A Day Away and some more thoughts about what’s wrong with me

March 10, 2007 at 11:32 pm 14 comments

The sun’ll come out tomorrow.
So ya gotta hang on ’til tomorrow,
Come what may.
Tomorrow! tomorrow!
I love ya Tomorrow!
You’re always a day away!
    — Martin Charnin, Tomorrow, from the musical Annie

I don’t trust brand new days, or starting over, or tomorrow being another day. I’ve had far too many brand new days where everything was going to be different to believe that they’ll last.

Still, today felt a bit like a brand new day. I cleared up a little. The evening sky was heartbreakingly beautiful, sounds carrying from far away and the air opening with a feeling of freedom. It reminded me of the days at university where we’d go to the pub, have a few drinks, walk home fuzzy-headed after buying a pizza and drink tea until the early hours. I’d have loved to have gone out, but there’s nobody around to go with. Days like today, it’s easy to believe in endless possibilities, so long as you don’t look too closely at them.

My cuts are healing nicely, and I have a feeling that it was cutting myself that meant today could be relatively good. It’s all about escaping from the horrible feeling of trapped numbness, for me. I’ve been reading a bit about dissociation and how that relates to cutting and it makes perfect sense for me.

Dissociation is, as Wikipedia puts it, ‘a psychological state or condition in which certain thoughts, emotions, sensations, or memories are separated from the rest of the psyche.” It’s a defense mechanism, essentially. You stop feeling so that pain (whether emotional or physical) doesn’t hurt. I probably started doing this, mildly, when I was bullied.

This is just theorising, but back when I first started cutting, I cut to hurt myself, to transmute the emotional pain into something physical that I could actually deal with. Now I cut to make myself feel again. The switch happened when I was 17 or 18. I dealt with the issues that were causing me such emotional distress. But while cutting had been a way to induce dissociation, I suspect my brain couldn’t deal with the sudden lack of over-powering emotions and began to over-compensate, dissociating when there was no good reason to do so. I’m not claiming that this is severe dissociation. For me, the best description I can come up with was when I said “I feel like I’m in a play, reciting the same lines over and over.” I feel numb, lost, cut off from the world, not entirely real for days. There’s probably not that much outward change, but it’s a horrible feeling. I cut until it hurts and then I stop. While cutting, I’m aware the pain is there, but it doesn’t hurt. And I feel better afterwards, like I’ve stepped out of the play, and can feel again.

Another difference: When I was cutting to deal with extreme emotional distress, the urge to cut would come in waves. Now, it’s something that usually builds slowly over days or weeks.

So when the psychiatrist suggested that something triggers me cutting, she was both right and wrong. The dissociation triggers the cutting. But what triggers the dissociation? I don’t think anything does. I think it just happens. In particular, it doesn’t appear to be related to stress-levels.

I clearly had some borderline-like symptoms when I was younger, (unstable relationships, inappropriate anger, identity disturbance, black-and-white thinking, etc.), but most of these symptoms didn’t continue past the age of 18 or so. I definitely don’t have the distorted all-or-nothing thinking that’s characteristic of bpd, nor the abandonment issues.

But what does this mean for me? Here’s my working theory:

I have a few problems that inter-relate. These are bipolar II, borderline personality disorder and a circadian rhythm sleep disorder.

The circadian rhythm sleep disorder has always been there. It was less severe when I was a child, and has become more severe as I’ve got older.

I developed borderline personality disorder in my teens, probably as a result of the bullying at school and problems with my father. It continued until I was 18, at which point I managed to deal with the problems, essentially giving myself a course in cognitive behaviour therapy. This was possibly co-morbid with social anxiety disorder or avoidant personality disorder, but it’s probably not worth trying to separate the symptoms out. What can I say? I was a neurotic teenager.

Bipolar II symptoms are hard to pinpoint up until I was 18, because my mood wasn’t hugely stable anyway, because of the other problems. But I’d sketch it out like this: Bipolar symptoms started to show up when I was 14, with a serious depression hitting, lasting maybe as long as a year and a half (with two suicide attempts in the middle). eventually moving back to normality when I was 16, then sliding into hypomania for a few months around the time I turned 17, and back to depression when I was 18 (although the other things going on at the same time make it hard to tell).

And I’ve been experiencing fairly regular ups and downs since then, which if I graph them out, seem to be very slowly getting faster. I think I’m currently getting back to normal after the horrible depression that hit me last year. It’s slow cycling (probably one full cycle in a year).

I probably shouldn’t be doing this self-diagnosing stuff, but since my psychiatrist doesn’t seem interested in doing anything at all, it seems to be up to me.

