Another Appointment With My CPN

Today, I had an appt with my CPN again. I can’t remember all the details, but I did tell her that I had had a breakdown on Sunday. I was completely honest, sharing that I had seen and heard things that aren’t there. It was as if something was truly telling me I’m a monster and everyone will leave me. Then I saw some form of Heavenly light. I can’t describe it really and it wasn’t very vivid even then, but it was more than mere wishful thinking.

My CPN encouraged me to discuss this with the psychiatrist when I see her on the 22nd. I really hope she can help me. My husband later asked me whether it was truly psychosis or a panic attack. I don’t think I was full-on psychotic but my perceptions and thoughts were definitely headed that way. My CPN agreed.

I can’t remember whether I told my CPN, but I had these thoughts and perceptions once before. Well, a few weeks ago I had them too, back when this depressive stuff all started, but then it wasn’t that bad. Back in December of 2009, I think it was even on Christmas, it was. I had run off from the psych ward in the snow. I picked up snowballs and somehow was convinced they contained drug needles. I wasn’t depressed at the time, just batshit crazy. It lasted only for a few hours though, but came back several times within the next few months, only disappearing when I was put on Abilify.

Now I’m pretty pessimistic. After all, I’m already on the highest dose of both Abilify and the antidepressant Celexa. (I mention this because I’m pretty sure I’m depressed, whether clinically or not.) I’m hoping though that the psychiatrist can put me on some PRN medication other than lorazepam, which I can use if I fully break down again. I know I have had experience with Phenergan (promethazine, a low-potency neuroleptic) and that worked great when I was on no other medication but not at all once I was on my current regimen. Maybe the psychiatrist can prescribe me something similar but different.

I also talked to my CPN about the incessant crying. She told me this may be useful. After all, I learned from a young age on to hide all negative emotions except for frustration (because I couldn’t hide that). In fact, I was told that I was “too quick to anger”, but this was used as an excuse to force me to repress every emotion other than a smile. I hadn’t been able to cry unless I was angry first until only a few months ago. As such, my CPN reasoned that I might have a lot of catching up to do.

A Profound Appt with My CPN

Yesterday I had another appt with my community psychiatric nurse (CPN). At first, we went into how I’m doing at the moment. Then my CPN scheduled some appts for me with my nurse practitioner. Last Monday, after all, he and the behavior specialist from my care facility had finally come to the conclusion that I need to do some work on stabilizing myselves and developing inner cooperation before I can do EMDR or another form of trauma therapy. At first, the secretary said the first appt she had available was late December. It turned out to be December 17, so that’s pretty early considering how long I’ve been waiting already.

Then we got to discuss some issues relating to my diagnosis or the lack thereof. These were mostly theoretical, since I have no idea what my current diagnosis is and I really don’t care. I mean, the most recent treatment guidelines here in the Netherlands for complex dissociative disorders, aren’t suited to me (or most plurals, honestly), so I have no reason to want such a diagnosis. All I want is help in getting the inner turmoil under control.

Then I somehow got to mention my former psychiatrist’s comment when first considering assessing me for DID/OSDD in the summer of 2018. She held both of my hands and said: “You have just one body.” Then she went on to explain that, while she was holding our hands, none of us could put our fingers in our ears and pretend not to listen.

We then repeated this exercise. A staff always attends our appts with mental health with us. She now held both our hands and said that we can stay at the care facility. Someone asked cautiously: “Even if I need more help than I get now?” She then reassured us that yes, even if we need more help, we can stay here.

Then the staff asked our CPN what she’s supposed to do when we openly switch, as we had the day before. My CPN seemed not to know, so I suggested she do not elicit it, but do not fight it when it happens either. After all, when she insists that “Astrid” come back, this may create some trouble since “Astrid” is either everyone or no-one at all.

I really hope our nurse practitioner isn’t going to insist people only talk to “Astrid”, as the current guidelines on DID/OSDD seem to suggest as far as I know. I mean, we are okay all listening to the body’s name and won’t sign our names on E-mails or the like when it’s not appropriate, but one of our main issues is that there is no host who somehow “owns” the others. As such, the daily living parts or apparently normal parts or whatever don’t have access to every bit of information needed to cooperate.

