Accepting the Extent of My Disabilities

Posted on by Astrid

Hi everyone. Yesterday someone in one of the online communities I’m part of shared about learning to use a white cane because of vision loss in addition to an acquired brain injury. The person summed up all the impairments the brain injury had already caused. This got me wondering how he’d be able to use a white cane, so I asked him. I won’t go into the conversation, but it reminded me how significant my impairments and particularly the combination of them are.

For example, I can’t use my white cane in the proper way without losing my balance. This isn’t even a new or semi-recent thing or so my best friend says: when I still tried to properly use my white cane over fifteen years ago, I fell far more often than I do now.

It doesn’t mean there’s no decline whatsoever. After all, everybody over 30 declines and I’m not one to regularly exercise other than by walking either. However, the decline is not as significant as I think (and have been thinking for, well, over fifteen years already) it is.

My best friend also says I used to have far more meltdowns at least in public than I do now. This may be related to the fact that now that I live in an institution the general public no longer has to put up with my meltdowns as much. However, I have an inkling this is not the full story, as I remember having daily meltdowns in the psych hospital, usually lasting several hours. I still have meltdowns regularly, but truthfully not nearly as often as I used to.

One of the things that may’ve contributed to my feeling that I’m declining as well as to my having fewer meltdowns, is the fact that I can no longer mask as well as I used to. Oh well, is it masking when my pushing through leads to severe aggression and other challenging behavior? I don’t think it is. Is it more that I can no longer pretend to be independent? That’s probably a better word choice.

I still try to push through more than I probably should, honestly. I have a very strong inner critic telling me that less support is always better, after all. Moreover, it tells me that I have absolutely no right to asssert myself because I’ll always be a burden regardless.

A few weeks ago, I had an experience that validated me in thinking that, well, I may be seen as a burden but that’s not my problem and it doesn’t mean I have no rights. I was trying to get onto care allowance (a compensatory payment for the cost of health insurance) now that I’m divorced and officially low income. However, as it turned out, my ex-wife was still listed as my partner in the system, so I had to call the relevant service. Well, the process of getting connected was already quite frustrating. Once I was finally connected to a human, it took three transfers for the right person to get on the phone. He then informed me that he couldn’t solve the problem right away but would be calling back later. I assumed correctly that he’d call me anonymously, so there wouldn’t be a way for me to reach him if I’d missed the call. Thing is, I need to use headphones when making phone calls because I cannot properly hold my iPhone to my ear and the speaker’s rather unreliable when the phone’s on my desk. However, since I don’t wear headphones when not using my phone and it takes some time for my headphones to connect, I feared he’d reach voicemail by the time I’d had a chance to pick up. I explained this, saying I have a disability and need to use headphones without going into too much detail about the why of it. He came up with the solution of calling a second time immediately if he was redirected to voicemail to give me more time. And guess what? It worked!

Spoiler Alert: Disabled People Are People!: Reflections on Involuntary Care

Posted on by Astrid

Hi all. As those who read my most recent post know, I had my Care and Force Act meeting yesterday. For those not familiar with this, this is the law governing when people with intellectual disability, dementia or brain injury can be subjected to “involuntary care”, such as restraint, seclusion and forced medication but also when restrictions can be placed on how a person lives their life. For example, it regulates the circumstances under which people can be prohibited from using electronics.

My own Care and Force Act plan only relates to measures like restraint, seclusion and forced medication. These three have more strict guidelines than other measures like prohibiting someone from using electronics. With these, it’s always “involuntary care” regardless of whether the person shows resistance or not. This is actually a reason I recently found out that my antidepressant prescription is “involuntary care”, because it does not follow medical protocols on when it should and should not be prescribed. This does not mean I will go off of it, by the way.

The meeting with the client confidante and my home’s behavior specialist went pretty well. I attended it without a staff, because at the last moment the staff who could attend it with me was switched and I didn’t like the one they assigned me.

The confidante however was quite critical, which I liked but the behavior specialist didn’t. There are three plans involving restrictive measures, all within the stricter category: two for restraint and one for seclusion. The one on my antidepressant hasn’t been written yet. I had E-mailed the behavior specialist in advance with a lot of feedback on the plans. Particularly, they were far too generic. For example, it is written in them that I can be restrained when in “high distress” and that this will prevent me becoming physically aggressive towards staff. The first part of this statement is horribly nonspecific and the second is frankly wrong: I actually rarely if ever become physical when not being restrained and the order is reversed, in that I am restrained first for verbal irritability and this leads to furhter aggression from me.

