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.

No Longer Defective #Bloganuary

Posted on by Astrid

Today’s daily prompt for #Bloganuary is to share about your biggest challenges. At one point, I believe I wrote on this blog that my biggest challenge ever is my poor distress tolerance. Right now, I’d like to take it to a deeper level and say that my two biggest challenges are basic mistrust and a sense of being defective. I think the sense of being defective is even worse. This stems from my being an Enneagram type Four – or my being a Four is a result of my sense of defectiveness. In fact, the most distressed Fours are called “Defectives”. The healthiest are called “Appreciators”.

Being an externally-oriented Four – I’m undecided as to whether my instinctual variant is Social or Sexual -, I commonly blame others, be they in my past or present, for my sense of defectiveness. Now it is true that my parents commonly alternated between idealizing and devaluing me, that I was severely bullied in school and that I suffered numerous other traumas. That’s an explanation. It’s not an excuse.

There’s a thing I forgot to list when writing my not-quite-resolutions for 2024 earlier today: to work on personal growth more. I mean, honestly, I’m pretty stable where it comes to the most severe of (C-)PTSD symptoms. I do still get nightmares and flashbacks, but they do not ruin my day nearly everyday. Rather, my main issues are probably clinically classified as personality disorder symptoms, shameful as that feels to me to admit. I may or may not need a therapist to work on those, and if I do need one, I may or may not be able to find one. I can, however, work on exploring my issues on my own. I want to stop seeing myself as defective and start moving towards becoming the appreciator I know I can be.

August 2023 Reflections #WBOYC

Posted on by Astrid

Hi everyone. It’s the last day of the month, so it’s time for my monthly reflections. Overall, August was slightly better than July, but it’s still been quite a tough month. Honestly, it’s been quite a tough year so far.

My spouse’s car broke down a few weeks ago, so we weren’t able to see each other each week this past month. Last Sunday, though my spouse did visit me, it was in my mother-in-law’s car. Thankfully, the car has been fixed for now.

My mother-in-law also only visited me once this past month despite there being five Tuesdays in August and her normally visiting me every other Tuesday. On the 1st, she had to work and on the 29th, a new horse was delivered. The story behind her having gotten a new horse is a bit sad, in that one of her horses, Remco, passed away suddenly last month. I mean, he was already crippled, so could only step around a bit, but still his death was unexpected. The new horse is a young mare called Marrit.

Now on to my own life. It’s been boring. I’ve been mostly waiting to find out more about the move. Last Sunday, my support coordinator told me that I’ll move within six weeks, probably sooner. I honestly have mixed feelings about the whole thing. Obviously, I try to remind myself it can’t be worse than here, but what if it isn’t any better either? Will I be expected to magically flourish there just because it’s not this home? I’m hoping, of course, that I will eventually flourish, but this isn’t going to happen magically. Indeed, this requires work, both on my part and on the part of the staff.

I also, like I mentioned yesterday, have had an increase in flashbacks to my childhood trauma. Of course, I could hope this will lessen when (if?) I’m in a calmer environment, but still I’m pretty sure they won’t disappear without support.

In the health department, I’m doing pretty well. I had a meeting with the dietitian yesterday and she asked me not to lose any more weight. I’m not sure how to do this, truthfully, as I’m eating well overall. There’s also this thought at the back of my mind telling me that I could still lose 10kg and be at a healthy BMI. Besides, I still have quite a lot of abdominal fat and watched some YouTube videos a while back that mentioned the dangers of internal obesity. Then again, the dietitian told me there’s very little I can do about this. The YouTube videos tell me otherwise, but then again my healthy voice is telling me (or at least I’m assuming it’s my healthy voice) that following those YouTubers will just lead to extreme restricting, which will probably just cause me to relapse into bulimia. I’m still struggling intensely with all the things diet culture tells me about what to eat and not to eat to preserve my health and, at the same time, my dietitian has one foot right inside diet culture as well. After all, my food plan was a classic weight loss plan up until I reached a healthy BMI. Heck, the very fact that I mention the BMI here shows how much I’m into diet culture. I want to unlearn this, but I’m not sure how.

With respect to other health factors, I’m doing okay. I walk more than I did in July, have been swimming again and went on the stationary bike occasionally. That being said, I do worry about a decline in my mobility. This could be the YouTube videos again, which told me a loss of arm swing could be a sign of overall decline. I have absolutely no idea whether my arm ever swung at all though. That being said, my drop foot seems to be getting worse too.

I did finally get the eczema on my legs treated. I also got a slight infection on the skin of my earlobes, where I had my ears pierced in early July. I’m currently on a course of an antibiotic ointment, so hoping that’ll work.

In the crafty department, I haven’t been very active. I did create a lot of unicorns out of polymer clay, but they were all done using cutters, not sculpted. I intend to paint them and use them as gifts for my fellow residents when leaving this home.

