PTSD 2--Automatic Mind

In my last post, I listed several new diagnoses for myself, and it seemed to spark similar questions for more than one reader, questions like, "Do you do anything but seek out labels for your issues? Isn't the actual diagnosis for one who constantly searches for diagnoses 'hypochondriac'? Does any of this then accomplish anything?" Today, I would like to address the ways in which my previous breakthrough has nothing but practical applications.

Defining Automatic Thoughts

Panic and anxiety sufferers like me are masters at a thought process called "catastrophizing," i.e. some little thing happens, and my mind has already built it up into the worst case scenario possible, then declared that outcome a certainty. Psychiatrists often refer to this pattern as "automatic thoughts," but the term is misleading at first. The thoughts to which they're referring did not spring to life from nothing, fully formed, to torment their patients. These patterns are built up year after very painful year, the patient teaching herself to panic first and think rationally later, if at all. However, once the habit is established, it is automatic; it happens before I'm even aware that it's happening, and therefore I have no chance to challenge it and calm myself down. I had to become aware before I could begin to change the mental behavior, and the resulting actions I take in response.

Image courtesy of Sports, Nutrition and Supplement Guide,
who offer very clear coverage of the subject

Some examples:

If someone says to you, "What's 2+2?", odds are pretty good that your answer is automatically "4". You don't stop to ponder, you just spit it out, and never question whether the mental path you took to arrive at that answer was accurate. But you weren't born knowing that answer; some diligent teacher drilled it into your head, or else you were just extraordinarily advanced and taught yourself. Either way, at the age of 6, you probably had to consider to come up with an answer. Equally, I'll ask you, "What is 3x4?", and you'll likely give me a quick and accurate response, but you wouldn't have when you were small, and still had no concept of multiplication. We function in adult society by using automatic thoughts all the time. Our thoughts automatically warn us that if a moving vehicle in front of us in traffic stops, and we don't, there will be a wreck, so we slam on the breaks. We don't have time to debate the point; we have to stop immediately, so our brain processes it all for us and gives us the answer. Now imagine if that function goes haywire on you.

Automatic Negative Thoughts (ANTS)

My discussion last time of the progression from being afraid of going to hell, to being afraid of God, to being afraid of any authority figure, to being afraid that any mistake can destroy my life, is an elaborate word-diagram of what now happens instantaneously in my head all the time. Someone says to me, "You need to go to a place to which you've never been before to fill out this paperwork," and right on the spot, I picture myself lost, roaming the streets of Minneapolis for hours, or reaching the office, but making a mistake on the papers that will somehow not only defeat my purpose, but land me in jail through some horrible misunderstanding. I'm not exaggerating. Every time I leave the house to do something I've never done before, that's a major triumph for me. After a lifetime of loved ones dying, people kicking my parents out as their pastor or fears that they might do so because of some mistake I made as the preacher's kid, living through a flood, my parents' bankruptcy and my own, I am accustomed to life going wrong, often without warning. My mind has me in a fictional account of the world crashing around my ears before I have time to draw breath.

A real-life example:

I'm on Medicaid as my only form of health insurance. Last week, I made a mistake and didn't inform a health care provider that I was going to have to miss an appointment. Several days later, I was notified that because the mistake was mine, the office was still going to charge for the appointment, and I would have to pay it myself. What are your first thoughts? Perhaps something like, "Well, that's unfortunate and a bit foolish, but mistakes happen. You learned an expensive lesson, I suppose! Won't let one slip past you like that again." Indeed.

MY first thoughts went something like this:

"Oh, my God! They'll probably take my Medicaid away over a screw-up like this! Why am I ALWAYS screwing up?! Even when I try to do everything properly and as they tell me to do it, I always manage to make a mess of it. What's wrong with me? What's wrong with the world, that there are always more requirements than I can ever seem to fulfill? I've never been able to keep up under the everyday pressures like all the normal people do, and I never will."

Maybe, like my partner, Kristina, you know me, and think to yourself, "But you look confident most of the time. I mean, you got all those degrees! Traveled the world! A lot of the time, it just looks like you don't want to do something, so you don't." Maybe. But now you know what it sounds like in my mind. I'm often terrified.

