(Preserving some deleted tweet content bc it may prove useful to hand over to MH professionals in future.)
I wish there was a word, or phrase, to succinctly, medically communicate what happens to me when I speak to people. It’s worse in a formal setting (eg Dr appts) or groups. I am completely & utterly incapable of showing emition, I become still, agreeable. Internally I completely lose control. I can see myself, hear myself, but I don’t choose what I say or how I say it. At all. How ‘bad’ this is depends on who I’m talking to/in front of. It doesn’t matter how much I want to be honest, or show my distress. If I don’t feel safe with the person my autopilot self will lit it’s fucking teeth off. Whilst I watch, knowing it’s counterproductive. And if I had a word for this, a word I could tell MH professionals, Dr’s, they might notice. Work with me on it. Put it on my file. Not only if there no word to convey all this in a concise way, but MH services won’t even take the associated needs into account. I wonder if this is a PTSD thing.
(Helpful stuff others have said in reply to this: ‘dissociation’, ‘learned compliance – an extention of the ‘fawn/freeze’ response to danger. Dissociative – it backgrounds ‘you’ and replaces your outward mode with the learned response, when triggered. PTSD/trauma root.)
You’re standing in front of two doors. One leads onwards, and the other one leads to (Ba-baba-BOOM!) certain DEATH! Yeah, just like Labyrinth. (Actually, no, worse than ‘certain DEATH’ – something more resembling Room 101). But there’s no riddle here. Only ever increasingly persuasive arguments from both sides. How do you choose? Would you EVER choose?
There are a thousand desperate voices in my head shouting to be heard, all telling me NO! Don’t do that! What if..! That primal terror/dread in the pit of your stomach as you are confronted with your worst fear (looking over an edge, coming face-to-face with the creature you have a phobia of). That’s happening all the time.. when I try to decide on taking diazepam, or D asks what I want to watch on TV, or I try to work out my opinion on *anything*… just all the time.
In CBT they talk about doing little experiments, to test your theory that the worse case scenario is inevitable, because mostly it isn’t, and it’s fine, and every time you see it’s fine you feel a little safer doing the thing. But what they don’t tell you is what in the everliving fuck to do if your worst fears actually happen. I spent time telling my therapist that I felt sure the CMHT consultant psychiatrist I got would not take me seriously, and that I felt sure they would never agree to refer me back after 6 months, like we talked about. She specifically wrote up in the discharge letter that they would welcome me back after 6 months if I felt it would be helpful, to help ease my worries. But here I am, with a consultant who did just that. Citing the cost. Budgets and cuts may be a reality, but tell a patient with crippling self-esteem issues that the treatment is too expensive, and that’s only going to go one way. D is going to take up the fight for me, and try to insist on the referral, at least for the assessment. But my original point remains.. what do you do when you push yourself into CBT’s behavioural experiments, and the result only serves to reinforce your worst fears, your internal truths? When it turns out Steve was right?
The last 4 days have been hell. I haven’t been triggered as violently as I was in that appointment for years – since not long after my breakdown, when I was at Maytree. I’ve lived with the ideas & behaviours & beliefs that stem from trauma my entire adult life in some way or another – it’s almost definitely the root of my social phobia, and my self-loathing (which allows depression to flourish). But something about being anxious about being vulnerable, and maybe it’s the power dynamic, leaves me particularly susceptible to being triggered in an encounter with MH professionals.
I’m having a hundred conversations a day with my psychistrist, in my head. But they twist and morph, and the line between him and my abuser is fuzzy. I’m in the little hospital office, but then I’m in the place of repeated belittling & verbal abuse. That sofa. That thick air, the crushing weight of expectation, and dread. Knowing what will happen. Knowing I’m about to do the wrong thing, even if (especially if) I do nothing.
So when my psychiatrist told me (contrary to last time) that using diazepam to go out is Wrong, is it any wonder I can’t just shake that off? I took 2.5mg this morning, after agonising over it so long D made the decision for me. It felt like swallowing a grenade. I hear the words of my therapist, “an experiment” – and a part of me hopes if I take it, see nothing bad happens, it’ll ease the panic. But the 2.5mg has barely touched me and now I have the whole fucking thing all over again.