I’m linking up with What’s Been On Your Calendar? (#WBOYC).

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.

Poem: Home Is…

Posted on by Astrid

Home was
At my parents’
Who were there and yet weren’t there for me
Hurting me in ways I feel I can’t express
It wasn’t safe
Or maybe that’s just me

Home was
On my own
Barely holding on by a thread
Surviving but that was about as far as it went
It wasn’t doable
Or maybe that’s just me

Home was
In the mental hospital
Where I stayed for nearly a decade
Only to be kicked out again
That wasn’t forever
And that wasn’t me

Home was
With my spouse
Again, barely holding on by a thread
Managing life by sleeping and panicking
It didn’t work out
But maybe that was me again

Home then was
In the care facility in Raalte
About as unsuitable as they come in theory
But it was near-perfect in reality
And yet, I left
And that was me (sort of)

Home then became
My current care home
With harsh staff, chaotic clients and poor quality of care
I wasn’t abused (not really), but that’s about as far as it goes
It doesn’t feel safe
But then I wonder, isn’t that just me?

Maybe soon home will be
The future care home
The big unknown
Will I feel sort of happy there?
No-one can tell
But it’s up to me

To make myself feel at home

This poem may sound a bit self-loathing. It isn’t intended this way, but I couldn’t express as concisely how I feel about my various “homes” and particularly the way people have told me I approach them (ie. the idea that I’m never satisfied anyway because I’m looking for perfection) without sounding this way. This is definitely not my best poem, but oh well, it shows my conflicting feelings about the fact that I’ve never felt “at home” anywhere.

I’m joining dVerse’s OLN. I’m also joining Friday Writings. The optional prompt is “muscle memory”. I guess repeating that I don’t feel at home anywhere counts.

Creating Glimmers

Posted on by Astrid

Today’s prompt for Friday Writings is “Glimmers”. A glimmer is the exact opposite of a trigger, something that brings you a sense of safety or joy.

Let me say that I often struggle with the fear of experiencing positive emotions, so even glimmers could be triggers in a way. I have yet to figure out why this is and what to do about it.

That is, one thing I do about it is to create positive experiences for my inner child parts that aren’t connected to the past. An example of this would be reading stories about unicorns. I don’t think my mother ever read me stories about unicorns as a young child, so unicorns bring out the playful inner child in me without the memories of my childhood attached. I can probably safely say that unicorns are a glimmer for me.

Another glimmer are my stuffed animals, but I honestly think the same applies that is the reason I love unicorns: they can’t be connected to my childhood. I currently have five stuffed animals on my bed, but the oldest one I’ve had for about four years.

I wonder why this is, honestly, given that my childhood, though not stellar, wasn’t horrifying either. Ah, who cares as long as I have my unicorn stories, unicorn polymer clay cutters, stuffed anymals, including several unicorns, etc.? Let me just live love laugh in unicorn land. If only it were this easy…

Mental Health in People With Intellectual or Developmental Disabilities #AtoZChallenge

Posted on by Astrid

Hi everyone. I once again didn’t have time for writing my letter M post in the #AttoZChallenge yesterday, because I was at the countrywide cerebral palsy day and then at my in-laws and was too tired once I came back to the institution to write my post. Let me for this reason write it today. For my letter M post, I am going to write about mental health as it relates to people with intellectual and developmental disabilities.

People with an intellectual disability are more likely to have mental health problems, including severe mental illness, than the general population. However, in the general psychiatric system, these people are not usually adequately helped. This means that early recognition of people with an intellectual disability is very important. Here in the Netherlands, some psychiatrists actually advocate for administering a simple screening tool for mild intellectual disability to each person coming into care with significant mental health issues. That way, if a person is identified as potentially having an intellectual disability, treatment can be adapted for them.

Other issues in mental health services for people with intellectual disabilities include the need for more trauma-informed care, since intellectually disabled people are at increased risk of being victims of abuse. Of course, trauma treatment, as well as therapy in general, needs to be specifically adapted to meet the intellectually disabled person’s needs. With EMDR, this is possible even with severely intellectually disabled people. Other forms of treatment, such as dialectical behavior therapy and schema-focused therapy, are, with some modifications, useful for people with mild intellectual disability.

In most countries, people with mild intellectual disability are usually seen by general psychiatric providers. However, here in the Netherlands, at least some mental health agencies have specialized teams or even an entire separate agency serving those with mild intellectual disability and co-occurring mental health issues.

Though autism as a co-occurring developmental disability with mental illness really poses some of the same challenges as does intellectual disability, this is not widely recognized. I mean, most mental health agencies here do have autism teams, but these are often dedicated to diagnosis and short-term psychoeducational support of autistic adults. There are a few specialist treatment centers for autistics with highly complex needs due to comorbid mental illness and/or severe autism, but these are inpatient units with long waiting lists. As far as I’m aware, there hardly seems to be any outreach-based, long-term treatment specifically for autistics with complex care needs.