Awareness: The Only Cure

After so many years of believing such horrible things about myself, about the world and its perceived dangers, the only way I'll ever change these patterns is to first become aware of them. Like your brain when it tells you not to hit the car in front of you, mine tells me not to leave the house, not to take risks of any kind, not to try things unless I absolutely know I'm good at them, even things I think would be fun, and for years, I didn't question its pronouncements. I don't particularly want to work most minimum-wage jobs, that's true, but I really do want to meet new people, try new restaurants, visit stores and museums, and I often don't do those things for the same reason that I don't currently try to work. The same fear drives all that avoidance--the technical term for when a patient goes to great lengths not to do things that terrify them--and until I knew that, I couldn't counteract it.

Now that I know what automatic gymnastics my mind is performing, I can say to it, calmly and internally, "That simply isn't true. You won't go to hell if you go to church and God notices you're gay; that assumes He didn't know before, and trust me, He knew a lot longer than you did. No, you won't lose your medical coverage over one mistake; you'll just have to pay the doctor's office a small monthly payment until that debt is cleared. No, not every mistake could cost you any job that you do land. When the moment comes, you'll admit your mistake, and carry on with your work day."

Cured?

So, I'm all fixed now, right? There should be news of a job within the next few weeks! No, it's not quite that simple. I spent 37 years building up these mental pathways for my automatic negative thoughts; it will be, according to my therapist, at least a few more months before I have enough practice under my belt with automatic POSITIVE thoughts that I will no longer burst into tears in the middle of the bank if my boss is frustrated with me, as I once did when I was 18 and made a mistake at work. Still, after last week's revelation, I filed my own taxes correctly, tried two new restaurants with my partner, met one of her friends from work for the first time, and have started writing again. I don't do self-analysis as a hobby; I do it to begin to rebuild my life.

PTSD 1--Afraid to Do

I have spent a lifetime searching for the information I found today on the internet in a 20-minute search.

I don't mean I just wanted to know what I found; I was desperate to know, terrified there was something horribly, fatally damaged in my character that would always leave me a procrastinating wastrel.

So if it was vital to know why I do certain things, why did I never just enter those search terms into a Google screen before and find my solution?

I call him "Google Monster"

I'm about to explain. The answer lies within the question.

[WARNING: Diagnoses ahead. If you truly believe that these days, everyone has a label instead of just taking personal responsibility, then this post will infuriate you, and I can't help that. You may not wish to read it.]

Frequent visitors here know that I suffer from Post-Traumatic Stress Disorder (PTSD), and that it stems not from any military service or pattern of childhood abuse, but from the trauma of events such as surviving a flood at age 13, and living with two terminally ill parents, until their deaths in 2007 and 2011.

However, you may not be aware that from about the age of 8, I have experienced anxiety and occasional panic attacks when confronted with a new task about which I do not feel confident. For many years, life has felt as if it adds more and more demands upon me, and each one takes a toll. So what, right? It does that to everyone. Very true. But not everyone lives in terror of not doing it perfectly the first time, no matter the task. And not everyone fears going to hell if they don't accomplish that mission impossible.

My father was a Pentecostal pastor nearly my whole life, and at the age of 4, I really listened to one of his sermons promising heaven to the saved and hell to the unsaved, and believed that I would go to hell if I didn't go forward to the altar and pray "the Sinner's Prayer" with him.

This old-fashioned Pentecostal "altar" is housed at the Cedar Rapids Museum of Art.
Known in the early "Revival" days as a "Mourner's Bench,"
it was a place where penitents sat, and later more commonly knelt,
to pray for immediate conversion and forgiveness.
I said my initial prayers while kneeling at the single-railed "altar" in the
Church of God of Mountain Assembly, in Salem, Indiana, c. October 1981.

In the minds of everyone around me, this was an extraordinary and blessed event, a wonderful thing for me to do at such a young age. No one seemed to take into account the very real terror of going to hell, nestled in the mind of an impressionable 4-year-old, that inspired the move.

