When Medications Go Wrong

For years, I’ve pretty much been medicating myself.  I take my scripts home and medicate how I see fit for my situation.  I realize that makes me medication non-compliant.  The trouble I come to is my trust in doctors.  I have been burned so badly before that I find I have a lack of faith in them to know how they are really treating me.

When I was in my teens, and being treated for Major Depressive Disorder (misdiagnosis – strike one), I was put on high doses over a slew of medications for years with little result (overmedication – strike two).  I suffered extreme side effects, with little done to relieve them.  I took Zoloft in increasing doses over a three year period.  I continued to complain of extreme fatigue, anxiety, motion sickness, and periods of flu-like symptoms.

The doctor’s answer?  More medication.  It came to a head when I found that if I sat still for too long, I would drift off to sleep.  Sitting in school became impossible, and I was sleeping fourteen to sixteen hours a day.  Eventually, I was put on 300 mg of Zoloft with Provigil to combat narcoleptic symptoms.

It was at the doctor’s suggestion that I continue to exceed maximum dose and go to 350 mg that my mother finally put her foot down.  “Put her on something else.  We’ve put three years into this, and it clearly isn’t working.”  And much to my doctor’s chagrin, I was switched to Lexapro.

Wrong answer.

Immediately, I started to have dissociative symptoms.  I recall laying in my room, laying on the floor, and staring at my ceiling in the dark.  My mother stood in my doorway, just observing me.

“What are you doing?” she asked.

“Nothing,” I answered blankly.

Yes, I was finally awake.  But, every moment was torturous.  I lost my sense of self, and started to drift away.  My memory began to fragment, and I sunk into a deep, desperate depression.  I was frantic and crazed, while feeling numb and blank at the same time.  I became paranoid, and started to assert that everyone was doing things against me.  They were intending to harm me, and I started to give meaning to harmless comments and phrases.

I attempted suicide several times in the first month.  The cutting became so bad that I was doing it in rather public places.  I was caught one time at my boyfriend’s house, and I had a dull exacto set ripped off of me and immediately chucked into the local creek.

We were unaware of all of the side effects at the time, because all of the medications I was placed on were brand new.  When a pharmaceutical representative left her office prior to my visit one day, it became clear that I had become an experiment to brand new medications.  I was taking expensive, largely untested medications for her financial benefit.  Strike three.

I had gained thirty-five pounds over a six month period.  I was 4’11” and 165lbs.  That put me at a BMI of 33.3, and in the obese range.  And despite all of my best, and even worst, and unhealthy efforts, I still couldn’t manage to get my weight below 145lbs.  I was starving myself on 900 calories a day, and I still hovered around obesity.

I couldn’t afford my medication once I was kicked off of my parent’s insurance, and I just decided that since it failed to ease my symptoms, I would stop taking the medication entirely.  They failed to mention that if I attempted to stop the medication cold, then I would be stricken with the worst withdrawal I had ever known.  It was a good thing my parents had been through this before with my father, because they knew how to ween me off.

It took me years to get the rest of that weight off.  But, by then, the medication had already done long lasting damage far worse than just weight.  I had begun to develop a drinking problem.  I had engaged in risky sexual behavior due to hypomania.  And it sent me walking with bad eating habits.

After that, I distrusted doctors and medication entirely.  I had lost faith in mental health treatment.  I was left with a feeling that I didn’t have a disorder at all, and instead, it was just me.  I was convinced that I wasn’t treatable.

It took a lot to make me realize that I was in desperate need of treatment.  I had taken psychology courses and was suggested by several psychologists in my college to have bipolar disorder.  I knew my behavior wasn’t “normal”, just as I had always suspected.  It took the my marriage, my depleting mental health of my husband, and the birth of my son to encourage me to start treatment again.

Three years, four doctors, and a another slew of medications later, and here I am, again the victim of overmedication and bad medication choices.

Recently, I stopped my Abilify.  Admittedly, it was because I noticed an interaction between the Abilify and my weekend consumption of alcohol.  I started to find that I would fall asleep soon after taking it on Friday’s while we drank.  I decided that I would just stop over the weekend, and continue during the weekdays as normal.  But, eventually, I just forgot to take it at all.  And soon, I started to notice an improvement in my worsening condition.

