Friday, September 28, 2012

Lucid Analysis: Trials in Therapy – Breaking up Edition

Let’s cut to the chase. I broke up with Tech Boy on Tuesday. It was pretty much the talk of therapy.

Right now. I feel okay. I’m not sure why. One of the things with self-awareness is you don’t necessarily stop over-thinking  you just try to do it more productively. So what I need to do right now, is take into consideration how I've felt in the past, what I've done in the past, how I've reacted in the past… and try not to do that again!

It’s only been a few days.  Every time I broke up with Boring-Ex it took me about a week every time I broke up with him to really hit the wall and go into full melt down and panic mode.  Which I found pretty ironic because I really didn't like him very much when we were together.  I remember being really un-enamored with him for a long time before I actually made the move to end it. There was no one thing, no defining moment, just a string of everyday experiences that I wasn't stimulated in any way at all. With Tech Boy things were fun, but there’s always been an aspect of disconnect. Every conversation we have is an experience in different life ideologies. We’re both very good at listening and accepting that the other person has a different perspective, but understanding? I've never felt like he understands me as a person, who I am. I usually feel this way with people, especially at first, but it’s been a y ear now. Sometimes I think this is just a product of my disordered thinking, that’s it’s just me and my disconnect, but I was talking to Doc the other day and he could see it. Whenever we’d talk about things, debate issues, get impassioned about something important, or just geek out… Doc said it was really pretty obvious that he wasn't engaged and just didn't get. I understand not being moved by the same issues, but with him, he doesn't understand getting moved at all. Why bother? What difference will it really make? It makes me crazy because it is how he lives. Maybe it’s product of my BPD, or maybe it’s a product of who I am, because my father is the same way; I like to be stirred. I need a certain level of passion in my life. I certain level of intensity. I like to be moved by things. (The right things! Not dysfunctional abusive things!).

I don’t like the way my brain functions sometimes. I don’t like all the maladaptive coping mechanisms I've developed throughout my life. I don’t like the way I've reacted to and treated people in my past. I don’t like the paralyzing depression and gut wrenching anxiety. These things are a part of me, but they’re not all of me, and they don’t  have to define or confine me. I do really like who I am as a person. Which is why I’m working so hard to make changes in my behavior and form new pathways in how my brain functions.

It’s really difficult to do that with someone that actively avoids any aspect of stress and uncomfortableness. The thing with doing what I am working to do, is that it can get pretty ugly. I have to face myself, who I was, and who I’m becoming. It’s stressful, it’s hard, but ultimately the outcome will hopefully be beautiful.

Just trying to talk to Tech Boy about some of my concerns and my disconnect, has been its own struggle. We sat down on Sunday. I've barely seen him the last couple months. I explained to him (and I’ve this before) how it’s difficult for me to hold onto my connection with him when I barely see him. That when there’s a significant amount of time passing in between it’s like I have to start over every time.
He understands the emotional disconnect. He clearly has his own emotional detachment problems that he doesn’t realize/care/feel the need(?) to work on.  I’m trying so hard to battle all these things, but being with someone that actively avoids all of those things is just not what I need.

Automatic geek cred if you get this. 
Yes, he flat out told me he’d rather avoid anything heavy or emotional if he can. After our last conversation where he had that “epiphany” that he should be more supportive and not try to fix things, he said it would be good to do some inward focusing. Then what he did was drop off the map for a week and a half. He’d only talk to me if I texted him, and not about anything significant. I asked him about this and he told me he thought we were taking time to ourselves for a bit. What? He never said that. He said me being stressed out was stressing him out, so he took sometime to just get things done that he’d been needing to do and honestly he’d like to keep a nice de-stressed state. So he figured he’d just give me time to settle in and then we could get back to the fun stuff. < --- I’m sorry, but this is yet another sign of emotional immaturity that I’ve seen from him. I get that it’s not fun having your girlfriend stressed out, but he hasn’t even been around to see me stressed out. He says he wants to be supportive, and then disappears. In the past he’s told me I take on too much and I should ask for help, so I ask him for help, he says he totally will, but then he takes care of his priorities* (detailing his truck, skim boarding at the beach, playing basketball) first before showing up after I finished everything on my own. I rarely, rarely ask for help. I hate asking for help. I’m very conscious about not being clingy or demanding. But yanno what, sometimes I think I should be because if I’m not, I don’t get to be a priority.

