Healing the Invisible

There is an event in the writing world called #PitMad. It is a Twitter event with a specialized hashtag, #PitMad in this case, where writers can pitch their novels to agents. It’s a bit like Carnivale crossed with Bedlam.

These events have really taken off in the past couple of years. From initially a few hundred pitches over the day agents and publishers can now be bombarded with thousands of pitches an hour. How they wade through all that, I have no idea.

How you stand out as a writer is even harder.

This is where my Complex PTSD enters the picture.

For someone who has grown up in an environment where they were in essence ‘invisible’ learning how to be seen, and heard, and noticed is an exercise in something not only new, but frightening in cases. If, like me, your home was dysfunctional with explosive anger you might also have learned that being unseen was safer. I learned early that it was better to be the child that didn’t need, or want, or ask.

I learned that lesson so well, so many times that I even made up a little chatechism that I recited every night.

Don’t Ask – You’ll be denied.
Don’t Rely – You’ll be disappointed.
Don’t Trust – You’ll be betrayed.

By the time I was 13 I had carved a reminder of this into my arm so I would never forget it again. I still have those scars fourty years later.

But, I’m trying not to live by those rules any more. Trying. The healing doesn’t always go smoothly, or in a straight line. Think of it more like a mental health cha-cha. Sometimes you go forward, sometimes you go back. You get the idea.

To tie these two things together – PitMad and CPTSD recovery – think of it as peeling off layers and layers of habitual camoflague. Rule one of PitMad is if you want to ‘win’ an agents attention via the event – you have to enter. You must put yourself out there. An agent is not going to come knocking on your door.

Image by 愚木混株 Cdd20 from Pixabay : Words by MStewart

Participation, putting myself ‘out there’, that means making an active attempt to be seen. That idea just registers in my core as pure insanity.

Be Seen. NO! That’s when ‘bad things’ happen. You get ignored or hurt when you are seen.

Don’t touch it! Just, put the idea down, and slowly step away.

One day you finally figure “Meh, I’ll try it.” So, you do. And you hear the worst thing you could. SILENCE.

Why is silence the worst? When in a situation like PitMad it could mean –

  • The agent just isn’t looking for a fantasy book about a mentally challenged heroine.
  • The agent blinked when your pitch scrolled by.
  • They stepped away for a minute (they’re human, too)
  • Their dog farted and they had to clear the room.
  • They already have a book that is a fantasy about a mentally challenged heroine.

Who knows? There are literally millions of reasons that no one put a little red heart next to your entry. And the competition is stiff. Thousands of entries for all kinds of books scroll by during the day. There is not enough time to respond to them all.

But, though my rational brain knows this, my emotions tie themselves into knots and I’m that small, inconsequential, invisible girl again. Being back in that place makes me wonder if I ever left it at all. Maybe that invisibility is permanent? Perhaps there is nothing I can do to be seen or heard. I will forever be shouting into the void. And, even there, drowned out by millions of others. Never to be more than a dull anonymous speck among stars.

Ouch.

After a few tries you wonder if the voices of the CPTSD are right. You fear you never will be ‘visible’.Part of you contracts with the pain of the idea. But, there is a tiny voice within undulled by all the abuses and fear that whispers – “Try.”

That seed, our original and true self is the one we must nourish.

So, rest when you must. When you can, move on; sure in the knowledge that the Universe sees you.

Falling off the edge

a grayscale photo of medication pills

I don’t know if this post will go up. Really. 
Most of my posts are crafted in a place of cerebral analytic detachment. This post originates in intense visceral pain. 
Still sounds like it is running through the brain, doesn’t it? Well, I have to do that, or I wouldn’t be able to spell viscera. 
Focus. 

Pain. Terror. The only way I could sum this up to myself or to anyone else is simply, I hurt. 
It doesn’t help that I’m quartering my meds. The Dr., the Pharmacy, the Insurance company are all looking at one another and telling me that I am not their problem. 

Meanwhile – I’m running out of my medication. 

I spoke to the state oversight board of insurers. Well, sure I can file a complaint – and then wait 30 days. 

30 days. 
Right. 
Did I mention one of the risks of rapid ungoverned withdrawal is psychosis? 

I’ve already been fighting for nearly 30 days, to get my medication. To keep some semblance of control over my emotions and my mind. 

I’m quartering my dose just to try to keep total implosion from happening. 

