Falling off the edge

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)

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.

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.

No, I’m not Procrastinating

Or maybe I am. This is a common saying around my desk. It’s a riff on Hemingway’s famous quote

Write drunk, edit sober.

E. Hemingway

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 Paradox #1

Since they never develop a sense of safety, they distrust others while simultaneously searching for a “rescuer” who can finally give them the unconditional positive regard they were robbed of in childhood.   

~National Center for PTSD

My earliest fantasies were of a man, a Prince, who would rescue me.

In my dreaming, I was always asleep, or sick, or injured before this magical person arrived. Their presence rewrote me. With them, I was well. With them I was alive. I physically ached for that person. The hole in my chest that remained exposed and empty hurt. Because I knew, I knew with all my heart and soul that this magical being would make me complete. So I remained in my prison, waiting.

I was the dog that cringed in the back of the cage. I was the cat, injured and half-dead that would claw and bite anyone who attempted to rescue me. Why?

Because people were dangerous. They put me in this cage. People cut the hole in my chest. People taught me I was hollow, defective, broken. They – those outside – could not be trusted. In my cage, I was separate from them. I was so alone. I was broken. I was voiceless. I was forgotten.

Being forgotten by all the world made me safe.

No one ever came to my rescue.
There was no knight, no prince. There was no magic to make everything better. No touch to soothe away the fear. I was singular, alone, a broken thing that marked time pacing the limits of my cage. For decades. There is a track worn along the inside of my prison. I know it grain by grain. I could close my eyes and tell you where I stood in the gray nothingness of my life by the feel of the sand beneath my feet.

I have never lived. I have only paced my circles. Over and over and over. Waiting for a fantasy.

Why Bother?

We often ask ourselves ‘Why Bother?’ as we are healing. We ask it when we are hurting, or when the amount of work seems too much, or in those moments when we feel we are not ‘enough’ of what we want to be.

In those moments, remember, you are a light.

You may not feel like a big, bright light, but that doesn’t matter.

What matters is that healing from your past, helps someone find their way to their own healing journey.

As we heal we light the way not only for ourselves, but for others as well.

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.

The Vanishing Point

Essays - Understanding Complex PTSD

Midnight thoughts with CPTSD

In the darkness of my bedroom I look at the ceiling.

Lit only by the pale moon, the fan, still in the autumn cool, is a black spider clutching the ceiling and hovering over the bed. In perfect silence and with the greatest care I relax my desperate grip on my sleeping husband’s hand.

It would be rude to wake him. Worse still to disturb his sleep with my need. And so, with practiced grace, I leave him in peace as I withdraw.

Down the stairs in darkness. I light no lamps that might pierce the darkness of our bedroom and thereby alert or alarm him. Silently past the sleeping dogs. The retriever yipping softly as he chases dream rabbits. The poodle twitching as he snores curled into a tight ball beneath his blanket. They might accompany me into the solitary darkness below, but…better to let them stay with him, blissful in their sleep.

When I was younger I was not so careful. Perhaps I thought I had some justification, some fundamental right to a voice, a sound, to even just the smallest word of distress. But all words fall silent.

It is their nature.
Even a scream ends when the breath is exhausted.

When I was younger the frictions that moved me, that jarred me or brought me to the edge of imposing on others, were more frequent.

They left me bruised.

At times I thought I would explode, but I couldn’t do that. The mess it would leave for others! That? That would be terribly rude. How could I possibly be so inconvenient? It simply would not do.

So to protect myself I have become, not harder, not impervious, but instead malleable, permeable. I am capable now of absorbing the pains that earlier would have broken me. I can smile and let the world go on, unimpeded by any concern I might cause.

I am not invisible—It would be far too jarring to simply wink out of existence: the days and routines of those I love would be interrupted—but I have no mass. Pain has nothing to cling to, despair nothing to resound through or echo off of. They pass through me as easily as through air.

What holds me in place and gives me shape are my thoughts. My mind is all that defines the void within.

My mind ties me together. Each insubstantial thought gives shape to me as the insubstantial air gives shape to a bubble: the only thing truly there is air.

My mind is a constant thing. It is like the sea, turning over and over. Even as it defines my limits it erodes my barriers. It turns over the pain, the desire, the loss, the resentment, the fear, the self-loathing, relentlessly. They all tumble against each other in perpetual action. They polish one another to a glossy shine; they lose their edges and become, almost, tiny jewels, moments of exquisite beauty and sadness.

One day, when the last tear is shed, the last resentment purged, the last fantasy dispatched, and the last desire let go, my mind will have ground all its emotions and thoughts to dust. There will be no more thoughts.

In that moment I will cease.

Bottom

There is
a monster
in the mirror.
I stand shaking,
clutching
at the cold porcelain
of the sink
to support myself
on withering knees.
My body is numb,
but the tears
that wash
over my cheeks
are hot.
There is
a monster
in the mirror.