And I think that’s one of the things. I’ve never really felt like I’m a priority to him.

Just getting him to talk about my concerns was hard. I almost broke up with him before talking to him because when I would ask if we could sit down and talk he would respond with, “Yeah I suppose.” Which makes me think he doesn’t care, so I ask and he says, “I’ve never been good at talking out problems. I actually usually try to avoid them. It makes me uncomfortable.” I get it. I do. This isn’t fun for me either, but when you’re in a relationship you can’t just avoid problems and hope they go away.

Here’s something Therapist wants me to keep in mind: When he says things like that I feel like he doesn’t care. Or more like, if it mattered to him, he would care enough to do it. Not just do it, want to do it. If it was important he would want to. If I were important enough he would want to.

Therapist kept reminding me that this is a projection of my thoughts onto him. He himself, doesn’t think about it like that. First of all, he doesn’t seem emotionally experienced enough to understand what to do. All he knows is something is uncomfortable and he doesn’t want to be uncomfortable. That’s the base instinct.  It’s not that I’m not important, but that he is in a different place of emotional development and doesn’t know what to do or how to react.  That’s his stuff. That’s not my stuff. Not my failing.

People have their own stuff, that isn’t connected to us at all, even if it colors how they interact with us.
I felt like I spent a lot of therapy justifying why I broke up with him. In the end we really are just such different people and what we need in a relationship (or not) is very, very different right now. He’s not right for me. I’m definitely  not right for him.

With Boring-Ex (hell, with most of my exes) I had this need, this sense of urgency to not be alone. I felt so alone, all my life, it was my biggest fear (also, I was living with an abusive ex-boyfriend and needed to feel some somewhere, anywhere) … that I would never find someone that would love me. I was so afraid of this that instead of letting things fit how they were going to fit (together or not), I needed to make them fit. Make them work. If they didn’t work it was one more proof that I couldn’t be loved.

Right now, I don’t feel like I’m in a place where I need someone. I’ve been in places like this before, but it was more a sense of keeping people out. I’m better off on my own. If people can’t get close to me, they can’t hurt me, they can’t leave. If I keep people out, they can’t leave. Years and years and years I subscribed to that theory. I was intensely self-isolated, intensely angry, intensely lonely, and completely miserable.

I’m in a place where I want to work on me. And I want to find something that fits on their own, without me having to always make everything fit. Without me having to delude myself or convince myself that something is working or okay. I want something different for me, better for me, inside, and outside of me.
I also don’t feel completely alone anymore, and I don’t feel isolated. I have some very close, very good friends that love me and care about me. Knowing that I have them, which I haven’t in the past, really helps. Growing up I had a lot of, um, disingenuous friends that I was extremely aware could not be trusted or relied on, in college I was on my own (until my sister moved in!), with my Evil-Ex I was alienated from everyone…. xRoommate was probably the best thing that could have happened to me. She respected my space and that I had a lot to heal from, but she was also present and caring. It took a long time for me to internalize a lasting connection with her, I was honestly not sure it was possible (even though I really wanted to), but I guess that’s why new things are scary. You can’t be completely sure they’ll work.

I don’t know. I’ve been seeing this whole relationship with Tech Boy going downhill for a while. Ever since the Mayhem Tour weekend it’s just been so incredibly difficult for me to reconnect, especially with him always being absent, physically and emotionally.  I feel like I was prepared for it in my own way, just keeping our eyes open and not trying to force it. That’s not to say this was easy. It was still scary and my brain was definitely freaking out at times. I also cried through most of our conversations, but idk, it’s a life change, we’ve been together for a year now, so even though I was ready for it, and made the decision, it was still hard.