I can understand why the psychiatrists have leaned towards borderline. Since I probably was borderline, hearing my history makes it easy to assume that I still am. But I don’t have those problems anymore, and haven’t really for the last six years. Cognitive behaviour therapy would have helped hugely when I was 16 (and probably did in that I developed similar techniques myself); now, not so much.

So what I’m left with now is:

1. Some odd dissociation problem that causes me to self-injure sporadically.
2. Relatively mild (I can move when I’m depressed and don’t actually get arrested when I’m hypomanic) bipolar II symptoms that may be slowly getting more severe.
3. A circadian rhythm sleep disorder (probably non-24-hour sleep-wake syndrome or delayed sleep phase syndrome) that’s severe enough to make working scheduled hours seem like a trip to hell.

This is just thinking out loud, you understand? But anyway, I’ve strayed far from the point I had when I started, so I’ll finish this now.

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Cut 90 Days

14 Comments Add your own

  • 1. ian  |  March 11, 2007 at 9:25 am

    i can really relate to this.

    i think its good on one hand to think about our conditions – you’re right – it’s not as if our therapists are a) there or b) brimming with explanations.
    its how we get a handle on ourselves i guess.

    i reckon my own SH when i’m in that mood is a way of emotional release/letting go…?
    more a kind of pale imitation of that rare state of getting beyond myself – death-of-ego-psychology stuff.

    much support EC,

  • 2. sisyphusledge  |  March 11, 2007 at 3:15 pm

    Dissociation can occur in so many different situations. Simplifying it, because my brain isn’t up to much this afternoon, sometimes it is an entirely normal (rather than a symptom of pathological psychiatric disorder) response to an abnormal situation. e.g. feeling dissociated after severe trauma such as an explosion, bomb, twin towers etc.
    Other times, it can arise because of pathology related to the brain. I would rather use that particular term as it incorporates what medics would class as neurological ill health (e.g. a brain tumour, epilepsy esp. TLE, arteriovenous malfunctions and others). Then there are the disorders currently classed as psychiatric or psychological.
    In severe depression dissociation can be part of the symptomatology. It is thought that this state of dissociation is what enables some severely depressed individuals to commit suicide. It occurs in what are currently classed as personality disorders, such as that which you have already pointed out, borderline personality disorder. I suspect that dissociation states are far more common than people realise.

    It is a shame that your experience with the psychiatrists that you have seen has not been enlightening. (But the whole of the NHS is crumbling and we doctors are/have found it very difficult to cope with the nonsensical paperwork and policy changes that make/have mad us too tired to look at the patients in front of us…..the past tense is used for those of us who have had enough of it and quit).

    I do know what it is like to be in a dissociated state, and it is very unpleasant and not something I have much memory for. I know of those times only because my husband has told me of my state and actions (or catatonic non-action).

    It is difficult to ameliorate by instant quick fix type solutions. I would tend to agree with you, from what you have said, that the psychiatrist’s view that there was a trigger for your episodes of dissociative self harm, was simplistic. However, looking for the triggers for the dissociation would probably need a psychoanalytical approach, preferably after other organic causes (though rare) have been excluded.

    I hope that I have not been unhelpful…I am curious and as a fellow blogger, concerned. I would like to echo Ian above, in offering much support.

    Sisiphus

  • 3. patientanonymous  |  March 11, 2007 at 3:26 pm

    Hi there, I can totally relate to this post. Or elements of it. I didn’t start cutting until I was an adult but I have practised other self injurious behaviours since a child. I couldn’t get pain or words out. It didn’t always happen but sometimes things would explode. I learned to hold a lot in.

    The cutting began as an adult and yes, at first it was to again, to get pain out but now, I become so dissociated, with no known triggers and it can build over long periods and I may think about doing it for a while and then…bang! This happened not long ago.

    I now become completely dissociated. I am aware of what I am doing of course but it is all I can see. After it is done, there is no remorse and I feel tremendously better. Except, perhaps for the distress of “backsliding” for not being “well” and doing it all over again… It is short lived, however. What can I do? It’s done. It’s over. Even though my cuttings seem to go far and few between. It’s just in my mind that I think about it regularly like suicide.

    Initially it was proposed that I too had BPD but I really didn’t and don’t fit the criteria.

    Nice to meet you.

    PA

  • 4. experimental chimp  |  March 11, 2007 at 6:41 pm

    Ian: Thanks.

    sisiphus: That is helpful, thanks. I wonder what role sleep deprivation has in attenuating the mind to dissociation. Certainly long term sleep deprivation seems to involve some of the same brain-tuned-to-static, not-really-here feeling that I get. And I’ve spent a lot of time like that.