I feel like I’m losing. 
I feel like I’m being torn apart. 
I feel frightened. 
I feel – too much. 

What is Complex-PTSD (CPTSD)

Complex PTSD - balance

Definition of CPTSD


Complex post traumatic stress disorder
is a psychological disorder that can develop in response to prolonged, repeated experience of trauma in a context where the individual has little or no chance of escape.

Honestly, I can’t remember if these are my words or not. Please tell me if they are yours.

That is the clinical definition of Complex-PTSD (CPTSD). Other resources will explain CPTSD as a form of PTSD that has other overlying factors. The two can be easily confused if you don’t start with the definition. The definition above holds some key phrases.

The first is “prolonged, repeated experience of trauma.” Most instances of PTSD are traced back to a single horrific event. Not so with CPTSD. Someone who has this form of mental wound has experienced not one instance of trauma, but multiple instances, even possibly their entire life.

The second phrase to take note of is “little or no chance to escape”. I would add the words ‘over time’ to that phrase, because that is a key part of CPTSD. Anyone who has suffered trauma was not in a situation to escape – but where PTSD is an instance, CPTSD plays out over a long period of time. The person who is being traumatized has no means to escape their situation.

Persistent feelings of worthlessness or emptiness are a sign of CPTSD.
constant feelings of emptiness or hopelessness

There is another central issue when differentiating PTSD from CPTSD and that is the mind that experiences the trauma. The initial group of the population where PTSD was observed was military veterans. In this group, the men and women were all over 18 years of age when they experienced trauma. This is important because most of their cerebral development was done. They knew who they were, and they knew who they wanted to return to being after the trauma.

When we talk about CPTSD the trauma can start as early as infancy. That is perhaps the most important difference. In PTSD the individual, usually an adult, has a point before the trauma to return to. People with CPTSD have no previous to return to in many cases because they were shaped from their earliest moments by their traumatic environment.

Symptoms of PTSD and CPTSD

Complex PTSD builds on the already accepted symptoms associated with PTSD. So, while someone with PTSD will experience symptoms from the list on the left, someone with CPTSD will experience symptoms from both lists.

PTSD

  • Memories of the trauma.
  • Flashbacks – Reliving the trauma.
  • Dreams or nightmares
  • Emotional or physical reactions to reminders
  • Trying to avoid thinking or talking about the event
  • Avoiding anything that reminds you of the event.
    Negative thoughts about damn near everything.
  • Hopelessness about the future
  • Memory problems
  • Difficulty maintaining close relationships
  • Feeling detached from family and friends
  • Depression
  • Feeling emotionally numb
    Being easily startled or frightened
  • Always being on alert
  • Self-destructive behavior
  • Trouble sleeping
  • Trouble concentrating
  • Irritability, angry outbursts or aggressive behavior
  • Overwhelming guilt or shame

CPTSD

  • difficulty controlling your emotions
  • feeling very angry or distrustful towards the world
  • constant feelings of emptiness or hopelessness
  • feeling as if you are permanently damaged or worthless
  • feeling as if you are completely different to other people
  • feeling like nobody can understand what happened
  • avoiding friendships and relationships, or finding them very difficult

dissociative symptoms 
depersonalisation or derealisation

physical symptoms: headaches, dizziness, chest pains and stomach aches

regular suicidal feelings.

This list is from mind.org.uk

Emotional Flashbacks vs. Flashbacks

You would think that there wouldn’t be a dividing line between these two terms. After all, both are moments when the brain is hijacked by the past and trauma is reexperienced. The difference lies in the brain. A flashback is a full sensory being there re-experiencing of the trauma. The person can see, feel, even smell and taste all the details of the event. Those details are stored in their memory. They reexperience every part of that trauma.

The concept of the emotional flashback extends this to include periods of early childhood where the ability of the brain to form, store and retrieve memories is still developing. Particularly in the area of the visual cortex. What that means is that the memories of the event are stored complete with all the associated emotions, but there is no visual context. So when you encounter something that triggers a memory of that trauma – you are instantly swept back to the emotions of that time. And, you have nothing to correlate it with.

This being flung into emotions that are overpowering, without knowing why, or being able to point to any specific memory is one of the most disorienting, and in my opinion frightening aspects of CPTSD.

Core Beliefs of CPTSD

If you would like to see more memes to help share information on CPTSD please visit the Meme collections.

