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.

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.

PTSD and Fumbling, or Homeless 3

Well, gang, I just finished my first 2-hour volunteer shift at the Lakewood Branch of the Jefferson County Public Library. I know the accompanying picture hardly seems appropriate to many of you, but to me, coming here today was terrifying, overwhelming, though it was a piece of cake once I signed in and got started. Let's break this whole thing down a little.

PTSD

I know that I've mentioned Post-Traumatic Stress Disorder often on this blog, and some of you may be wondering what that actually works out to be in everyday life. (I've covered this material before, but I thought an update might be helpful.) We've all heard of it, of course, ever since WWI when it was first discovered and labeled "shell shock," and most of us still associate it with warfare. "Oh, yeah. That's what the Vietnam vets all came back with, right? Some kind of mental problems because of everything they saw and lived through over there? Poor guys. It's not surprising that would mess somebody up!" But men and women who have seen combat are not the only people who can develop PTSD by any means; even children suffer from this condition, if they have lived through something so horrifying that it permanently scars their psyches. Prolonged verbal, emotional, physical or sexual abuse often cause children to develop PTSD, and rape victims, witnesses to violent crime or suicide, and survivors of terrorist attacks commonly suffer from this disorder, as well.

However, there need not be any violence or abuse for a person to develop PTSD. Any event that is so horrifying and traumatic that the brain is forever marked by it can trigger the condition. These include natural disasters, and enduring prolonged illness oneself or watching a loved one slowly die of a terminal disease. In my case, the combination was a flood in English, Indiana, in 1991, where my family was living at the time, my mother's diagnosis with lupus, and a heart attack which left my father with only 20% of his heart muscle still functioning, after which my parents finally died by slow stages in 2011 and 2007, respectively.

Symptoms

The symptoms of PTSD vary and manifest themselves differently in people, but I'll give you the run-down on my own situation at present, since I'm the one doing the blogging here.

Sleep Interruptions

This is exactly what it sounds like; I may have trouble falling asleep, and when I get there, I wake up several times a night, feeling as if something isn't quite right with the world, and lie there trying to fall back to sleep, sometimes for several hours. As you  might imagine, this can have a negative affect on efforts to hold down a job.

Nightmares

When I do sleep, I will likely dream about my parents, their illnesses, their absence, the gaping holes it left in my life when each of them died, and how desperately I still wish I could talk things over with them sometimes. Not often, but occasionally, I dream about the flood, as well.

Panic/Anxiety/Depression

During my waking hours, any or all of these may visit me, the difference between the three being (1) totally unnecessary but very real feelings of absolute terror, as if a lion is staring me down with a very hungry look in his eye and I can't decide if running would help; (2) just generally feeling nervous, as if something terrible but completely undefinable is wrong with my world, which may not sound too bad until you do it for hours at a time; (3) the inability to care about the most basic things, like making sure I've eaten something in the past 24 hours, coupled with a debilitating sense of exhaustion and feeling absolutely overwhelmed by the thought of doing pretty much anything.

Hypervigilance

I don't suffer with this one as often as I do the others, but it has been disturbing me lately, probably because of my fears about my impending homelessness if I don't find some place to stay before my deadline of January 17th. My dear friend and current roommate pointed out to me the other evening that I was jumpy and responding more strongly than necessary to noises that happened in other rooms of the house or of the bar we were in. This is hypervigilance--constantly, and unnecessarily, being on the alert, a sense that at any moment, I may be called upon to leap into action to deal with a crisis. When I was an undergraduate, I once got a phone call in the middle of a Hebrew exam because my father had been taken to the hospital, AGAIN. It took me years to cease being terrified every time I heard a phone ring or an ambulance siren drive by anywhere near me.

SO,
     as I contend with all of that, is it any wonder that the thought of re-entering the workforce is overwhelming to me? Hence, the volunteering at the library. It's a "job" in the sense that I am expected to be at a certain place, at a certain time, to remain there for a set period of hours, and to engage in assigned tasks while there. This is a baby step, sort of practice for getting my mind used to working again, since I can simply walk out of a volunteer position if I suddenly develop a panic attack or what have you. Therapists call this "desensitization" or "exposure," allowing the mind to get used to an experience, see that nothing bad happens, and stop producing disturbing thoughts or fears just because I enter a "job" situation.

The Washington Township Public Library
in Salem, Indiana, where I had my first paid job.
(from the "Salem, Indiana" Flickr group)

I'm doing library work here. I got my first paid job ever at my hometown public library when I was 16. I've worked in the largest library on the campus of Indiana University, both in collection maintenance and for the Middle Eastern Studies librarian. I could do library work in my sleep, and on occasion, when I pulled an all-nighter getting a paper written, have at least been among the walking dead while working in the stacks. As soon as I stepped into this peaceful, cerebral environment today, allowed my beautiful books to envelop me and began shelf-reading (making sure books were in the right order), the world made sense again, and I belonged. That didn't stop me from being terrified on the drive here.

