The Stigma Of Treatment

All the important people in my life know I struggle with my mental health. That’s old news. I’m not even overly anxious about sharing some of my struggles with the right people at the right time.

On the other hand sharing what treatment I’m receiving for my mental health is so much more anxiety provoking and worrisome.

I’m on three psychotropic drugs, and there’s plenty of judgement and stigma from people about that. I need these medications to function, if anyone has a problem with that, they can get lost.

I’m seeing a therapist weekly. At this point in time the therapist is a psychiatrist. In the past they’ve been psychologists, clinical psychologists, and counsellors. Therapy is a really good way to help me manage my mental health. Again, if people have a problem with that, they can get lost.

Then there’s the inpatient psychiatric admissions. Five in the last two years. Most of them for about three weeks. Not all in times of crisis, but of great stress, and with multiple crappy coping strategies being used.

I’m heading for my seventh admission with the same doctor at the same hospital. I trust my doctor, and I trust the nursing staff. I know the admission will be helpful, they always are, but I’m scared to tell anyone.

I worry so much more about what people might think about me being in a psychiatric hospital, than being on medication, or in therapy.

Is it really that bad that I need to be in hospital?
Yes. Doing the same amount of work in therapy outpatient is impossible. Plus I’m stuck, again. DID chaos, and multiple shit storms brewing beneath the surface. That doesn’t even cover the issues I’ve had with mood (both hypomania and depression in the last month). It is that bad.

Can’t I just get over it? Isn’t therapy enough? Can’t they give you medication?
I’m doing the therapy, and taking the meds. I’m still struggling. As for getting over it? Get lost.

I know hospital is a safe place to crash land. I can be a mess, be emotional, struggle in any kind of way and it’s okay. I don’t have to keep it together. I don’t have to keep smiling. Staff are kind and supportive. I have time and space to unleash the chaos, work through it, and put myself back together again.

I’ve still only told a few people. I’m so fearful of their reaction to, and judgement of inpatient treatment that I stay silent.

I think the stigma associated with psychiatric or psychological treatment can often be so much worse than the stigma associated with a diagnosis.

It’s okay to not be okay, and it’s even more okay to get whatever help you need to be okay again.

This Is What Depression Can Look Like

Depression.

Depressed.

Someone curled up in bed, hidden under the covers. Sunlight peeking in through the drawn curtains. Phone calls and voicemails ignored. Text messages unread. A dirty plate, and empty, coffee stained mug on the bedside table.

That sounds like fairly stereotypical depression, right? It is. The trouble is, not everyone with depression struggles like that.

What about the person who smiles, and chats happily to friends and family. Who cleans the house, keeps up with chores, and pays all the bills. The dishes are done, there’s food and leftovers from a home cooked meal in the fridge, and the fruit basket is full.

Is that person depressed? If that person is me, then right now, yes. It’s just so well hidden.

I smile and chat with family and friends because I adore them, but I also don’t want to burden them with my sucky (technical term!) mental health. I busily keep up with chores  so I have less time to think about how much I detest myself, my life, and everything about me. Keeping busy keeps me safe. Leftovers in the fridge are from a meal I cooked when I felt like eating. I swing between having no appetite and comfort eating.

No one sees the tears that slip out when I’m finally alone, or on the way home from visiting friends and family.

No one sees the self-hatred, pain, hopelessness, and defeat that flood my mind when I finally stop doing chores.

No one sees the torment that fills my mind over needing to eat, having no food, then ordering groceries, and not wanting to eat.

I usually manage to function until I’m extremely depressed and suicidal. On the way down into that pit of doom very few people know or see that I’m struggling.

Not being able to see it doesn’t mean that I’m not depressed.
Not being able to see it doesn’t mean that I’m not struggling.

Depression looks like many things for many people. Ask before you pass judgement on whether someone is depressed, or how depressed they are.

Do You Ever Feel Invisible?

Do you ever feel invisible? Like that the things you say and do have no impact on anyone or anything?

That’s where I’m at right now. I try to fill my days and weeks with activities that help give meaning to life, but sometimes it seems almost pointless. Like all the things I do make no difference to anyone or anything.

I explained to one of my doctors that I try to set myself one task to complete each day. That could be a small amount of gardening, washing the dishes, washing my clothes, or going to a healthcare appointment. One day each week is set aside for work, and the following day reserved for resting.

It sounds like I keep myself busy and have purpose. I’m definitely kept busy, but it feels so purposeless. I do these things so I don’t drive myself insane with boredom, and because I’ve been told over, and over that it’s good for me.

Would it matter if I stopped doing all of these things? Would anyone notice if I quietly withdrew from the world?

My only sibling currently living in the country and his his family are busy with their own lives. We live only half an hour away from each other, but see each other only a handful of times each year. Would they notice if I were gone?

I have wonderful, caring friends that appear to like me, even though I don’t understand why. All seem to be very busy with their own lives. Work, relationships, hobbies, life. Would they notice if I were gone?