"Hell"
by Hans Memling

DIAGNOSIS #1--Hadephobia, aka Stygiophobia/Stigiophobia--a fear of hell, of being eternally damned to hell, so severe that it can debilitate the sufferer. At best, a person with hadephobia may spend most waking hours trying to decide how best to please God in order to avoid this eternal fate.

Even though I was so young, I do remember that before these events, I loved and respected God, just as I loved and respected my father/pastor, and I saw them as very similar in behaviors, motivations, and affections toward me. Now, God became a source of terror, even though my father certainly never was. If anything, the fear of God began to color my view of my father, making me afraid that failing to please one directly equated to being eternally judged by the other, a fear I had never envisioned before. Soon my mother, and then all authority figures, were swept up into the mental fray; any failure of any kind could lead me straight to hell.

DIAGNOSIS #2--Hagiophobia--fear of anything holy, including God, Saints, and sacred objects or buildings.

If God was willing to send me to hell for even small mistakes (again, the understanding of a child mind), then He was best prayed to daily (i.e. appeased), and then avoided as much as possible. Who knew when I might fatally disappoint Him? Churches were terrifying places, a truly debilitating state of affairs when your parents were full-time pastors. We were in the church house any time the doors were unlocked, even if only to clean it or mow the grass! There was no escaping the place!

However, this fear of churches didn't develop all at once. It built up over time, compounded by a growing awareness from a very young age of another issue God was supposedly willing to smite me over--bisexual orientation. I describe it for people this way: "I discovered both boys and girls when I was three, and Jesus when I was four." Along with surety of my family's love, the fact that I had a crush on another little girl was one of the few certainties in life that I experienced BEFORE I became a believer in Christ.

By the time I hit puberty, several things about my character were set in stone:

(1) I was a Christian, by choice, but also by fear.
(2) I lived with such terrible dread of hell that I was in constant fear that I would, or already had, "blaspheme[d] against the Holy Ghost" (Matthew 12:31, Mark 3:29, Luke 12:10) (KJV). My parents had to talk me through this issue many times, and long stretches of my teen years are a horrible blur of terror when I look back on them. I didn't even want to think about the Holy Ghost, and to this day, prefer the term "Holy Spirit," because it does not engender the old fear. It's hard to love someone who you think is constantly waiting for a reason to hate you.
(3) I was gay, by birth, and living in terrified denial. I had fallen in love with a girl, and was no longer young enough to dismiss it as just one little kid being fond of another. Through one awful summer, I burst into tears every time I stepped into a church building, because I was sure God couldn't love me any more, even though I was pushing down the feelings as hard as I could and had no intention of acting on them.
(4) After so many years of fear, I was terrified to make a mistake, which leads us to...

DIAGNOSIS #4--Atychiophobia--commonly just described as "fear of failure," it is really much deeper and more horrifying than that. It is a paralysis that comes on any time I am asked to perform a new task, one in which I am not 100% certain of my ability. What if I screw up? With all this background noise of panic going on, I see every potential slip-up as another way to fail an authority figure, and if that happens, we all know what the ultimate result will be.

This mosaic of Hell by Coppo di Marcovaldo was placed on the inner dome
of a building where new converts were baptized. What a welcome to Christianity.

Only now do we reach the era of my childhood where we must add...

DIAGNOSIS #5--PTSD, aka Post-Traumatic Stress Disorder

Psychiatrists place very strict criteria on diagnosing PTSD, and virtually all of them center around a fear of death, either one's own death, that of loved ones, or in cases of extremely traumatic events such as war, witnessing the deaths of a number of unknown people. Living through a flood, during which an entire town must flee uphill in the middle of the night before rising waters, naturally creates a certain fear of death. Being forced to watch the slow, wasting deaths of both parents also counts, for sure. All create a fear of someone else's death, and ultimately a fear of my own mortality. So, where does this leave us?

CONSEQUENCES:
I fear going to hell, therefore I fear the One who supposedly sends people there. Thus, I fear making a mistake, and naturally just freeze when something I've never done before, or something about which I don't feel totally confident, is required of me. (Imagine how much fun that makes it to try to hold down a job!) Finally, because I've seen death and people threatened by death, I fear that any medical issue could kill me, which would only send me to hell FASTER. So we start back at my fear of hell, and VOILA! One really mean vicious cycle.