Suddenly, I was able to think again.  I started to feel more like myself.  I became more aware of what I was thinking and feeling, and I finally started actually living in the world around me.  It actually felt like living again.  And that’s when I noticed the weight I had put on.  I had fell victim to Abilify’s weight gain, among other things.

I can blame the dissociative symptoms on Abilify.  It had created an emotional flattening, and I started to dissociate from myself and my world.  It had robbed me of my ability to write and care for my family appropriately.  I wasn’t feeling, so I wasn’t caring.

The anxiety?  Well, I recently started to run out of a supply of Wellbutrin I can’t really afford right now.  I started to cut back to make ends meet, and I discovered that was starting to subside.  Other than rebound depressive symptoms, I was feeling better.  It didn’t matter to me anyway.  I was still going through crying jags, whether I was taking the Wellbutrin or not.  The difference was between whether they were loaded with distressful urgency to cut or not.  I decided that I would prefer to keep my near streak of four months without cutting.

I don’t blame my doctor.  He’s an old school doctor who works off of the biological model and treats symptoms.  I have declined therapy several times, though my requests to be seen since have not been honored.  All of my symptoms point to mild psychosis in general, aggravated by extreme life stressors.

I blame myself for not listening to myself and taking action sooner.  Treatment happens on both ends, and I have not been holding up my end of the bargain.  I have not been mood charting, and I have not been notating subtle symptoms.  It has become abundantly clear to me since my extreme meltdown and psychotic break during the summer that I had been probably Bipolar 1.5 all along.

Though I don’t experience full on mania, I do experience mild psychosis, practically all of the time.  I have not been pressing the issue about invasive thoughts, paranoia, “The Voice”, or any of the mild hallucinations that I experience.  Only when I had my break did I bring it to my doctor’s full attention.  And I was met with extreme medication.

Personally, I’m at a loss as to what to do.  I’m damned if I do, and I’m damned if I don’t.  I noticed last night that “The Voice” has returned, even if it’s benign (right now).  I don’t want to be overmedicated, and I can’t risk gaining anymore weight.  The weight is worse for my mental health than anything else.

And it completely screws up my bodily function.  Now, I’m experiencing weight related problems again.  My knees and back hurt.  I have acid reflux near to the point of anorexia again.  Sexual dysfunction is destroying my sex life, my self-esteem, and hurting my marriage.  And I’m back to full on social anxiety, because I’m too self-conscious to function.

But, at the same time, I’m aware that I need some kind of medication.  While, for now, I’m better off without it, the day will come where I am asked to step up, and perform at a higher function.  My family, including Finn, has been very great about my general lower function and picking up a lot of the slack for me.  However, this won’t last forever.

BPD and Me

A post by Angel, concerning Avoidant Personality Disorder, had me thinking again about the possibility of me having Borderline Personality Disorder.  This is a suspicion that has plagued me throughout the course of my treatment within the last year or so.  Instead of going straight to the Borderline Screenings, I went to a personality disorder screening to see the possibilities of what I may be dealing with.

Disorder	Rating
Paranoid Personality Disorder:	High
Schizoid Personality Disorder:	Low
Schizotypal Personality Disorder:	Moderate
Antisocial Personality Disorder:	Low
Borderline Personality Disorder:	Very High
Histrionic Personality Disorder:	High
Narcissistic Personality Disorder:	High
Avoidant Personality Disorder:	High
Dependent Personality Disorder:	High
Obsessive-Compulsive Disorder:	High
— Take the Personality Disorder Test — — Personality Disorder Info —

I really never imagined that I would be symptomatic of multiple disorders in Axis II.  Since BPD still remained the highest, I decided to take a specific screening.

Results of Your
Borderline Personality Test

You scored a total of 43.
Severe Borderline Personality Disorder Likely
You answered this self-report test in a way that’s consistent with people who have been diagnosed with severe Borderline Personality Disorder. This suggests that these concerns may be an issue for you as well, and something that you should seek out further assistance with this issue from a trained mental health professional immediately. Borderline Personality Disorder is characterized by a pattern of unstable and intense relationships, as well as frantic efforts to avoid abandonment — even if it’s not real.

