Time to Talk Day 2015- Self-Harm

Trigger Warning: This blog post discusses self-harming. There are no ‘graphic’ descriptions of any acts of self-harm, but I do talk about the feelings and emotions I associate with self-harm.

So far, I feel that I’ve been pretty open and honest about my mental health. And really, I haven’t found it all that hard. Despite the stigma that surrounds mental illness in general, I’m fortunate enough to be surrounded by people that make me feel at ease with admitting that yes, I do have a mental illness. I think that’s because I know that they will appreciate that my mental health does not define me, and does not change who I am or who I’ve always been. However, there is one part of my mental health that I’ve hidden away, so to speak. I’ve written about it in the past tense in these blogs, but I haven’t addressed it as an ongoing issue- Which it is, and honestly, always has been. I’ve been struggling with the decision to write about it, because it is that much of a taboo, or it seems that way to me.

However, I desperately want it to become less stigmatised, so that people can start talking about it more openly and start getting help the way I’ve been able to. What I’m referring to here is self-harm. I did put a trigger warning at the beginning of this blog, but just to re-iterate, I will be discussing it in some depth over the course of the blog, but this won’t be in the form of graphic descriptions of acts of self-harm. Instead, I want to briefly explain what my history of self-harm has been, where I’m at with it at the moment, and then also describe how my relationship with self-harm has changed over the years. I hope this won’t be triggering to anyone who currently self-harms or has done in the past, but if it does cause any problems for you then I’m incredibly sorry, and please don’t keep reading if it’s not helping. My intentions for this post are to help people think beyond their initial, gut reaction to self-harm, and to encourage those who are struggling with it alone to reach out to someone.

I first self-harmed when I was around 13 years old. To be completely frank, I only did it because I became aware that someone at school (not even a friend) had begun ‘cutting’, and I was curious. I did a bit of digging, and found that it was something people did when they were upset. And at that time, my depression was just starting to manifest. I wanted to know if it would help me feel better like it did for other people. Evidently, it did. I don’t have much recollection of my thought processes at that time, but I do know that I continued to self-harm, though relatively infrequently, for the next few years. Then I started sixth form, which was the time when I think I was in the most mental distress over my school years. It got gradually worse until I took an overdose once in an attempt to manage my increasingly intense and distressing feelings, and thus spent a night in hospital. After that, I don’t think I self-harmed for a while- In a way, I feel like the act of taking an overdose wiped the slate clean for me. My mental state settled considerably.

The next time I remember doing it was in my first year of uni, when symptoms of depression and anxiety started to manifest again, for the first time in what I consider to be my ‘adult’ life. I have been using self-harm on and off ever since in an effort to control my emotions, or maybe just as a way to deal with them full stop. I do still currently use self-harm as a coping mechanism, though this is by no means a frequent occurrence, and is definitely becoming less common as of very recently. I find it quite hard to imagine a life without self-harm, because it’s been such a reliable way for me to cope for a long time. At times, I’ve actually felt resentful towards therapists who have encouraged me to stop self-harming, because really, if it keeps me in a state where I’m able to function and carry on from one day to the next, why should I? I almost feel like self-harm is something which belongs to me, in the sense that I am the only one who can control it and decide whether or not it happens. In a world where we really have very little control over a lot of factors, I don’t think it’s surprising that so many people use self-harm as a coping mechanism.

Being that I work in a mental health setting, self-harm is also something that I’m very aware of in a professional capacity. This has been an eye-opening experience for me, as I’ve been able to see self-harm from a totally different perspective. One thing that I’ve picked up on, and battled with the idea of, is the concept of responsibility and choice when it comes to self-harm. Unfortunately, even within the mental health profession, there is stigma surrounding self-harm, and judgements are often made against those who do it. As I mentioned before, self-harm is something which I feel that I make the choice to do to myself. For many professionals (and non-professionals), this makes people who self-harm liable for the consequences of their actions. People who are admitted to A&E with self-harm injuries are treated with disdain and are rebuked for their actions. This is, quite frankly, a disgusting attitude, and so incredibly unhelpful. I do think that self-harm is a choice, but if that person thinks that self-harm is the best or only option for them to be able to carry on existing, or coping, or functioning, then what does that tell you about how they are feeling at that point in time? What does it say about the things they might have experienced to drive them to this point, or about what feelings they must be experiencing at that moment? So how could anyone possibly pass judgement and treat that person poorly for self-harming?