Gratitude List (November 21, 2020) #TToT

It’s been forever since I last did a gratitude list. I just checked and it’s been five weeks. These weeks have been incredibly hard. I am really struggling to stay positive. I am going to try to come up with some gratefuls anyway. As usual, I’m joining in with #TToT. I’m typing this post on my iPhone, which I hardly ever do nowadays, so sorry for any typing glitches.

1. My husband! Even with our not living together and only talking on the phone most days, he tells me many times a day that he loves me. I am struggling to feel such a powerful emotion due to my current state of depression, but I’m trying to love him back.

2. My faith. My husband, who I always thought was a strong atheist since leaving theology school, has taken a renewed interest in Christianity and this has encouraged me. Today, he recommended a book called You Are Beloved. I am a very progressive believer, but I’ll definitely give this book a try.

3. My staff. They have been so kind to me despite my challenging behavior.

4. My community psychiatric nurse. She has been very helpful.

5. Pizza. Okay, on to the superficial stuff. My husband and I ordered a delicious pizza today. No, not from Domino’s and I must say this one is better!

6. Cheesecake. Two of my fellow clients had their birthdays this past week and another client got to help the staff make cheesecake.

7. Homemade noodles. That same client made those for us on Monday. He used minced meat instead of chicken, but still it was so delicious.

8. Lots of walking. So far this week, I nearly surpassed my step record from last week. I didn’t get in as many minutes in active heartrate zones, but that’s okay.

9. The ability to write and blog. I am not writing as much as I’d like, but at least I’m still writing.

10. A good night’s sleep last night. And yay for no nightmares that I can remember!

What have you been grateful for?

Appointment With My CPN

Yesterday, we had an appt with our community psychiatric nurse (CPN). I can’t remember all that we discussed. I went into some detail about our sadness and overwhelm over the last few weeks and explained that we had signed a letter to the manager requesting more help.

I tried to ask my CPN to get me an appt with the psychiatrist to discuss my meds, as my overload and irritability are increasing. While I was trying to get this out, I constantly heard someone in my mind say I shouldn’t be asking this as it’s attention seeking or drug seeking or whatever. I don’t even want a med increase per se. In fact, I’m at the maximum dose for both my antipsychotic and antidepressant already. I might want something to help with sleep and especially the restless dreams/nightmares. I feel intense shame about discussing that though, as my nightmares aren’t your standard PTSD nightmares. In fact, my trauma isn’t your standard PTSD trauma.

That is another issue I’m facing. Yesterday, I read an elementary school friend’s story of child abuse. It triggered me to an extent, because I can relate. Still, my trauma wasn’t that bad. She is a child sexual abuse survivor. I am not. Though I endured some physical abuse, it wasn’t that which caused my complex PTSD and dissociative symptoms. The most significant trauma in my life was the emotional abuse and neglect.

Of course, I just told another survivor that childhood emotional neglect and emotional abuse can cause C-PTSD and dissociative disorders too. In fact, dissociative disorders are largely attachment-based, so anything that disrupts normal attachment, can cause it. Still, to apply that knowledge to myself, is quite a bit harder.

I eventually did ask my CPN to refer me to the psychiatrist. My nurse practitioner would normally prescribe my medication, but he does consult with the psychiatrist also. Besides, I’ve never even seen the psychiatrist. So my CPN was more than happy to get me an appt.

Early November 2020 Health and Wellness Update

Like I said a couple of weeks ago, I had a physical health check-up at the mental health agency. That wasn’t good. That is, my blood pressure was high and so was my weight. Even though the nurse said I might not have gained any weight compared to the last time I stepped onto the scales, as each scale is different, I was pretty alarmed. So was my husband. He asked whether I could be put on a diet. Well, no-one can force me, but I did agree on a food plan with the staff.

Now we’re a little over two weeks on. I didn’t get my blood pressure taken today, as my GP recommended we wait three months and then check it everyday for a week. I did get weighed in though. And guess what? I lost 1kg compared to the last time I stepped onto this scale in early September and 3kg compared to the health check. Only two more kilograms to go and I’m no longer obese.