I thought about the entire year and the instability of my own marriage – the most solid thing I can think of.  I had all of these paranoid delusions that my husband was cheating on me, although in the back of my mind, I knew it was not a possibility.  I sabotaged myself at work with the line of thinking that everyone was against me.  I started severing ties with coworkers and hiding in my classroom.  I had always thought that was characteristic of bipolar psychosis, but now, I’m not so sure.

Using the same site that Angel used, I discovered something kind of shocking:

You may be at risk for developing BPD if:

• you have a family member who has BPD
• you felt emotionally unstable or emotionally vulnerable as a child
• people in your household were impulsive when you were a child
• you were emotionally abused as a child

And all of those were true.  My mother does not have a confirmed case of Borderline Personality Disorder, but it seems she is symptomatic.  When she was a very young child, she was put into foster care.  She has absolutely no memory of this, and none of her family members will detail what happened.  My mother married her first husband on a whim, because his draft number came up to go to Vietnam.  She had an extremely turbulent relationships with him, and he mostly left her alone all of the time.  That’s how she met and fell in love with my father.

Their marriage isn’t much better.  In private, she has gone on and on about my father’s faults.  They have had a rocky relationships, where I recall them throwing around the word “divorce” probably far more often than they should have.  She binge drinks and sometimes takes too much medication.  Medication that isn’t even hers to begin with.  She is as impulsive as she can be in her restrictive environment and goes through so much emotional turbulence.  But, she will never leave my father, no matter what.

I was an emotionally unstable child, and I wasn’t the one to immediately notice.  My preschool teacher had mentioned to my mother that I needed to “toughen up”.  That one little phrase was enough to spark years of tough love and general emotional abuse and neglect.  It gave them a free pass to call it “good parenting”.  As a result, I developed this need for achievement as a means of recognition.  I was designed to people please.  Regardless, another comment came from a teacher stating, “Doesn’t take constructive criticism”.  And the idea that criticism was encouraged compounded what I was already going through.

Impulsiveness!  My father used to just go drive off in his car without telling my mother where he was going.  He’d be gone for hours, and she’d be a wreck.  One time, he went through the house waving a gun, terrorizing us with suicidal gestures.  Honestly, I can never get that scene out of my head as hard as I could ever try.  My parents have both run their credit into the dirt over impulsive shopping sprees.

Now, here’s where things get tricky.  Friends and family in the past have suggested that I may be suffering from Borderline Personality Disorder.  An ex used those weaknesses against me.  So the presentation is convoluted because my actions are purposefully deceiving.

frantic efforts to avoid real or perceived abandonment

I self-sabotage in this area.  When I perceive abandonment, I start to shut that person out of my life.  I have this funny idealization that person will perceive my own emotional abandonment and come running back.  It’s what my parents and my ex did to me, and I seemed to have picked it up.

I’ll also become more sexual and start having defensive sex or performing certain sexual acts to peak someone’s interest and entice them into staying with me.

I also have this habit of changing everything about myself to appease my partner.  This is an effort to avoid abandonment.  And it’s one that’s been preyed on before.

pattern of unstable and intense interpersonal relationships, characterized by alternating between idealization and devaluation (“love-hate” relationships)

People that are close to me are also subjected to this regularly.  Honestly, this is a major reason why I don’t let people get too close to me.  At first, I idealize someone and pick out the best of their characteristics.  Then, I start to idealize how the relationship with them will go.  Soon, I will become disillusioned at the first sign of trouble.  And it is at that point that I begin to demonize someone.  Everything about them is bad, and I have ever right to be suspicious at their deceptive behavior.  Except, it wasn’t deceptive.  I perceived them to be something that they weren’t and assigned them to the task of living up to my unrealistic expectations.

extreme, persistently unstable self-image and sense of self

I’d like to paraphrase the way I perceive myself.  I have lived a dozen lives, and each time, with every death, I’ve risen like the phoenix out of the ashes.  In my life, I have been a dozen different people and will be dozens more, each with their own birth, life, and death, only to start once more.

