“One Chance!” Still Haunts Me…

Posted on by Astrid

Today, I’m feeling like writing but am uninspired, so I’ve been checking out a ton of writing prompts and the like. I’ve been fiddling with various notetaking apps too so that I can finally write snippets without them needing to be finished right away. I know I could do WordPress drafts, but I for whatever reason don’t like that. I’m now trying out Google Keep.

One of the writing prompt series was Halloween-themed and the question was about my most recent nightmare. I can’t remember and, thankfully, I rarely get vivid nightmares anymore. I do get snippets of conversations that replay in my dreams. “One chance!” yells the staff trying to force me to accept her new colleague. Those two words haunt me. I have had this experience before.

I recently learned that PTSD nightmares do not necessarily involve the details of your trauma. I don’t know whether the Redditor who said this, based this idea on the DSM, as I’m fairly certain that in the criteria for PTSD, nightmares do need to be trauma-specific except in young children. However, even just reading that someone else experienced vivid dreams that aren’t necessarily connected directly to their trauma, feels validating.

When I was living on my own, I experienced extremely vivid dreams almost nightly and, even when those dreams weren’t directly connected to my trauma, they were disturbing nonetheless.

In a somewhat similar fashion, the staff’s comment haunting me, in itself, might sound rather innoceous. I mean, I know that it doesn’t necessarily take physical or sexual abuse for someone to be traumatized (again, contrary to what the DSM says), but if this comment were a one-off experience rather than a symptom of the rather traumatizing power dynamics involved in institutional care settings, it wouldn’t have stuck with me. Or it might have, but it wouldn’t have had the negative connotation it has now.

There’s a reason secondary triggers are a thing. I often feel shame about the numbers of triggers I have. Usually though, when the context isn’t in itself distressing, I’m able to point out that something is a trigger for me and move on.

Not with this one, but then again it was actually a boundary that was crossed. If this had happened with three people who aren’t professionally related, it’d have been considered a form of harassment. I still struggle with this concept: that what is considered “normal” in a care setting, would be considered a violation anywhere else.

Grief: Dealing With Loss (Of Any Kind) #AtoZChallenge

Posted on by Astrid

Hi everyone. I’ve been struggling a lot lately again and, as a result, today am particularly late writing my #AtoZChallenge contribution. Today’s letter is G and I want to talk about grief.

Grief can refer to a person’s reaction to losing a loved one to death. That’s the most heard of definition anyway. Grief for a loved one who has passed away can last very long and, in fact, isn’t considered abnormal for the first year. If a person still experiences significantly distressing symptoms of grief more than a year after their loved one has passed, they may be diagnosable with prolonged grief disorder (also known as complicated grief).

Grief, of course, can also refer to the distressing symptoms experienced after losing a beloved pet. It doesn’t matter in this respect that the pet isn’t human; grief can still be experienced very deeply. I mention this because, like I said on Saturday, my spouse and I lost our cat Barry that day.

Grief, however, can also relate to distressing symptoms experienced after a loss that isn’t due to death. For example, heartbreak is in a way grief too. So are the distressing symptoms I experienced when losing my sight and, later on, many acquired skills due to autistic burnout.

Most people will be familiar with the five stages of grief described by Elisabeth Kübler-Ross. These stages are denial, anger, bargaining, depression and acceptance. In reality though, many people will not necessarily experience these stages in order and they may fall back due to stress. Still, many of the symptoms associated with the earlier stages in this model, made it into the criteria for prolonged grief disorder. Symptoms of prolonged grief include:


  • Identity disruption (eg. feeling as though a part of oneself has died).

  • Marked sense of disbelief about the death.

  • Avoidance of reminders that the person is dead.

  • Intense emotional pain (eg. anger, bitterness, sorrow) related to the death.

  • Difficulty reintegrating, such as problems engaging with friends, pursuing interests or planning for the future.

  • Emotional numbness (absence or marked reduction of emotional experience).

  • Feeling that life is meaningless.

  • Intense loneliness: feeling alone or detached from others.

Of course, people can experience many of these symptoms without having lost a loved one to death. Emotional numbness and avoidance of triggers, after all, are also symptoms of post-traumatic stress disorder. Many other symptoms occur in people who were traumatized in some way too. As an example, I relate to all symptoms when the aspect of bereavement is removed, and not just since Barry was put down. I don’t know whether that makes sense, but oh well.

