X-Patient: Psychiatric Rehabilitation and the Recovery Movement #AtoZChallenge

Posted on by Astrid

Okay, welcome to my letter X post in the #AtoZChallenge. I’m not really motivated for this one, but I don’t want to give up on the challenge either. My topic today doesn’t really fit in with the rest, but well. Today I’m writing about what it is like to be an ex-psychiatric patient. In the anti-psychiatry movement, some people choose to write this without the E, so it counts.

When I first heard of psychiatric rehabilitation around a year into my psychiatric hospital stay, I hated the entire concept. It was all based on training people to be more independent whether they wanted to or could do this at all. I knew already that I needed long-term care, so I was like: “Didn’t I just complete 18 months in a training home only to have it fail?”

Then, a few years later, I heard of the recovery movement. Unlike psychiatric rehabilitation, this is entirely patient-led. I signed up to participate in a recovery course. What surprised me immediately was the fact that my mental hospital chose to only allow those staying there as inpatients on the course. They later started a course for outpatients too. I loved this course. Going into long-term care wasn’t frowned upon but seen as a means of getting my life back on track. Unfortunately, that’s not how most professionals, at least on my last unit, saw it.

A few weeks ago, I watched a short video on a Center for Consultation and Expertise case in which the recovery viewpoint was misapplied to an autistic man. Indeed, I’ve never felt that concepts like “rehabilitation” apply to autistics. I mean, the idea that we all want a meaningful life, is good. However, considering a meaningful life as the same as independent living, is in my opinion rather misguided.

#WeekendCoffeeShare (April 26, 2020)

Posted on by Astrid

Hi all, how are you all doing on this fine Sunday evening? I just had a drink of my favorite soft drink, called Dubbelfrisss. I had my favorite flavor too, apple and peach. I also had some chips. If you’d still like a cup of coffee, I’m sure I can make some for you. I’m joining in with #WeekendCoffeeShare.

If we were having coffee, I would tell those of you who follow me from the coffee share linky that I’m rather active in the blogging department. I’m still going strong with the #AtoZChallenge. I in fact still have a long list of things I want to blog about even after this challenge is over. I really hope the writing juices keep flowing.

I did downgrade my WordPress plan from Premium to Personal. I, not being very tech savvy, can’t use most Premium features anyway and I don’t need the upload space, as I hardly ever post images. The only thing I used from the Premium plan, was Google Analytics, which was rather depressing.

Also in the tech department, I’d like to tell you that I’ve been struggling for weeks to get an eHealth app called Minddistrict working. Somehow, the E-mail that should have been sent to me to sign up, didn’t reach me. My CPN from mental health contacted some guy in IT about it, who replied rather bluntly that his role is not to teach clients to look in their spam folder. Well, if that had been the problem, my CPN could have told me. I’m not stupid! I eventually contacted my hosting provider, who want to look into it but need the headers of the bounce message Minddistrict should have received. My hosting provider was trying to be very helpful, but still the whole thing frustrates me to no end.

If we were having coffee, I would tell you that I reached my 10K steps three out of the seven days of this week. On two more days, I got over 8K steps.

I also got weighed in on Thursday. I didn’t use the same scale I normally use, because that’s at the day center. As such, my results may not be accurate. However, if they are, I lost over 1kg. According to this scale, I just about crossed the line back from obesity to overweight. Yay!

If we were having coffee, I would share that the client who came to our home as an emergency placement two weeks ago, left again yesterday to go to a more suitable home.

If we were having coffee, I would share that I’ve been exploring personality traits a bit more. Like, I’ve joined some Facebook groups for what I think is my MBTI personality type. Most other people see me as INTJ, but I honestly think I’m more INFJ, as the feeler/thinker dichotomy is based on how you make decisions. Note that I learned in psychology class in college that one changes personality type about every month if dichotomous scales are used. I’m a clear introvert, but have no strong preference on all three other determiners. I’ve heard cognitive functions can make the MBTI more reliable, but I find most tests that include that pretty inaccessible.