I take one aspect of my life and characterize myself through it.  I’ve been a baker, a mother, a wild child, a caretaker, a housewife, a teacher, a crazy woman, a bipolar woman, etc.  And for some reason, I can’t seem to integrate all of those periods of my life into the same entity.  They are just all separate from one another, as if I were living so many different characters in the same skin.

impulsive behavior in at least two areas (such as spending, sex, substance abuse, reckless driving, binge eating)

It is well known that I have a substance abuse problem with alcohol. But, here are a few facts that are the most difficult things for me to admit. I am guilty of day drinking every now and again. It is never when I’m alone with my child, for the record.  I am also guilty of taking too many benzodiazepines to escape reality from time to time.  Yes, I abuse my medication every now and again.  But, it’s not a dependence kind of thing.  I don’t find that it’s necessary, until I get into a frenzy of hysteria that produces so much distress that it’s unbearable.  The drugs quiet my mind.

And the other one is very difficult to admit as well, and I’m not sure if I can spell it out in detail.  I have a difficult relationship with food, dieting, and exercise.  I am guilty of binge eating.  I am also guilty of purging if I am distressed.  Especially if it’s about my weight.

And lastly, I recently made a confession of my sexual exploits in my youth in Promiscuously Yours, in the series The Friday Confessional.  I had multiple reasons for cheating on my ex, which is something I wouldn’t normally do.  I have a better moral compass than that.  Sometimes, I was so distressed that I just wanted to feel some kind of love.  Sometimes, I was trying to prove to myself that I was something special.  And other times, I did it out of spite.  Any which way you look at it, I did it in highly emotional moments.  And I always regretted it later.

recurrent suicidal behavior, gestures, or threats, or recurring acts of self-mutilation (such as cutting or burning oneself)

My cutting has been well documented in the past.  Unless I make a mindful effort not to self-harm, I will engage in the behavior.  I’ve written posts about the whys and wherefores in Why Self-Injurious Behavior?.  It’s complicated.

unstable mood caused by brief but intense episodes of depression, irritability, or anxiety

The mood episodes aren’t brief, so it leads me to believe that I may have a co-morbid diagnosis instead of a misdiagnosis.  However, I’ve always said this, and people have disagreed with me.  The only two constants for me and my disorder are reactivity and irritability.  I was under the impression that everyone with bipolar disorder is reactive and generally irritable most of the time.  Apparently, I was wrong.

I always have this underlying anxiety.  It’s made worse by social interaction, certain phobias I’ve developed, and worst of all, having to make decisions on my own.  It’s difficult for me to take care of my personal affairs, because I am always waiting on another person’s approval.  I get anxious when I make a decision by myself, because I often second guess myself.  I am constantly seeking reassurance about my decisions and guidance from others.

chronic feelings of emptiness

This one is complicated.  I don’t often feel empty.  I often feel lonely or distant.  Sometimes, I feel invisible, rejected, or ignored.  Most of the time, I actually feel too full.  I’m too full of emotion, noise, and stimuli.  I often have several voices and personas that follow me and make commentary on my life.  It’s too much.  But when medicine gets rid of them, though I am relieved by the lack of conflict, I am lonelier.  It feels like a piece of me is absent.

inappropriate and intense anger, or difficulty controlling anger displayed through temper outbursts, physical fights, and/or sarcasm

I recently wrote a post called, “I Want My Yellow Dress” using the analogy of a little girl in a movie in the most epic temper tantrum ever known to describe my own inner child.  My anger is often out of proportion for a given situation.  I have a bad temper, and I know it.  It’s something I’ve tried to deny for a long time.

In Love the Way You Lie, I described a mutually abusive relationship.  It was the only time in my life I have ever lashed out physically, but the point is that I did.  Whether a person could classify that as self-defense is questionable.  There were times I did it because I wanted to inflict pain on him.  I felt like he needed to know my own pain.

stress-related paranoia that passes fairly quickly and/or severe dissociative symptoms— feeling disconnected from one’s self, as if one is an observer of one’s own actions

I’ve written scores of blog posts and theories about this.  I am prone to paranoia, and I experience it rather frequently.  With my recent medication change, I can say that I usually only go through it once weekly.  Prior to the medication change, it was much more frequent than that.

