A gift from my CBT chum

..and this is what she gave to the group:-

Autobiography in five short chapters - by Portia Nelson

1.
I walk down the street.
There is a deep hole in the sidewalk
I fall in
I am lost...I am helpless
It isn't my fault
It takes forever to find a way out

2
I walk down the same street.
There is a hole in the sidewalk
I pretend I don't see it
I fall in again
I can't believe I am in the same place
But it isn't my fault
It still takes a long time to get out

3
I walk down the same street.
There is a deep hole in the sidewalk
I see it is there
I still fall in...its a habit
My eyes are open
I know where I am
It is my fault
I get out immediately

4
I walk down the same street.
There is a deep hole in the sidewalk
I walk around it

5
I walk down another street

Absolute genius!

Did I mention I'd been discharged?

After a year of support, my lovely CPN feels I am well enough to be let off the leash. I am well enough mentally,  and have successfully reintegrated into the real world. Apparently I am a mental health success story. Sadly you don't get a certificate of sanity but I'm just happy to be well. I cry when she says goodbye - its been an emotional journey and she's been amazing.

Although I am free from regular mental health team scrutiny, I am still seeing other professionals. Sadly I'm still not typically "Normal" in the brain area. I'm to see my psychiatrist every 3-4 months and my psychotherapist on a one-to-one basis to do some exposure therapy. This doesn't mean I get forced in front of a pervert in a rain mac to stop me feeling unhinged, but means I get to learn a new technique that'll help me with the intrusive thoughts. I'll explain more later.

I feel like a grown up, healthy person at work, and in my flurry of wellness, I decide to work and extra day and a half a week. I have told everyone with whom I work that I am of a slightly disordered mental disposition and explain that I will be doing certain things that keep me centred. For example, sharing some inspirational quote cards around the office, not doing meetings after 3pm, dispensing joy in amongst the stress to lighten the mood and working from home one day a week. Most people embrace my eccentricity and realise that although I'm bonkers I'm quite good at my job and let me get on with it. There are a few who tell me off for talking in the office and laughing (God forbid I should have fun at work) and the odd one or 2 that look at me as if I were a big lump of dog poop on their shoe. These people I learn to accept and ignore. Get me with my CBT techniques!

I have begun to live a again and the hopefulness continues. I go to my appointment with the psychotherapist and talk about my intrusive thoughts. What I learn is that ALL people experience intrusive thoughts. She gives me a sheet of data relating to 100 people and a list of the intrusive thoughts that pop into their head. Most people, and I mean ordinary folk, have the odd thought that is not really acceptable. You know stuff like, "Shall I let go of the steering wheel?", or thinking you've not locked the door or left the cooker on, thinking about someone else whilst making love to your partner, thinking you might yell an obscenity in a quite place or have an odd sexual thought at what you would deem to be a completely inappropriate time; you know like when you are cleaning out the guinea pigs or something.

When non OCD people have these types of thought intrusions, they ignore it, probably give it a few seconds reflection, think, "That was odd" and carry on. Not so for us with an overactive amygdala:

Amygdala: "a small area hidden within the temporal region of the brain. In humans, the amygdala is the size and shape of an almond (amygdalum is Latin for almond).  [...] this area is the heart of the emotion system. It is "able to process the emotional significance of individual stimuli as well as complex situations. The amygdala is, in essence, involved in the appraisal of emotional meaning"." (The Emotional Brain: The Mysterious Underpinnings of Emotional Life by Joseph LeDoux, Simon & Schuster) Keeping it simple what this means is that an almond blob in my head is responsible for my flight or flight reactions. And mine is overdeveloped, and overstimulated, so my brain, hormones and emotions are all out of kilter. I told you I was a bit on the broken side. Maybe this is where the term "She's nuts!" comes from?

Basically me and my brain overreact. Which is a pain as it means I spend a lot of time being over stimulated by normal day to day things and being hideously anxious. It also gets worse when my mood is low. In classic OCD, people will try to make the anxiety go away with rituals, that make the person feel free from the anxiety. When you speak to about OCD, people will ask you if you clean and wash your hands obsessively. I feel that the thought intrusion side is left out and people don't really get that part. Apparently the overstimulated amygdala can be a result of traumatic childhood, a serious stressful incident, that type of stuff.  Spending too much time on high alert makes you over sensitive.

