Archives

Trauma is in the eye of the beholder

illusion-1877120_1920

What do people really think about you? What are you showing them? Well what they think depends on how they frame it in their minds anyway. So much subjectivity, so much interpretation and assumption.

I’ve become increasingly interested in my doctors varying opinions of my mood lately and how it applies to my future. As most of you know, as soon as you have “Psych” history on your record, it can be difficult to get medical attention without doctors telling you how you feel and that somehow trauma and depression are actually causing the issues, not anything they can solve, and you end up with another referral for therapy.

If you have an “extensive Psych” history like mine, it is almost impossible.

I started comparing notes.

My back surgeon notes that I am pleasant and upbeat, cheerful, even 3 weeks post surgery when my pain level was still quite high.

But the neuropsych team inote, flat affect, appears to be severely depressed, speaking noticeably slowly, moved to tears.

Let’s see what is the difference here? It’s not just that the psych team is looking for it, I’m not saying that, I am behaving differently in these appointments. Hmmm, I wonder why? Seriously. That was snarky if you couldn’t tell. OK let me spell it out by giving you a glimpse of the conversations.

When I am talking with my back surgeon, I am grateful, he has changed my life, reduced my pain, restored strength and balance to my weak leg. He see me as strong, able, resilient, and able to do whatever I want to do. He knows nothing about my traumatic past and never has asked about it. He expects me to heal, because nerves, bones and muscles heal at an expected rate.

When I am talking with the psych team, they continually poke and prod about the relationship with my parents and brothers and husband. They force me to relive and retell some of the worst moments of my life. Usually I am meeting someone new, forced to tell my story to someone I do not fully trust for them to make another assessment of my condition. My flat affect is me trying to remain calm and choose my words carefully, knowing I am being judged. My tears are me, reacting to pain in the moment, recalling my sorrow.

But I don’t live there in that sorrow. Each doctor is only seeing a snapshot of me, a moment of me, not all of me, not how I function each day all day, not my life. I wonder how many people can retell their worst fears and memories without appearing traumatized. Even if you weren’t abused, I bet if you spent 3 hours describing every pet that died, how you miss your grandparents, maybe you were bullied, your boyfriend broke your heart in high school, your friend died in a car crash or overdose, your parents split up – whatever – life is full of heartache and tragic moments that we don’t call abuse. I bet if you made a list of them and described them out loud, that any “normal” person would appear depressed and traumatized and dysfunctional.

I don’t think its me that needs realistic expectations, I think it is the medical community. I almost want to prove my theory by starting over with a new doctor, stating I have a brain injury from purely physical means, caught in a shockwave perhaps and see I still have the same sad “Sorry but we can’t help you, you’ve been through too much to get better at this point in your life” story. I bet I would get sent to rehab and expected to heal if I didn’t have a psych history.

Well I expect more of myself, always have. Yeah, I got knocked down. But I’ve been down before, so what. I am out there jogging you guys. It isn’t beautiful, I mean I won’t win any medals, but I am not using a cane and both feet leave the ground at a pace faster than walking. I know I am healing. I know what I can do. I can do more.

I don’t care about my history, its irrelevant at this point. My brain doesn’t care. I am no longer being traumatized. I am sleeping, eating well, exercising, going to therapy, doing brain training games, pushing towards creative thought – why can’t I expect healing to happen? I don’t have a bunch of faith, but I’ve always believed in resiliency, set a goal, make a path, and eventually you get there.

My therapist thinks my lack of creativity is tied more to grief than brain damage. I’m starting to think she is right. My mom was my constant cheerleader, so supportive of my artwork and writing. I always shared my ideas and progress with her, always created for her, and she poured on the constant praise, sometimes annoyingly so, and almost over the top. I think I depended on that more than I ever knew though. Without her daily comments on my blogs, her multiple emails, I have no one else cheering me on, encouraging me to draw something today, asking what my next project will be, asking me to make something for her. She kept me going. I see this now. So at some point I will have to draw through the tears, and just keep going, until I am drawing for myself and the world, and show her that her years of support were enough to keep me going even after she is gone. I need to feel this pain of missing her and draw anyway. Somehow with my teary eyes and shaky hands I know this is the next step I need to take. An empty page has never been so frightening.