I’m beginning to feel quite isolated, disconnected, and alone. There are many people that seem to care about me, but I feel different to them. My life moves at a slower pace due to health issues. Sometimes I’m okay with that, and I’m grateful that I’ve learnt to appreciate the smaller things in life, but right now I feel invisible.

I suspect that depression is beginning to creep back in. The hopelessness, worthlessness, and despair are clear warning signs. The anxiety, the worry, the eating disorder symptoms. They’re all warning signs. I’ve adjusted my medication, and I know this will pass.

It’s just, right now, I feel so very invisible. I feel like I’m watching the world go on around me. Others seem to be doing all that I’m still dreaming of, and I’m not sure I’ll ever be able to do those things.

Can One Alter In A DID System Have A Mood Disorder?

We were diagnosed with DID (Dissociative Identity Disorder) in 2009 by our psychologist, and had the diagnosis confirmed by our psychiatrist in 2010. Since then our psychologist has also diagnosed Bipolar II, but our psychiatrist seems hesitant in confirming that diagnosis.

I think DID can look a little confusing from the outside. If we’re rapidly switching, and everyone is in a different mood, has different energy levels, different concerns, and different priorities it could look like our mood is rapidly changing.

However our system generally isn’t like that. Overall each of us seem to have a relatively stable mood and way of perceiving the world. Except me. As far as I know I’m the only one that has ongoing mood issues. It’s true that, at times, other parts have been unsafe and suicidal, but that’s been related to specific trauma, not mood issues.

I’m struggling to manage my mood with medication. My mood is still up and down no matter what medication I’m taking. Up can be fun if I’m happy and not agitated, but that hasn’t been the case lately. Down is crushing and soul destroying. I’m currently trialling one last medication regime before I go back to my psychiatrist to discuss other options.

What’s interesting is that when my mood is elevated, other alter’s moods are not. Even when I’m severely depressed it’s unusual for other alters to also be depressed. Their moods, thoughts, and perceptions seem entirely separate from my own.

When I’m hypomanic we don’t switch. It seems like I’m so busy, excited, and happy that other parts simply do not get a chance to come out. I also feel much more confident and capable, and experience no anxiety so there seems to be less need for switching.

When I’m depressed we switch more often than when hypomanic. I think that’s because I become so overwhelmed and unsafe that I don’t want to be out, or other parts become so concerned for our safety that they come out to keep us safe. When that happens, whoever comes out is not depressed. They express obvious concern for me and my mood, and our safety, but they do not share the overwhelming depression.

It’s quite confusing. I’m not sure if that’s common or ‘normal’ for people with DID and a mood disorder, but that’s how it works for us. I don’t know if that makes a Bipolar II diagnosis more plausible, or just more confusing. I think I have Bipolar II, but I don’t think other parts do.  Does it mean that I do (or don’t) have Bipolar II? I have no idea.

Understanding, Compassion, and Respect.

We’ve decided that 2016 is going to be the year that we only include people in our life that treat us with understanding, compassion, and respect. People that can’t or won’t do this, will not have a place in our life.

During our last hospital admission (over Christmas 2015) we spent quite a bit of time contemplating what life would be like if we believed we deserved understanding, compassion, and respect.

What would it look like?

We’d take care of the body. We’d meet the body’s need for food and fluids. We’d plan for, and pace ourselves with all activities to help better manage our ME/CFS. We’d use more helpful coping strategies in order to avoid self-harm because we’d believe that we don’t deserve more pain and suffering.

We still struggle to believe and accept that we do deserve understanding, compassion, and respect. We go around in circles arguing about our worth, evidence for and against it, and usually end with overwhelming self-hatred.

Asking ourselves what we’d do if we believed that we deserve understanding, compassion, and respect bypasses that unhelpful circuit. We can ask that question of ourselves without having to believe it.

To make it a little simpler to understand let me tell you about a situation I found myself in recently. I was struggling with the eating disorder (ED) and was feeling anxious, upset, and desperately wanting to avoid emotions, thoughts, and my next meal.

I realised I had a choice. I could side with the self-hatred, shame, and more self-hatred. I could skip the meal and dive further into the ED. Safe, comfortable, familiar, but a cruel, and torturous headspace.

Alternatively I could pause and ask myself a question. ‘What would you do if you believed you deserve compassion, understanding, and respect?‘ I’d eat that meal. I’d eat it because I deserve food and nourishment. I’d eat because that’s how I care for my body. I’d eat because it allows me to think clearly. I’d eat because it allows me to be a good friend.

Comparing the two possible outcomes was interesting. I could plunge further into unhelpful behaviours and self-hatred, or try something quite different and end up feeling more okay about myself.

Being able to try the alternative behaviours whilst bypassing the ‘we’re bad, horrible, undeserving’ argument has been incredibly helpful. It’s helping us to make better choices as well as very slowly beginning to think better of ourselves. Maybe one day we’ll be able to believe it 100%.