Four Skills I Wish I Were Good At

Posted on by Astrid

Today, one of Mama Kat’s prompts is to write about something you wish you were good at. I can’t just name one thing, so instead, I’m going to make a list of skills I wish I possessed.

1. Creative writing. Like I said on Sunday, I don’t really have a vivid imagination at all and my works of creative writing aren’t all that original at all. Now of course Julia Cameron (from The Artist’s Way) and others say you really don’t have to have natural talent to be a creative. Maybe then, I wish I had the perseverance to actually sit down and write those tons of freewrites, raw drafts, etc. it takes to come up with a coherent story in the end.

2. Photography. Okay, I don’t really mean the ability to point the camera correctly, set the right filters, etc. That’s a skill I will never possess due to being blind. I rather mean the ability to find picture-worthy things in my environment and then direct my staff to take pictures.

3. Language learning. This is a broad skill. Again, it is not something I wish I were good at per se – I already think I’m a decent language learner if I set my mind to it. Of course, I wish I were better at phonics in general, so that I could more easily develop decent-sounding speech in the languages I know (which currently is singular language, honestly, as I only know English as a second language). However, as with creative writing, I wish I had the perseverance to actually devote myself to learning a language rather than wanting to be able to write a blog post in said language immediately.

4. Distress tolerance. Ha, let’s share a skill that isn’t just useful for the fun of it. I really wish I were good at tolerating frustration. In dialectical behavior therapy, this is considered a skill that can be learned indeed, but I honestly am highly skeptical about it in my case at least.

What do you wish you were good at?

Mama’s Losin’ It

How I Cope With Stress

Posted on by Astrid

Today in her Sunday Poser, Sadje asks how we cope with stress. We all face stress in our lives, yes, even the most laid-back people out there. Maybe they’ve just found better ways of coping with it.

I for one find that a major stressor for me is frustration with my disabilities. For this reason, it may be that my parents thought I was very laid-back until I became aware of my blindness when I was around seven. Now, frustration in general, such as with failing technology, can set me off, but really so can frustrations when trying to accomplish something.

So how do I cope? Over the years, I’ve found several ways to ride the waves of frustration. Dialectical behavior therapy and in particular the ACCEPTS skill set has helped.

I find that distracting myself by focusing on something other than the frustrating situation or thing helps. This is hard with my autistic tendency to perseverate. For example, when I get frustrated with a polymer clay project, it’s currently hard to let go and focus on something else. But it is necessary. This is why my staff encourage me to take regular breaks and also do other activities, such as walking, besides polymer clay.

I also find that talking through my problems sometimes helps. Then, I may realize I’m catastrophizing or using other cognitive distortions. Often though, to get rid of a stressor, I need someone to take over part of the problem, or all of it, from me. After all, my problem-solving skills are practically nonexistent.

Other things I do to cope with stress include finding relaxing activities, such as diffusing an essential oil blend or lying under my weighted blanket. Lastly, writing about my stressors, problems or frustrations also helps.

What helps you cope with stress?

Finding God in the Middle

Posted on by Astrid

Today’s prompt for Five Minute Friday (#FMF) is “Middle”. I sat thinking about what I want to write for a bit. The prompt really resonates with me, but I wasn’t too sure why. Then I realized that, in all of my life, I struggle to find the middle.

In dialectical behavior therapy (DBT), I learned to practise finding the middle. The middle between emotional mind and rational mind, for example, is called Wise Mind. But there are other things that require the skill of dialectics.

For example, I struggle to reconcile my relatively high (sometimes even seen as very high) IQ with my low emotional level of functioning. I know rationally that, when staff leave the room, they aren’t on the North Pole, but emotionally it feels that way.

Then again, there is somehow a middle. I still am both highly intelligent and emotionally vulnerable, after all. If they were mutually exclusive, I wouldn’t be me. And I am me. And that’s okay.