Advertisements

Get Motivated. Right Now.

How do you reach that motivational state of mind?

Motivation is tricky and not well understood. It is not linear or one sided. No motivation is complex and loopy and involves multiple factors, some within us, some external to us. Each move we make is a choice. How do we choose?

Our motivation is a combination of our beliefs, our goals, our dreams, our environment, and our mood. Currently I’m in a safe environment that is a bit lax on housekeeping standards. No one here cares if I leave some dishes in the sink or dust on the shelves. No one cares if the papers pile up on the counter. The clutter is overlooked.

I would prefer if everything was perfect and tidy at all times. Somehow I allow myself to overlook the clutter as well, feeling overwhelmed and defeated by it, by the repetition, by the fact that even if I clean it all up perfectly now it will be destroyed later the same day. I can’t keep up so I stop trying. I lost my motivation long ago in this losing battle.

But when someone is coming over to visit, I dig in deep and take care of it. I talk to myself encouragingly to get the job done. I break it down into small steps and lists. This may sound silly. If it does, then I am happy for you that brain functions without you having to kick its ass. If I don’t jumpstart mine, I will remain motionless, thoughtless, an empty shell trapped inside itself. I have tried being my own drill sergeant. That makes me angry and stubborn. No, I like to be my own nurturing mom, holding my hand, gently reminding and encouraging myself that I can do it and what I need to do next. I speak to myself firmly but gently, just like I do to my own kids when I give them instructions. They listen to me because I’m supportive and authoritative. They know there will be consequences if they don’t

Make yourself some coffee
Load the dishwasher
Wipe down the counters
Sort the papers from the hutch

Go on, get up, get started, you can do this. (give possible consequence: You don’t want so-and-so to see this mess, right?) back to supporting. It won’t take long. You’re strong now. Just get started and it will be done before you know it.
Coffee, dishes, counters, hutch

Coffee, dishes, counters, hutch

I turn into a Dora the Explorer episode, repeating to myself what I am going to do. I usually do about 3-4 things in my list. Then I start a new list if more needs done, so nothing gets overwhelming. Often I turn on music once I have my list going in my head.

But something always happens, I can feel the change in my brain and mood once I make the decision and start this motivation process. I go from feeling empty, spaced out, exhausted, to having a bit of energy and focus. Although I don’t exactly enjoy the tasks I am doing, I feel good about doing them. I battled depression and won again.

I found an interesting article here http://www.npr.org/sections/health-shots/2016/03/03/469033034/could-you-hack-your-brain-to-get-more-motivated explaining how people could use feedback to access the motivation centers in their brains. With practice and fmri they could see this area of the brain lighting up. Super cool.

Excerpt from the article:

Two of the researchers, Kathryn Dickerson and Jeff MacInnes, tried the system out on themselves. Not everything worked. Dickerson said she tried thinking about different memories that left the feedback meter cold. “Zip lining was super fun, but [thinking about that] was just terrible and not effective at all.”

So she switched strategies and tried giving herself a pep talk in the scanner. “I was like, ‘Come on Katie. Move the thermometer. Just do it and move it.’ And I just pumped myself up. That was very effective,” she says. “It was exhilarating.”

It was also exhausting, MacInnes says. “The experience of the task was very difficult. You’re being asked to generate these intense motivational states for 20 seconds over multiple periods. It was very fatiguing for people.”

Study participants had a similar experience, Adcock says. Some people sang Queen songs to themselves or imagined having an angry coach yell at them. “My personal favorite was running down a line with everyone giving you high-fives,” Adcock says. When she took the feedback meter away, the participants were still able to light up their ventral tegmental area by thinking about the same things.

