Tag Archives: self harm

DBT; a realisation.

Sat in the corner of my room, tying a ligature round my neck. Pinned to the floor and injected. Lying on a bed being wheeled through for ECT. Fainting and being sent to hospital for glucose multiple times. Being watched 24/7 for over 8 months, no privacy at all. Having a CT scan after headbanging. I came into hospital very unwell and there’s a lot I can’t remember, but I’ll never forget these things.

Thankfully I’m so much further on, the idea of tying a ligature is so far away, I never kick off. I am compliant. Those baby steps I mentioned in my last post? They’ve turned into giant leaps. I’m sat here at home on overnight leave, I’ve been out to town with mum and exercised my debit card! I’ve helped cook lunch. I’ve cleaned the kitchen. This time last year I was just starting to have home leave, escorted by a member of staff for 8 hours only. Now I’m a completely different person.

On Wednesday I completed my second and final cycle of DBT. I remember a year ago starting on the programme I was so, well, obstinate that it wouldn’t work. I didn’t understand it. I couldn’t open myself to it. Now I look back and it has helped me so much.  There were four modules; emotional regulation, distress tolerance, interpersonal effectiveness and mindfulness. Each taught me skills I can use to live with, control and maybe even overcome my illnesses.

Through DBT I found a way to manage situations where I needed or wanted specific outcomes. I learnt how to voice my opinion and ask for my needs to be met without shutting down or disregulating. I started being able to take part in my treatment and to get my needs heard and met. Mindfulness taught me how to recognise my emotions, how to observe them and employ my most effective skills to deal with that emotion, or, simply stop and watch the emotion pass by. I learnt to use pros and cons of a specific situation or behaviour to balance out whether the urge I was having would actually be effective.  I went from feeling awful all the time and reacting immediately  to being able to stop, use my skills to recognise that I was feeling bad and instead of self harming or ligaturing I would distract myself. I would ‘radically accept’ I sometimes cannot change the situation (for instance I have to come back to hospital after time at home) but I can employ techniques to help.

I never thought I’d say thank you to DBT. I really struggled to grasp it, it didn’t really fit with my illness but with help I could use skills from DBT anyway and slowly that opened up a way for me to engage in DBT. It’s very weird thinking I won’t have anymore DBT but I’m so thankful for it. And to anyone starting DBT, stick with it. Don’t let anyone derail your recovery by telling you horror stories of DBT. It’s hard, you will probably cry with frustration, you won’t understand at times, you’ll feel stuck. But, for me, there’s almost a sudden moment when I realised, I do understand this and I am actually using the  skills. I can only say thank you to the therapy team for not giving up on me.

And so from baby steps, this is a giant leap. I’m on the home run.

What’s it like to feel suicidal?

First off a bit of an update. I disappeared over a couple of weeks due to slipping backwards with my eating and drinking and then my mood followed. I was admitted to hospital rehydrated. But I’m not fainting everywhere so I’m allowed off the ward to blog.

Now onto the topic I wanted to address this week.

People don’t talk about, it’s shoved in the corner and not allowed out. But it happens. Suicide is one of the biggest killers of males under the age of 25.But for some people feeling suicidal and not able to shove it in a corner is a harsh reality of their life. I’ve felt suicidal many times and over long periods and it’s been one the hardest parts o my illness for them.

So what’s it like to feel suicidal. For me it’s like smoke, it fills your eyes and nose and mouth so you can’t breathe or scream for help. Talking is an effort, breathing is an effort. The black smoke weighs you down so you can only shuffle. It convinces me not to talk to staff as they’re too busy or you don’t deserve anyway. You search endlessly for a sharp object is you’re a self harmer. I’ve literally gone through everything in my room searching for something to harm with. Usually it’s futile.

That’s my experience of suicidal feelings. I’ve not spoken about other people’s experiences because I’m not in their heads and have no idea what it’s like for them. But male, female, race, sexual orientation and all of them, we need to speak more about suicide, take away the shame by taking it out the corner.