Especially since I don’t hate him. Check it out with the no splitting, no black and white, not evil, not even all bad… just a guy that’s not right for me/me for him. I was really sad through a lot of our conversations, and there were times I wanted to just scream in frustration, but I always tried to be mindful. Mindful of my own reactions, and mindful of how I was interacting with him. I know I brought up things that made him uncomfortable but I tried really hard to not be hurtful and remain open to the things he had to say. At the end of it, we called it quits, he said he loves me as a person but acknowledge that we just need different things. All in all, I think it went as well as I could expect it to.

I’m still trying to remain mindful of myself though. I know how I react isn’t always expected or predictable, even to me, so I’m watching out.

Therapy has helped me out a lot. Having issues that I was freaked out about and being able to talk it through with Therapist before I freaked out in reality, was immeasurably helpful. Not gonna lie, my meds have helped a lot too. I’ve been having some pretty bad anxiety lately, but I haven’t felt out of control. I’m getting there.  

Wednesday, September 26, 2012

The Fix: Skin Picking and Addiction

As you may know if you follow my Twitter or Facebook, I broke up with Tech Boy last night. We talked a lot.  It’s just been becoming more and more abundantly clear that we’re in different places in our lives and we need different things. I can honestly say this is the most amicable break up I’ve ever had.  At the end of it he said he loved me as a person, definitely wanted to stay friends, and would give me hug at work today (which is weird, but okay?).  I’m sad, but so far I’m not devastated. If anything I feel relieved. My brain is still whirring though so I’m not really feeling up to posting today.

Fortunately I have another cool article for you from The Fix. Of course by “cool” I mean informative and possibly triggering. Enjoy!

Skin Picking and Addiction
Cutting gets most of the media ink these days, but an equally prevalent form of self-injury—skin picking—is increasingly afflicting many addicts. Shannon Kelley gets to the root of the problem.

When Annie, a 35-year-old recovering addict in Brockton, Mass., who has been sober six months, talks about picking her skin, she could just as easily be talking about using.

“When I pick, it’s the same feeling,” she explains—when she’s skin picking, her thought process reminds her of when she was using. “It’s like, ‘Okay, I’m only going to pick one or two cuts, but I won’t do them all.’ And then... It’s sick, but it makes me feel good, so I do it more. Then I get those feelings of, ‘Ohhh, what did I do? Why did I do this?’ I’m so angry at myself, so I say, fuck it, why not just pick at all of the scabs, because now I look horrible anyways, so what does it matter if I do the rest of them? I end up feeling guilty and ashamed and embarrassed and I have to cover it up so nobody knows.” She sighs. “It’s the same euphoria, the same feeling of trying to hide it, the same embarrassment. And shame and regret and guilt. All the same feelings.”

Annie’s not alone. In More, Now, Again, Elizabeth Wurtzel’s 2002 memoir of addiction, she writes not just of her drug addiction but of her compulsive hair tweezing that would result in bleeding legs. Lilly, a 30-something addict in New York, has managed to kick booze, cocaine, and cigarettes, but not picking the skin on her fingers -- from the cuticles down to the knuckles. Even when she’s not doing it, it preoccupies her thoughts, and once she starts, she admits, “it’s like a never-ending train.”

Though you’d never know it from how much the disorder has been covered in the media—it hasn’t—addicts picking at their skin (a condition known clinically as dermatillomania) or pulling out their hair (trichotillomania) isn’t all that unusual. Still, knowing what to call it is tricky. Skin picking and hair pulling are often labeled “body focused repetitive behaviors” (B.F.R.B.s), but also fall under the umbrella term for “non-suicidal self-injuries” (N.S.S.I.s), which includes more severe behaviors, such as cutting. Classification is up for debate, too; some believe B.F.R.B.s belong on the O.C.D. spectrum, although many disagree. Meanwhile, dermatillomania is currently listed as an “impulse control disorder.” And, while there are similarities, skin picking is not the same as cutting.

“In general, skin picking is a more compulsive behavior associated with anxiety disorders and it’s similar to O.C.D.,” says Dr. Joseph Shrand, Instructor of Psychiatry at Harvard Medical School and Medical Director of CASTLE and the Adult Inpatient Psychiatric Unit for High Point Treatment Centers in Plymouth, Mass. “Cutting is often associated with more complex character pathology such as borderline personality disorder, while skin picking is frequently associated with trauma.”