#WeekendCoffeeShare (September 21, 2024)

Posted on by Astrid

Hi all on this beautiful Saturday in September. I’m joining #WeekendCoffeeShare today. It’s 7:30PM, so I just had my last cup of coffee for the day. I also had a delicious smoothie I made. I must admit, I normally don’t make the best smoothies, or at least I don’t really like them myself. This one though was absolutely great! I used banana, pineapple, coconut water and a bit of cinnamon. The cinnamon was old, so even though I’m pretty sure I put quite a bit into my smoothie, I only got a slight taste of it. I shared what I had left with my fellow residents, but since this is a virtual get-together, you are invited to grab a virtual cup.

If we were having coffee, first I’d share about the weather. It’s been absolutely gorgeous with daytime temperatures of about 23°C most of the week. It’s also been quite sunny. Mornings are chilly, but then again it’s September, so that makes perfect sense. Tomorrow is supposed to be the last warm day and then next week daytime temps are supposed to drop to as low as 13°C.

If we were having coffee, I’d probably be stating the obvious if I said I’ve been walking a lot. I sometimes feel guilty when this is pretty much all I do during my allocated activity time. Then again, I tell myself the weather isn’t going to be as beautiful as it is now forever.

I also have been taking photos on my walks. That is, I usually hand my phone to my staff, who then will be snapping the pictures. I enjoy it nonetheless. Yesterday, we were able to capture a bunny.

I have also been loving using Be My Eyes and other image description apps. Be My Eyes was even able to correct me and my staff on what type of bird was swimming in the institution pond.

If we were having coffee, I’d talk a little about the new iOS and WatchOS versions that came out on Monday. They’re quite stable and there aren’t many bugs affecting VoiceOver or Braille use. That’s a rarity with the first release of a major software update. I didn’t initially think I’d care for iOS 18, but WatchOS 11 does have some nice features and I’d need iOS 18 for that. I am looking forward to seeing my Vitals trend in a few weeks.

If we were having coffee, I’d tell you that I’ve been struggling a little with flashbacks and nightmares. I am, thankfully, for the most part still able to cope.

If we were having coffee, I’d share that on Wednesday, I celebrated one year in my current care home. I treated the entire home to burgers again, like on my birthday, but this time the salad I made as a side dish was the highlight for me.

If we were having coffee, lastly I’d tell you that on Thursday, it was my and my spouse’s thirteenth wedding anniversary. We drove to Nijmegen to have lunch at what I consider to be my favorite restaurant, Dromaai. Not that the food is exceptionally good, but I have fond memories of eating out here with my partner when I still lived in Nijmegen.

September Dreams and Memories

Posted on by Astrid

Last night I dreamt of being admitted to the psych hospital. It’s no wonder, since the anniversary of my actual admission isn’t very far away, on November 3. September 23 is my anniversary of going into long-term care and last Wednesday, I celebrated one year in my current care home.

I was reminded yesterday that September is a bittersweet month. That is, I was reminded of the sweet aspect, ie. it being me and my spouse’s wedding aniversary yesterday. The bitter aspect has overshadowed my days with flashbacks and my nights with dreams more than I’d like. I am, thankfully, still coping.

I am hoping that, as I acquire more pleasant memories here at this home, the flashbacks and nightmares will lessen. I know I was saying something similar when reclaiming November in 2021. I hope this time around I will choose following my dreams and aspirations over re-enacting the past.

Sharing this post with Friday Writings #145, for which the optional theme is dreams and memories. This was more of a freewrite than anything else, but oh well.

My Medication Musings: Topamax

Posted on by Astrid

Hi everyone. I had a med review today, which prompted me to write a post in my series discussing the various medications I’ve been prescribed. Today’s med review mostly concerned topiramate (Topamax), so I’ll write about that.

Topamax is an anticonvulsant usually prescribed for epilepsy. It has also shown effectiveness in treating migraines. How exactly it works is not known, but it does in these cases, although it’s not the first choice of treatment for either epilepsy or migraines.