The behavior specialist got quite uncomfortable with the critical comments from the confidante. After all, she pretty much told it like it is: if I were to file a complaint, there’d likely be several grounds for it being upheld. She also quite clearly said that restraining or secluding someone without a proper plan is deprivation of liberty. I liked this validation, because it shows that well, just because I’m a client doesn’t mean the staff can do as they please. Actually, when the behavior specialist claimed this side of the home being locked isn’t for me (which I frankly believe isn’t true), the confidante quite bluntly suggested I get a key. This is unrealistic in my opinion, but it does show that staff can’t randomly be locking people in just for the sake of it.

Today, I had a horrible argument with the staff who’d been initially assigned to attend the meeting with me. It wasn’t even about me: another resident had eloped and she was threatening to refuse him access to his electronics after he was taken back here. I didn’t actually want to go into this client’s situation, as it’s honestly none of my business. All I wanted to do is raise awareness of the fact that just because someone is intellectually disabled doesn’t mean they don’t get to live their life as they want. This particular staff has a rather ableist attitude towards care, literally having told me that she gets to decide most things about me because she’s the staff. The reason for this comment was my telling her that we were going to take a shorter walk than she wanted. This is another example of the not-so-strict measures, because deciding that I have to take a certain walk is restricting me from living the way I want to live. Not that this particular situation would’ve been one I’d make a fuss of if not for the fact that I was literally in pain and had already been going on two longer walks that day.

Unfortunately, the Care and Force Act is a bit vague in terms of what does and does not count as involuntary care. For example, a home’s front door being locked at night doesn’t necessarily count, because it is not disproportionate and affects every client equally. That being said, there is some push towards open doors and I can see why. After all, like I said when a staff used as a reason for the front door being locked at all times that regular front doors are locked too, regular house residents have a key.

After digesting the meeting, I E-mailed the behavior specialist that I understand that it takes quite a drastic attitude change to actually fully validate this home’s client’s rights and that I don’t expect this to happen overnight (or before I move out of here). I however do want to make sure that we’re making progress and at the very least it doesn’t get worse.

Care Needs to Be Suitable

Posted on by Astrid

Hi everyone. Yesterday, I came across a post on Facebook advising people who are feeling that the care they get doesn’t suit them. The basic point was care has to suit the client, not the other way around. In other words, as a client, you do not need to make yourself fit into the mold people caring for you have created.

I have struggled with this idea forever. In my case, there is an additional layer of complexity that the poster didn’t experience, in that not getting care isn’t an option for me. As such, if a care agency gives me the choice between consenting to whatever they want and being kicked out, it’s pretty much no choice. At least, in 2008, when the psych hospital gave me the choice between consenting to seclusion or discharge, they pretty much weren’t giving me a choice. Now, that “pretty much” doesn’t even apply, in that I’d be literally homeless without the institution. In this sense, my former staff who told me I’m easily replaceable, was right. It’s not like my staff would be unemployed without me, but I would be homeless without them.

This reality, however, has kept me silent far too long. Just because staff mean well and feel powerless themselves in the face of a complex case like me, doesn’t mean everything they do is justifiable or in my best interest.

Yesterday, I decided to apply for specialist client support. I used regular client support before and this is how the Center for Consultation and Expertise thing got started, but it’s been over eighteen months since I was in touch with this organization and it looks like I need more intisive, long-term help. I put on the application form that I’m struggling in multiple ways at my current care home.

The outcome may or may not be yet another move. I don’t want to decide either way yet, as I know that if I decide I want to stay here, it’ll likely mean having to put up with the current care situation, because my staff are at the end of their tethers. However, being that there simply aren’t enough people with my combination of needs in the Netherlands to form a home, I doubt any truly suitable place exists. This means that a care home, including the responsible higher-ups, has to full on agree that they want to and are able to adapt to meet my needs. That’s what I asked the behavior specialist responsible for this home at the time when I was put onto the waiting list to be placed here too, but apparently she wasn’t listening.

All I can hope for is that, with the help of the specialist client supporter, I can avoid this becoming yet another hopeless situation in which I’ll be involuntarily shoved down another home’s figurative throat and that home in turn will be shoved down my throat.

The Most Important Life Lesson

Posted on by Astrid

Hi everyone. Today Sadje asks us in her Sunday Poser to share life lessons we’ve learned. I was pretty sure I’d done a post on the most important lesson I’d learned in life some years ago, so went to look and indeed, I wrote about this topic in 2018. Wow, how time has flown!

And it doesn’t surprise me that, when I read Sadje’s question, my initial thought was to share the exact same lesson I shared back then: that it’s important to stay true to yourself. Today though, I’m going to make it even bolder: I am the most important person in my life. That sounds selfish, right? But guess what? Each of us is the most important person in our own life. You can’t live for anyone else, by which I mean no-one else can make you happy. No, not even when you think that someone else does; it’s still your understanding of their love or acceptance that makes you happy.