I remember having a bad depression week and my mood was really low. WHAM the nasty thought pops in and because its hideous, I immediately feel frightened, and worried that I might actually act out on my thought even when I don't want to (That's the compulsive bit), I become incredibly distressed and go to pieces. Most OCD people are conscientious and quite perfectionist in nature. The thoughts are usually massively removed from the values and ethical choices of the person suffering, so the thoughts feel even more disastrous. So for me the thoughts are usually around hurting myself in savage ways. Stuff like swallowing bleach, pouring boiling water over myself, chopping off my arm with a bread knife. My core belief is about living and not death or suicide, celebrating life, gentleness and love, looking after my family and surviving my mental illness. So if I were actually to do those horrid things, it would go completely against my moral code. That is why it feels so awful. And the stimuli is centred around day to day things - making a coffee, loading the dish washer, cleaning the house. Its not like I'm stood in front of an axe murderer and I'm fighting for my life. When I shared about the intrusive thinking in group, they all looked appalled and sympathetic. None of them could identify with my experience, so I felt incredibly vulnerable.  The therapist god love her, explained it by saying,"Its like a devout Catholic sitting in church, suddenly wanting to shout out a swear word, or wanting to flash her breasts at the priest". Its unthinkable that she'd actually do it. 

So the exposure stuff is about retraining my almond blob into what is really terrifying and what is not. The homework is to walk around the house holding glass, putting sharp knives in the sink whilst washing up (Only for me not the rest of the family), putting the nail polish remover next to my coffee cup whilst I'm drinking, and standing near to a boiling kettle for an extended period of time poking fun at it. The plan is that after doing these things over and over again, my brain will learn that I'm not going to do what the thought intended. I'm not going to hurt my self and the anxiety level then reduces dramatically. I also learn that the thought is a lie and I don't need to panic. 

I also get superstitious thoughts too, things like if my husband is late home from work, the almond blob places the, "He's died" thought into my head. If I act out on the thought, I panic, have to ring everybody and ensure that he's not dead in any way, shape or form. Now, I remember its folly, ride out the panic and breathe. I don't phone, I don't imagine horrors and I calm down.

Its hard work but it works. The following few weeks I have to look at my rituals. I thought I didn't have any. oops!

Apparently I have TRAPs

Don't worry, its not a STI or another mental illness. Avoidance apparently has been my best friend. TRAP stands for TRIGGER, RESPONSE, AVOIDANCE pattern and CONSEQUENCES.

So, a mega twat from work says something really nasty in a meeting. I either become sad, angry or fearful, I revert to an avoidance behaviour and then I feel rubbish. Apparently I do this a lot. Getting stuck in TRAPs exacerbates low mood and TRAPs joined together like a sick Christmas paper chain result in being depressed even more. Avoidance behaviour for me usually involves crying, zoning out, eating, sleeping, avoiding conflict, being subservient, emotional fatigue (where you lose interest in everything and just can't get going), running away, or anything else that will shut off the feelings that make you uncomfortable and shatter your joy. Run for the hills, hide under the duvet,deny all knowledge, look at the floor - I could go on.

I am so damn sick even I am beginning to wonder if there is any hope for me. Thankfully, the CBT group mirror reflects 9 other emotionally unbalanced friends, so I will carry on regardless. Bless them all. We all look tortured after this session, realising that we are actually going to have to push out of the comfort zone, and expose ourselves to our worst nightmare. Dealing with other people.

So, I have to implement TRACs ( Sorry about the acronym overdose), which means TRIGGER, RESPONSE, ALTERNATIVE COPING mechanism. So when twat colleague says something that makes me wither, I have to take a deep breath and say, "I disagree with your comment and your behaviour is unacceptable." When the therapist tells us this, we all giggle and do the opened mouthed and prolonged, "Nooooooooooooo!" It feels liberating to think I am actually allowed to do this. Even if I don't actually carry it out, the knowledge alone sends my happiness soaring. I am also told that guilt is a waste of time so I have to bin it. Apparently normal folk do this stuff all the time and think nothing of it. They dismiss rubbish and resolve conflict, and walk freely through the maze of day to day life. I find this fascinating.