I have neither epilepsy nor migraines. Besides, the highest dose of Topamax I ever took, 75mg/day, is far lower than the effective dose for these conditions. The reason I took Topamax is because it is also believed to help with PTSD-related nightmares and flashbacks. The way my psychiatrist explained it to me back in 2021, it might even lower my general distress level slightly. Well, it didn’t.

Topiramate can have significant side effects, including cognitive impairment, tingling in the hands and feet, and others. On 75mg, I experienced slight tingling, but I honestly don’t know whether I ever had any other side effects. I do have quite horrible tremors in my hands and legs, but these could be from any of my medications or from something unrelated altogether, although my doctor didn’t say what.

I, after some tweaking, eventually settled on a dose of 25mg twice daily. I never really questioned its effectiveness until I was wanting to taper another medication, Abilify, about two months ago and my prescribing physician and I reviewed all of my current psych meds. I said that none of my meds except for my antidepressant, Celexa, seemed particularly effective. The doctor then decided I could discontinue my morning dose of Topamax.

Today, I had a review. Though I have been a bit more distressed lately than usual, this could have many causes, including fellow clients being in distress more than usual too. Furthermore, I don’t experience an increase in nightmares or flashbacks. I admitted that most of my flashbacks are emotional, in the sense that I get dysregulated when triggered rather than having a visual reliving. I’m not sure whether these have increased.

When the doctor asked me what I wanted, I was clear: to discontinue my other 25mg of Topamax as soon as possible. This will happen in mid-August.

I am, honestly speaking, also guided by general principles in addition to personal experience: I learned about a year ago that a then recent systematic review had disproven the effectiveness of topiramate for PTSD-related symptoms.

No Such Thing As “Minor” Trauma

Posted on by Astrid

Recently, there was a discussion online I participated in about what caused our complex PTSD. I mentioned emotional, mental and physical abuse, bullying, a few instances of sexual violation and medical trauma. Most others not only went into far more detail than I was comfortable, but also discussed traumatic experiences that seemed far worse compared to those I’d gone through. When I mentioned this, saying reading others’ stories made me feel as though my trauma was minor, someone else commented how there’s no such thing as “minor” trauma.

Indeed, if something was significant enough to have caused C-PTSD, it was traumatic, and this means it was major. I am reminded of something my spouse said at one point when I was seeing a potential new trauma therapist back in 2013 (who ended up rejecting me for reasons not related to me). I was doubting the reality of my trauma. To this, my spouse said that, in reality, something as “minor” as slipping on the bathroom floor, could be life-threatening, so in theory I could’ve developed PTSD from that. I didn’t and I didn’t develop PTSD from any of my countless other falls, but I might have. Of course, this is a bit far-fetched, and of course I couldn’t have developed complex PTSD from falling, but I hope my point is clear: it’s not always easy to distinguish between events that objectively speaking count as trauma and things that don’t.

There are trauma centers here in the Netherlands that adhere very strictly to criterion A (the presence of things that count as trauma, according to professionals) in DSM-5 for treating people with (C-)PTSD. I’m not sure I’d meet their criterion. I mean, yes, I did experience exactly one potentially life-threatening medical event that I remember, when I was four. I was also hit quite regularly, but does that go beyond “tough love”? If it doesn’t, I’m pretty sure it doesn’t meet the trauma criterion for (C-)PTSD.

Then again, I’m not seeking to get into one of these centers. Tomorrow, I’ll have a get-to-know-me appointment with the care agency’s therapy practice. They haven’t yet decided whether they can help me or not. I hope they can, because right now I’m feeling rather hopeless.

Opening Up About My Trauma

Posted on by Astrid

Last Monday, I was going for a walk with my one-on-one for the moment when we saw a few clients and staff she knew (she’s a temp worker). She wanted to “say a quick hi”. That turned into a fifteen-minute conversation between her and one of the other staff, which eventually turned to clients with severe challenging behavior being taken on outings off grounds and then, when they act out, staff being filmed by bystanders when restraining the client. This discussion triggered me, because it led to flashbacks of the times I’ve been “guided” (as staff call it) to my room. More like physically moved by several staff at a time, and the fact that I wasn’t officially restrained (because that probably only counts when you’re pinned down to the ground), is solely due to my lack of physical strength.