To word it even more bluntly, if everyone thinks of themself first, no-one will be forgotten. This doesn’t mean we need to be going against moral sensibility or harming other people just because we want it. After all, harming others isn’t in our own best interest in the long run either.

By saying that no-one else can make us happy, I also didn’t mean we don’t need connections. However, no-one else can live our life for us.

I also want to share what learning this life lesson has helped me with since 2018. I still struggle with everyday decisions, but I attribute this to the fact that I often get overwhelmed with them.

I am happy to report that, since indeed landing in a less than supportive environment (ie. the intensive support home) in 2022, I was able to stand up for what I needed. I’m now back in quite a supportive place, but I’m glad I’m still able to advocate for myself. This doesn’t mean that the thought that everyone will ultimately abandon me if I’m myself, is gone. It’s worse than ever, in fact. I still need to work on the idea that, even if they do, that doesn’t mean I’m a bad person.

Developing My Fighting Spirit

Posted on by Astrid

Over at Pointless Overthinking, DM asked what circumstance got you to learn something surprising about yourself. I already responded there. I explained briefly about the time my psychologist removed my autism diagnosis and diagnosed me with dependent personality disorder instead. In this post, I’m going to expand on my answer.

In August of 2016, it had come to my attention that my psychologist had changed my diagnosis. I was at the time hospitalized long-term and had had an autism diagnosis ever since 2007. For a reason I still only partly understand, she had decided to remove it. I’m pretty sure she didn’t fully understand her own reasoning either, as she kept coming up with different excuses. When I involved the patient liaison person and requested an independent second opinion, she even started to negotiate diagnoses.

Being a little too trusting of people’s good intentions, I at first went along with her proposal of a new diagnosis. I wouldn’t get my autism diagnosis back, but I would get diagnosed with brain injury-related emotional issues, which still gave me a reason to believe my impairments weren’t imaginary. It made some sense, in that my psychologst said the brain bleed I had sustained as a baby, was her reason for removing my autism diagnosis.

By November though, my psychologist came up to me to say that she’d rediagnosed me yet again. This was it and there was no further room for negotiations. My diagnosis was changed to dependent personality disorder, borderline personality disorder traits and “developmental disorder” not otherwise specified. I didn’t know what that last one was, but I accepted it anyway.

A week after that, I found out that the “developmental disorder” had not been put into my records at all, but instead depressive disorder NOS had been written into my chart. In Dutch even more than in English, these words are so differently spelled that it couldn’t have been a typeo. My psychologist finally admitted that she’d not diagnosed me with any type of neurological or neurodevelopmental disorder and wasn’t intending to either. She said she’d written depressive disorder NOS into my file because a diagnosis on axis I of DSM-IV is required for someone to stay in the mental hospital. She was vague as to whether she believed I was depressed, being convinced that I was still mostly just dependent. A nurse added insult to injury by saying the psychologist did me a favor by giving me an axis I diagnosis.

When I was first told I’d been diagnosed with dependent personality disorder, I assumed that the psychologist would probably remove it if I fought it hard enough. After all, DPD is characterized by passivness, compliance and an inability to voice disagreements with others for fear of losing care or approval. She said she wouldn’t. Besides, suggestible as I am, I quite easily tacked off the five out of eight required criteria.

At first, I was just angry and defeated. Pretty soon though, my fighter insider, Leonie, emerged. I requested an independent second opinion and this time I left no room for negotiation. I got re-assessed for autism in early 2017 and got rediagnosed on May 1.

Readers who don’t know me, might be wondering why I care. Well, the reason I care about my diagnosis is that I experience significant limitations that can’t be explained by just blindness. I do try my best and this to me signals that something else is going on. My psychologist felt I was making up my impairments. She didn’t say so, but she did say I couldn’t be diagnosed with autism because of my brain injury, yet I couldn’t be diagnosed with that either. She felt that the fact that occupational therapy was mostly ineffective, proved that I had no self-confidence. Her way of helping me develop self-confidence was to kick me out of the hospital almost with no after care. It was effective, in that it did allow the figher insider to fully develop.

Only later did I find out that, even though she rationalizes her decision to this day, it probably wasn’t about me. There are significant budget cuts to mental hospitals, so my psychologist was under pressure to kick some people out. She picked me, probably because of my relatively young age and the fact that I wasn’t psychotic. She claims that dependent personality disorder was the most appropriate DSM-IV code for someone with bad institutionalization syndrome. That completely overlooks the fact that I’d not been admitted to hospital for no reason 9 1/2 years prior, of course.