I also have been exploring the concepts of HSP and empath. I read Elaine Aron’s book The Highly Sensitive Person in Dutch back in like 2006. I downloaded the 2013 English edition on Bookshare a few days ago and got some books by Dr. Judith Orloff too. It does remind me that, when the Dutch translation of one of Aron’s books first came out in 2004, my father read me a skeptical article in the newspaper about everyone needing labels nowadays. He said I was an “asparagus addict”, making a bad pun on the Dutch word for asparagus being similar to Asperger. That got me to stop self-identifying as autistic. Well, I guess I don’t care now.

What have you been up to lately?

Valid? #SoCS

Posted on by Astrid

I’m not sure I’m valid. I joined some groups for highly sensitive people and empaths on Facebook. I relate to literally almost every trait associated with being an HSP/empath. Then again, I’m also autistic and this means I don’t have the cognitive ability to know what’s expected of me in social situations.

I’ve heard there’s some theory about autistics being hyperempathetic where it comes to feeling others’ emotions but less able to know what another person needs. Something with cognitive empathy being lower than emotional empathy. Or was it the other way around? I have no idea and am too lazy to google it now.

I always feel like I want to see myself as a lot more positive than I am. I mean, some people close to me have said I even have some narcissistic traits. Some people think of me as a pretty stereotypical autistic and I’ve always felt good about that, as it validates my feelings of being different and my need for support. Empath/HSP only validates my feeling different.

Yet sometimes I feel that my seeing myself as somehow highly sensitive, is a way of obscuring my negative traits. It’s not that I don’t see them, but that I label them positively in a way. I mean, 90% of empathy traits are worded at least somewhat negatively. For example, have you been told you are “too sensitive?” Do you need alone time a lot? When a friend is distraught, do you feel it too? Heck, I sense negativity a lot, but isn’t that just me being a generally negative person?

I have a feeling that part of the reason I want to see myself as unique somehow, has to do with an external locus of control. I don’t want to see my huge flaws and instead go label them as assets or blame them on my childhood trauma.

And yet most people say I have a negative self-image. My CPN from mental health wants me to do a module of cognitive behavior therapy on helping me get a better self-image. Maybe I need to learn to see myself as just the ordinary person I am without either negative or positive stuff that make me different. After all, when I say I’m a pretty good writer, people close to me often say: “Well, about average for someone with your education.” Apparently I’m quite arrogant in this respect.

So am I allowed to feel different or is that just an excuse to set myself apart from the herd? Remember, feeling like you can only be understood by certain people, usually those with high status, is a narcissism trait in the DSM. I’m not sure. I want to feel okay about myself, but doesn’t that mean seeing my negative traits too? And seeing them as well as the positive ones for what they are: just traits? I guess I’ll learn this in the module.

I’m joining in with #SoCS, for which the prompt today is “val”.

A New Client Came to Our Home

Posted on by Astrid

Trigger warning: mentions eating disorder behaviors
So a new client came to our care home yesterday. It was completely unexpected also to the staff. They didn’t hear she was coming till Friday evening. She has some form of brain injury, dementia and she broke her hip, which is why she had to come here. She lived independently until this. She seems okay, but due to her dementia she needs a lot of support. This did upset some of us, particularly Rachelle. It completely wrecked with her sense of structure and also the trust she had in the staff.

Today we had an Easter dinner. We had had the choice between pizza or fries. We chose pizza, but weren’t sure about it after all, as everyone else got fries. This further upset us, particularly Agnes. Agnes was feeling off, so she wanted to binge, but the staff prevented her, saying she was full already. This led her to a teenage tantrum.

Then once we talked to her about the importance of sticking to a somewhat healthy diet, she wanted to purge. Thankfully we were able to talk her out of it. Then however Rachelle took over again, with me (Eleanor) being present too. We were able to articulate our feelings to some extent.

Part of the problem is Agnes wants to be independent and make her own choices, including unhealthy ones, but Rachelle really needs more support than we’re currently getting. Thisdispute between them was also triggered by the new client getting pracctically one-on-one support all day, while we were in our room by ourself a lot. There is an extra staffer for the new woman, but we still feel like a burden.