Recently, I’ve started training to work as a helpline volunteer for the charity Self Injury Support (SIS). SIS is a Bristol-based but nationwide charity which looks to support women who self-injure. Being that self-harm and self-injury is something that I have experience of, I wanted to be able to engage with the charity and try to give other people what I feel is most needed to help reduce the need for self-harming- A space to talk about their feelings without fear of judgement, and to unload a little. I’m 3 and a half weeks into a 7 week training course, and in that time, I feel like my relationship with my own self-harming behaviours has changed massively, for the better. For one, just being in an environment where people are speaking freely about self-harm (and mental health) is a breath of fresh air. We have been trained so far on the many possible functions of self-harm and reasons behind self-harming, among other things, and it has provided an opportunity for me to think about my own reasons for using self-harm. In doing so, I feel like I am much more attuned to my own feelings and emotions about it, like how I don’t always hurt myself for the same reason. Sometimes I do it to release a build-up of emotions that I can’t express externally, and reflecting back on some diaries I’ve kept in the past about self-harming, I can see that a lot of the time I need to self-harm before I can cry or talk to someone about how I’m feeling. However, at other times I’ve felt a need to punish myself, which relates to how anxious I often feel, and how I often see myself as being inadequate. In both of these examples, self-harm has allowed me to continue functioning in the face of emotions which I feel are otherwise unmanageable.

I obviously don’t speak for everyone who self-harms. There are so, so many reasons why someone might use self-harm, and so many functions that it might serve, even if the act itself might not seem particularly severe. What is important is that someone who self-harms feels such intense distress at that moment in time that they feel like self-harm is something they need to do. It makes no difference whether you objectively think this is a reasonable reaction or not, and it has everything to do with their subjective experiences. Like I said, self-harm continues to be a taboo subject, despite an improvement in public attitudes towards mental illness (although we definitely still have a long way to go with that!). And I can absolutely understand why- No one wants to imagine another human being choosing to inflict pain on themselves, and potentially put their own life in danger, due to their feelings and experiences. It is extremely uncomfortable to put yourself in those shoes, and to imagine that level of psychological pain. But this really does need to change. My experience of this stigma has been really quite harmful, as it means that after self-harming I often experience feelings of shame, guilt, and worthlessness- Most of which are reasons for me self-harming in the first place! It sustains the cycle of self-harm further, and also makes me feel like I can’t talk openly about it. I hide my scars/self-harm marks when I’m in public, and when questioned about them feel like I have to lie about how I got them. But I know that when I’m in a ‘safe’ space, and can talk openly about self-harm, I feel instantly better. Just knowing that people will be accepting of what I say is a relief. I just wish that this kind of attitude was more common, and that more people had somewhere to go to when they needed space to talk.

I realise this post has been a really long one, so thank you for sticking with it! I’ve never dared to talk openly about this before, because I’ve honestly been scared of what reaction I’ll get. I also know it will be painful for those who care about me to hear that I self-harm. I understand that, and I wish I could change it, but what I want to make clear to everyone is that my self-harm is no one’s fault. No one has ‘failed’ to help me, or be there for me, or has done anything wrong. And in the grand scheme of things, it’s really not the worst thing I could be doing to manage my emotions. Granted, I would definitely like to be able to cope without self-harm, and am working towards it, but it’ll be a slow journey. I just need you to accept me and my reasons for self-harming. I need and deserve to be validated and supported, whether I’ve self-harmed recently, or whether I’ve gone months without it. And this goes for everyone who self-harms- No exceptions. If you know someone who self-harms, or if someone opens up to you about it, please just let them talk. You don’t need to ‘fix’ it. Just let them know that you’ve heard them and that you are still there for them. If you currently use self-harm, I hope that hearing about my own experiences helps you feel less alone. And I hope that you can find a safe space to talk about it.

Thank you for reading!