"Vicious Cycle"
(courtesy of a site called, believe it or not,
Alligator Sunglasses)

Which may all leave you with one big question: Why on earth am I telling you all of this?

Honestly, I'm not. I'm thinking in print, telling myself, and finding new freedoms for the first time ever, by discovering why I'm afraid to do anything. Not just worried, or hesitant, or I just don't like doing lots of things, so I don't do them. Nope. It's so much more than that, and understanding it is the first step to overcoming it. I just put my discussion with myself here, in case any of you realize that you see some aspects of yourself here, as well.

Homeless 15: Terror by Night and Day

In response to a comment I made, a friend asked me yesterday in some shock if I was afraid of them. The question staggered me to a point that I've spent most of the time since sorting out why, and I have finally sussed out the reason that it rattled me so: I was astonished that the person even had to ask. Of course, I'm afraid of them! I'm afraid of everyone! How could this have escaped everybody's notice? And then I realized how much of my interactions with others is guided by this principle, and how unfair it is to all of you not to make you aware of this if you don't already know it. Without this key to the way my mind functions, my behavior must often seem bizarre, baffling, and infuriating. I need to rectify this. Today.

One reason it has taken me this long to start actively seeking a job again is that bosses and customers terrify me, to a PTSD flashback level. I can tear up just at the thought of facing some stranger who expects things from me, and may react harshly if I can't meet those requirements or do so in a way that does not satisfy their whims. I am afraid of everyone I've ever known. If we've met, then you terrify me. Those of you who are kind enough to consider me a friend, we are friends because I eventually came to love you enough that the love outweighed the fear, and I refused to deny myself the joy of your friendship any longer. That doesn't change the fact that I expect you to hurt me, to decide that you hate me for something about myself that you don't like, at any moment. I expect you to leave me.

You may be wondering, if all that I've just said is true, how on Earth did I end up so damaged? My fear that those I worship will suddenly become angry with me began with my father, at whose shrine I certainly always did worship as the most adoring "daddy's girl". It was a mutual admiration society that we had, and he was a kind, gentle man with a big heart. He certainly never demonstrated any violence toward me or anyone else in my presence. But he did have a temper sometimes, and I have been reliably informed that when he was younger, that temper could be dangerous to those around him. He changed dramatically when he accepted Christ, and I never knew that angry version of him, but he could still lose his temper at times, raise his voice occasionally, or demonstrate a bitingly sharp tongue. These times were what my brother and I have come to refer to as the "go silent and pretend to disappear into the backseat of the car maneuver". Since Dad's slightest hint of disapproval crushed me, his actual anger was a fearsome thing for me to behold, even though I knew intellectually that he would never harm me.

Dad mellowed as he aged, but I soon found a whole new fear of both my parents through no fault of their own, when they were each diagnosed with a fatal illness. Suddenly, the two people at the center of my life had become ticking time bombs, and I knew that when they finally died, they would carry my whole world out from under my feet with them, which they have now done. I am still rebuilding a life that doesn't center around feeling responsible for them, worrying about them, dreading and waiting for their deaths. So many people have died in my life. In my battered emotional head-space, I'm afraid of everyone I love, because everyone I love will die. I'm dating someone right now, and one reason I feel very safe in that relationship is because I know she'll be moving away soon for her job. I already know how this will end, what the worst will be, and I know within a narrow margin when it will occur. I knew going in when the patient would die. That's a luxury so rare that, having found that safety, I joyfully lose myself in it for as long as it will last.

They say you marry someone like one of your parents (which I specifically leave gender-neutral, as a member of the LGBTQ community), and I certainly married a man like my father in one major area--volatility, only much more so. Again, my ex-husband never raised a hand to anyone in my presence, but I spent a good bit of our life together worried about what innocuous comment or query of mine would annoy him and therefore draw verbal barbs with which I wasn't prepared to deal. The addition of a child only exacerbated this for me, as he was often irritated by her being a child--making too much noise, watching that same show one too many times, making a mess--and then we would get barked at, and I felt the need to protect her while at the same time feeling as if I was failing if I allowed some action of hers to annoy him. As I said, my father was such a good man, and he mellowed in the 25+ years that I knew him, but I no longer had the resources to start that process of mellowing all over again. Besides, I didn't want my daughter to have to grow up knowing when to meld herself into the backseat.