DBT is partly based on Buddhist thinking. However, I do believe that God does call us Christians to find the middle ground too. Like Kate writes in her own contribution, God is there always: He was there in the past, He will be there in the future, but He is definitely also there in the middle, that is, the present.

This is also what DBT calls us to do: be present in the here and now. Mindfulness is one of the core skills of DBT and it doesn’t matter that the idea of it originated with Buddhist thinkers. In fact, when we as Christians pray and especially when we are still, we are present. God calls us to be present, to receive his grace in the Holy Spirit. DBT fans can call that Wise Mind all they want. I call it God’s speaking to me.

Verbalize Your Needs: Assertiveness as Self-Care #AtoZChallenge

Posted on by Astrid

Welcome to my letter V post in the #AtoZChallenge. Okay, I already posted a V post and originally didn’t want to write another one for this challenge or at least not so soon after posting my earlier post. However, I had a topic in mind already. Today, I’m going to write about using assertiveness as self-care.

Assertiveness is nothing more than sticking up for yourself appropriately. It doesn’t mean aggressively dictating how others need to treat you. Like, I am always reminded of a scene in the first Adrian Mole book by Sue Townsend, in which he desccribes that his mother went to an assertiveness training for women only and started to rigidly divide all household chores evenly between his father, herself and Adrian. Well, that’s not how it works.

Assertiveness also doesn’t mean passively agreeing to everything someone else says even if you don’t. I have a tendency to do that and then to complain to other people about the person’s behavior. That’s passive-aggressive.

In order to resolve interpersonal disagreements, I like the DEAR MAN approach from dialectical behavior therapy. DEAR MAN stands for:

D: Describe. Describe the situation as objectively as you can in order to get on the same page with the other person about what you’re actually talking about.

E: Express. Tell the other person how you feel and what you think. Use “I” statements and take responsibility for your stance.

A: Assert. This is where you verbalize what you need or want or don’t want. Be as clear as you can be. Don’t expect the other person to know what you mean if you’re vague.

Remember, we all have different love languages (which apply to friendships and family relationships too). Say your partner’s main way of expressing love is through kind words, but you prefer physical touch. Then you will consistently feel disappointed if they keep saying “I love you” without touching you. State clearly that you want your partner to hug you more often. COVID-19 permitting, they’ll most likely be happy to do so.

R: Reinforce. This means to reward the other person for their behavior. Sounds weird, right? You know you are not dealing with a 5-year-old who gets candy for eating his veggies. Okay, sometimes you are, but in this post I’m mostly talking about relationships between equals. However, what I mean is simply to focus on the positive you want instead of the negative behavior the other is showing you. Often we tend to react negatively in times of conflict, such as by yelling or threatening or withholding our affection. I definitely do. Instead, express how the other person’s changing behavior makes you feel more appreciated, respected or loved.

M: Mindful. Be present and in the moment. Don’t bring up past grievances. I’m often guilty of bringing past stuff into conflicts.

A: Assertive. Stay calm, make eye contact (if possible), keep an even voice. Don’t shout or threaten. It’s okay to express emotions, but let your words express your needs or wants.

N: Negotiate. Once you’ve done all these previous steps, it’s time to let the other person express their reasons for possibly not changing. You need to listen to these mindfully. If you can’t negotiate or you come to an impasse, it may help to ask the other person how they would react if they were in your situation. If nothing else works, you can always agree to disagree.

Recovery Time After a Crisis #AtoZChallenge

Posted on by Astrid

Welcome to my letter R post in the #AtoZChallenge. There are a lot of R topics related to self-care. I want to write about recovering after you’ve been in a mentally hard space or crisis.

First, let me tell you that recovery time is important in preventing a crisis too. You just can’t go, go, go all the time. No-one can, whether you struggle with mental health issues or not. So take your down time. Whether that be a nap, a nice bath or shower, or listening to your favorite music, is up to you. Or something else entirely, of course. I often need to take a little time to unwind in the afternoon. I do this by lying on my bed with nature sounds or relaxing music playing on Spotify. When we still went to the day center, I’d go to the sensory room for about half an hour to an hour.