The manner in which the other major symptoms of CPTSD can manifest are as varied as the people who suffer with this condition. One core belief that many people with CPTSD have is that they are essentially fatally flawed. And because of their own brokenness, they are undeserving – of anything.

This is the core belief that tells us we are not worth ‘the bother’. This is the core belief that makes us accept the least. This is the core belief that makes it difficult, at the least, to face conflict. The script in our head says we are not worthy of our parents love, therefore we are not worthy. It is the core belief that we are worthless, completely without value.

CPTSD: Survival before growth

Most of the people with CPTSD have created defenses to keep them safe from their early environments. Most of the people who live with CPTSD are fiercely independent. We are also likely to be stoic. But many of these traits come from the need as a young child to be ‘easy’. Many people report a similar scenario of not asking for anything, because asking was dangerous. Others report that they abandoned things they enjoyed for the sake of peace. Many of the strategies we developed as children were not to explore our world, but instead to survive our world.

Where are we now

Post Traumatic Stress Disorder (PTSD) is more widely known in the public. Efforts to educate about this mental wound, typically found in soldiers but also victims of violence, have been ongoing since the 1980s. In contrast the study of CPTSD is relatively new. So new, that it is not yet included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

But, European sources are starting to recognize that CPTSD is a disorder that should be recognized as a unique set of symptoms, behaviors and challenges. Hopefully, one day the DSM will follow.

There is a great deal more to convey but, for now, to sum it all up, Complex-PTSD is a bitch. Really.

A little victory over CPTSD

selective focus photography of assorted color stars

I didn’t have a migraine last night.
Read that sentence again because I’m going to explain WHY? that is a big deal. Ready?

One of the symptoms of my Complex PTSD, since I was 12 perhaps, has been debilitating blinding headaches. I could expect expect 3-4 nights out of the year that I would spend sleeping on the bathroom floor. The tile floor was cool and I could close the door and be alone with my pain. Pain that was so bad I saw auras, I suffered muscle contractions that twisted me involuntarily, I would bang my head on the walls to find some focus away from the lancing pain through my skull. The pain was so severe there was the added insult of nausea and puking.

When my parents finally witnessed one these headaches, (huh, I can’t remember how that happened), they took me to the doctor. A neurologist. There was a long day of many tests. At the end of the appointment, the doctor sent my parents home with the knowledge that there was nothing physically wrong with me.

In retrospect, I think I really hate that he did that. Because, of course, for my parents if there was nothing physically wrong then there was nothing to treat. End of story.

Only it wasn’t. I have spent another forty years living in fear of one of these ‘headaches’. For a long time, I had no idea of where these came from and what triggered them. In my 20s when I was in grad-school the general practitioner I was seeing prescribed massage for me as a way to lower my anxiety. Best three months I had experienced in a long time. And that lead me to one of the ways to alleviate these events, touch. A person who would hold me as I writhed, or better before it got that bad. could usually halt or at least soften the episode.

I knew nothing of the sympathetic nervous system or the role it plays in cptsd. This was, like so many of the coping mechanisms we find hard won out of brutal experience. After nearly a decade in and out of therapy I put another pair of pieces together. I found I could predict when I might experience a headache. That knowledge allowed me to attempt to stop it.

Not all of those attempts were wisely chosen. Most of the time I cut to let my demons out. Only once or twice did I turn to alcohol. I still can’t stand the smell of most alcohol. Never chose drugs because my central need is to be able to control myself. With alcohol and drugs I might have been able to stop the pain or blunt it, but I would lose control and that wasn’t acceptable. So I chose to bleed instead. Most of the time it worked. But, not always.

The trigger I found that most commonly lead to this reaction was a case where I felt I had failed or where I had been rejected. If you have cptsd you’ll understand how fundamental those triggers are and how far ripples can travel even decades later.

Over time I discovered the most effective method for me to handle an event that might trigger one of these episodes was to talk to myself. Yeup, I still think it sounds corny – and I know it works. As I started to learn about cptsd, the sympathetic nervous system, triggers, dissociation, integrated family systems I was learning how to better manage those events in my life that at one time would have produced a migraine. (Technically I don’t know if it was migraine, but you get the idea, right?)

I am making progress. Huzzah!