BUT,
     despite initial terror, I completed my two hours without incident, during which time I shelf-read one side of an entire row of non-fiction. For the uninitiated, I can assure you that is pretty quick work, and I felt quite pleased with myself to know I've "still got it." It was a minuscule step toward wellness, toward working again, toward getting established and back on my feet and not being homeless any more, but it WAS such a step, and it scared me, and I did it anyway. And dammit, I'm proud of myself.

Lesson 1

Hurray! I've officially finished my first book for My Re-Education Challenge! (Please note that links to all my reviews for this challenge will be available on the Challenge homepage. Reviews of any other books I read for the year will be linked on my "Reviews" tab, as usual.)

The Perks of Being a Wallflower

by Stephen Chbosky
MTV Books/Gallery Books 2012
213 pages

Well! We're certainly starting off the year with a bang! This book is definitely NOT a fluffy, light-hearted read. For most of my way through it, all I could think was that it reminded me of J.K. Rowling's The Casual Vacancy in its unrelenting sobriety and human tragedies, only on a smaller, less cynical scale, because this book's protagonist and first-person narrator, Charlie, is very sweet and certainly an innocent.

But Stephen Chbosky is a very talented, subtle, even sly author. I immediately felt that Charlie was a sympathetic character; before long, however, Chbosky had me truly caring about many of his characters, through the vehicle of Charlie's deep and sincere love for them. Charlie is a beginning freshman in high school, and scared about this big change in his life. He has problems the full nature of which are slowly revealed over the course of the novel, and this is another element of similarity between this book and The Casual Vacancy, touching as it does on issues of mental health.

By the time I was 2/3 of the way through this book, I could barely put it down to deal with little trifles like eating and sleeping!  It may have many of the typical hallmarks, even cliches, of an average YA "coming-of-age" tale, but it's very intelligently constructed, and is simply an interesting, well-crafted story, though NOT for the faint of heart.

On a personal note, I identified very clearly with the mental health problems Chbosky adresses, though mine began for very different reasons than those named in the book.  It was very interesting to me, even though it was also saddening, to see from the inside how things develop as a result of abuse, rather than from fear for terminally ill parents and surviving a natural disaster, which were my particular triggers for 20+ years of emotional ill health. I sincerely hope, now that this book has been made into a major Hollywood film, that it will greatly help to raise awareness concerning mental health problems in adults and especially in teenagers and children. In all their mental romanticizations about the supposed "carefree innocence of children," too many adults never realize that traumatic events have as great an effect on children as on anyone else. Worst of all, the child's suffering often goes unnoticed and therefore undiagnosed; kids may not comprehend what is happening to them, don't know how to ask for help, and frequently act out in ways and for reasons that even they don't understand. It is vital that both adults and children receive treatment as soon as physically possible after a traumatic event, because the longer the emotional wound festers, the greater the chance of serious, even irreparable repercussions.

Moreover, the stigma that our society still attaches to emotional and mental health problems--in the 21st century, for God's sake!--has got to stop. It makes it much more difficult for people to get the help they need, or to lead a normal life. Some employers are too nervous to take the "risk" of giving them a job. Mental health professionals actually have to advise their clients NEVER to mention their illness at work, for fear that an applicant might be denied or an employee fired on those grounds, even if the company would invent some other, less harsh-sounding reason for their action. As I said, I sincerely hope that this powerful book, and the very popular film adaptation of it which has now been released, will go some way toward changing the status quo.

Can You Hear Me Now?

All right, I've debated with myself for two days about whether or not to blog about a therapy session from Hell, and I finally decided I'd feel better if I just wrote about it and got it out there.  It'll certainly be more cathartic and therapeutic than the session was!

I've been given diagnoses of Post-Traumatic Stress Disorder, anxiety, panic, and depression. I lived through the slow deaths of both my parents from horrible, wasting diseases, a flood, frequent moves, more than one bankruptcy, the deaths of several friends, the deaths of numerous family members--though people in war zones and third-world countries experience things I can't even imagine, most Americans who aren't homeless or something are pretty startled when I begin rattling off the list of things I've seen. Not too surprising then, I think, that I should need to see a counselor. Unfortunately for me, there seems to be a dearth of good ones where I live.

I know there are people out there who disagree with me about this, but I'm a big fan of therapists keeping their religious beliefs out of sessions, especially when those clash with the views of the client.  When religion has been as big a part of a life as it has been of mine, I need to talk about it as part of my therapy, not to mention that I take my faith in Christ seriously, and He appears in my conversation.  If I'm speaking to a friend, an acquaintance, a fellow shopper in the mall, who is clearly not a Christian, I carefully temper how I phrase things and what I say, because I never wish to give offense, though I do my best to be honest.  In a counseling session, however, one of the primary requirements of the scenario is that the client feel safe and uninhibited in their speech.  So, I don't check my faith or pretty much anything else at the door when I walk into therapy.  But if you think you know where this story is going, you may be in for a shock.