The dissociative symptoms have been documented in Conscious, Subconscious, and Extraconscious, where I described a theory of multiple personas rather than full blown personalities residing in a place between the conscious and subconscious mind.  It’s complicated to get into, but it’s worth a read honestly.  It would give you a better idea of what I’m talking about in terms of dissociative symptoms.

When I’m doing something out of character, I often feel like I’m not the one who is doing it.  I feel like I’m trapped inside myself, or even completely outside of my own body, as a helpless observer.  When everything is said and done, sometimes I don’t quite remember the details of what happened.

It’s something I’m going to have to talk to my doctor about, because as I get older, it seems to get worse, rather than better.  Sure, I am not self-injuring in the sense that I’m not cutting.  But, I am still engaging in impulsive behaviors, and I can’t tolerate distress or disappointment.  My anger is out of control most of the time.  And that’s not when I feel too doped up to do anything.  Sometimes, I have symptoms regardless of the medication.  When I relapse, it’s usually very bad, and feels like it’s worse than the one prior.  I don’t just have a blip of an episode, but a full blown, complicated one.

With or Without You : 30 Days of Truth

Day 15 : Something or someone you couldn’t live without, because you’ve tried living without it.

Most people would prefer to choose a certain special someone or an object to contain all of their affections.  Though my relationship with this is troubled, I have found it to be impossible to live without it.  Even if it’s so hard to live with it.

Medication.

I have made the attempt several times in my life to live without psychiatric medication.  My first was a psychiatric evaluation when I was thirteen, and I refused treatment.  What thirteen year old has the intense desire for repeated therapy visits and pesky medicine?  As a direct result, my symptoms progressed, and I wound up my own cutting board.  When it became concerning, no one was willing to take me back for actual treatment.  Instead, I unnecessarily suffered until I humiliatingly revealed myself and my wounds to an outsider.

The next time was in my late teens.  After being medicated for nearly five years with no result, I was ready to give up on $60 co-pays for a medication that just gave me heroin-like withdrawal symptoms when I forgot to take it.  (That was also the first time I became strongly inclined to start carrying medication on me in clever, cute containers).  I spent a gratuitous amount of time on weekends in a different county, an hour away from my home.  The bus services were shoddy at best, and if I forgot to take my medicine on Friday, then by Sunday morning, I was violently shaking and vomiting in front of my relatively new boyfriend.

This new boyfriend, Avi, convinced me that there was absolutely nothing wrong with me.  The medication was doing more damage to me than good.  It was a waste of time and money.  Psychiatry was a joke and a con for cash.  It would be in my best interest to get off of the medication.

The funniest thing about that was the fact that I became irreconcilably depressed when I weaned myself from the Lexapro, an SSRI.  I required way more than my typical six hours of sleep.  I could no longer party until dawn.  And mostly, my only desire was to scream and cry my eyes out.  After you’ve been hypomanic for so many years, having a crash like that was epic.  Coincidentally, it coincided with the very first cliff fall in our torturous relationship.

And resulting in that choice, I developed functional alcoholism prior to the legal drinking age in the United States.  It took several abusers, victimization, abject poverty, and becoming an abuser to take me down into the depths of a bottle.

I found that I had even given up on self-medication.  When Xan and I got together, it became obvious that he suspected I suffered from addiction.  Though our relationship was certainly not new, our courtship was brand new.  In order to not put him off, and make a show of my own self-control, I slowly ditched the bottle.  I was so addicted that I found I had to be intoxicated to make love to him.  At least a little.

A few years later, I started treatment.  I had managed to remain sober, however, I had completely lost control of myself.  Several months into treatment, I ran into every medicated person’s greatest fear.  My medical coverage was eliminated.  Every pharmacy reported the same thing; Lamictal costs a fortune, and if I can’t afford COBRA, then I sure as hell cannot pay for it from pocket.  I found myself soliciting every pharmacy within a 10 mile radius for assistance.  Finally, one came through for me.  But, not before I suffered cruel withdrawal symptoms.