When you have just come out of a mental health crisis, it’s especially important to take your time to recover. Your recovery time, according to my DBT handout, may help you come to an insight as to how to prevent this crisis from happpening again. It often does for me. It may not, but then at least you’ll need time to come back to your usual self.

I have a crisis signaling plan here at the care facility. Its different phases normally range from -2 (asleep when you shouldn’t be) to +3 (emotional outburst or loss of control, ie. crisis). My staff put in another phase for me, which they call “recovery”. This is what happens after I calm down from a meltdown. I usually feel sadness and shame then. Staff are in this phase advised to stay near and help me process my thoughts and feelings. This is, for me, often the time when I can be most honest about my needs.

What do you do to recover when you’re climbing out of a mental pit?

ACCEPTS: Coping with Distress By Using DBT #AtoZChallenge

Posted on by Astrid

I haven’t decided on a theme for this year’s #AtoZChallenge, so I can basically write about whatever comes to mind. Right now, we’re in the midst of the COVID-19 crisis and we’ll most likely be by the end of April still. As such, today’s post is about self-care in times of distress.

Dialectical behavior therapy (DBT) is a commonly-used approach to treating emotion regulation issues such as those found in borderline personality disorder, but its strategies can be useful for anyone having a hard time coping with crisis. DBT’s founder Marsha M. Linehan was probably fond of acronyms, as DBT has many. One such acronym, which is particularly useful for coping with difficult emotions during times of distress, is ACCEPTS. ACCEPTS stands for the following.

Activities: find a hobby or sport to do. Yes, playing video games or watching Netflix counts. For me, reading is my hobby of choice.

Contributing: do some form of volunteer work or help a friend. The book The More or Less Definitive Guide to Self-Care by Anna Borges provides babysitting for a friend as an example. This is not likely possible in these times of lockdown, but helping out online probably also counts.

Comparison: look to a real or fictional situation that could be worse.

Emotions: try to channel the exact opposite of the emotion you’re trying to fight. For example, if you’re sad, watch funny YouTube videos. You can also train yourself to act opposite of the emotion. This doesn’t necessarily mean you need to put on a smile when you’re sad, though that might help. It also means, for example, doing the opposite of your initial response to your emotion. For example, if you’re feeling like sleeping it off, try exercise.

Push away: visualize building a wall between you and the negative emotion or imagine that it is a mass you can push away.

Thoughts: do something that requires your full cognitive attention. The More or Less Definitive Guide to Self-Care clarifies that you don’t need to do any sort of critical thinking. Borges instead provides the example of reading a book, focusing on each sentence intently. I prefer word games.

Sensation: provide yourself with a strong sensation to focus on. For example, hold some cubes of ice. I’ve seen some people even suggest smelling ammonia. That’s crazy to me (I initially thought ammonia was another acronym). Borges, however, says you can actually focus on pleasant sensations such as soft textures too. I love essential oils.

What are your favorite techniques of coping with distress?

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

Carol and Jane

Posted on by Astrid

This week’s Reena’s Exploration Challenge is all about describing the interactions between (your) thinking brain and feeling brain as if they’re characters, perspectives or mindsets. In the theory of dissociative identity disorder, alters are divided into two categories: apparently normal parts (ANPs) and emotional parts (EPs). Some theorists refer to them as Daily Living and Trauma Fixated parts instead. Additionally, I have experience with dialectical behavior therapy, which has the concepts of rational and emotional mind and Wise Mind as the goal to integrate the two.

I don’t believe in the rigid ANP/EP divide and the alters I’m going to describe in the piece below, would most likely both be seen as EPs, even though they’re on opposite ends of a spectrum. You see, one of the main triggers for identity confusion for me is the inability to integrate my low functioning level with regards to my social and emotional development with my at least somewhat above-average verbal IQ. In this sense, Carol and Jane do represent thinking brain and feeling brain.