 

Chemical sedation versus verbal deescalation

This is going to be quite a personal post as I’m going to focus my writing on my own experiences of the two. It may contain triggering content for some so if it does stop reading and find someone you can speak to.

Chemical sedation

The first time I was restrained and injected was possibly the most terrifying moments of my life. I was pushed through the ward to the seclusion room and restrained by a mixed gender team and injected. There was no explanation, no attempt at verbal deescalation and no debrief. I was left half asleep in seclusion with my new key nurse watching me. This was a situation I found myself in many times. Though sometimes there was a relief in finally being knocked out and not having to face the pain anymore.

I’m not sure what I feel about chemical sedation. I think it has its place in psychiatric settings but sometimes it is used as a punishment or too quickly without any attempt at deescalating the situation.

Verbal Deescalation

This is a method that has worked really well for my sometimes and not so well others.

First I’m going to tell you about the time the didn’t inject me and tried verbal deescalation. It involved being restrained to the quiet room, me sobbing and shouting, and sat there for two hours with three members of staff trying to keep e sat down not desperately running at walls. It was the most painful night of my life. They tried to talk me down and talk me into taking the tablets but two hours later and we were all flagging. I did eventually concede that taking my medication was the only option if I didn’t want the injection.

That was a fairly negative experience of verbal deescalation. There’s been a change since I’ve moved units. Verbal deescalation is the norm and very rarely is the injection used. When I was constantly headbanging the staff unfailingly talked to me until I was grounded enough to be removed or walk away from the wall. There’s a much greater feeling of ownership for your emotions if you’ve been talked down rather than forced down on a bed.

I can’t give you an answer as to what is the better option. Both have their merits and disadvantages. But I do think verbal deescalation should always be the first line of treatment before the injection is considered.

2015: a round up

When I think back on 2015 it’s with very mixed emotions. The year started off wobbly, I had just found out I had been successful in getting a job which sounded perfect- a reablement assistant post helping people get back into their own homes after hospital. The snag was it was felt by occupational health that I wasn’t fit enough to work a full time job in such a stressful environment. I was gutted but soon rallied and applied for jobs at Waitrose where I’d  worked before. I was successful and started to work there 22hours a week as a petrol station supermarket assistant. A job far more stressful than it sounds. Manning the tills, authorising fuel, safety checks, bakery checks, customer service and refilling the stock. But I initially really enjoyed it and the team. Very early on full time and management contracts were starting to be mentioned although this pressure led to the eventual decline in my health. 

Before working I spent two weeks in the Oxford day hospital as my suicidal thoughts had returned full blast. The admission worked and I left feeling better than I had in a while. Then mum and I spent a magical 3 days in Iceland where we were hoping to see the northern lights but they never showed up and to go whale watching but the sea was too stormy. But we did manage to fit in our Goldern Circle tour and the city itself was stunning. So much snow and we had lobster soup in a fisherman shack and the best fish and chips I’ve ever had. And it was wonderful spending time with my lovely mum.  

 March and April were spent working and trying to find my feet at work. I liked my co workers but didn’t find it easy to make good friends. 

As the pressure increased at work, demands from an unwell friend piled up and my mood dropped faster and faster. Until on the 1st may in my way to work I got to the park and ride and knew if I got out the car I would run into the traffic. I phoned my mum and then panicked and smashed a bottle I had in my car and cut my wrist. Deep but not deep enough. I was sent home from a&e but the next day my CPN called a meeting with me and my mum and it was agreed I would go inpatient voluntarily. There no beds in the trust so the next day I found myself at the priory roehampton.

The priory was good, I found the groups  really helpful although it saw the beginning of my anorexia creeping back in. About three weeks later I was transferred back to the ward at home. 

This was where things really crashed. I went from being on a planned 10 day admission to te ward to prepare for discharge to ligaturing and self harm so often I was placed in a anti ligature suit and my discharge was cancelled. I was placed on 1:1 and haven’t been off it since. Around the same time I completely stopped eating and drinking only tiny amounts. On the 16th June I tried to leave the ward and was put on a section 5(2) of the mental Health Act.  Later that day I was assessed and put straight on a section 3. 