    PA: Nice to meet you, too. I did feel quite angry at myself after my first recent episode of cutting. It had been a year or two and I was completely confused about why I’d suddenly gone back to doing it.

  • 5. sisyphusledge  |  March 11, 2007 at 7:47 pm

    I am sure that sleep deprivation does cause dissociative states…in fact, I shall go and look for some papers, as I am sure that I have read about this in the dim and distant past. You may find them quicker than me, depending on your access to research libraries online and otherwise. I wish I could recall the titles, even, but ECT really does wipe parts of your memory completely. (Makes me very, very angry too….about the ECT).

    Best wishes,
    Sisiphus

  • 6. remember  |  March 11, 2007 at 11:33 pm

    I’ll do it again. And then I’ll stop I promise.

    This time I won’t even boter trying to rationalise it, I’ll jsut say as for the cutting business. Ditto. I’ve been asked twice why I do it, and your play analogy seems to fit best. I’ve described it (to myself) as a way to feel something other than the same dull nothingness I seem to encounter when I feel as if my life’s become a TV show I’m watching from the inside. So far inside I can’t hear the audience laughing.

    I was eondering about you bipolar ‘diagnosis’. (I don’t see anything wrong with self diagnosis, every official diagnosis I’ve had I’ve realised myself first. From lactose intolerance to bipolar) Only I’ve reaserced a lot into rapid cycling(my flavour) and never really looked at anything else. I just about go crazy after more than a week of hypomania/mania, and the longest depression was a month, that allmost turned me into a vegetable.

    The problem with blogs is you can’t read on a few pages to see what the next bits like. Keep writing this, I think I’m hooked.

  • 7. livingoutloudagain  |  March 12, 2007 at 5:48 am

    I haven’t cut in 2 months, but I can feel it building and I hate that. Part of me is not really ready to totally let go and that in itself is frusterating. I would love to cut now, but for some reason I am still holding out. I just don’t know.

  • 8. experimental chimp  |  March 12, 2007 at 6:09 am

    remember – Thanks, glad you can relate.
    livingoutloudagain – I always seem to try to hold out. Sometimes the feelings will go away on their own, I think.

  • 9. patientanonymous  |  March 12, 2007 at 2:38 pm

    Sisiphus makes some excellent comments re: dissociation. I often get confused as to where the line gets drawn between dissociation and “flat affect” or being completely disaffected. What tips the balance?

    I can also experience dissociation when I have had my seizures but it is a very different type. It’s difficult to explain unless you’ve actually had a seizure and this happens (aka depersonalization/derealization in the seizure world) but you can *feel* it. It’s like it’s separate from any emotional context and entirely neurologically based (i.e. I’ve had no desire to self harm when I’ve had a seizure; I’m not upset.) It’s just like my brain decides to spaz out for a brief period. And these are simple partials–I’m conscious and aware while I’m having them although I might be partially impaired. I usually try to time how long they last but sometimes that is hard. I have a whole host of other weird things that can happen when I seize too.

    I was completely shocked after I first cut myself. I required surgery and when they took the cast off after about three weeks and I saw what I had done I cried so hard right in the middle of the room. I had a wonderful surgeon who did the best he could to repair the damage who was very sympathetic and just kept telling me that it was okay and that I would be alright (mentally.) My physiotherapists were great also.

    Now, I seem to do it with great abandon (when I do it) and don’t care at all. Now, THAT is dissociation.

    I apologize if this is too triggery for anyone but I speak honestly and openly about my experiences.

  • 10. experimental chimp  |  March 12, 2007 at 4:06 pm

    PA: Given the stuff I talk about here, I don’t think you need to worry about whether anything you write is triggery.

    As far as I know, dissociation and blunted affect aren’t two distinct states. Blunted affect is a description of how emotions ere expressed, while dissociation is an internal experience. Someone dissociating may display blunted (or flat) affect, but not necessarily and vice versa.

    I remember when I cut myself at Christmas. It was late at night and I was the only one awake. I was watching TV. And over the course of an hour or two, I slowly gathered everything I needed together. This included breaking open a disposable razor to get the blade. I watched myself do all this, without ever thinking consciously about it, like watching a play.

    I have a decent-ish knowledge of anatomy, so I tend to stay away from problematic areas. I probably learnt this when I first started cutting and it’s carried across to the times when I’m less concerned with what I’m doing. The usual location of my cuts is on my upper arm, where nerves, arteries and tendons are buried fairly deep. I’ve never needed medical attention, although there have been occasions when they’ve been fairly deep and should have been stitched. (I have gone to casualty with my cuts once, but that wasn’t because I though they needed medical attention). To be honest, I think I’m lucky none of them have ever got infected.