I asked the staff, admittedly more curtly than I should have, to not have these discussions in my presence in the future, as it was triggering me. She told me I was making it all about me and if I wanted to offer an opinion I should’ve made sure I listened to the whole thing because now I was twisting the truth. I told her about the time I was shoved to my room and staff threatened to lock me up in there. “You probably deserved it,” was her response.

This led to a whole chain reaction of triggers, in which I started to doubt the validity of my trauma-related symptoms. Didn’t I deserve the harsh punishments my parents gave me? I know at least back in my day an “educational spanking” was legal. In some U.S. states, child abuse isn’t even child abuse if it’s used as punishment.

I can’t go into the details of the punishments I endured as a child, and I’m pretty sure they’re not necessarily illegal. Does that mean they can’t have caused me PTSD?

That evening though, I was having intense flashbacks and decided to open up to my staff for that moment. She happened to be one of the staff who’d shoved me to my room on Friday and threatened to lock me in there. I had to admit – even though I don’t believe it – that I deserved to be physically moved to my room. I mean, the reason was my dropping the F-bomb while in the communal room (and then refusing to go to my room on my own when told to), which, well, truthfully staff do all the time.

After I’d given examples of the way my parents treated me, my staff seemed quite shocked. I honestly don’t understand this, as she restrains clients everyday and never even cares about the impact this has on them. I mean, I know, staff restraining clients is legal, but then again does something have to be illegal to be traumatic? And if so, where’s the boundary between an “educational spanking” and child abuse? Or does it have to be unwarranted? In that case, I must say, my parents acted out of a need to show who’s boss because they’d felt powerless over my behavior. I did, indeed, try to excuse my parents’ actions by explaining about my own behavior. The staff didn’t seem impressed.

I know, in my heart, that the truth is that restraints can and do traumatize clients too. I know I experienced trauma while in the psychiatric hospital because of being locked up in seclusion against my will. I know I still experience emotional trauma. And, of course, I’m more sensitive to this due to the trauma I endured as a child. But it isn’t black-or-white. And this is confusing.

Heal

Posted on by Astrid

Today’s prompt for Five Minute Friday is “Heal”. I read several of the responses before writing mine. Some left me feeling all sorts of things, which I will try to articulate in the below freewrite.

Is it possible to heal from a hurt you can’t explain in words? Can something that you can’t describe in words, a memory that is just visceral, even be traumatic? I am referring to preverbal trauma, of course and, in theory, I know the answer: yes, it exists and yes, healing is possible.

However, in reality, how can I prevent my cognitive processes from constantly interfering with my experiences? Or should this be prevented at all? I mean, if I can rationalize that I’m now in 2022, living in the care facility and not in whatever danger my body thinks (feels?) it’s in anymore, does it even matter that I endured preverbal trauma?

After all, it’s a fact that I did: I was born prematurely, spent the first three months of my life in hospital and had several complicated surgeries before the age of five. The question is whether said possibly-traumatic events affected me and, if so, how to heal from them.

Share Four Somethings (January 2022)

Posted on by Astrid

Hi everyone. Can you believe it’s almost the end of January already? I can’t wait for this month to be over with, honestly. February can be depressing too, but not as depressing as January. At least then the weather may start to warm up a little. Let’s hope! Anyway, today I’m joining Share Four Somethings. I think I joined this link-up once before, but am hoping to make it a regular habit now that it’s a new format. Here goes.

Something Loved

Essential oils. Yay, my three new oils arrived today! Though I haven’t tried them out yet, I will certainly be doing so soon. One, lemon, isn’t really new, but I’d had to throw out the old bottle because it’d gone past its shelf life. This really should be a motivator to use my essential oils more often. The other two, spearmint and sweet marjoram, I haven’t used before.

Something Gleaned

Honestly, I had to Google the definition of “glean”, so I could say I gleaned the meaning of the word. I guess my English isn’t as good as I’d like to say it is.

Seriously though, I have been reading the Bible everyday since January 1. While 24 days isn’t my longest streak ever by far, I do find that the more I study God’s Word, the more I learn. My most recent realization came from the story about the Bible passage I mentioned yesterday. The pastor sharing the story about the passage said that “favor” in Psalms 30:5 could also be translated as “grace”. This, until then, I’d always seen as a decidedly New Testamental term. Then again, I now am beginning to see that the Bible isn’t really strictly divided between OT and NT, but it’s all one story leading to Jesus. To those of my readers who’ve been believers for longer than I have been, this may seem obvious. To me, it’s a big eye-opener.