Yesterday I struggled. I got an official reminder from local taxes from when my husband and I still lived together in the tiny village. An official reminder means they’d previously sent out another type of reminder that doesn’t come with extra costs. This one did come with extra costs and the next step, if I don’t pay, would be a debt collector’s visit. I don’t know why the reminder was only sent to my My Government inbox and not to my husband’s and I didn’t understand the reminder. I texted my husband to ask him for help. By this time, Carol, the alter who is very emotionally immature and vulnerable, was already getting upset. Why don’t I just go under financial management and never bother with money again?

My husband was a little annoyed that I shoved this task onto his plate. For this reason, Jane, who wants to be the intelligent, successful, self-reliant one, said: “Okay, I’ll solve it.” Carol was still prominently present in my mind and she has difficulty thinking clearly. In the end, I paid off the tax debt, but put the wrong identification number in the Comments field. This means the tax agency won’t be able to identify me as the debtor, so it may mean I lost the money. It was €160.

From there on, Carol took full control of my mind. I cried my eyes out and really wished I could crawl under the covers, get a guardian, be supported in the care facility and never worry about difficult decisions again. I didn’t even feel like seeing my husband, as Carol feels too inadequate for marriage.

Ultimately, the situation got sorted (hopefully). My husband sent out an E-mail to the tax agency asking them to either process my payment with the wrong number or return it to me so I can submit it again. Still, this whole situation has us (as in, me with all my parts) truly triggered. It’s a sad reality that each time, I am confronted with the disconnect between my good intellectual functioning and my poor emotional functioning.

A Timeline of My Mental Health

Posted on by Astrid

And yet again, I did not write for almost an entire week. My cold is gone, but now I’m fighting the strong pull of depression. I’m having really dark images in my mind, particularly at night. During the day, I can manage, but often feel too unmotivated and/or uninspired to write.

For this reason, I dug up one of my many collections of journaling prompts. A prompt that spoke to me is to draw a timeline of my life. I’m pretty sure I did this already, but can’t remember whether it was here or on one of my old blogs. I searched this blog for “timeline” and nothing came up, so if this is a duplicate post, I’m sorry. I think I wrote a timeline of my mental health on my previous blog in 2015 or 2016, but I’m just going to write one again.

2006: This was when I entered mental health services for the first time. I had my first appointment with a psychiatry resident on December 12. I was very nervous and could hardly speak a word.

2007: The most eventful year. First, in March, I got diagnosed with autism. I started treatment with a community psychiatric nurse. In July, I started my first psychiatric medication (other than sleeping pills for a while in 2006), an antipsychotic called Risperdal. This was a week before I moved out of independence training to go live on my own. In October, I stopped my antipsychotic again. In November, I landed in a suicidal crisis and was hospitalized.

2008: I remained on the locked acute unit for this entire year. Various follow-up placements were discussed, but none wanted me.

2009: I moved to the resocialization unit.

2010: I got diagnosed with dissociative identity disorder and PTSD in addition to my autism. I started medication again. First, just Abilify (an antipsychotic), but then, Celexa (an antidepressant) was added. I also was put on the waiting list for a workhome for autistic people.

2011: The workhome didn’t work out (no pun intended). Other options were unsuitable for various reasons.

2012: I started to think that maybe I could live with my husband. This wasn’t because I really wanted it (or thought I could do it), but because every other option seemed to have been exhausted and at least my husband wasn’t going to refuse to be with me for needing too much care.

2013: I moved to the hospital closest to where my husband and I had rented an apartment. This was one of the biggest mistakes I’ve made in life. First, my diagnosis of DID and PTSD got changed to borderline personality disorder. This should’ve been a warning sign.

2014: I had to change psychologists. My new one said at our first appt that she didn’t believe I’m autistic.

