.

In the afternoon I had a daily check-in meeting with a social worker. As a side note I mentioned cutting a little during lunch. I didn’t think it was a big deal to mention. I’d never agreed to the no harm contract.

I was transported into an office with another woman (someone with a higher level of authority). She demanded to see what I’d used. I handed over the knife.
A lecture proceeded in a disgusted tone, wondering how I could have possibly thought it was acceptable to bring a “weapon” (aka a small swiss army knife) into a hospital.

She demanded to see the cuts.
I refused, explaining they were minimal and did not need medical attention.
She argued that because I had done it “on the premises” she had to see them.
I continued to refuse.
“I’d have to take off my pants to show you”, I protested.
She seemed unconcerned.
I was scared and eventually intimidated into giving in.
I tried rolling up the pant leg to show the cuts, but as I’d suspected the leg wouldn’t push up far enough.
I unzipped, pulled down my pants and showed her the cuts.
I felt very violated.

“Well there’s not too much damage this time“, she huffed.

That was it. The last straw. I announced I was leaving the program.

She bombarded me with questions assessing my current suicidal risk, trying to trick me into saying something to allow them to keep me there.
I didn’t fall for it.

My knife was returned and I went home.

I still didn’t have a therapist. While making phone calls to find one, many therapists refused to see me on the basis that I’d not properly completed the partial hospital program. I only was able to get into therapy (although this was my fake therapy, because anything I said was at risk of being reported back to my school) eventually when I left out the bit about the incomplete partial program.