Something Braved

Well, as regular readers of my blog will know, this month was quite hard. I’ve been dealing with a lot of anxiety and PTSD symptoms. Even though one of my medications, topiramate, which specifically works to combat trauma-related symptoms, was upped earlier this month, I’m not yet noticing the change. On the contrary, in fact, it looks like I’m doing a little worse. That is, I might be noticing a slight positive change over the past few days, but it’s so early on that it’s hard to know for sure and I’m not sure whether the change is positive compared to how I did on my old dosage too. I thankfully will have an extra appointment with my nurse practitioner on Thursday to discuss how things are going.

Something Achieved

Two somethings here, is that okay? First, I have been writing more frequently and more widely than I did before. I am really proud of myself for this, as it is actually one of only a few ways in which I’m still staying active lately. Due to my anxiety, after all, I’m struggling to try new things such as crafting or even to go for a walk. However, I do try out new writing techniques and that’s something at least.

The other achievement is my diet. I started on a healthier eating plan with the help of a dietitian early in the month. Not with the aim of losing weight, although it would be great if I could lose the 1.5kg I need to lose to no longer be obese. My main goal is to experience less inner conflict about eating, as I have a history of eating disorder symptoms. So far, I’m sticking to it pretty well. More importantly, the one day when I couldn’t fully stick to the plan, because we had Chinese takeout, I didn’t resort to eating disorder behaviors. That’s quite an accomplishment!

Most Relaxed When I Am Slightly Distressed?

Posted on by Astrid

I had a meeting with my nurse practitioner today to discuss my topiramate. Like I mentioned last Sunday, the increased dosage isn’t doing what it should. I was experiencing slight tingling in my hands and feet and, more annoyingly, increased drowsiness. Moreover, the medication wasn’t working for my hypervigilance; if anything, it was making it worse. The slight tingling in my hands and feet has decreased to the point of almost disappearing over the past few days. The drowsiness has not. Neither has the hypervigilance.

A theory I came up with recently, in a conversation with the care facility’s behavior specialist, is that my ideal level of alertness is really slight distress. In terms of the care facility’s signaling plan, phase 1 rather than 0 is really when I’m most relaxed. The reason, in fact, is that relaxation scares the crap out of me because it includes a sense of loss of control.

I am reminded in this respect of my last surgery as a child, when I was eight-years-old. I clearly remember going under the anesthesia – I had refused a tranquilizer to calm me beforehand – and I also vividly remember keeping on talking, even when my speech became slurred, up till the moment the anesthetic knocked me out. I was deathly afraid of letting go of my control.

I am also reminded of my fear of going to sleep, which goes back to early childhood. It may in part be related to my trauma-related symptoms, because of course my traumas started as early as infancy. However, I wonder whether this is also somehow related to the fear of losing control.

I once heard that benzodiazepine tranquilizers are no good for people with borderline personality disorder, precisely because the anti-anxiety effect causes aggression in them. I am not sure whether my current diagnosis includes BPD or not, but something similar might be going on with me. I don’t generally become aggressive when I’m under the influence of tranquilizers. However, as my nurse practitioner said, this thing does show that alertness and distress are not some linear thing on a scale from -2 to 3 (on my care facility’s signaling plan) in real life.

The bottom line is that we don’t yet know what to do about my topiramate. We’ve so far decided to wait another week or two to see if, since the drowsiness should decrease with time, this will cause the positive effects to start becoming noticeable. If not, we may go back to my old dosage, but I’m not yet sure what to do about my PRN quetiapine then. After all, we upped my topiramate in hopes that I could do without quetiapine then. Right now, I’ve felt like I would’ve needed a PRN medication quite regularly, but I’m trying to suck it up for now. That’s pretty hard. I’ve had a few almost-sleepless nights over the past week and am pretty anxious most evenings. But yeah, I’m muddling through. Thankfully, my nurse practitioner did give me an extra appointment next week to check in on the meds.