A similar withdrawal happened over a holiday.  I was unable to see my Pdoc before Christmas, and he had taken vacation through the New Year.  The office had a policy not to call in medications, so I had to make an appointment to go in.  Catch 22.  For four days, I laid there writhing in bed.  Xan took charge, and I had a refill that same day.

The very last time was one of my own poor choices.  That is exactly what mania does – it gets your hooks into you and tells you dirty little lies.  I had decided to attempt to wean myself from medication slowly so that I could prepare to attempt pregnancy.  I did so alone.  Instead of consulting a doctor, I went ahead.  And instead of getting off of medications, I had psychotic breaks the likes of which I have never been remotely acquainted with.  The result was more medication and a lesser likelihood of having a second child.

I have been without by force, by accident, by coercion, and of my own volition.  Like it or not, I cannot live without medication.

The Friday Confessional : First Edition

Thanks to C, writer at Seasons Change and So Have I, I have taken on the idea of the Friday Confessional.  There’s something so cleansing about it.  I am not Catholic, nor have I ever been.  But, I can see why confessional is an important part of their Christian denomination.

October 25, 2000

It was quite an eventful day.  Not even a week earlier, I had come out to a teacher about my cutting that had gone on in secret for two and a half years.  I was on psychiatric suspension until I was able to see a doctor.  I suppose that was probably a punishment that was meant for my parents.  Their only respite from me was school.  It was likely intended to force them into seeking treatment for me, rather than ignoring the problem, as I confessed in that principals office.  They had known about it for more than a year at that point.  And it was my father’s taunts about it that gave me the little white scar with two teeth just under the freckle on my left forearm.  That was the nasty gash that led me to this very day.

My mother cautioned me before we left.  “Don’t say anything crazy, or else they’ll put you in inpatient.”  I was going to an inpatient facility for outpatient care.  It was twenty minutes away from my home, and filled to the brim with all likes of troubled kids, far worse than me, from all around the area.  I heard the horror stories of that place from friends that had complete meltdowns and whose parents were scared out of their wits.  “I roomed with this girl who had fifty stitches around her neck.  She tried to slit her own throat.”  Talk about cutting.  I was an amateur digging at my wrists with a dull steak knife.

My father was a bastard the whole way there.  I always hated being in the car with him.  It felt like I was trapped, forced to listen to him go on and on about whatever was grinding his gears, usually me.  It seemed like there was something I had done or not done that set him off on a raging tangent.  Today, it was the fact that I was going to therapy.  “This is a waste of fucking time and money!  I’ve been in therapy for 20 years, and do you know what it got me!?  A fat sack of nothin’!  So wish in one hand and shit in the other, girl!  See what fills up faster!”  At least I can say that he was memorable in those states.

It didn’t matter.  That day was about me.  It was the overdue response to all of my distress calls.  They took to prepping me in the car.  I was not to say anything about the family.  I was not to smack talk anyone, or else I was going to get taken away.  If I lied or exaggerated in any way, they’d go to jail, and my brother would be put in a home.  It would be all my fault that they broke up our family.  The fate of the family was in my hands now, and I’d better now screw it up, or else I’d never be forgiven.  They would leave me to rot in a foster home.  Eighteen was still two years away for me.  Two years is a long time in your teens.

We arrived, and I was greeted by a woman who looked to be about my mother’s age.  She was thin and had bright eyes.  Her name was Dr. H, but she preferred Ann.  I was hesitant.  It was impolite to refer to any adult by their first name.  It was a sign of disrespect.  She handed my mother a huge stack of paperwork and told me to come right in when my mother was finished.  My mother looked through the stack, and then started thoughtfully.  I couldn’t understand why I wasn’t signing my own consent, and then I realized I wasn’t of age yet.  It looked too large to be consent.  My mother leaned in to me and asked, “You don’t torture animals, do you?”

I was astounded that she even asked!  What the hell was on that form?!  She explained it was just an assessment, and that there would be ridiculous questions on there.  Some kids were a lot worse than me, she noted.  Clearly.