We talked to our assigned staff about maybe making some form of communication cards that don’t require speech, so that Rachelle (and others) can ask for help when we can’t quite talk. We also talked about us getting a more structured daily routine particularly on week-ends.

We’re not sure this will help, but we’ll see.

Eleanor with some others chiming in here and there

#AutisticBliss Is…

Posted on by Astrid

A few days ago, I came across a discussion on Twitter with the hashtag of #AutisticBliss. I don’t follow many autistic bloggers, so I cannot be sure the conversation has been taken over to WordPress yet. Regardless, I wanted to write a blog post in contribution to the topic. Here are a few things I consider sincere bliss as an autistic person.

1. The sensory room at the day center. I mentioned this in my Twitter reply too. Back when I was trying to prepare for leaving the mental hospital in 2017, I asked my psychologist whether I could try out snoezelen® at the intellectual disability unit. She said I couldn’t, as it is only offered to people with severe intellectual disability. I’m so extremely grateful I ended up attending a day center for people with intellectual disability once kicked out of the hospital. Ever since, I’ve come to very much enjoy the sensory room.

2. My own sensory equipment in my room. When at my first day center after leaving the psych hospital, I discovered an online sensory equipment store while looking for birthday presents for myself. I currently own two lavender-filled, microwave-safe soft toys from that store, one in my room at the care facility and one in our house in Lobith. I also have a lot of soft toys that aren’t specifically sensory. I enjoy my exercise ball too, as well as my essential oil diffuser.

3. Being able to hyperfocus on my special interests. One of the main autistic characteristics I love about myself is my ability to perseverate. I love it when I’m in hyperfocus mode and actually have an interest I’m passionate about.

4. Being able to collect things, particularly if they’re cheap or free. For example, I have at least a dozen books of journaling prompts on my phone. Most were free either on Kindle or in Apple Books. Now that I am more money-conscious than I used to be, I no longer spend as much on my special interest du jour. However, I really love collecting free stuff.

5. Stimming. Especially if I’m happy. Stims were often so discouraged that I struggle to find ones I can engage in for fun, but when I can, that’s utter bliss.

6. Having found my tribe. I love being part of the autistic community. It helps me feel that I belong somewhere.

What surprising aspect of life do you find is utter bliss?

Writer’s Workshop: If I Could Change One Thing About Myself

Posted on by Astrid

Mama Kat in one of her prompts for this week asks us what one thing we would change about ourselves if we could. She also asks us to think on why it can’t be changed.

This is pretty much a no-brainer to me. If there’s one thing I could pick to change about myself, it would be to widen my window of tolerance. The window of tolerance is the window at which point someone is stimulated enough that they aren’t bored too much, but not so much that they are overloaded. Each individual’s window of tolerance is different. Some people thrive on challenging activities and exciting stimuli. Others can barely handle any sensory or cognitive demands. I belong to the latter category.

If I’m correct, the window of tolerance also refers to the ability to tolerate distress or frustration. My distress tolerance is and has always been extremely poor.

So why can’t it be changed? Well, I tried. Ever since I was a little child, psychologists have recommended I work on distress tolerance. Now I must say I really wasn’t aware of the problem at all until I was about eleven, but even when I was, I had no idea how to heighten my distress tolerance.

My tolerance for sensory and cognitive demands was manageable up until I suffered autistic burnout at age 21. I mean, I was in classrooms with 30+ students in them, doing my schoolwork at a high level high school. Ever since my burnout though, I’ve hardly been able to function in group settings without getting overloaded. I also can’t seem to handle any sort of pressure.

In 2017, when I was being kicked out of the psychiatric hospital, it was recommended that I do dialectical behavior therapy (DBT). One of the modules of DBT is distress tolerance. The community psychiatric nurse (CPN) who started DBT with me, even wrote increasing my frustration tolerance as a treatment goal without my having asked her to. I didn’t see how I could work on this. After all, seeing this goal written on my treatment plan already created such immense pressure that I felt overloaded without even trying to work on the goal.