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Crumble

So, I’d like to update you all on my mental health at the moment. I’m going to try to be as vivid and descriptive as possible, because I’m finding it so, so difficult with all this in my head all the time, and I think it will help if I can explain it to someone else so they have an idea of what I’m experiencing on a day-to-day basis. If you get it, then great! If not, then that’s fine- You’ve done me a massive favour by reading this in the first place and giving me a chance to unload all of this. So whatever you make of this post, thank you for taking the time to read it and helping me on my journey to recovery. ((Whatever the hell that is!))

It’s like I’ve been falling apart recently. But not in a really big, dramatic way. I love cakes and sweet things, so let me use a food-related metaphor for this… I think I’ve just been crumbling away, like how shortbread just kind of falls apart when it’s fresh out the oven, and you pick it up with too firm a grip. I didn’t even notice to start with, because at one point, I was really making progress, and my relapse wasn’t something I wanted to acknowledge. So I have been spending the last month or so just powering forwards, with parts of me crumbling away being left behind as I go. But now when I try to think back to what I’ve been doing and how I’ve been feeling, it’s just a big blur.

A couple of weeks ago I had that light bulb moment when I realised something was wrong. Nothing was exciting any more. I got no pleasure from exercise, from food, from reading. Every single time I sat down to do something, or thought forwards to what I had planned for that day/week, I couldn’t help but wonder what exactly the point was. I try to think about it, but the answer continues to evade me. I’m trying to hold onto something that is turning into smoke and drifting away from me and I can’t do anything to stop it. For a while I’ve been able to ignore that this was happening, but it’s been sitting in the back of my mind, just waiting for the moments when I let my guard down. I stop focussing on my job, or on a task that I’ve managed to find to fill my time, and that terrible feeling just creeps up on me.

I can feel it across my whole body. It’s a tangible, physical thing. A horrible, dark fog, dense and all-encompassing descends on me. My brain is filled with hopelessness, and the fog dampens down my thoughts- I can’t process stimuli like normal- the fog pushes its way into all the gaps in my head and gets in the way. It sits behind my eyes, and presses on my tear ducts. I’m constantly on the brink of tears. This massive weight settles into my chest, and my limbs. I want to stop. I want to sit down, or lie down, and never get up again. My tongue is heavy in my mouth, and talking, responding to people is so hard. The weight in my chest gains substance and squeezes tightly.

How does this translate emotions-wise? It varies, to be honest, and I often feel totally contradictory things. I want to stop being, but I also desperately want to carry on. I feel panic, as I struggle to find meaning in anything, in anyone. I am guilty for feeling such deep despair, when I am surrounded by people who love me. I don’t want anyone to hurt because of me, or feel like they are not enough to make me happy. God, I appreciate you all so much. I feel such strong emotions that they tear my psyche apart, but at the same time, I feel so empty. How is it possible to feel both everything and nothing? I exist apart from the world all of a sudden, and I struggle to link my subjective experience of life to the events that are going on around me. Like the strings connecting me to the world have been cut, and I am desperately trying to reconnect them in time… I don’t know where this feeling of haste comes from. I think it’s just that I need to know I will get better. Again, what is ‘better’? What is ‘recovery’? I am hopeless. I don’t even know myself what will make me feel better in those moments where I’m falling apart, so how could anyone else possibly help me?

I can’t think. I can’t process anything. I am crying, and I have this horrible feeling bubbling up inside me, in my chest. It claws its way up my throat and sits in the roof of my mouth. I need to expel it so badly. I don’t think I can even express this enough, how trapped that feeling is and how strong my desire is to rid myself of it. I have cried, loudly, I have punched things and gone running until my legs ache. It won’t go. It just recedes slowly, until finally I can move again and function, and I go about my daily business. I go to work, or I throw myself into something that encompasses my attention, and slowly, with nothing from me to feed it, that fog draws back into a small space in the back of my head. And I always know it’s there, but at least I can breathe again, and I can carry on in a forward motion.

At this point, I do just want to point out that as horrendous as this all sounds, I’m not in a state where you need to be worried about my safety. I feel a bit nervous, as this whole post is a bit dramatic for my tastes, but it serves a purpose for me, so I am going to go ahead with it. I need people to know how hard it is to carry on sometimes. I realise that’s extremely self-indulgent, but I’m willing to accept that if it eases some of the pressure I live with at the moment.