I went into her office, and it smelled like lavender.  The lights were dimmed, a candle was lit, and there was an inviting sofa with pillows and a blanket next to her desk.  “How are you feeling?”  I burst out crying.  I couldn’t stop.  I spilled everything.  All of my misery and isolation fell from my eyes and mouth into her lap.  I purged, like word vomit, until I felt empty again.

She told me, “This isn’t your fault.  You have a disorder.”  It was a relief.  All of these years, I had known that I wasn’t like other children.  Children aren’t sad and scared.  People don’t go around crying every single day of their lives, wishing they were dead.  She continued to explain was Major Depressive Disorder was, and assured me that I would see a doctor about getting medicine for relief.

“Will I have to be on this medicine for the rest of my life?” I asked.

“Sometimes, medication is just a crutch until you can get better.”

Famous last words.  (I’m on five psychiatric medications as of right now.)

I went home and went to bed.  Bed was home.  Bed was the only safe place there was in the entire world.

My boyfriend showed up later, and we went out to celebrate his eighteenth birthday.  When we came home later, everyone was gathered in the living room.  My mother announced to me, “We’re taking your father to the hospital.  We think he had a heart attack.  Your grandmother is coming to watch you.”

Fine by me.  My boyfriend and I went into the game room in the basement and had sex again.  He stayed pretty late, as my mother announced he had to go into emergency open heart bypass.  And all I could think to myself was, “Good.  I hope he dies on that table.”

Invitations to Narnia : 30 Days of Truth

Day 05 : Something you hope to do in your life.

As it stands, one can find me within the wardrobe amongst the coats, between the real world and my Narnia. This is not the Narnia as others know it. It is the absolutely surreal, ever shifting landscape, containing both horrific monsters and beautiful, majestic creatures. All of that world is tucked away, within a wardrobe, in an innocuous cranny of my home. Many unsuspecting people could stroll up to it, jam their coat in, and never give this unassuming wardrobe another thought.

Lunaria

But, this world is not meant to exist tucked away.  This world lives inside of me, wrapped up in an old world map, tied with a satin ribbon.  It waits to unfurl for all of the world to see.

Snapshots of this map are contained within every word, in each piece that I carefully create.  Some have been privy to view them, scanning the terrain, gazing upon the horrors and magesty.  Others have been lucky enough to set foot on the Terra Amici, The Land of Friends, specifically set aside to welcome guests who have braved the Sea of Aliquim.  And others, those closest to me, have journeyed through the deepest, darkest places of Lunaria.

I dream of the day that I allow Lunaria to emerge from the wardrobe.  This is the day that the earth will quake around me to birth Lunaria from within.  I will invite others to explore at will, without the requirement of the confines to Terra Amici.  To brave the fiery mountains, volcanoes spewing molten rock,shifting and shaping the landscape daily.  The mountains grow higher, only to be whittled away by the erosion.  Bask in Bad Wolf Bay.  Peer deeply into Mare Demersi, but still fear to tread too closely.  Lose themselves in Vac Saltus, and navigate the sullen, sunken lands of Val Mergullado.

All of this, one day will be accessible to all.  Lunaria will rise.  I can openly narrate the tales and history of Lunaria without fear of persecution and ostracism.  I hope to accomplish my quest of bringing this all out of the wardrobe.  I want others to see what my world, one world of a woman with Bipolar Disorder looks like.  It possibly connects to other places, to weave a global patchwork of personal worlds, connecting us all, to encompass every single person who has been hiding their own Narnia.

I hope to have a voice that can bring this all to the world.  And I hope to build the strength to do it.

Why Self-Injurious Behavior?

A response to carla’s post about self-destructive behavior. It expands upon the basic concepts noted in the reply.

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Most of the time, in the clinical world, it’s referred to as “self-injurious behavior”. That includes all kinds of harmful behaviors directed toward oneself across all diagnoses.

It’s fact that SIB (self-injurious behavior) is often a behavioral expression for emotions that have no other outlet. Many children with autism spectrum disorder engage in SIB. Most often, it is because they are developmentally delayed in the social and language domains. However, many times it does have the function of attention seeking behavior – but not in the way that some perceive it. It does not carry sole intentions of “acting out” in the role of negative reinforcement. It is a way of communicating, “I’m hurting. Please attend to the situation.”