What I also have to learn is that a new bag, or top, or scarf, or all of those things will not resolve the conflict or make the terrors go away. Hiding is not a solution. This behaviour lulls me into a false sense of security and doesn't challenge the fear. Really a TRAC is throwing the bucket of water over the wicked witch. I am required to turn up at work in my magic red shoes, banish all negativity and focus on the wizard and finding my way home! My colleagues will now be the munchkins and my therapist is Glinda. This does mean that every now and then the flying monkeys will try and get me but really, all will be well. The witch is my nemesis - she is my TRAP. When I am finally well, I will return the the normality of the farm, and realise it doesn't hold the fear and control it once did. Life will no longer get the better of me.

um.....

The Social model of disability

"The social model of disability proposes that systemic barriers, negative attitudes and exclusion by society (purposely or inadvertently) are the ultimate factors defining who is disabled and who is not in a particular society. It recognizes that while some people have physical, sensory, intellectual, or psychological variations, which may sometimes cause individual functional limitation or impairments, these do not have to lead to disability, unless society fails to take account of and include people regardless of their individual differences.

The model does not deny that some individual differences lead to individual limitations or impairments, but rather that these are not the cause of individuals being excluded. The origins of the approach can be traced to the 1960s and the disabled people's Civil Rights Movement/human rights movements; the specific term itself emerged from the United Kingdom in the 1980s".  (http://en.wikipedia.org/wiki/Inclusion_(disability_rights))

So what this actually means is that society, my environment and my illness play a huge part in how I am treated or understood. Its about you as well as me. Some people embrace mental ill health; some people call you a nutter or a psycho and either fear you or persecute you. Its a bit of a gamble when you decide to share your truth with someone.

So lets explore the social model a little further. Now I am back at  work its suggested that my employer makes, "Reasonable adjustments" to my working day in order for me to have optimum functionality. This can actually be quite difficult for depressed individuals, as their symptoms and triggers are all completely different. And being mentally ill is very different from being physically ill. If I'd have broken my leg it would be pretty obvious how to help out. But my brain is a bit broken so I have to try and figure what works and what doesn't. Sadly some things I cannot avoid, like senior members of staff that have had a personality bypass and think shouting louder means things get done quicker.Or those idiots that refuse to see your humanness and attack you with academic brutality just for kicks. Work for them is an arena to dispense pain and misery to the masses and get paid for it. They probably kill bunnies in their spare time or get beaten up by their wives. In these instances I have to re-engage that whole zoning out thing that I do to avoid any outburst and subsequent repercussions.I can also call on sarcasm and/or Socratic irony in an emergency . Sorry.....Socratic irony means:

• n.( a pose of ignorance assumed in order to entice others into making statements that can then be challenged.) Basically its a very good way of making someone who thinks they are clever look very stupid in a very gentle but cut throat way. I didn't say I was a nice person all of the time did I? 

 Anyway, what my boss and I agree to do is stick to half a week, create a stress action plan and see how it goes. I'm allowed to go off to a quiet area if I'm feeling overwhelmed, sometimes I can work from home and I need to structure my time to minimise deadline chaos. I have to implement CBT techniques, keep to my sleep hygiene plan (That's the one where I sleep at a regular time, in a cool dark room, with no excess noise etc) and try not to have a mental breakdown. They also let me pop out to mental club every week and to see my CPN and Psychiatrist too. All in all, they are quite accommodating and for that I am truly grateful.

Its quite a hard balance to strike with people.  I don't want to become a total fruit cake so I  have to pick my way through the situations as they arise and not get too done in if I get it all wrong.  I am responsible for my own well being and although my employers do what they can, ultimately I'm the one who has to call the shots. And this will almost certainly be my downfall.