One of Rorschach's Inkblots

I didn't find myself in a room with a therapist who was also an atheist, and therefore offended by my mentions of God and church.  Quite the contrary, much to my annoyance.  This woman is an Evangelical of strong beliefs and even stronger opinions, and when I felt so free to discuss Christ in the course of my soliloquy, SHE then felt free to make her own insertions and observations not about my mental health or how we might improve it, but more like we were having a nice chat about the state of the world and all the things we disagree with that other people do on our way out of a Sunday morning service.  If you've never been in therapy before, let me say that it is a very vulnerable place; you feel quite naked emotionally, and you're baring your soul to a clinician in the same way that you would bare some strange rash that suddenly developed on your butt to a doctor.  The last thing you want is to suddenly be drawn up short by the announcement that the doctor can't stand the candidate you voted for in the last presidential election.  The doctor has a perfect right to hold whatever views he likes, but what does that have to do with the inflamation on YOUR ass?  It may be a somewhat flawed analogy, but I think you get my point.

Eastern Orthodox Christianity is a wildly unknown quantity for many Americans, so the need to be involved in constant inter-religious dialogue, to be a representative of my Church, comes up at some point in pretty much every conversation I have with a non-Orthodox person.  I realized that this would be part of the deal when I signed on, and converted anyway, because I believed it was the right thing to do.  I had to learn very quickly how to speak diplomatically about my faith to my in-laws, my long-time Protestant friends, every member of my family, including my parents--I was raised the Pentecostal daughter of a Pentecostal preacher and his wife, for Heaven's sake!  Everyone in my world, until I began forming a wider circle of Orthodox friends, was Evangelical.  So, I'm used to this, and all I can do is be honest, tactful, and hope I represent my Church well and don't offend anyone around me.  Still, it makes many of my everyday interactions with people an awful lot of work.  I don't expect to have to do that kind of mental gymnastics while talking to a therapist, because I don't expect a therapy session to be ABOUT THE THERAPIST!  It's one of the few places where both you and the therapist are supposed to pretend the therapist HAS no opinions, thoughts or needs, except those that relate to your mental health, because as much as you need to be the focus of this person's professional attention, they need to keep clinical detachment from you so that at the end of the day, they can leave you and all their other cases at the office.  Therefore, they don't dive into personal information about themselves in order to maintain that detachment for their own well-being.  They don't discuss their religious views, political views, food preferences, sexual proclivities, vacation plans (beyond mere small talk)--they don't discuss ANYTHING that isn't germaine to your mental health!  Has a doctor ever asked you if "your church is a Bible-believing church," when you came to him needing help with an odd pain in your knee?  Wouldn't you be tempted to look at him like he was crazy if he did?  That's one of the things this woman asked me, and was the point where the clinical relationship between us ended, as far as I'm concerned.



Freud's Famous Couch
(Photo by Konstantin Binder)

I said in my last post about therapy that I was hoping to find one decent therapist and make some progress before having to move away again, like I usually have to do.  Well, the search continues.

30-Minute Autobiography

Having your first appointment with a new therapist is a lot like going on a first date, with a couple of very important differences.  I mean, you have to go through all the work of getting acquainted with someone, trying to teach someone else a lifetime's worth of your stories, your idiosyncracies, and the shorthand of how your thought life functions, all the while knowing that it will be two or three more "dates" before you have any idea whether this relationship will really work, and whether all this energy invested will have been worth it.  Those all-important differences I mentioned make up for a lot, though; there is absolutely no sexual tension (unless you've got even bigger problems that need to be dealt with!), and it's not only okay but absolutely expected that you'll be totally self-absorbed.

Therapy can be dangerous, though, especially if your life really has sucked to a great extent.  The more you tell the story, and watch even a professional counselor go "Oh, holy shit!" by the time you get to the fourth or fifth major death in the family, flood, bankruptcy, or car that died in the middle of the road and never moved again under its own power, you start thinking to yourself, "Wow, my life really HAS sucked!"  And NOW you're REALLY depressed, not to mention the fact that an AWESOME pity party could well be in full swing any time.  Another way that my life has sucked, however, is that I have rarely lived in one place long enough to get past this initial, "Ooooo!  The awesomeness of your sufferings!" stage with somebody to reach the point where we could start being productive.  Since I know for a fact that Michael's job is going to keep us here for at least another 6 to 8 months, I'm hoping for better things this time.  My family and I need me to overcome the more paralysing effects of PTSD, and more importantly, the rest of the world really needs there to NOT be one more person enjoying her own morose celebration of self-pity!