The frustrating thing is that I don’t feel like this even captures the full spectrum of my emotions! I feel so many other things at the same time when I experience what I’ve tried to verbalise above A mini-crisis I think, would be a decent way of describing it. It might last a few minutes, or it might drag on all evening, from the instant I get in the front door from work until I manage to fall asleep many hours later.

I’m not the only one living with mental health problems by a long, long way. And I’m not even the worst off, by even more. I am also writing about my mental health for them Everyone who is suffering from poor mental health and feels totally overwhelmed by it. It can just totally smother you, until the you the world sees is just the bare bones of you, and you are powerless to fight back.

Be kind to people, because you will never know how much they may or may not be suffering at any moment in time. Please understand that it is so hard to fight against your own mind. Imagine it. You second-guess every passing thought, to try to work out whether you are being ‘rational’ or not. You can’t trust your own judgement.

I do everything I can to maintain ‘good mental health’. I exercise, I eat well. I take my medication, I attend therapy. I am still experiencing the same cycles of being ‘fine’ and being ‘unwell’ as I did before. Not in the same way, but that pattern definitely remains. I feel like this blog is my last chance in a way. Can I heal myself through activism? I really hope so.

Thank you for sticking with me! I hope that for those of you that identify with some of the things I’ve written can find comfort in the fact that you’re not alone.

Jess

Getting “better”

I’ve been thinking for a while that I might finally be getting better. I’ve had both low and high intensity cognitive behavioural therapy in the last 6-12 months, which I really learned a lot about myself from, and which enabled me to control my anxiety a bit better. I also have been pacing myself a lot more with my work, and managed to solve some of the issues that had been bothering me on a day-to-day basis, such as finding a new job to replace my old, stressful one. I managed to up my meds with no significant side effects. I have been exercising just like they tell you to do when you’re depressed. I make myself go out and be around people when the last thing I want to do is be sociable. Actually, I’ve been doing just about everything ‘they’ (doctors, psychologists, mental health professionals) say you should be doing to keep yourself happy. And so, I told myself that I must be getting better, because how could I not be when I’ve exhausted all my options? What else is there left to do if I don’t get better from all that?

But, as you may already suspect from my tone in that last paragraph, I am coming round to the idea now that I might not be as okay as I thought I was. I’ve been trying to fight against that thought for months, because honestly, the idea that I might still need more help, or that I still have some ‘getting better’ to do terrifies me! I feel like I’ve run out of solutions treatment-wise. I go back to my doctor for help, but she just tells me that I need to stop over-thinking things, or that sometimes it’s normal to feel certain ways. Maybe I brought that response on myself however… After all, I did admit that I was concerned that I might be making myself feel depressed, and stopping myself from getting better.

I’ve been seeking treatment for my depression/mental health problems for coming up to 7 years now, give or take a few months. So really, that makes it a chronic condition rather than an acute one. And I think when it comes to mental health problems, whether an illness is chronic or acute makes a world of difference, particularly to the way that the patient perceives themselves and their illness, and how accurately they are able to identify changes in behaviour away from what is ‘normal’.

When someone first experiences a ‘depressive episode’, having not ever been clinically depressed before, the changes in their behaviour will be fairly stark and plain to see. Someone might go from being a social butterfly to wanting nothing more than to stay inside the house all day, away from the pressures of being sociable and having to interact with people. Their appetite may either increase or decrease, they may experience sudden weight loss/gain, or they might suddenly find that they either sleep all the time or find it incredibly difficult to sleep at all. It wouldn’t be true to say that everyone can identify a definite change in their personality/behaviour upon encountering a depressive episode, but certainly I think that for the large majority of people, they will be able to complete a questionnaire and provide evidence for a substantial change indicative of depression. For me, I don’t feel like this is the case at all. Maybe to start with I experienced depression in ‘episodes’, where I saw a noticeable change in my motivation, concentration and mood etc. But honesty, nowadays I just feel like I’m consistently not experiencing life like I should be. But it’s been such a long time since before I first encountered depression, I can’t remember what that felt like. Which leads me to wonder: Am I better already, but I’m so used to being depressed that I drag myself back down out of the desire for something familiar? Or am I genuinely still ill? Is my knowledge of psychology hindering my recovery, as I constantly analyse and over-think my cognitions and behaviour?