I am even afraid of my own daughter, because I fear unintentionally harming her, disappointing her, being unable to soothe her tears or meet her needs. I think every parent has these feelings, and I do manage to overcome them, because she needs me to and she comes first. But they would still be debilitating if I let them.

And of course, being homeless brought a whole new type of fear into my existence, fears for my basic needs and those of my daughter, fears for my comfort, because I am a creature of comfort when allowed to be. I won't attempt to deny it. But it also brought whole new levels of fear into my relationships. So long as you are my friend, and so long as I have to be surfing friends' couches, then you potentially hold my life in your hands at some future point. What if you become fed up with me? To whom will I turn for help until this nightmare is over? Where will I go? And if you're thinking no one would leave me stranded like that, three friends already have, one of whom was my brother. If you're NOW thinking that there must be something really wrong with me, if that many people had to throw me out, you're absolutely right. The whole point of this post is to admit that I have issues, and pull back the curtain so you can see what those issues are, in preparation for the next time that my fears drive me to unwittingly hurt or disappoint you. Still, when a friend is ready to throw you out, you become ever more fearful. I'm afraid you'll become angry enough at me to say horrible, hurtful things to me, even if that was not your initial intent. After all, my own brother reached that point with me eventually.

Most importantly, I've been stark raving terrified of God since my first conscious thoughts, because He might become angry with me and send me to Hell. So, if I'm afraid of my Sustainer, the two people who created me--one of whom carried me in her womb--the person to whom I used to make love, the child I carried in my body, and the only other person my parents ever produced, can you think of anybody that I wouldn't be afraid of? Indeed, the closer I grow to someone, the more afraid I am of them, because their power over my peace and happiness becomes ever greater.

If I've ever not responded to a phone call, a letter, a text, it wasn't because I didn't want to--it was because the fear defeated me that day. If I've ever hurt you by doing something inconsiderate, something seemingly out of character that was painful, you could probably ask me what I was afraid of and running from, and I could probably tell you without much hesitation for thought. I'm not saying any of this excuses my mistakes, nor am I asking you to like these things about me, because I don't like these things about myself. The past year has been about working on correcting these things. I am only asking for patience, and forgiveness. The mere fact that I've begun seeking work again indicates how far I've come, but I'm fighting a lifetime of habits, and I will regress.

Homeless 13.5: And on the third day...

In my previous post--the writing of which was a harrowing experience--I predicted that it would take me 72 hours to pull out of the siege of panic I was under at that moment. By now, I know this pattern pretty well. Nothing about those three days was fun, but it's nice to have it confirmed for me that my instincts are good, and that 3 days is about standard now. It used to take about 2 weeks. This is definite improvement of my own mental abilities to fight back, and in the long-term recovery from my traumas.

Day

You read Day 1 in real time--shear, unmitigated, relentless terror. Going to bed at the end of it is the best that Day 1 gets.







Day

I wake up dreading a repeat of Day 1, but reminding myself all the while that dreading panic is the surest method to experience it. As a certain level of normalcy returns, this is the point at which the frustration really sets in, the fury at never knowing for certain what set me off. Mental wellness is a constant patchwork of bits that all have to be working at once in order to maintain stability. Are my meds out of balance? Is my potassium low again? Is my glucose (blood sugar) level far enough out of alignment to have triggered this? What's the date today--is an anniversary of a traumatic event coming up, or just passed? (You'd be astonished how often this factor is all it takes to explain an episode. This case, however, was an exception.) But the frustration doesn't help, either; it alone can exacerbate things, so let's get back to the business at hand. Watch how you're breathing, Jennifer. Yep, as I expected, you're taking quick, shallow breaths. Wonder how many days I've been doing that? I often don't realize, until the panic is upon me, that I've been anxious for some time, growing more and more fearful without consciously realizing it because fear is my normal state. Exercise your mind, Jennifer; force yourself to calm down, to recognize that there is no new threat, to choose peacefulness. All day long.