Throughout June and July my eating remained non existent and my fluid intake was minimal. I was taken to hospital twice for dehydration and malnutrition needing IV fluid and vitamin infusions. Then in August it was decided that as my self harm, suicide attempts and mood weren’t improving ECT was the only option and that way I could receive fluids under sedation without having to go  to hospital. ECT was stopped early though as I tried to abscond on my way to it with staff. 

In September I was finally persuaded to start eating and drinking again with the support of my wonderful mum who came to ward round and told the ward they needed to get a handle on my eating disorder. I started off entirely on ensures but I’m slowly coming off them. 

At the end of September I had my tribunal which was not pleasant. I was prepared that my section wouldn’t be lifted but it hit home when the said no. They did however make a recommendation that I be transferred to a specialist unit. Which has very slowly been worked towards by the ward and I had an assessment the other day. 

The other day I was allowed to see my dogs which was lovely even if it was in the hospital. 

   I wasn’t allowed to go home for Christmas but I got an hour with my family where mum made it feel like Christmas by going to so much effort- non alcoholic champagne, a table cloth, mini Christmas tree and presents. It was the best part of my day.  

 The support and care I’ve received from family and friends this year has been amazing and I couldn’t thank people eniugh. 

The other absolutely massive part of my life this year has been meeting my boyfriend chris who I love to pieces and has been an absolute star, visiting every night. He’s more than I could ever ask for. 

And that’s been my 2015. A mixed bag and 2016 will probably still be spent in hospital but I hope it’s a better yesr. Happy new year all! 

World Mental Health Day: Dignity

This years theme for World Mental Health Day is dignity in mental health care. This is something I’m quite passionate about and have had such mixed experiences. 

Having a mental health problem makes you vulnerable. When you’re in crisis or at rock bottom it’s hard to keep yourself safe. And that means safety from poor treatment by professionals too. 

As someone who self harms I’ve had a large number of experiences in A&E, some of which left me feeling calmer and cared for, others which left me even more distressed. I’ve had some brilliant health care professionals in A&E who have gone out of their way to ensure I was treated well- the doctor who stitched my cuts so carefully and talked to me as a human being last year whilst I was in hospital, the doctor at another hospital who sat me in a side room with a 1:1 nurse and who came and persuaded me to stay the night rather than them having to call a mental health act assessment. He came after the end of his shift just to check I was okay. It was one of the most distressing nights of my life but he sticks in my head as someone who really cares about my welfare and dignity. I’ve also had some horrible A&E experiences- sent away after being told yes I needed stitches but because it was self harm I wouldn’t be stitched. Or being brought over in a wheelchair unable to walk and semi conscious after loosing too much blood only to be stitched and sent away- I remained unwell for the next few weeks before my GPs did a blood test and I was called in for a blood transfusion. Or the time they stitched me without adequate anaesthetic. 

Then there’s dignity involved in being brought into hospital. This is a tricky one because I honestly believe there is no right way of doing this other than making it as least distressing and public as possible. When I was hospitalised for the third time the crisis team were visiting my and I refused to go into hospital with them. They told me that they would have to call 999 but I tried to run so they promised they wouldn’t. Next thing I knew the were four police officers and a paramedic banging on my door and coming into my flat. They were kind but there was no dignity in screaming and crying and finally being persuaded in a state to walk to the police care and be taken to hospital where I was later sectioned. It was humiliating, my flatmates had to see me screaming at the emergency services and everyone on the street outside and in A&E got a sideshow of me being half dragged into and out of the police car. But there was also no better way they could do it, I was too unwell and my health was at risk and I guess that’s the same with many incidences of being brought into hospital. But it certainly lacked dignity. 