I suppose the only way to find out is to look at the evidence as objectively as possible, considering these are my own subjective emotions that we’re discussing! Like I mentioned just now, when depression is acute, the difference in mood or behaviour before and after is very severe. You can easily compare the two and know that the low mood you are experiencing is not normal, because your emotions before were so much more positive. However, after 7 years, I sometimes doubt myself. When I’m sitting on the sofa, and I’m trying to motivate myself to get up and do something (such as work on my dissertation or make a phone call), I agonise over whether I can attribute this to my depression, which is known to sap energy and motivation, or if I’m actually just being lazy. How do I tell the difference anymore? When I’m in a class and I’m struggling to concentrate and take in the information that’s being given, is this due to my mental illness too? Experiencing poor concentration is another well-documented symptom of depression (and anxiety, which I have also been dealing with), but maybe I’m just not trying hard enough? I could go on and on like this for all my symptoms… But thinking like this is pretty exhausting, and at the end of it I just want to cry while I wait for someone to come along and just make everything better for me.

To be honest, I’m not sure what I’m getting at here. Really, I think that I must still be unwell. Because the thought that everything might just be my own doing, and that I just need to suck it up and get myself together is devastating. And that can’t be normal. If it’s normal, then I really, really don’t want to be normal at all! I can’t live like that, always doubting myself and trying to deal with the pressure of succeeding and functioning. But equally, the prospect of having to fight my GP for more referrals for therapy is so daunting. I just don’t have the energy to do that. I also don’t particularly want to increase the dose of my medication again. The more drugs I take, the higher the risk of side effects is, and the harder it will be to come off of them eventually. I also have a fear of sinking into apathy, where the only way to get away from my anxiety and depression is to take so many drugs that I feel nothing at all.

I’m so angry that it’s this hard to get help from the NHS for a mental illness. So I haven’t been able to get better from the treatment that they initially provided for me. I also feel like I’m being told that I’m not ill enough to qualify for any more support. So am I being punished for being too ill but also not ill enough at the same time? It’s a worrying thought for me, because I’m certainly not getting better by myself, so the only way to go is down. How sick do I need to be before someone will help? And how can I objectively prove that I am at that point? I can totally see how people with less support from friends and family than I have feel like their options are limited. Desperation can lead people to do very extreme things. All I can say is that I am so, so thankful for my family and friends, and for my extended social circle who I interact with regularly. You guys are my lifeline.

In an ideal world, what I would like is for my GP to refer me to see a mental health professional, who can re-assess my symptoms and make recommendations as to what treatment I should be seeking. I want to know for sure that I have spoken to someone at length about my history of mental illness, and about my current thoughts, feelings and behaviours. I want to be given a correct diagnosis, or at least a more accurate summary of what my difficulties are and where they stem from (the debate about the usefulness of a diagnosis is a totally different ball game), and then what drug treatment and/or talking therapy I might find most useful. People change over 7 years, and I’m no different. I’ve gone from mild depression, to moderate depression, to self-harm and an overdose, to mild depression, to anxiety, and then to anxiety with depression! My mental health, just like my physical health, is in a constant state of flux. I want the care I receive to reflect that.

Self-care

TW: Depression, Mental Illness

 

N.B.: Before I go on, I think it’s important that I address an issue that has recently come to light with me writing these blog entries, and it has to do with the effect they might have on my close friends and family. I realised that friends and family members may read these entries and find out things they didn’t know, or maybe just hear things phrased in a very candid way, and then they might go on to feel guilty somehow, like they should have known how I was feeling. Or maybe that they should have been there more, or been more supportive. To incite these kinds of feelings is not what I intend to do with my blog entries! Please understand that I have always felt fully supported and loved by my friends and family. And I’m so sorry if I write anything that is upsetting or shocking, but I am doing this for me, as a kind of therapeutic release, and also to try and encourage more open and honest conversations about mental health. It is not about placing blame on anyone for not doing enough! In fact, I don’t think there’s anything more that could have been done. When you are in the middle of a depressive episode- and I’m sure those of you who have personal experience of this will back me up here- one of the hardest things to do is pick up the phone and ask for help. It’s not even because I don’t think I will be supported, it’s just that it takes so much energy to do this, and all of my energy at the time is centred on my internal feelings. This probably deserves a whole entry to itself, but I just wanted to make it known before I go on that I blame no-one for my mental illness, and do not feel let down or unloved by anyone close to me in my life. If you read something you’re unhappy with, please let me know. I’ll be happy to talk about it.