People really are changing their mood when they’re doing this, Adcock thinks. They’re really becoming more focused and eager. And it seems the effect begins reaching out to parts of the brain involved with learning and memory,

“We think that’s exciting because it shows after this training, something changed, Dickerson says. “The brain isn’t quite the same.” She thinks people might be achieving a state of mind that’s more conducive to learning and motivation.

I believe I have learned how to do this myself with the self talk I mentioned above. I know how to get myself moving. My problem is, I don’t often find a reason to these days. Most things sadly seem pointless. I’m struggling with staying motivated or setting goals that I care about. I used to be an overachiever. I know how to get things done. I simply don’t want to anymore. I’m not even sure I’m depressed exactly. I’m struggling with my purpose and identity, which I suppose is depressing and exhausting. But I’m able to motivate myself when I need to, when I see a reason to. And so I am desperately searching, seeking a goal, a dream, something to cling to, to attach motivation to, to stop floundering and wasting all this time.

What I’m good at:

  • I go to the gym and workout at home because I want to be stronger and have a healthy body. I hate being weak. I hate relying on others to lift and carry things. I hate feeling vulnerable. So I am motivated, this one is easy, I exercise daily to meet this goal and my progress is easy to see.
  • I eat whole foods from my safe list because I do not want to have a migraine attack. I do not want days of pain and suffering. I do not want to let my family down and be a burden. I want to take care of them. I am motivated to avoid pain and be a good mom.
  • I continue to blog and fill out cpt worksheets even though my therapy program has ended because I want to continue to heal, to process, to grow. I am motivated to be self aware of ptsd, to manage it as best I can, and work towards minimizing the symptoms.

What I’m not good at:

  • I am not working yet. Although money is tight, we are managing with one income. I am not motivated to return to work. I feel I am a better mom and wife without trying to work. I’m already exhausted and stressed daily. I do feel guilty, but this guilt is not a strong enough motivator to overcome the rest. I am grateful Hubby supports this decision.
  • I am not doing much with my free time. This should change. Eek there’s a dreaded should, but I’m leaving it because it came out. I do have considerable guilt about how I spend my days. I don’t feel like I am doing enough, or like I am enough. No one complains, I put this on myself. I’m so used to achieving and I feel so lost. I want to feel motivated again. I’m hopeful this whiny stage is the first step to finding an action item. As odd as it seems, this is better than not caring. This is an improvement.

So. I know how to put my mind to something I care about. I know how to make a change. I know how to set goals and achieve them. I just need something to care about. I need something to do. Right now. (Yes of course it’s Van Halen time)

 

Imprisoned

Life of pain, Life of fear

Not insane, but oh so near

Imprisoned here, broken brain

Twisted mirror, shattered remains

Needing no one, they take, she gives

Being no one, she fakes, they live

The sun will rise, she will open her eyes

Like every day before

She stifles the tune her heart wants to hum

Looks to the sky, lets out a sigh

Ignores the chore

That breathing has become

I forgot to get you up

owl-1566419_960_720

That’s what my daughter said to me this morning. “Sorry Mom, I forgot to get you up”

My heart sank into a pool of shame. My daughter should not have to get me up. I try telling her I am already up, try to fake it that I was up and that everything is fine, but she can see how slow I am moving, that I am speaking slowly too.

Some people ask if I am a night owl when they see me online late at night. I say yes. But in reality my sleep issues keep me awake at night. I have trouble falling asleep, trouble staying asleep, trouble getting into deep sleep, trouble with horrific nightmares, trouble with sleep panic attacks, trouble with hypervigilance (I need all the lights on, lock the doors, close the blinds, tv on for grounding noise). PTSD tends to keep me awake until about 4am, so it is difficult to get up at 6am to help kiddo get ready for school and drive her at 7am.

I try to be gentle with myself. I know I am doing my best. I know I don’t sleep well. I know I am not out partying or something that should make feel guilty – And yet I still do – I feel guilty and ashamed and weak and stupid. I don’t want to be like this. I want to be strong and reliable, especially for my kids.