My biggest experience of dignity in mental health care has to be as an inpatient. I have such varied experiences. The hospital I was in last year had no concept of dignity. The ward wasn’t really designed with patient privacy in mind the beds were in a H shape with the communal area and nursing office in the middle. With the exception of wardroubd room there were no side rooms that could be used for private conversations or deescalation. At the time I was struggling with head banging and self harming but all the would simply happen would be I was restrained to the sofa with all the other patients watching and left in a crying heap with no option of talking to staff.  I remember one night I was so distressed I couldn’t sleep and spent the entire night awake in the communal area but not once did a member of staff check on me. My current ward is much better. Even when I’ve ligatured and they’ve had to pull the alarm they always ensure there’s as few people present as possible. And when I’ve been restrained and injected they’ve always tried to talk my down first before using the injection. I did have one incident where I was face down strip searched and my knickers removed as part of that which left me very distressed especially with my history but I put in a complaint and it was upheld and the policy adjusted for when to use strip searches . The other times I’ve been face down restrained and injected although highly traumatic and undignified the staff have been kind and given me the opportunity to talk after. 

Mental health is not dignified. I’ve been found in various states of undress after ligaturing with an item of clothing or vomited in front of staff when my ED was in control.I’ve  spent three months showering and toileting in front of staff. My medication causes me to suffer from hyper salivation causing me to dribble a lot. 

There’s little dignity in mental health crisis but with appropriate care and caring and supportive staff  you can be treated with dignity and respect. Something I strongly believe improves recovery, when you feel you’re being treated with dignity it goes a way towards improving your self worth and ultimately self esteem. When you’re treated with no respect and dignity it destroys your feeling of self respect and self esteem. Dignity  shouldn’t be something we’re surprised to find in mental health (and physical) care but something that is a given. But whilst it’s not we need to celebrate the staff who treat us with dignity and respect whilst educating those who don’t. 

A letter (Trigger: rape)

Dear X,

I don’t really know where to start this letter. I think you probably know what it’s going to be about though. Or maybe not? Do you even remember that night? Or has it faded into the background of your life like any other normal day to you?

Maybe I’ll start by telling you what I was like before that night. I was bubbly; not just cheerful but joyous. I loved to laugh and spend time with everyone. Every morning at 10am I’d go to the library cafe with the biology girls intending to work and every morning work would fall by the wayside in favour of lattes, cake and funny YouTube videos. I would laugh until my sides hurt. Yes I had bulimia and self harmed but I felt like a young woman whose life was just opening up for her. I loved to wear nice clothes and dressed to flatter my body. I dressed up for nights out, wore heels I couldn’t walk in, got drunk and danced with my friends until I could barely stand! I was young and relatively carefree. My whole future was ahead of me. I wanted to study graduate entry medicine and specialise in tropical disease. I enjoyed time with my family and days out pretending to be tourists. I loved to sing and play violin, I was part of the the choir and ICSE, I loved concerts and the sheer joy of making music in beautiful venues.

Now let me tell you who I became after. I withdrew, nights out became fraught with fear. I felt tainted and dirty and any male attention sent me into a panic. I drank to numb rather than enjoy. My eating changed, suddenly my stomach was too full of poison for food and I began to obsessively restrict and lose weight. As my body became smaller, more angular, more protected by anorexia the safer I felt. And then there were the binge purges where I desperately filled and emptied trying to squash the poison down. By the middle of third year, the week of Christmas, I was admitted to an eating disorders unit with a BMI in the critical range. I spent ten months there, I had to defer uni, I lost the trust of friends and family. My mood crashed and the badness I’d always felt was inside of me intensified and the only way I could get it out was by cutting, deeper and deeper. Landing myself in A&E more times than I can count, arms covered in scars. In January 2014 my anorexia morphed suddenly and violently back into bulimia. I remember walking the streets at all hours- day and night- to the supermarkets multiple times a day, stuffing it all in and making myself sick up to 20 times a day. The sheer desperation I felt. I remember multiple overdoses, rarely seeking help, hoping this time it’d work. I remember losing my music, I still can’t play the violin or sing without feeling panic. Then there were the admissions, 2 to a general psychiatric unit in 2014, one under section, day hospital after that and another day hospital admission earlier this year. And then this admission, sectioned, on my 5th month in hospital, into my fourth month on 1:1, feeling hopeless I’ll ever get my life back. Too scared to move forward in case I fall even further. I should be starting an MSc, I have a place, but here I am, not even able to shower or piss in private.