Now, onwards!

Self-Care

This week has been hard. Like, really hard. But I’ve definitely learned a lot from it, and something that I’ve been thinking a lot about is self-care.

For me, self-care is essentially the opposite of self-harm, and the absence of it is even a form of self-harm. If you google it, the following definition is given:

“In terms of health maintenance, self-care is any activity of an individual, family, or community, with the intention of improving or restoring health, or treating or preventing disease.”

So what immediately springs to mind are things like washing, eating, drinking, sleeping, taking medicine, exercise etc. etc… And those are absolutely activities which come under the umbrella of ‘self-care’. But it also includes other behaviours that many people do instinctively, like resting when you are ill, and forgiving yourself when you make a mistake, or when something doesn’t go to plan. For a long time, and even now still, self-care has been extremely difficult for me. It is something that comes up in near enough every counselling session I attend, and I feel like it’s at the root of most of my mental health issues.

Somewhere along the line when I was growing up, I got it into my head that I wasn’t good enough. That it was crucial for me to identify as a ‘Good Person’, and for other people to be able to see me as such. I formulated a set of rules and guidelines in my head, as to what constituted a ‘Good Person’, and what I needed to do to be one. Overwhelmingly, this meant I had to put other people before myself at all times. I thought as myself as a martyr, as much as I hate to admit it- I associate this label with self-righteousness for some reason, and this is not a quality a ‘Good Person’ should have.

Self-care was not on my mental checklist for being a ‘Good Person’.

And so for years and years, I overworked myself. I suppressed my own feelings when I thought it might cause people upset. I went out of my way to accommodate for other people’s wishes. And when I made a mistake, I did not forgive myself. I assimilated all the guilt, and all the blame, and I used it as a reason why I was not worthy of self-care. I didn’t feel like I deserved forgiveness, or kindness, or any form of leniency. And unfortunately, this belief became very deeply ingrained in my self-image, and it is something I still struggle with from time to time.

But this week, I have made a conscious effort to be kind to myself, because I haven’t had a great time of it. I went for an interview on Thursday but didn’t get the job, and I instinctively sunk into a dark place where I wasn’t good enough, and that it was all my fault because I should have been working harder. On top of this, I somehow misplaced my passport during a recent house move, but didn’t realise until this week… With two holidays planned in the next 7 days. Too late to get a new one for the first trip planned, and cutting it very close for the other! It had been my intention to use these holidays as a time to indulge in massive amounts of self-care, after working so hard on my MSc dissertation, and for my three part time jobs, where I seemed to be doing work of some sort every day of the week. But in an instant, my plans fell apart. I felt total despair, and cried on and off for days. Then there was the guilt, born from my feeling of having let people down…

It was an awful cocktail of emotions. I was very angry, both at myself and at the world for being so NOT FAIR. I finally decided I might be worthy of some time off work, relaxing with my friends and family, only to have it taken away from me at the last minute. Nothing would ever be okay again.

Except, it will. And thankfully, my loving boyfriend took the time to remind me of this. He looked after me, and sat with me when I was bawling my eyes out- Messy crying, not Hollywood crying (lots of snot). On Friday morning, I woke up with the whole day to myself. I had been dreading it, thinking I would sink further and further into this horrible dark feeling, and then end up damaging myself somehow because I struggle to process and deal with my emotions so often. But to my surprise, I felt much more at peace than I thought possible. I felt tired and ill, and emotionally drained, but suddenly I felt like I might actually be able to deal with life again. I suddenly had the strength to think “This is really shit. But I can get over it. Things will be better”.

And then, I did something even more incredible. I took care of myself.

I felt ill and tired, so I let myself relax on the sofa. I didn’t force myself out for a run, or sit down and write more of my dissertation. I still felt that urge to do something, but every time I managed to justify my time to myself. I deserved this. This was fine. I was worth looking after. I will inevitably make mistakes, as will everyone else, but I will only do myself harm by refusing to forgive myself.

I guess I just needed someone to remind me of that. I can’t thank my boyfriend enough for his time and attention and understanding.

As it happens, I might just scrape that second holiday after all…Fingers crossed. 🙂