Yesterday one of those events of life happened that would have had me out of commission on the bathroom floor last night. But, it didn’t. I processed that F*er. Ok, probably still processing it, but the major danger of having a reaction headache as some type of punishment that my psyche thinks I believe is low. Perhaps, I would even go so far as to say – very low.

And that feels like a miracle. Feels like. I know it isn’t. The ability to deal with yesterday’s ‘thunk’ was decades of practice and finally understanding my brain.

So here is to recovery and the many little victories it brings.
May you have many, many little victories.

Off the rails : CPTSD Cycle

The Thinking Read

Complex Post Traumatic Stress Disorder

is a bitch.
I was trying for something more academic sounding, but let’s face it, I’m not on that plane today. Nope, today is one of those days where I’m just trying to figure out where I put my sh*t. Or, more accurately, where I lost it.

I know when. That much I am certain of. But, where all my bits scattered to after that I have no bloody idea. I’m off the rails, ground to a halt and trying to find a way to right myself and start moving again.

I hate this.

A cornerstone of my CPTSD

And yet, I know this process very well. This is a cornerstone of my CPTSD. This cycle repeats itself ad nauseum. Every time through this process these days I’m better at being able to identify which part of the cycle I am in. That, although it sounds trivial is a huge step.

It used to be that I didn’t know what was happening. My CPTSD manifests in many ways. The aspect being activated here is my emotional dysregulation. The cycle goes something like this.

It almost seems like nothing’s wrong.

Calm, cool, collected. Moving forward with life tasks and goals.
Small emotional moments are managed by either listening to the emotion or ignoring.
The sum of the emotion is no change in my equilibrium.

CPTSD : Normal or Intensely dangerous? From the inside I really can’t tell.

An event of intense emotion.
The event can be almost anything and can trigger almost any emotion possible. The track-record is more to the negative, but positive emotional events have also kicked the cycle into motion.
In the event there is a sharp dichotomy about expressing or not expressing what I am feeling. More often than not I fall to the side of repression. Which, as loved ones have told me, can feel deceptively normal – or intensely dangerous. I’ll admit, from the inside I can’t tell the difference.
On the upside, I am at least getting better at acknowledging that I am feeling ‘something’. Even if I cannot always identify the emotion, these days I am at least aware that I am feeling. It may sound inconsequential, but for someone who has lived with emotional paralysis for 40+ years, this is a huge step.

CPTSD : Believe me when I call it work.

Working my way out of ‘the moment.’ Because of the confusion surrounding my emotions, their muted state and sometimes just the delay in determining what is happening, the ‘moment’ of emotion can last. It is like sitting down and teasing apart lines of rope that have been coated in tar. Laboriously I peel apart the strands of what I am thinking from what I am feeling. At the end of the process I need to sit with that feeling and try to not only understand it in a rational manner, but to also process it at an emotional level. That processing is another intense period of labor as the creaking and stunted machinery of my inner emotional self is prodded into motion.
Previous patterns of attempting to ignore or stuff the feelings away results in anger, depression and intense self-loathing. Enough of that and I will begin to start longing for ‘out’.
So, these days I work through it. Believe me when I call it work. It is.

CPTSD : The aftermath is all encompassing.

The aftermath of one of these events is all encompassing. Every system of myself suffers under the impact of such an event. Physically there might be muscle spasms, stomach upset, migraines, exhaustion. Emotionally the rawness caused by this unprepared for intensity leaves me in one of two states; hyper-aroused or depressed. Periods of hyper-arousal are followed by emotional numbness.
There is another feature in all this backwash. The question inevitably comes up of “Why am I doing this again?” Why am I spending time and effort and money on trying to connect with these emotions when I was doing well-enough as an automaton?
All those storylines where an android wants to ‘become a real boy’ – wow, I’m pretty sure I could talk them out of it. Because, seriously – why am I doing this?

CPTSD : Recovering my balance.

Much as I wish that recovery from such an event was as simple as recognizing that I am in the midst of one, it isn’t. Recovery takes time. Time to process the emotions. Time to process the event that caused it. Time to herd the physical and mental processes back on-line. Time to pour it all out onto a page in an effort to move past the wreckage. Time to reflect, but not to fall into an old pattern of over analysis.

That is where I am, right now.

I’m trying to feel my jaw unknot. I’m coaxing my shoulders to relax. Telling my stomach that this too shall pass and to try to stop cannibalizing itself. Above all reminding myself to breathe.