Dr. Simone Madan, a San Francisco-based psychologist who specializes in treating people dealing with B.F.R.B.s, offers a significant stat: 25% of those who suffer from a B.F.R.B., 25% are addicts. But numbers, too, are problematic. Because of the shame around such behaviors, it’s safe to assume that they’re extremely under-reported. That said, recent literature estimates that around four percent of the population has trichotillomania, while anywhere between two and 5.4 percent of the population is affected by pathological skin picking. Skin pickers and hair pullers are more likely to suffer from body dysmorphia, depression, anxiety, and other mood disorders.
This is no coincidence, says Shrand. He’s treated several patients who are dealing with both addiction and N.S.S.I.s and says that when there’s an underlying psychological issue—such as depression or anxiety—drinking, using and even skin picking become “ways to suppress these uncomfortable feelings and overcome them with feelings of pleasure.” The problem, he says, is that “at some point, it’s not pleasure anymore. It’s simply a way to not feel the other feelings.”

While the notion of picking at skin to feel pleasure might sound odd, Dr. Shrand explains, it makes sense thanks to a trick of evolution. “It was important to be able to suppress pain if you were being chewed on by a saber-toothed tiger, so you’d release an endorphin, suppress pain and run away fast.” Endorphins, he adds, are “our bodies’ morphine”: they sit in the same receptors as opioids do and deliver the same high. Any N.S.S.I. will offer a taste. Shrand points out that, although the causation is different, this is where skin picking and cutting are similar; both, he says, “appear to have the same end point of endorphin release and relief.” On the television show House, when Dr. House is attempting to kick Darvon, he cuts himself to get a fix. In A Million Little Pieces, James Frey writes of ripping off his toenails while in rehab to get some relief. Skin picking and hair pulling offer a little dose of the same medicine—a high or escape. Madan says her patients report feeling like they’re in a “trance-like state” while engaged in the behaviors.

This makes sense, according to Shrand. “You get this sense of relief and a high,” he says. “With picking, you don’t feel actual pain at the time. There’s this buildup of emotional pain, this anxiety, and the brain has learned, ‘Well, if I pick at myself, I will release an endorphin’—which is the brain basically going, ‘Ah, this is great, I feel so much better, I’m so relieved: thank you!’ And you really don’t feel the pain until maybe 20 or 30 minutes later.”


I think a lot of the Borderline pathology also has to do with trauma, which is why these kinds of behaviors, impulses, and compulsions are such a problem for many of us.

Tuesday, September 25, 2012

The Fix: Over the Borderline

One of my followers sent me an interesting article written by a comedian that, among other things, is diagnosed with Borderline Personality Disorder and Alcoholism. It's a great read from someone that is actively healing. I thought it would be nice to hear a realistic, yet hopeful, experience from someone other than me for a change, haha. I've copied it below or you can follow the link here.

Over the Borderline

Treatments for borderline personality disorder and alcoholism are similar. But dealing with one doesn't fix the other.

If borderline personality disorder sounds familiar, that may because it was made famous by the movie Girl, Interrupted featuring Winona Ryder and Angelina Jolie back when Winona Ryder was the big star between the two. It was based on a memoir by Susanna Kaysen about her experiences being diagnosed with BPD and then ending up in a psychiatric hospital in the 1960’s. I liked both the book and the movie when I was exposed to them but I didn't think much about them. I hadn’t been in a psych hospital then. I didn’t keep roasted chickens under my bed. Case closed. 

I first found out I suffered from BPD in 2004 when I received a bill from my psychiatrist and noticed a code at the bottom of the page. Out of curiosity, I punched them into Google. Up came depression (no shocker there), substance abuse (ditto—I was a full-fledged cocaine addict at that point) and then...Borderline Personality Disorder. Whaa? At first, I was speechless. Then I Googled BPD, and was even more speechless when I read the description and symptoms. It was as if I was reading a report that had been specifically written about me. 