Driving this morning was extremely difficult and I am not even sure I should have been doing it. I felt like I was a bit drunk, like my thoughts were moving through molasses. I have to tell myself how to get dressed and drive, each step spoken out loud.

Seriously middle school starting at 7am is torture. This time of year is terrible and it will get worse with time change in a couple weeks. I will walk around even more zombie like. Doctors have not been able to help me with this. Therapists have not been able to help me with this. I feel better in the summer when I don’t have to get up so early. I have decided it is not SAD, it is not light deprivation or depression, it is sleep deprivation. My mom schedule is what wears me out this time of year. I do have depression, not denying that, but I don’t think it gets suddenly worse when school starts. I think I get physically exhausted.

I do nap during the day, but my hyperarousal only allows me to sleep for about 15 minutes at a time. If I do manage to sleep longer, the nightmares get me and I wake up sweating, screaming and the fear from those last for hours, while the images can haunt me for weeks, months sometimes depending how bad they are.

I am sleeping separate from Hubby right now, which helps a little to reduce the hypervigilance and multiple triggers and anxiety. Unfortunately we do not have a guest room, so we take turns who gets to sleep in the living room to spare our sore backs and necks from the old sofa or recliner.

Melatonin helps me get to sleep sometimes, but can make the nightmares worse. Keeping up on vitamin D helps. Too much of either makes me very hard to wake up in the morning. Exercise helps and except on very bad days I am doing my best to stay active and keep up on my physical therapy routine.

I don’t want any of this, but this is my battle to fight. I am so tired. I don’t feel like I am winning. Hell I don’t even feel like I am breaking even yet. Is this a winnable war? I am not so sure. I think I need to accept this is my life and make it work rather than keep trying for something impossible.

Where do we go from here

What if you can’t get there from here? What if you can’t go back, those roads are gone? What if you look ahead and see the same familiar roadblocks?

I lost hope that hubby will ever be a strong yet gentle supportive being I need. We try to be kind to each other but it is not working. The hurts run deep. Each unable to forgive and trust. Each day only hurts worse. The tension makes me sick as I try to smooth things over, do what he needs, explain again why I can’t, try to avoid him and this horrid sense of obligation and burden. I feel obligated to be affectionate. He keeps telling me how much it hurts him that I can’t. He keeps telling me how he can’t stand to hear all my negativity. He keeps saying he is confused, and frustrated.

I feel like a burden. I can’t be what he wants and it seems no matter how much I explain I cannot get him to understand ptsd and what this therapy is digging up.

I tell him I can only sleep for about 15 min at a time, then I wake up in a panic. If I am lucky those minutes are nightmare free. I am usually not lucky. No, my brain is creating new gruesome images to torture me, things that would make Dexter queasy. 

I tell him I barely manage to shower once per week.

I tell him most days I don’t eat food, only coffee or ice cream.

I tell him I have daily flashbacks transporting me to various childhood memories unexpectedly.

He knows all of this, and yet he is confused when I struggle to respond quickly when he invites me out to lunch. I say I don’t know, because it is the truth. I don’t know if my prison of a brain will let me out today. 

And he is frustrated when I dare to give him conditions for this lunch, like that place is too noisy, that one is too smelly. Yes it is frustrating for me too. No I am not being manipulative as you said to me today.

I think if you could, you would understand by now. So I think you can’t. I think you lack the empathy. I know you care about me, but it isn’t enough. You need to be nice to me too. You need to accept me as I am.

I know my behavior is odd. Ptsd is winning right now. But it isn’t like you are clueless. You know my stories. And yet you remain confused.

The sad truth is I feel much better when you aren’t near me. Without you my anxiety is not crippling or devastating. Without you I can make decisions without being badgered. Without you I feel less guilt, more valuable, less fear, more happinesss.