I will end with a couple of quotes from Winston Churchill:
First “When going through Hell, keep walking,” and the second – “Success is never permanent, and failure is not fatal.”

So – here’s me, walking.

CPTSD Paradox #3 : joy and fear

Yesterday was a remarkable day. So many people felt as if they were coming up for air after fighting to breathe for years. The announcement of Joe Biden and Kamala Harris being elected as the next president and vice-president of the United States was literally celebrated around the world.

All the aspects of life that bring my CPTSD into full bloom were central at that moment; change, relief, uncertainty, hope. I was caught between feeling the moment too much or not feeling it at all.

That first instant of glorious relief was cut short by the fear that this was an illusion and would not last. As I watched the celebrations erupting around me the only thing that passed through my mind was, How long until we find out this is a lie?

I couldn’t dive into celebration. My brain, my past, kept telling me that this was a mirage. Don’t trust it. Wait until you see if it sticks. Don’t let go. So, I kept that death grip on myself that I call rational self-control.

Change can bring such a relief. It can also throw everything into the air indiscriminately. With change I wonder will it stay? How long? Can I trust it? What are the rules for survival now?

Folks with CPTSD often live with the knowledge that what you have been given can just as swiftly be taken away. So many parts of me were echoing with past experience last night that I felt ready to fly to pieces. The memories were jumbled and pressed in from every direction. This was the moment of the backlash, or the crushing blow.

This was the moment when if you allowed yourself to believe the world contains goodness you invited disaster. Happiness only exists in milliseconds because inevitably the hope is smashed, the toy broken, the dream shattered.

With CPTSD you try to remember that this moment can’t last. We guard our feelings so closely because we have been taught that to show emotion is like placing a drop of blood in the water. To demonstrate a moment of happiness is the same action that summons the monsters which will destroy it.

Hope. Hope is the most treacherous emotion of all. That is the driving force that makes you pull yourself over the glass time after time. Hope is so often an illusion, untrustworthy. For those of us who live with CPTSD hope is a double edged sword where both sides can wound .

So, last night, with the world celebrating around me, I clung to my husband unable to breathe. I lay there feeling the muscles around my eyes tighten, my jaw clench, my throat close, my chest contract. Afraid to breathe, I was waiting for the blow to come.

Coming Alive Amidst a Pandemic.

Gabby Petito

Oh, the irony.
Thirty plus years of
Being various degrees of suicidal
And now we have a pandemic
Upending the world
I want to live.

Strangely, that’s about average for me.
Let me take a moment to unpack this one.

My depression started somewhere in seventh or eighth grade.
It’s possible it started earlier, but
I have no memories earlier
Except for a very few, so let’s say – around 12.

At age 12 I started to self-harm.
‘Escape’ was the word always in my thoughts.
I didn’t know much as a pre-teen
but, trust me, I knew I wanted out.

At this tender age
Out was still a fantasy
Of rescue or of running away.

Other people, with other issues,
Might have managed to escape on their own.
I couldn’t.

Where would I escape to?
Was escape even possible?
Did I even deserve better?
Who did I think I was?
This was where God put me.
This was my lot.
Suck it up.
Manage.

As a teenager, my resources changed.
I had access to a car and endless mountain roads.
I was always safe in my car.
I felt ‘in control’ of something.
That was where I started to think
Maybe, at least, I could control my death.

My fantasies of escape became fantasies of dying.
I wore black constantly.
I was erasing myself from my life.
(Not that there was much to erase.)
Vanishing before my own eyes.
I was content with that.

I was content with
The process of unbecoming
Because I had a way out.
Sitting in the driveway was
A 1980s bright orange mustang.
Ugly as sin, but the straight six was a beast.

Having that door made staying easier.
Because I knew I didn’t have to stay.
I had a choice.
Of all the things in my life that were broken,
Out of my control,
Dangerous, or terrifying.
I had control over one thing.
One choice.

How does all of this relate to today?
For better than 30 years
I managed to face tomorrow
Because I knew that if I didn’t want to,
If it was too hard, I didn’t have to.
I could stop.

In my 20s,
I saw all my friends growing and flying,
Becoming these spectacular people.
While I was sheathed in lead.
The learned helplessness,
The ‘shoulds’ of my family
Ruled every aspect of my life.

I slept a lot.
hoping I wouldn’t wake.
And when I was awake
I prayed to die.