Overall, I’m doing okay sticking to the food plan. I eat bread rather than crunchy muesli for breakfast, make sure I eat enough veggies and fruit and drink at least 1.5 liters of water a day. That plus coffee, which contrary to common belief does hydrate the body to an extent, and occasionally green tea. I do usually eat a cookie with each coffee break, while my food plan says I can only have a cookie with my evening coffee. However, each day that I skip a cookie, I’m proud of myself for making a healthy food choice. Same each morning with breakfast, which is a real struggle, as I’m not a bread person.

I also make sure I get in enough physical activity. Last week, I felt really lazy, but, according to my Fitbit, still got more than the recommended 150 weekly minutes in active heartrate zones. This week, so far, I got 341. I broke my personal step count record yesterday by getting in over 16K steps. I don’t go on the elliptical as often as I’d like, but that’s because after walking two to three times a day, my legs are often tired.

In other health-related news, I talked to my CPN from mental health about sleep on Tuesday. I usually get enough sleep, but I have very vivid nightmares most nights. They aren’t your standard monster-chasing-me nightmares. In fact, most revolve around my sense of safety here at the care facility. My CPN may talk to my nurse practitioner about it. She said I might benefit from medication to help with this. Thankfully though, having discussed the issue has already calmed things down a bit.

#WeekendCoffeeShare (August 30, 2020)

Hello all. I’m not feeling like writing much right now, but maybe by just starting I’ll get somewhere. I just had a cup of coffee and a soft drink. I think the flavor soft drink I had is gone now, but we might still have coffee. As usual, I’m joining in with #WeekendCoffeeShare. Let’s have some drink – there are probably other soft drinks out in the fridge – and let’s catch up.

If we were having coffee, I would ask you how your weather’s been. Ours is okay. Not too hot, not too cold, not too rainy and not too dry. I’ve been out taking regular walks most days. I don’t think I shared this in this type of post before, but come September, I’ll be starting a sponsored physical activity challenge called Steptember. It’s for the cerebral palsy charity. The idea is to get in 10K steps everyday – or as many days as you can get. I find it quite a challenge – both the sponsoring part and the step goal. However, I’m trying.

As regular readers might know, my Fitbit activity tracker broke down some months ago. I’m now using my iPhone’s built-in movement detector to count my steps. That works okay. I did reach the 10K steps on both Thursday and Friday.

If we were having coffee, I would tell you that I spent most of the week escaping into books. I’m okay, but I do need some escapism right now.

If we were having coffee, I would tell you about the appt with my community psychiatric nurse on Tuesday. It went pretty well. We did go in some depth considering her role as just a nurse. She also told me my nurse practitioner was going to refer me to the specialist center on developmental disorders (autism and ADHD). If the information on the website is correct – which I’m not sure of, as the date of the last update was August 27, 2019 and I’m not sure that’s a typeo -, the wait is several months for an intake interview and then another six months for treatment. I’m not sure that’s just for the inpatient units though, as I know that the workhome is part of the center too. That one has a wait of several years due to it being a living facility.

In any case, before I knew there’s likely a long waiting list, I had all kinds of worries and thoughts about it. I mean, I’m hoping to eventually get trauma treatment and lowering my antipsychotic is still on the agenda too. However, I’m very scared either of these could destabilize me. Then again, I just don’t feel my life right now is all it can be.

If we were having coffee, lastly I would share that I spent the week-end in Lobith. It was good. My husband made us hamburgers with cauliflower and baked potatoes, all out of the freezer. I really didn’t taste that about the cauliflower and the burgers and potatoes were delicious too.

As usual, we spent some time together on the couch and some time apart in the two bedrooms. I have a desk in the master bedroom and my husband has his desk in the other bedroom. That one is also used as our cat’s place though.

Then this afternoon, my mother-in-law came to pick me up and drive me back to Raalte. There, I arrived just about in time for my dinner to still be shoved in the oven.

How have you all been?

Accomplishments for Today (August 25, 2020)

It’s been a few days since I last wrote a blog post. I just wasn’t inspired. I still am not. For this reason, I thought I’d revisit a type of blog post I did a few times before and share my accomplishments for the day. Here goes.

1. Stayed in bed all night. I’ve been struggling with keeping a proper circadian rhythm lately, sleeping a lot during the day and not at night. Though I didn’t have too restful a sleep last night, it was good enough and I managed to stay in bed all night. I went to bed at 9:30PM and got up at 8:30AM. I also only napped for about an hour this afternoon.