Day

Light through yonder end of tunnel breaks. My rate of breathing has returned to a healthier state, and with it my adrenaline-crazed fight-or-flight instinct. I can feel panic at the edges of my consciousness; I know where to find it if I wanted to experience it again, but I'm back in some illusory control. My psychiatrist says that every panic episode is a chance to exercise, to practice these mental skills, to keep them sharp and in readiness. In other words, we've reached the "maintenance level," the point at which you know what to do when you get temporarily debilitated. And for many of us, folks, that's as good as it will ever be again. I live and I deal. But my body will never un-learn how to have panic attacks for no obvious reason. I did it, again, and each time helps me grow a little stronger. Now, if I just didn't have to do it at all...

Homeless 13: How I Got Here

Horrible nausea.

It's the nausea that starts first.

It has always been one of my worst triggers, and to this day, no one knows if the nausea or the panic arrives first, which is causal and which simply an aftershock. All I know is that when this pattern begins, the only possible relief is to weep until it passes. Crying doesn't make it go away; it just ameliorates it a bit. I feel slightly better if I sit, sobbing, than I do if I sit, dry-eyed and sure that any second I will simply come crashing out of my own skin. I'm issuing forth loud, bitter sobs as I type this. God, it feels better.

Dizziness, also.

That's another major trigger.

I think the dizziness may actually have been the precursor I tried to ignore, yesterday afternoon, when this bout was in its infancy.

By today, the stark, naked terror had begun full-force. Nothing had dramatically changed in my life in the past two days. Whatever damnable alchemy ignites anxiety, depression, panic, PTSD and all its fellow demons, is simply marching triumphantly back through my body and brain. They have set up a squatter's camp in which to dwell while wreaking as much havoc as possible before finally being banished by drugs, therapy, and my own slow but sure techniques of battling my way back to daylight. For anyone who thinks that people like me "don't work" because we're unemployed, I defy you to do this for the 48-72 hours that loom ahead of me right now, and scrabble your way out, still alive and sane, on the other side. This will be by far the most hellishly difficult work I have ever done, as it is every time I have to do it.

If science and medicine knew why it happens, they would certainly stop it--I am by no means the only person in this country who is laid low by these attacks on a regular basis. There are millions of us in the US alone, all at the mercy of the kind of mental wellness issues that routinely take a massive bite out of the national workforce every year. After a lifetime of fears and trauma, any brain will eventually announce that it has had enough, that it demands some rest, and those of us who merely cry and feel genuine terror without any genuine threat are among the lucky ones. Some go to a place from which no one can ever help them return.

More of the secondary symptoms come into play now--hot flashes and sweats, waves of shame and guilt, fear at the stigma attached to these issues. There are reasons that I have never before written my way through one of these attacks. But how else can I ever share with you what this truly feels like, as nearly as you can grasp it without experiencing it for yourselves? And believe me, there is no one in all of human history on whom I would wish these sensations. Last week, on this very blog, I advised myself to write through anything, through everything, as a way to defuse self-defeat, as a way back to sanity no matter the hurdle, so I have written it out, and bared it before you all. The factors of my situation feel as if they form a bewildering, impenetrable web around me, and I often wonder how I will ever break free, but fundamentally, this is the reason I am homeless. Very generous employers these days still give smoking breaks to those trapped by nicotine, but I have never met one who felt comfortable giving breaks as needed to someone who has to sit in a corner, rocking back and forth with her arms wrapped around herself, crying.

I am not crazy. Depression. Anxiety. Panic. Post-Traumatic Stress Disorder. Look them up. I am not insane. But something broke, and we live in a time when therapists still tell clients on a regular basis not to reveal any of these maladies to prospective employers, because they will be turned away, no matter how many laws supposedly protect them. Too much pain, too many years of waiting for someone to die, too many memories of a flood that saw boats drifting down Main Street, too many fears that I was doomed to hell because I wasn't good enough for "an angry God". Something broke, and until a merciful God and medical professionals and I can fix it, even finding a job is not my biggest problem.