Things can change. Maybe they will. But you were given tools, ABC sheets and homework from the counselor. You never did them. I can’t ask you to change, I can only work on myself. But one day I will be back on my feet, a completely changed woman. If you don’t learn, grown and change too, I fear the distance between us will be irreparable. It is your choice to stay stuck. I want out of this mess.

Mom’s assets

The lawyers sent me a list of mom’s assets. Her life savings all in black and white. A cold, horrible itemized list, reducing her life to a dollar amount.

She worked so hard and died at 68 with barely any savings, no hope of retirement. So sad. 

I can’t quite explain how this list makes me feel but I would like to try. Renewed grief at seeing her name next to the word deceased. Anger at the lawyers, at the legal necessity for all of this due process. A different anger, a sad anger at my brother that still won’t talk to me. A deep pain, sadness perhaps, this longing, this hole, this emptiness that washes over me and chokes my breath out as I cry. I want a family. Yes I have my children but they don’t fill this aching hole. 

I had a major accomplishment in PT today. I used the one machine without my weak leg shaking, first time ever it just went smoothly. Everyone cheered for me there. That didn’t fill the hole either. I wanted to call my mom and tell her too. 

But all I have  of her is this dreadful bank statement. And so many mixed up memories. She wasn’t always good to me, but she was trying.

And that was her true asset. 

PTSD: The animal within

The reptilian brain exists within all of us, not only in those with past trauma. Trauma seems to keep this area of the brain alert, extra sensitive, unable to rest. The image below explains many areas of the brain, including the reptilian inner brain.

brain

(image from http://www.traumarecoveryinternational.com/the-reptilian-brain—where-ptd-lives.html)

The brain is divided into 3 main areas, reptilian, limbic, and neocortex. The chart below is from http://thebrain.mcgill.ca/flash/d/d_05/d_05_cr/d_05_cr_her/d_05_cr_her.html

The reptilian brain, the oldest of the three, controls the body’s vital functions such as heart rate, breathing, body temperature and balance. Our reptilian brain includes the main structures found in a reptile’s brain: the brainstem and the cerebellum. The reptilian brain is reliable but tends to be somewhat rigid and compulsive. The limbic brain emerged in the first mammals. It can record memories of behaviours that produced agreeable and disagreeable experiences, so it is responsible for what are called emotions in human beings. The main structures of the limbic brain are the hippocampus, the amygdala, and the hypothalamus. The limbic brain is the seat of the value judgments that we make, often unconsciously, that exert such a strong influence on our behaviour. The neocortex first assumed importance in primates and culminated in the human brain with its two large cerebral hemispheres that play such a dominant role. These hemispheres have been responsible for the development of human language, abstract thought, imagination, and consciousness. The neocortex is flexible and has almost infinitelearning abilities. The neocortex is also what has enabled humancultures to develop.

The reason I was thinking about the parts of the brain, and the reptilian part specifically, is because I wanted to understand more about what happens to me during my response to hide (or freeze), when the flight part of fight or flight is activated. This is a powerful feeling, stronger than butterflies in your stomach or stage fright or social anxiety. I was talking to hubby, and he said something that after all these years with me I could not believe he still misunderstood, and so I need to clear this up here as well.

PTSD – and the actions within flight or fight – are not my choice. I do not choose to run away. I have to run away. No thought has happened. I have run before I know I have run.

Before the running, when anxiety and fear is lower, when the danger seems manageable, yes, I can choose whether to attend an event or not. But once certain triggers are activated, it is an automatic process, my brain has decided for me that the situation is far too dangerous and tells me to hide – NOW. It does this by turning off the neocortex, and possibly even turning off the limbic brain too to get me moving. It’s why you don’t cry until later, gets in the way of fighting or running.

So why do we have this part of our brain that allows us to act without thinking? Well to save our lives. If we had to debate whether an oncoming car was moving fast enough to kill us, or if that intruder has a gun, or if that bear saw us, well we would already be dead. We need our automatic reactions to pump the adrenaline, to get our heart and muscles going, to move us out of harms way without standing there thinking about it.