I know I have a bit of an external locus of control. This seems to be tied in with poor distress tolerance. I mean, it isn’t that I genuinely think the world owes me a sensory-friendly, low-demand environment. However, I can’t see how I can work on changing my ability to handle sensory stimuli, demands and distress.

Mama’s Losin’ It

After Diagnosis: Dropping a Mask or Seeking Excuses?

Posted on by Astrid

I didn’t end up writing anything for the second and third prompt in the 10-day writing challenge. I also skipped the Insecure Writer’s Support Group day yesterday. It wasn’t really that I felt unmotivated or uninspired, but I was busy doing other things.

For example, I read a post on Facebook by a Mom of a neurodivergent child asking the autistic community whether it was possible that the child could be faking autism. That had me thinking. The short answer is that it’s highly unlikely. It is much more likely that, upon learning you are or may be autistic, you drop the mask.

I was self-identified as autistic for some years before I was formally diagnosed. However, my parents and high school tutor shamed me out of seeking an official diagnosis, claiming I was a hypochondriac for believing I’m autistic. Never mind that hypochondriasis is as much a mental condition as is autism.

At the time of my official diagnosis, I was resisting it a bit. I was in college with a psychology major and I didn’t want a diagnosis to stand in the way of my completing the program. Never mind that I was already failing and a diagnosis in fact helped me get some accommodations.

Then after I was diagnosed with autism, I started dropping the mask. Some people, including my parents and staff at the time, thought I was using my diagnosis as an excuse. Well, I wasn’t. I was experiencing what eventually turned out to be extreme burnout.

To get back to the topic of “faking” autism, I won’t deny that a small percentage of people may want to fake a disability to get services or financial help they don’t need. Others might be encouraged by family or friends to “just” go on disability. At least, I know some people who say they experience this. However, with how strict the social security and care systems are here, it is highly unlikely that someone would be granted benefits or care based on just a diagnosis. After all, a diagnosis is just a label.

Besides, said child had already been diagnosed with a neurodivergent condition. More labels doesn’t necessarily mean more care. It can mean more self-knowledge. It did in my case at least.

For example, I’ve over the years been given at least ten different diagnoses. Some may be correct while others most likely aren’t. Exploring these conditions did give me more understanding of myself. Especially with autism, there is a very positive community surrounding it. That definitely helps me finally find my tribe.

Today’s prompt in the 10-day writing challenge was “After”. The idea of the challenge is to write for five minutes. This post took me much longer, but that’s okay too.

Today I Feel…

Posted on by Astrid

Today I feel pretty awful. Several of my day activities staff were off sick, so I got assigned a relatively new staff. This was hard enough. To make matters worse, I was pretty badly overloaded all day. I did try to relax in the sensory room, but really couldn’t find my calm.

In the evening, I started a Dutch blog again. It’s been the umpteenth time that I started one and I’m not feeling too optimistic about how long I’ll be able to keep it up. Then again, I did finally find a way to link to it from this blog, so that I don’t have to keep switching primary sites each time I comment on a Dutch blogger for them to see it. Of course other bloggers seeing your content shouldn’t be the point of blogging. At least, it wasn’t my point when I first started blogging. I didn’t care about my stats. But that was over thirteen years ago. Now, of course I do care.

I saw a post by a Dutch disability blogger. That blogger in fact inspired me to start a Dutch blog again. She was discussing the notion of “mild” forms of impairments. I generally hate that notion, even though I still often fall into the trap of judging people, including myself, by it.

For example, I am diagnosed with level 1 autism spectrum disorder and probably level 1 cerebral palsy too. Only my blindness can be seen as “severe”. Even so, it’s of course the combined effect of these disabilities that causes me to need the support I need. Thankfully, the long-term care fudning agency got that in my case eventually. It doesn’t get it in some other cases.