But, SIB has many different functions in other diagnoses. SIB is absolutely complex in development, function, and reinforcement. Some people engage in the behavior as an outward expression of inward suffering, others do it for the adrenaline that it releases. But, most people who engage in SIB are never aware of the root cause that sparks the behavior, nor are they aware of the function.

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Reader beware: The following section may be disturbing and trigger inducing. Discretion is advised.

I have been engaging in SIB since the onset of symptoms in my early teens. Nowadays, SIB is a widely covered social issue through media outlets. So, it is pretty easy for children and teens to get some ideas and tips. However, when I was young, SIB was very hush-hush. I did not get the idea from anywhere in particular. It just occurred to me.

It became a regular and highly ritualized behavior. Dark room, so it would look like I was sleeping. Music in the background, nothing in particular. Just some background noise not to raise suspicions. My knife and me. Because, it was easier to get a hold of a kitchen knife than it was to obtain a razor. Besides, that didn’t occur to me until later on.

I will refrain from detailing it any further. The development is obvious, and needs little explanation. However, I will explain the function and reinforcement. I have had well over a decade to study it and witness it in for myself, through myself.

SIB has multiple functions for me. First, for me alone, it is a physical manifestation of the pain I experience. Sometimes, there are no words to pair with it. There are no words in the world to make the feeling go away, and the behavior has become an impulse, rather than a carefully planned, ritualistic behavior.

Second, it is a form of self-punishment. This is the behavioral response to emotional neglect and abuse as a child. I had no confidants. There were no adults that existed in my life that I could relate this awful depression to. And when I attempted to do so with my own parents, it was dismissed. PMS, a phase, attention seeking behavior, imaginary, excuses. I’ve heard all of the rationalizations there are for depressive symptoms.

As a form of self-punishment, much like those of the clergy in the old church, it represented all of the punishment I deserved for being a bad person. A failure. For being insignificant and terrible enough to be unworthy of love. All that a despicable person like myself deserves is wounds. Terrible wounds that will bleed, and scab, and scar so that I might be reminded every time I look upon them.

SIB also serves as a mechanism for control. I have always noticed a pattern about the stimuli that prompts this behavioral reaction. I get to a point where I am overwhelmed, and my life is spinning out of control. I feel helpless and hopeless. The only thing I have control over is my own body, even when I cannot temper my emotions. This mechanism is dangerous, because it is the gateway to an abundance of other methods of SIB.

It is also a small part of the lingering, highly romanticized desire for death. Suicide is something else entirely, so I will leave that at that for the moment. In a way, it is like blood letting of the barbaric medicine practiced in medieval times. When a person was afflicted, blood letting was a common practice. It was though to purge toxins and evil from the body and mind.

And lastly, and most importantly is the addictive component. The act of SIB releases endorphins in the body. It allows the mind to focus on the most immediate pain it perceives, distracting from emotional suffering. Instead of being trapped with those emotions, the mind can be set free from that cage. It focuses on the real pain and the real injury. These endorphins, once the climax of the pain has been reached, take over. For a moment, a brief moment in time, the mind is empty. Everything is numb, with the exception of the radiating pain from the wound. It is similar to taking a drug to escape.

SIB is really a dangerous behavior for all of those reasons, and many more in the realm of somatic damage. I have incredible amounts of scar tissue, some still visible more than ten years later. Other bloggers have related worse to me. Nerve damage, lasting pain, etc. For those that engage in other types of SIB, the risk becomes even greater. Especially with ED and promiscuous behaviors. I am typically a very faithful person, remaining monogamous. (I am completely monogamous in my marriage. Don’t get the wrong idea. That was then, and this is now.) And I still ended up with HPV, causing me to have cervical cancer and two surgeries. The more partners, the higher the risk.

In summation, SIB has an seriously addictive component, and is not a substance, so it makes it harder to control. With a substance, a person can refrain from the substance itself. SIB is a little different because devices of self-harm exist everywhere, and can be carried out in a variety of ways. SIB can be most effectively treated with ABA techniques, mostly behavioral replacement with positive reinforcement. It is a long and difficult process, but it can be accomplished.