    One weird thing is that my eyes often feel quite odd after I’m done. I suspect that my blink-rate goes way down while I’m cutting, but it’s hard to tell.

  • 11. patientanonymous  |  March 12, 2007 at 5:26 pm

    Well, I’ve learned my lesson about how to cut more “effectively”–god, that’s so terrible to say–after needing medical attention twice. I have a good knowledge of anatomy but the first time I well…really messed up and went far too deep. Hello median nerve. Or I should say, “Goodbye.”

    And no, if you are careful infection isn’t generally a problem.

    Okay, anyone reading this this isn’t a bloody (no pun intended) advice board! Although self injurious behaviours are difficult we ALL should be learning how to cope with them and NOT be telling each other HOW TO DO THEM BETTER!

    Sorry for all the block caps but I do try to advocate responsibility and what we all should be doing for ourselves even if it is difficult.

    Interesting about your eyes. It could be a physiological manifestation/reaction to your dissociation and resultant trauma after your action?

    And yes, I think your analogy of sort of being outside of yourself and watching it “like a play” describes it rather well, indeed.

  • 12. livingoutloudagain  |  March 12, 2007 at 7:12 pm

    it just helps to know how others deal with it. I like people who are honest about themselves.

  • 13. sisyphusledge  |  March 12, 2007 at 8:06 pm

    The feeling of, “being outside of yourself and watching it ‘like a play’..” as PA put it above and you yourself described, is what is known as ‘depersonalisation’. The current definitions are:

    in DSM–IV as an

    ‘alteration in the perception or experience of the self so that one feels detached from and as if one is an outside observer of one’s mental processes or body’ (American Psychiatric Association, 1994: pp. 488–490).

    In ICD–10, depersonalisation is explicitly linked with the related phenomenon of derealisation, in the diagnostic category depersonalisation–derealisation syndrome,

    ‘in which the sufferer complains that his or her mental activity, body, and/or surroundings are changed in their quality, so as to be unreal, remote, or automatized’ (World Health Organization, 1992)

    However, the DSM!V and ICD10 betray an uncertainty about the nosological status of depersonalisation. In ICD 10 , it is included under the vague heading of ‘other neurotic disorders’, whereas in DSM!V, it is listed under dissociative disorders, an equally problematic classification, as the hallmark of true dissociation is a lack of subjective awareness of change. By contrast, sufferers from depersonalisation are all too aware of a disturbing change in their experience of themselves and/or their surroundings.

    Not terribly helpful. However, they are not mutually exclusive despite the above and can co-exist within the same illness.

    Cranking my battle-worn brain into action, it seems that my hazy memory of association with sleep deprivation is with depersonalisation, not specifically dissociation.

    Dissociative states can also be induced ( I forgot to include hypnosis as an example of non-pathology in my previous reply).

    Whilst I was looking at some of the recent research into SH, I came across a reference to a US based website with information and advice for those who self injure. It is by no means complete, but it may be of some help to some of your other readers. It also has a link to a web-ring for self injurers, although when I had a look at some of the sites listed by following the webring link, they seemed to be aimed and written mainly by adolescents.
    The first site address:
    http://www.selfinjury.org/indexnet.html#mission

    Sorry my computing skills are not up to embedding the link.

    Look after yourself,
    Sisiphus

  • 14. experimental chimp  |  March 12, 2007 at 8:54 pm

    Thanks Sisiphus. I think I’m describing depersonalisation rather than dissociation then. Sleep deprivation definitely does that (as the nameless protagonist of Fight Club says of insomnia: “everything is a copy of a copy of a copy”).

    When I was a teenager I was on the bodies-under-seige list (mentioned by the site you linked to) for a couple of brief periods. There was altogether too much virtual hugging going on for my liking. Most self-harm support groups seem to have a disturbing tendency to (unintentionally) encourage their members to patholigise every facet of their behaviour, probably because of their predominantly adolescent member-base. I’ve no doubt that some of the people there had very serious problems, but I’m not so sure the undercurrent of hysteria is actually very helpful, or indeed, supportive.

    Thanks,
    E.C.

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Hi, I'm James. I'm a 26 year old guy from England with bipolar disorder (currently well controlled). I also have a circadian rhythm sleep disorder (not so well controlled). This blog has charted my journey from mental illness, through diagnosis and, recently, into recovery. It's not always easy, but then, what is?

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