Borderline personality disorder—or BPD—is a condition, I read, marked by emotional instability and turbulence, impulsivity with money, substance abuse, sexual acting out, binge eating, shoplifting, repeated acts of self-injury or suicide attempts, fear of abandonment and a fear of being alone. People with BPD, it said, idealize and then devalue or demonize people and have a tendency toward “splitting” or black-and-white thinking. They are extremely moody and have a very unstable sense of self. Perceived rejection or failure can trigger long-lasting states of depression, anger or anxiety. And while they know that BPD is much more common among young women, they don't entirely know what causes it, though it's thought to be a combination of genetic predisposition and early trauma.

Way before I had picked up booze, I had an eating disorder. I’d always struggled with depression, starting back when I was 13. I had just recently tried to kill myself. I had very volatile relationships with other people: friends, boyfriends, coworkers and bosses. I had no sense of self and couldn’t remain committed to what I thought I wanted to do with my life. One minute I wanted to be an actress, the next minute I hated acting and wanted to write. Then I wanted to be in fashion. I moved constantly, trying to get away from—well, myself. The list of medications and rehabs grew longer with every year.

My horror at being diagnosed with BPD turned to relief. Finally I knew what was wrong with me. All those times I had been berated by my family for being self-destructive or flaky or dramatic were all explained by this one disorder. The apologies came flooding in. I forwarded the BPD links to my father, mother, and multiple step mothers and they all apologized for judging me, for misunderstanding, for making light of what turned out to be a serious condition. But that didn’t really solve the problem of having yet another condition that needed to be dealt with.

What immediately struck me the most about this type of therapy is how similar it was to AA. 

The best treatment for BPD, I came to learn, is a type of cognitive behavioral therapy called DBT—which stands for dialectical behavior therapy. It is a series of tools that the patient uses to quell impulsivity and calm turbulent emotions. You’re given a “diary card” so that you can check the tools you used and rate your “urges” and whether or not the urges led to an action or you were able to use the tools to avert the action in question each day. You meet with a DBT therapist once a week and go to a “group skills” group once a week as well.

My therapist was a tiny old hippie. She looked a little like Linda Hunt. She was soft spoken and never judged. She was so encouraging that, even when I engaged in self-destructive behavior, she found a positive spin. “Well, you made it through the week,” she’d say. “You’re here.” Or: “You haven’t dropped out of therapy.” Her catch phrase was “Just breathe”—which, I have to admit, I always found annoying and trite. If I was successful and used the skills when triggered to stay balanced, she put stickers on my diary card. Cats or frogs or gold stars always felt like a pretty infantile reward for not fucking up your life.

It was the group skills groups where all the action happened. That’s where I studied the different skill sets with a bunch of other borderline women. My role in the group was to be the comedic relief—when I wasn’t crying, that is. Group skills met on Monday nights for an hour. It was a motley crew of girls. But in that group, I didn’t feel “crazy” like I often did in the real world. These girls got me. They also had multiple suicide attempts, psych ward visits, trips to rehab. To each other, we were “normal.” What a relief it was to feel normal, if only for an hour a week. There were certain rules we had to follow for everyone to feel comfortable, like we weren’t allowed to talk about any self-harm or drug abuse, lest it trigger the others. One girl referred to her drinking and drugging as “festivities,” which I always found highly amusing. It was obvious to me, a member of AA, that she was a fledgling alkie and drug addict but I kept quiet about that.

Come Monday nights, we’d all sit in chairs in a circle in a tiny office on the West side. There was a 30-ish plump executive who was struggling with anxiety and cocaine abuse and a very young student who had a terrible cutting problem. Her arms were scarred from wrist to shoulder and she was constantly in and out of the ER getting stitches for her self-imposed injuries. I called her “chopping block”—my attempt to make light of a horrifying situation—which always made her laugh. There was an old Persian woman who never knew what skill we were studying and constantly complained about her stomach. There was a “dancer” who wore very short shorts and whose aspirations included marrying rich and being a Playboy centerfold. There was an angry, arrogant bisexual with a pierced septum who always showed up loaded and bragged about her bondage fetish. There was a rich aspiring stylist who constantly commented on everybody’s footwear and eventually landed in Debtors Anonymous after buying $600 sheets. And then there was me: a young-looking 40-something rocker chick with a foul mouth and a botched suicide attempt.