Saying Goodbye to Mental Health Services

Posted on by Astrid

Hi everyone. October 10 is World Mental Health Day. In honor of this, many bloggers are writing about mental health this week. As a person with serious mental health challenges, I think I need to offer up my contribution too. However, mine will be a bit different, in that just last Tuesday I had my for now final appointment with a professional from a mental health service.

I did not usually share details of my less than stellar experiences with my psychiatric nurse practitioner on the blog, but let me say that my appointments, except for those concerning medication, over the past three years, have for the most part been useless. Maybe my expectations of an assertive community treatment team were too high. For those who don’t know, an assertive community treatment team is an outreach-based team that treats the most severely mentally ill, usually care-avoidant patients. As a result, a lot of the care they do is more like support and steering towards services than actual therapy. They do have a psychologist on the team, but the majority of clinicians are actually community psychiatric nurses.

Back when I got kicked out of the psych hospital in 2017, I did need such a team, as I needed lots of support in my daily life. However, once I’d moved into long-term care, maybe an assertive community treatment team wasn’t the most logical choice of treatment teams. And yet that’s where I ended up.

Not to say it’s all my or my referring agency’s fault. My nurse practitioner did flat out refuse to refer me anywhere else even when he should have realized he couldn’t provide the kind of treatment I needed. He also claimed we were doing “trauma treatment” by merely talking over my mental health struggles, which happen to be trauma-related, occasionally. In my opinion, it was neither specifically trauma-focused nor treatment.

Now I know that my staff and the behavior specialist at the care home are probably as capable as my mental health professionals were at helping me deal with my everyday instability. Neither can provide trauma-focused therapy, while both can provide a listening ear (my staff at my old care home at least often better than my nurse practitioner, in fact).

I did, of course, start my topiramate and pregabalin while in treatment with my now former mental health team. This I do credit the team’s psychiatrist hugely for. I don’t honestly think an intellectual disability physician would’ve been able to come up with this idea and I’m not sure a consulting psychiatrist would’ve gotten the idea either. Then again, now that I’m on a stable dose of both meds and only wanting to slowly decrease my aripiprazole, my agency’s intellectual disability physician can manage that.

All this combined got me to conclude that I don’t think I want mental health services anymore. If I or any of my current professionals ever change our minds, I can always get referred back to a mental health agency.

The Wednesday HodgePodge (July 20, 2022)

Posted on by Astrid

Hi everyone. I haven’t posted in a few days, because I was too tired from the heat. It’s still quite hot here, but I feel okay now. Today, I’m joining the Wednesday HodgePodge. Here goes.

1. Last time you drove more than 100 miles from your home? Where did you go?
I don’t drive, but I’m assuming riding in the passenger seat counts too. That being said, the last time my husband drove more than 100 miles with me in the car, was probably eight years ago when we went on a short vacation to the Black Forest in southern Germany. We drove in our Kia Rio, which we later found out deserves its acronym, “killed in action”, because shortly after that trip, the car crashed on the highway and my husband could just about move it onto the shoulder before it completely malfunctioned. We thought we had the problem fixed, but it developed the same problem that had caused it to crash back then again half a year later. Needless to say we sold that car. We’re thinking of going back to the Black Forest this September, but my husband has a really small car now, so he might want to replace that one first.

2. Something that drives you batty?
WordPress’ ever-increasing number of ads on free sites. I hope at least that, since I have a paid plan, they aren’t displaying on mine.

3. Do you feel like you’re “on track”? For what?
In my blogging life, I don’t feel as though I’m “on track”, but maybe that’s just my feeling. I mean, I really would’ve wanted to write at least as much this year as I did in 2021 and, up till the month of June, I was keeping up nicely. Now though, I’m not.

Similarly, I have a ton of craft projects waiting for me to finish them. Not that there’s a timeline for those to keep track of, but it does sort of feel as though I’m losing track anyway.

4. Your favorite car snack(s)?
Licorice and winegums (gummy candies).

5. Something you’ve done recently “on the fly”?
Nothing really. I plan most of my activities at least some time in advance. That being said, I do buy things impulsively at times. Does that count? In that case, going to Action (a budget store) in town and buying some random craft supplies last Monday. The trip into town was planned, and I had sort of planned to go to Action too, but I hadn’t planned to buy any of the things I ended up buying.

6. Insert your own random thought here.
Yesterday, I had a review with my nurse practitioner from mental health and the behavioral specialist from my care facility. I could rant about it here, but I’m not going to. Instead, I’m going to say that, after it, I finally concluded that, screw it, I’m ready to face whatever it takes to get real help for whatever it is I’m facing mental health-wise, be this trauma-related or a personality disorder or whatever.

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.