Like, a friend of mine shared a newspaper article a few weeks ago about an elderly man who was profoundly hearing impaired, nearly blind and hardly able to walk but still too “mild” for nursing home funding. This man ended up taking his own life. I was incredibly saddened by this and at the same time, it made me feel guilty. I’m trying to turn this guilt into gratitude though.

This post was partly inspired by the first prompt in a 10-day writing challenge I participate in. The prompt was “Today”.

Feelings After Watching a Documentary on the Blindness Rehabilitation Center

Posted on by Astrid

Today, I got a subscription to see past episodes of Dutch television programs mostly so that I could see a documentary series called Five Days Inside. It’s where three presenters rotate to visit mostly health care settings or other institutions that are not commonly shown to the general public. The episode of four weeks ago was about the blindness rehabilitation center I attended in 2005. I actually still recognized some of the staff talking to the presenter from when I went there.

Watching it had me very emotional. I don’t know why. I guess because most of the clients who were featured, some roughly my age when I attended the program, are so optimistic about their future despite sometimes having recently lost their vision. When I attended the program, I often felt way ahead of these people and way behind of them at the same time. After all, I had pretty good Braille reading skills. My reading speed at the start was more than twice that which is the ultimate goal of the rehabilitation program for adults. As I learned today while watching the episode, some people don’t even have the tactile ability to ever learn Braille. Most will only be able to use Braille for simple labeling, not for reading books, like I do.

On the other hand, I never learnd to cook. Not in those four months in the center or the eighteen months in an independence training home that followed. It wasn’t for lack of teaching, but I couldn’t manage these tasks. Or even simpler tasks such as putting peanut butter on bread.

Today, I talked to my CPN from the mental health agency. We were talking about my skills or lack thereof. She seems to blame my parents for not having taught me properly. I understand. Then again, with my having had a meltdown each time my parents tried to make me learn new practical skills, it’s only understandable that they gave up. My CPN acknowledged this is a common autistic trait. My parents would say I’m not autistic, just stubborn. Apparently I decided from as early as age seven on that I would never learn practical skills because I couldn’t do them visually. Or maybe because I thought I was too smart for them. I don’t know what my father’s theory boiled down to exactly.

And now I see these blind or partially sighted people who are planning on working or going to college. I don’t know how I feel towards them. On the one hand, I feel envy. I wish I could cook tuna macaroni or zucchini soup. I wish I could ride the bus on my own, then go into town to buy raisin rolls. I wish six months of training could teach me the skills to live independently and go to college or work.

Then on the other hand, I feel an enormous sense of relief. I feel relieved that somehow my support coordinator was able to convince a long-term care funding lawyer that it’s at least partly due to blindness that I can’t.

PoCoLo

Fidgeting

Posted on by Astrid

A few months ago, one of the staff at my day activities showed me a fidget spinner. I’d never seen one before, although I’d heard of it, of course. It was a little disappointing, to be honest. I mean, yes, you can fidget with it, but it doesn’t have as many features as some of the other toys at day activities. I didn’t really understand the hype.

Last week, the things my assigned staff had ordered for me to play with, came in the mail. There was a deck of cards to play games with, a set of dominoes, but also a fidget toy. This one had a lot more buttons and things.

I often love to fidget, but not necessarily with standard fidget toys. I have a set of makeup brushes at day activities that I like to stroke.

Then again, my main stim (the autistic term for fidgeting activity) is hair twirling. I remember my second autism diagnostician telling me I really needed to unlearn it, as it was a “serious social handicap”. I was at the time in my first month of my psychiatric hospitalization for suicidal ideation, so even if it were a serious social handicap, I had other things to worry about. Turns out my parents and said diagnostician are the only people truly offended by this behavior.

Speaking of which, everyone stims. I have mentioned this a few times before but I remember one day sitting in on a demonstration some social services students were giving of their work. The student pretending to be the social services person was constantly clicking his pen when talking to the client-student. I thought this was odd, but no-one else noticed.

Still, I may want to get myself a stim toy to replace the hair twirling with. I saw some on Stimtastic.com that I may love, but the shipping cost from the United States to here holds me back from ordering anything.

Linking up with today’s Daily Inkling.