What immediately struck me the most about this type of therapy is how similar it was to AA. One of the central beliefs of DBT is “radical acceptance,” whether it was the situation you were in or a strong painful feeling. Acceptance, they teach, does not mean that you like what is happening or how you are feeling—just that you are willing to stop fighting it. Pain plus non-acceptance, they said, equals suffering, while acceptance decreases suffering. Also, the thinking went, in accepting the negative emotion, you can stop trying to run from it through self-harm, drug abuse, acting out sexually, or whatever else you might have done in the past. Sounds a little like the Serenity Prayer, right?

In DBT, there is a heavy emphasis on “observing your breath” to get centered and on “mindfulness”—which means staying in the moment rather than dwelling on the future or past. When you’re washing dishes, just wash the dishes. It’s all very one day at a time.  

There is also something called “Wise mind,” which, they say, is a cross between your rational mind and your emotional mind. It’s your intuition—your God consciousness, as they’d say in the program. There is a tool called “Turning the Mind,” where you return to accepting something over and over even if you have an aversion to it. To me, this is like turning your will over—and over and over again. And, just like with alcoholism, there is no cure for BPD—only active treatment. And when you stop using the tools that treat your BPD, you lapse back into old behavior—just like with alcoholism. And, just like with meetings, skills group is a place where borderlines can hear other borderlines voice their life struggles and talk about how they are trying to use the steps to keep from acting out and creating more wreckage. 

Plus, once you go through all the modules of the skills, you go back through them again. You never stop. Just like the steps. It’s a continual process of relearning, remembering, mastering. And among the many “self-soothing” skills are prayer and meditation. Can anybody say 11th step?

At first, I thought that I could just go to skills group or just go to AA. They overlapped so much that attending both felt repetitive. But I soon realized that too much is never enough when it comes to BPD and alcoholism. How many signs did I need that these were the tools I needed to master to keep from destroying my life and myself? These days I go to AA meetings every day and DBT group once a week. They reinforce each other and I’ve found that when I remove or back away from one, the whole structure of my life comes tumbling down. 

I’m certainly not proud of or happy about the fact that I’m borderline. It comes with a ton of baggage and stigma—just like alcoholism. I’ve never understood people who said they were grateful to be alcoholic. What I would give to be normal. But I accept that these are the cards I’ve been dealt and that I must play the hand to the best of my ability. And just as with alcoholism, I wear my BPD with irreverent rebellious shamelessness, hoping to diminish my shame through humor and acceptance.

Amy Dresner is sober comedian who liberally pulls material from her depressive illness and drug addiction. She performs all over Los Angeles and is also on a national recovery tour called "We Are Not Saints." 

Monday, September 24, 2012

Quotes from the Borderline

“The reason we struggle with insecurity is because we compare our behind-the-scenes with everyone else’s highlight reel.”

~Steve Furtick~

One of the reasons I often think I’m a bad person is because I remember all the hurtful things I’ve done, all the pain I’ve experienced, and I refuse to let it fall into the background so that no matter how good I become, how much positive change I work towards, I always feel tainted by my past. This seems unfair to myself, because I’ll be the first person to tell others that it’s who they are now, who they choose to become, that matters most. I believe this. But because I cling so tightly to that behind-the-scenes, that archive, I factor that into everything, and don’t have that same experience with everyone else… it results in me judging myself much more harshly. I often feel like because I’ve struggled with things, and it appears to have been easier for someone else, that I’m not as worthy of that thing, my knowledge is somehow lessened, my accomplishment is diminished because of my struggle… when really I think it shouldn’t be diminished, but perhaps lauded, because despite the fact that something did not come easily, I did not give up, I pushed on despite the difficulty.

It’s hard to not compare ourselves to others. It rarely ever results in anything but unpleasantness. Either you’re judging someone else, or judging yourself.

We should try to be the best version of ourselves that we can be. Not the best impersonation of someone else. 

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