2. Ate three healthy meals. We had cheesecake with our coffee today because it was another client’s birthday, but other than that I ate quite healthily today. I had yogurt with crunchy muesli for breakfast, three slices of bread for lunch and carrots, potatoes and fish for dinner.

3. Brushed my teeth, hair and used deodorant. Personal hygiene has been a struggle again lately, so this is good.

4. Had a productive appointment with my community psychiatric nurse. We discussed some of the sources of my abandonment/separation anxiety and also went into my fear of being one giant attention-seeker.

5. Did 45 minutes of mindfulness. At the appt, my CPN suggested I try mindfulness more often. She said she used to do a 45-minute daily meditation and thought I might benefit from it too. She didn’t specify which meditation she used, but I selected a body scan off Insight Timer. I actually did pretty well doing it. Of course, I couldn’t keep still the whole time, as I just had to scratch a few times when I itched. That should get better though.

6. Read for an hour. This isn’t really an accomplishment lately, as I read most days, but it’s still good.

7. Went for two walks. This is more of an accomplishment now than it used to be, as I’m sometimes seeking excuses not to go for walks. I also used the stairs, which I’m not always doing of late.

8. Did some weight-lifting exercises. I just remembered to do these while writing this post and so took a break from writing to do them. I also did some hand strength exercises.

What is something you are proud of yourself for today?

Yet Another Night-Time Crisis

Honestly, I don’t know why I want to share this. It’s late Monday evening here and I’m feeling okay’ish. Tomorrow, I’ll have another meeting with my CPN and nurse practitioner to discuss my treatment. This got us worrying a lot last night, so much so that we ended up in crisis.

As I probably said a few weeks ago, my nurse practitioner wants me to try acceptance and commitment therapy. This wasn’t what we’d expected at all and honestly I still don’t understand how he thinks it’s a good fit for my issues. I mean, it’s evidence-based for depression, anxiety and OCD, none of which we deal with to a significant degree.

He was also pretty dismissive of my trauma-related symptoms. Obviously he doesn’t believe we’re plural. Fine by me, though not by some of the others. But somehhow he seemed not to believe I suffer with any type of trauma-related condition at all. At least, he didn’t feel that trauma treatment could or should help us.

This got us worrying last night, as we really have no idea how to advocate for ourself without coming across like a malingerer. It got so bad that we ended up impulsively leaving our room.

After our last case of elopement, the staff decided to lock the door to our home, so I couldn’t go outside. The night staff though hadn’t come to my room to check on me yet. It was 11:10PM. The night shift normally starts at 10:30. Eventually, a substitute night staff came by, saying he had to do one-on-one with another client, that the real night staff was delayed and he was really busy so could I please go back to my room? That upset us greatly, so even though we went back to our room as requested, some of us started self-harming.

About twenty minutes later, the real night staff came to check on us. We were upset, so told her to leave. She left and we cried and self-harmed some more because we were still very upset. Our signaling plan says staff are to stay with us if we’re upset even if we tell them to leave, but I don’t know whether the night staff have access to this plan.

Finally, we left our room again and waited, still panicked, for the night staff to be alerted and to come check on us. She was distraught at seeing us so upset. It makes me feel shame and guilt for making her feel this way. She got us a PRN lorazepam, which calmed us slightly. Still, we didn’t sleep till 2AM.

Now I’m feeling okay again, but I’m still not sure what to do with tomorrow’s appt. I mean, after each crisis, my mental health team say I somehow managed to get out of it. They probably mean it as a compliment, but it doesn’t feel that way. Today, I didn’t even care to call the mental health team. I’m still shifting between wanting to give up mental health treatment altogether and demanding trauma therapy. After all, the reason the appt upset me so much is that it triggered my feelings of being unseen, unheard, unsupported. Then again, maybe we’re not worth being seen, heard or supported.

We Ordered Some Beads

I’m feeling pretty uninspired to write today. I’m still feeling upset about last Friday’s meeting with the nurse practitioner. I mean, I don’t want to claim to have a dissociative disorder, even though on this blog I do sort of claim this. At least, we claim to be multiple. I’m not sure we fully are, but we’re definitely not fully singlet either.