Dear God,
Fix me.
Or finish me.

I actively debated suicide.
And came close to death a couple of times.

I was so depressed
I had my first hallucination.
Thankfully, it was also my last.

My 30s were calmer,
At least, on the surface.
I finally found help for the depression,
But not for the problem at the root of all of it.
Ideation moved back and forth
Between passive and active.

As my 30s wore on
I found the pendulum
Spent more time towards the passive side.
That was good.
I was able to function.

Although I went through the motions
I did not understand
This ‘joi de vivre’ that others expected

I’m not saying I was never happy.
I am saying every day was a trudge.
An exercise in existing.

So, where I slept through most of my 20s,
My 40s were marked by
A type of emotional numbness.
On occasion, the ice beneath my feet would break.
Plunging me into terror.

Two years ago,
Perhaps three
I finally made the connection with cptsd
I found a good therapist to work through it.
I’m still working on it.
Likely, I will for the rest of my life.

Now, I’m over 50 and discovering how to live.
I grieve so much of the life I missed.

So here’s the irony:
I’m writing. I adore my husband.
Finally, I am discovering who I am.
I have put most of my desire for death aside.
I want to live. I have something to live for.

Here, at a very scary moment,
In a world that I have always shunned
Because of my twisted roots,
At the moment when
Life seems most precarious,
My life is most precious.
Now – I want to live.

#WriteYourStory

I have spent 50 years doing as I have been told, as I have been advised, as seemed best by the masses. It has brought me a living but one washed in doubt, grayness, and despair. No longer. I will write my own story, and if I fail I will do so with my spirit in tact, instead of surviving in dreary mediocrity for someone else’s dream.

It’s not often I have something burst into my mind fully formed.  But this thought, once tangled up with so many others, broke free from the pack today.  I stopped what I was doing, full stop.  My hands dropped, the sheet drifted to the floor, the dog started from beneath the sheet, and my world tilted, it was that kind of stop.  

As many of you might surmise, I’m trying something very new for myself.  I’ve finally given myself permission to follow my dream of being a writer.  Win or lose, fly or fail, I am allowed to pursue this for myself.  Not for my family, not for my father, not to fulfill expectations that my brother couldn’t shoulder, but to define my self by myself.  

I would love to insert something witty or humorous about being a late bloomer right about now.  But, I’m determined not to look backwards at all the ‘wasted’ time, because as a writer, I call it fodder.  So here is a thought…  Gardens use manure to bloom.  

Midnight Writing Jan 9, 2016

Some people travel through the Shadowlands and after trial and tribulation they emerge. They shake off the dark soot of so many sorrows and return to the sun.

I did not travel through. I lived in the Shadowlands. I ate of the fruit and drank from bitter streams. Years have passed here and the Shadowlands have swallowed decades. Now even though I, at times, emerge into the whiteness of the midday sun, I know that the Shadow is with me, hidden beneath my heel.  For I have learned, after long and ardent denial, that the Shadows live within me.

CPTSD and the Miracle of Survival

Usually when we talk about survival we talk on a grand scale. We think big. Our mind’s eye conjures up disasters and world changing events, daring adventures and the impossible quest, things on an epic scale worthy of eighty point type on the front page or a close-up on the television. 

Survival is the story of the hard choices, endurance and the will to live. The struggle. True stories like Aron Ralston’s choice inspire us. Fictional stories like Sophie’s Choice move us. We thirst for those big moments.

SURVIVORS FOUND!

The drama calls to us. 

But not all survival comes with sirens, ticker tape parades, spot lights and the crowd of the paparazzi. The tales that make the world gasp and hold their breath are the exception, not the rule. Most of the stories of survival I know are very quiet with almost no one aware that they transpire, day in and day out. 

While the treatment of mental ill health has progressed beyond the Hell-like Bedlams of the past, there is still a social stigma attached to it. The struggle faced by the mentally ill is largely unseen by the populace because, in general, we work very hard to appear normal. Our external calm can be the result of tremendous effort to suppress the internal chaos that an individual is feeling. 

Most people don’t think about actively choosing life. For those who struggle with severe depression it is a question that can become a daily exercise. In the grip of my deepest depression survival was often facing the day and simply saying, “I can. I will.” The decision to face another day is itself a tiny miracle. It is the victory of hope over what seem to be insurmountable obstacles. And, that is what survival is all about.