I also suffer from the freeze response. When fight or flight does not seem a good option, our reptilian brain freezes us. It is like playing dead while wishing you were dead. Many child abuse victims know this response, they could not fight back or get away, so instead they experience system shut down. I did this so many times as a child. I still do now for certain triggers. For years I would lay there frozen, unable to speak, while hubby had his hands on me, thinking I am enjoying his touches. He was devastated and even angry when I finally told him. He still doesn’t understand that being frozen was NOT my CHOICE. That inside my head I am screaming and crying, but outwardly unable to do or show any thing.

Sometimes when I retreat to my room, I am not being rude, I am not trying to hurt anyone’s feelings, I am not choosing to ignore people, my brain thought I was in danger and believe me, there is no arguing with your reptilian brain because it nicely shuts off your thinking portions for a while, as part of the safety feature. Once the adrenaline slows and my brain can send out the ‘all clear’ call, then I can start to reason through what happened and make choices about coming out of hiding or not.

I am learning the early alert signals, when fear and anxiety are rising, I can try and breathe and ground to keep the reptilian brain from taking over. Sometimes I can, and sometimes I can’t. Although I know more about it now, I am also more sensitive now, like I have mental trip wires everywhere that I don’t even about – a side effect of my current ongoing therapy stirring up symptoms.

I made a connection one evening to this idea of the animal brain. Before a storm, my dog started pacing and looking anxious, coming to me for support for her fear. I know not to comfort her with affection, but that she needs a strong, calm leader in those moments. Someone to show her that she will be safe with me. I don’t pet her or talk to her. I walk around with her, distract her, get her to lay quietly, massage her, call her out if she tries to hide. I don’t let her fear overtake her. I realized I was grounding her and not letting her reptilian brain take over. It really made me start thinking.

Because when I am afraid, I act just like a frightened animal, and also like her I am unable to communicate exactly what is wrong. I also need a strong, calm leader. I look to those around me to provide safety and comfort, and not finding that, I need to be my own leader. I tried explaining this to hubby. That he instinctively knows a bit more about frightened animals than how to treat me. Would you yell at the dog? Would you let her hide, scared, shaking and alone, for hours or days? Would you tell the dog how frustrated you are that she won’t let you hug her when she is frightened? Would you blame the dog or would you comfort and gently try to help her overcome the fears?

I know it must be difficult for hubby, I truly do. That my brain is afraid of him, that he keeps triggering me. But when he leaves me alone after the flight or freeze, it does nothing to disprove those triggers in my brain and instead reinforces those pathways that he cannot be trusted. I keep asking him to let me go for a bit, let me cool down, 20 minutes is usually enough for the nervous system to restore itself. Then come check on me and be strong. Don’t ask me a question – I will say no. Bring me coffee or ice cream, don’t ask if I want any, just bring it to me. (like luring the dog out from under the bed with a treat, right?) Tell me to get a shower or take a walk – don’t ask me. Tell me to ride with you to the duck pond or the grocery store. Make up any reason to draw me out of my hiding place. If you are strong I will listen because I want a leader, someone strong to take care of me. Show me you are not the enemy.

Because in reality – that is all I have ever wanted. someone to properly care for me, to nurture, to understand, to lead with strength, to show me the way when I am scared. I have done this my entire life, when I should not have done this for myself. So maybe I am asking too much of a husband. Maybe it isn’t his job. But maybe he needs to do it anyway, just for a while, just to get me through this. But I know he can’t because he doesn’t. It is what I want, but will never get from him. I try not to be disappointed because I don’t think that is entirely fair to him.

So I will continue to go it alone, relying only on myself to lead the way in these dark moments, and hope that one day the moments will slow down and the triggers will not be daily. No one is saying to hope for triggers to go away completely, only to be less than they are now, easier to manage.

I am getting tired of shaking, hiding and licking my wounds and would like to use all of my brain again. We weren’t meant to function on reptilian brain alone.