I’m going to the dentist this afternoon. I should probably cancel, but I can’t. They will charge me, and I will worry that doing so means my teeth will imminently fall out. I don’t need the teeth dreams right now, on top of all the hospital dreams I have when I’m this anxious. Saving grace is that it’s a woman. And I remember, all this might have been avoided if they’d just let me see a woman as my psych too. I still get worried and anxious about doing the wrong thing, but I wouldn’t see his face. I wouldn’t be so afraid to go against my psych’s advice – so afraid it’s not fear, it’s terror. Cold, reptilian terror. It rears up every time I try to make a decision. I’m so afraid of doing the wrong thing I’m tearing myself into shreds. I get stuck in loops of contradiction. I hear everyone’s voice but my own. Knowing I’m about to do the wrong thing, even if (especially if) I do nothing.
The part before an appointment I dread is horrible. But the part after is worse.
Where most people fit into safe/not safe to talk to, in the weird system in my head, my psychiatrist falls under ‘very unsafe’. I did “good” in that I spoke, I tried my best to convey my realities & answer questions. I even admitted the extent of my social phobia, bc he asked direct questions. But this is causing so much unrest, noise, pain in my head.
I can’t stop playing it over and over and over and over. What I said, what I should’ve said, what I didn’t say. But more, the ways he shut me down, waved me off, interrupted me. Dismissed my ME. Asked things like “and I started you on the pregabalin, yes?” (no!). Told me my coping strategies are “wrong”, told me using diazepam to get out of the house is wrong, too. Told me what was going to happen in my treatment. Like a child. I feel myself bracing for impact every time I speak, knowing it could be met with a knowing nod, a new dx written on his notepad in big letters, or a big red buzzer of interrupting and “Wrong”. And then I’m not sitting in an office in a hospital but in the place of all my trauma. Looking at my hands and feeling all the empty space, space I am expected to fill with my words, words that will inevitably be the wrong ones.
I don’t think I can keep doing this.
Why don’t MH professionals… actually, make that Psychiatrists… give a flying fuck about anxiety? I get that it’s a secondary diagnosis (whatever the fuck that means). I presented with depression.. Chronic & Recurrent Depression, and it’s still a massive issue, don’t get me wrong. The eighty billionth medication I tried sorted out my sleep, and as a result I am marginally less depressed, on average. But that space, the difference between severe & moderate depression, has been filled by anxiety. And even when it’s the most debilitating problem, I can barely get psychs to bother with it.
Weirdly, the one psych who did try a few meds for it when it appeared was the one from the Specialist Depression Service. He’s the one who diagnosed me with GAD. And I’m glad he did, it’s accurate. But alongside the GAD, which is relatively new, is the social anxiety. My latest psych positively, actively dismissed me when I mentioned it (waved his hand at me and everything). To this day I don’t have an actual Social Anxiety Disorder dx. I realised not long after my breakdown that this was a much bigger problem than I’d ever thought. It’s something I’ve been negotiating my entire adult life, with avoidance and a lot of suppression and those lovely “safety behaviours” etc etc. I’ve been in services for years, seen maybe a dozen psychiatrists, but none of them give a flying fuck about it.
The more I think about it, the more I wonder if this is my biggest, most enduring, most disabling problem. My self worth is.. it genuinely couldn’t be lower. I’m sure that’s what feeds it. I’ve done all this unpacking & tracing back & pinning down, with just the help of M. Two years ago I could never have described the issues so clearly. But I’m sat staring at all this unpacked shit, now aware of the voice (not an actual voice, more disembodied ideas, like someone else’s thoughts implanted firmly in the back of my mind, behind my usual thoughts) that tells me frequently & loudly how fucking awful I am… and I haven’t the faintest idea where to start with it all. I just wish it wasn’t so routinely ignored.