I have flashbacks to that night you know. I can feel you on top of and inside me and how much it hurt. I don’t remember most of what happened but I have flashes and they are too traumatic to verbalise here. I remember the sickly, dirty, unclean fear the next morning and the way it’s stayed with me ever since. I haven’t felt clean since, no matter how hard I try to wash you away.  I should hate you, but I feel tremendous guilt for letting you do that to me. I feel it’s all my fault. And yet at the same time you ruined my life. You took everything that was good about me, everything I valued and everything I wanted from my life and ruined it, spoiled it, made it twisted and negative. You’ve turned me from someone who had hope to someone who feels the only way out is suicide. I hate that I let you win. You took my virginity, my dignity and my future and made a joke out of my life. And there you are; making a living, building a life for yourself, laughing, happy and ultimately victorious. I don’t know what you wanted to achieve that night but I feel you killed off the Becca I used to be. I’m not dead but I might as well be because I can feel your poison running through my veins and it’s destroying me. I can’t even enjoy the time I have with my partner because every time he touches me I feel you doing the same and the clutch of panic and disgust inside me is so real and overpowering.

Youve put a millstone of guilt around my neck and it’s dragging me down. To quote Stevie Smith ‘I’m not waving but drowning.’ I’m drowning in guilt and fear and disgust. I feel completely detached from my body, I punish it by cutting, burning and my ED. I tried to starve and overdose and ligature it away but none of it’s worked and I’m stuck in a body which let me down so badly, which you invaded. It’s an object which you used and I now need to punish.

Youve got a life and I’m not going to take it away from you, but know that on January 18th 2011 you took my life and made a failure and laughing stock out of it and I can never get the Becca I was before back. And I hate you for that.

Becca

ECT 

Tomorrow is my third session of ECT. I’m not going to lie and say it’s a treatment I feel particularly positive about or one I’m 100% dedicated to. But I’m doing it and that counts for something. I wanted to write a post about what it’s really like. 

When I was told ECT was my next line of treatment I was terrified. In my head I had images and descriptions of the type found in The Bell Jar. Descriptions of a barbaric process which is painful and undertaken fully conscious. 

The reality couldn’t be further from the truth. I do not like ECT and I am terrified before every treatment. But it is now a clinical and controlled process only used where clinically indicated. 

On ECT days I do not take any medications in the morning and am nil by mouth. A nurse or HCA takes me over to the ECT suite about 9-10amish with my thick ECT folder. We wait together in a pleasant sitting area watching TV until I am called through by one of the ECT nurses to the prep room. There I am settled into a trolley and all my observations taken. As always my pulse is high. My nurse/ HCA is with me throughout as memory tests are checked and then I am wheeled through to the ECT room. There a cannula is inserted and jelly and monitors stuck to my temples and forehead. An oxygen bag valve mask is placed over my mouth as the anaesthetic and muscle relaxant are injected. I quickly lose consciousness. The next thing I know I am waking up in recovery with a cracking headache feeling woozy. Because I am not drinking or eating I always awake to a bag of saline being pushed through. I am slowly re orientated and then taken through to the recovery sitting room where I have the option of a cuppa and something to eat. Whilst in the sitting room my obs are repeated multiple times before I’m taken back to the ward by my HCA / nurse to sleep and have my obs continued. And then that’s all repeated a few days later. 

If I’m honest, I hate ECT. I do not trust that it will work and I hate being unconscious. Then there’s the side effects- memory loss, headaches, muscle pain, disorientation and fear. But neither is it the draconian torture method so frequently projected.