We sent an E-mail to my assigned support worker explaining our issues with the nurse practitioner’s comments. She might forward it to my other staff and maybe the behavior specialist too. The behavior specialist replied to her E-mail from last Friday that I could ask my nurse practitioner why he thinks ACT is proper therapy for me and why he doesn’t want me to do EMDR. Some of us were pretty upset at her reply too.

Today we were upset at not being able to do much with respect to day activities. It rained all day, so we could only take one walk. Other than that, we sat in the living room or in my room. At the end of the day, our crafty part came up with some ideas. We might try making some bead jewelry. It doesn’t have to be professional-looking, but it could be cool.

So I ordered some beads at a store called Creadream. I originally intended on ordering glass beads, but ended up going with plastic ones. They were cheaper and the store had a larger variety of shapes. I got some round beads, some cubes, some rectangles and even some butterflies. Some of the purple ones were on a discounted price, so only like €0.66 for 25 grams (about 45 beads I think it said).

I also ordered some wire and elastic, including memory wire. This is a type of metallic wire that is shaped like a coil that fits around your arm. It can be used for making bracelets. I forgot to order pliers to cut and bend the wire with, but I or my day activities staff might be able to find some later. I also forgot to order a beading needle.

I think the littles will definitely enjoy working with all the different shapes and colors. Of course, we can’t see the colors, but we have some memory of what they look like. We ordered mostly purple ones, like I said, but also some pink, green and I can’t remember what else.

Now I constantly feel shame when I refer to the littles or write in first person plural or the like. I know I can’t fully be myself with mental health professionals, because they aren’t my friends, but why can’t I be myselves on here? My CPN knows the address to this blog and has occasionally read it, but yeah.

Not Quite a (Traumagenic) System?

I feel so awful right now. The visit from my parents went so well and this is actually confusing me. I mean, I consider some of my childhood experiences traumatic. Quite a few, in fact. How can this be the case if I have such loving parents? I mean, yes, they’re still a bit odd. My father just talked about the birds and butterflies and flowers we encountered. He didn’t ask me any questions or share anything about himself. That doesn’t make him a CPTSD-engendering parent though.

I had a dream yesterday about me needing to take the SCID-D assessment for dissociative disorders and it came back showing that I don’t have a dissociative disorder. It was probably triggered by my having read a message in a DID support group about how plurality is now something anyone can claim because of endogenic (born multiple) systems etc. We’re not an endogenic system, but can we claim to be traumagenic? Can we even claim to be a system at all?

I mean, other than online and to a few specific people who know us closely, we don’t share our names. It could just be that I gave names to different emotions or aspects of myself that I find hard to understand. This is what my community psychiatric nurse said on our last appointment. She said the consultant recommending EMDR for my traumatic experiences hadn’t recommended any type of “deep-digging” therapy. Not that I want that, but on some deep level (no pun intended), her claim that my parts are feelings, made me feel invalidated.

I told my CPN that, whichever treatment approach I try, my parts always show up and disrupt the process. She countered that we hadn’t tried EMDR yet. I know, but this approach is known to cause worsening of dissociation in those with dissociative disorders. Can it get me to “split” even more, even if I’m not a genuine multiple in the first place?

When I shared my doubts/denial on an E-mail list for DID, someone replied that I sign my E-mails with lots of different names. Well, that’s as easy as typing on a keyboard. No-one needs to have any special characteristics to be able to do this. It doesn’t prove my multiplicity. Besides, I know there are parts and they have names, but are these parts truly differentiated enough?

In a sense, it doesn’t matter. I’m not planning on seeking a DID/OSDD diagnosis anytime soon and by the time I might have overcome my fear of psychological evaluations, I guess DID has been removed from the DSM. Either that or Onno van der Hart and other scandalous therapists have given it such a bad name that no-one in the whole country will support me. And that’s even assuming that said assessment would show some type of dissociative disorder. Then again, if I’m claiming plurality for the sake of it, am I not contributing to the stigma surrounding DID myself?

In addition to the dream I had yesterday, I have recurring dreams about my parents finding out I’m in childhood trauma survivor support groups. They always confront me and my husband always sides with them. I guess I should leave those groups in case it really happens. I mean, I’m not an adult child of normal parents, maybe, but then again who is?