2015: My husband moved to our cuurrent house. I tried to arrange to be transferred again, but this was refused by my social worker and psychologist. I tried to make arrangements to be placed in supported housing in my new area, but got told that the train has to move on and I had to live with my husband.

2016: My autism diagnosis got removed and replaced by dependent personality disorder, BPD traits and depression not otherwise specified. The process by which this diagnosis came to be, was the weirdest I’ve ever seen.

2017: I got kicked out of the hospital with almost no after care. In my final week, I got some day activities arranged, but that was it. Thankfully, I did get my autism diagnosis back after seeking a second opinion. My current treatment team agree with this diagnosis.

2018: I had a mental crisis at day activities and was told I had to leave that place. Thankfully, I found another place. I started dialectical behavior therapy and movement therapy, but quit again too because I couldn’t really apply what I’d learned. I finally got put on an effective dose of my antidepressant.

2019: I currently get only suppportive counseling with my nurse practitioner. I still take the high dose of both Abilify and Celexa. Would someday like to lower my Abilify dose, but that’s something for the future.

Multiplicity: Living with Dissociative Identity Disorder #AtoZChallenge

Posted on by Astrid

Welcome to day 13 in the #AtoZChallenge. I had today’s theme in mind for a while, but then I realized I already shared about my experience of being multiple in early March for DID Awareness Day and Plural Pride Day. Several other possible topics floated through my mind, but none felt right. So instead of choosing a topic I don’t know what to write about anyway, I”m choosing multiplicity again. I will try not to repeat myself in this post. As such, I recommend those unfamiliar with dissociative identity disorder read the post I wrote last March first.

We are a system of, last time I counted, 26 alters. Most are female, ranging in age from one month to 42-years-old. Each has a different role in our system (the whole of me). We don’t subscribe to rigid categories of alters. Like, the currently most scientifically proven theory of dissociation distinguishes between apparently normal parts (ANPs) who do the daily living and emotional parts (EPs), who are stuck in trauma time. Though most of us can be put into one of these two categories, we prefer to refer to them by different terms. We for a while tried dialectical behavior therapy (DBT), in which the different states of mind are called rational, emotional and wise mind. We see the ANPs as rational mind, the EPs as emotional mind and wise mind would be if all these parts can constructively cooperate.

Another way of distinguishing alters is by categories such as protector, persecutor (often a perpetrator introject), inner self helper, etc. We do have an inner self helper of sorts. Other than that, our roles are more complex than these. I mean, some of our protectors can be highly destructive relationally.

As you may know, dissociation stems from severe, repeated trauma in early childhood. This used to be thought to only encompass sexual and ritual abuse, but more and more people are realizing that physical and emotional abuse and neglect can also cause DID. There is no evidence that the severity of one’s trauma can predict the extent of dissociation. For example, we didn’t endure major sexual violation at all, but still have a pretty large system. DID is largely seen as an attachment-based disorder now, so insecure attachment early on could predispose one to further dissociation even in the event of relatively “minor” trauma. I, for one, was at a disadvantage already due to being born premature.

I also think that people on the autistic spectrum are more likely to develop DID than neurotypicals, because living in a neurotypical world predisposes us to a lot of trauma. I remember once, when in a Dutch DID community, being told that autism is so pervasive a disorder that it keeps us from developing multiple personalities. There is absolutely zero evidence for this.

I had a nurse practitioner’s appointment last Thursday. At the end of it, we got to debate the end goal of treatment (even though I haven’t even been formally diagnosed with DID yet). The three phases in treatment are stabilization (learning coping skills and internal cooperation), trauma processing and finally integration. There are some DID therapists who believe merging of all alters is a requirement for completing DID treatment. Others mean rehabilitation into society when they say integration. We prefer cooperation to a full-on merger. We wouldn’t mind if alters merged spontaneously, but we have zero interest in forcing it.