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Mental Health FAQ

When you go to a psychiatrist appointment, a general practitioner appointment, or a therapist appointment to address your mental health issues it can be scary, especially if it’s your first time. I was terrified the first time I decided to see a therapist when I was 20 years old. I was alone, I had no support, I didn’t know anyone who had seen a therapist, and I had stress diarrhea for weeks. The first time I brought up my depression with my general practitioner was scary also because I was terrified that he wouldn’t take me seriously. The first psychiatrist appointment ever was daunting because I didn’t want to believe that I needed a psychiatrist.

I imagine I’m not alone in my fears because living with mental illness is scary. We are up against a stigma that spreads through almost all parts of our lives. Even when we ask for help, things can go wrong. But when things go like they’re supposed to, there is progress. I have been to many therapists, may psychiatrists, many GP’s for mental health, and I’ve seen good ones and bad ones, and ones that have just not worked for me. Here are a few things that I wish I could have known when I started treatment. If you are considering getting help for your mental health, I applaud you and hope this helps.

Q: What will a therapist do on my first visit?
A: They will introduce themselves, and they will ask you why you came in. This is not a judgement, they want you there, and they want to know how to help you. Even if you aren’t able to be articulate why you’re there, do the best you can. They will ask you questions and lead the conversation when you’re not able to.

Q: What if I’m embarrassed by something I need to talk about with my therapist.
A: Your therapist will never judge you. The truth is that they’ve probably seen it all. I tend to seek out older therapists who have been practicing for a long time because there is literally nothing you can say that will surprise them. Being honest is the only way to make true changes in your life. You’ll get out what you put into therapy.

Q: What if I don’t like my therapist?
A: The best thing you can do is be honest with your therapist and yourself. It’s okay to discuss this with the therapist. If you can’t work it out, find another therapist you can work with. It takes some trial and error sometimes, and there is absolutely nothing wrong with leaving a therapist you’re not comfortable with. This applies to all doctors and psychiatrists as well. Trust is a big part of mental health treatment.

Q: What could a general practitioner possibly know about mental health?
A: Enough to help point you in the right direction when you need help. Sometimes a GP is all we have available to us, and there’s nothing wrong with that either. They can prescribe medications and refer you to a psychiatrist or therapist if they think you need it. Go to who you trust as your first step.

Q: Is it as interesting to sit in a psychiatrist’s waiting room as you’d imagine?
A: Waiting rooms are always professionally discreet. No one is even paying attention to you much less trying to guess why you’re there. I’ve never felt unsafe in a psychiatrist waiting room.

Q: What is the difference between seeing a psychiatrist and a general practitioner?
A: A psychiatrist specializes in only mental illnesses and mental illness medications. They will be more up to date on specific medications and specific diagnoses and can provide a more in depth mental illness treatment. Generally, the philosophy is that if it works, keep doing it. I mean that if your GP prescribes you some medications that make you feel better, then keep taking them. If your GP has tried everything they know to try (like in my case) they may say go to a psychiatrist to try something different.

Q: What is the difference between a psychologist and a psychiatrist?
A: A psychologist will be your therapist and cannot prescribe medications. A psychiatrist will prescribe your medications. Most psychiatrists don’t do therapy, but there are some who do. I’ve never been to one who does, but it sounds like it could be a nice simple “one stop shop.”

Q: What’s the deal with medications? Are they pills that make you happy? Are they just a crutch?
A: Mental illness is much more complex than happy/sad. The hardest part of getting mental health treatment is that there is still so much that even the experts don’t know about it. They don’t know exactly why some medications work and some don’t, or why it’s different from person to person. While mental illness is a real, diagnosable medical condition, just like diabetes, or a broken arm, the treatment is different for each person. A doctor will pretty much treat a broken arm the same way for each person, because if they do, it will heal. Unfortunately depression and other mental illnesses are not so linear. We use medications as a way to stimulate our brain chemistry to do what it should be doing anyway. Just like a diabetic gives insulin because it’s what their pancreas is supposed to be doing anyway. Medications are not happy pills. They are not a crutch. They help clean up your thought processes and clear pathways so that you can function as yourself, just like when you clean out the hallways of a house so you can get around the house with less stress. I was prescribed medications for the first time at age 20, and I carried the bottle around, unopened, until I was 22. I was afraid of the stigma. I was afraid that they would give me a false perception of the world. I wish I had been more open minded sooner though, because it was the depression that was giving me the false perception. The meds helped me see more truth.

Q: Is it possible that medications won’t work?
A: Unfortunately there’s always that possibility. Sometimes it takes trying a few medications that don’t work before finding ones that do. It can be a frustrating system because often you have to take the medications for several weeks before you know if they’re helping. It can be so time consuming. It’s an imperfect system, but it’s the best one we have right now. There’s so much research being done about treating mental illness, learning why it happens, and learning what the symptoms mean that there are new options available all the time.

Q: Can insurance be a pain in the ass when it comes to mental health?
A: Sometimes. Mental healthcare is still a completely separate section of insurance from healthcare (guess what, it’s all healthcare!) and it can have its own rules. The issues I’ve run into over the years are that insurance can sometimes dictate how many therapy sessions you get per year, and they can limit the options for doctors you can see. The staff at therapist and doctors’ offices are pros at dealing with insurance, and will work the system if they need to to get you what you need.

Q: Is it okay to be scared?
A: Absolutely. Getting help is supposed to be the greatest thing you can ever do, and there are supposed to be circles of cheerleaders following you around wherever you go, and everything is supposed to be perfect and amazing and rainbows and smiles. Well, getting help is a great thing, but more than that it’s a brave thing. We’re still in a world where it’s often an uphill battle to get help for mental illness. I wish to god it wasn’t. I wish that mental health was treated like the rest of healthcare, and that people didn’t have to be afraid and anxious to seek help or even avoid seeking help because they’re afraid they won’t get it. I’m going to be real with you – getting help can be hard work. I will cheer for you and assure you that you’re not alone, I will share everything I’ve been through in hopes that it helps, but I can’t tell you that it will be smooth sailing. I do think you’re worth the fight. I also believe that you can be strong and brave and terrified all at the same time. And I think it’s worth asking for help, even if it looks like just showing up in a doctor’s office, not making eye contact, and saying the word “Help.”

These questions and answers are based on my own experiences, and my own fears before I got into treatment. I have not had a smooth ride with mental illness or its treatments, but I have met some really good people along the way who have helped me a lot. I’ve met some good people who haven’t helped me too. And I’ve met some idiots. But so far I haven’t given up on myself, and I don’t think you should either. I hope that at least some of this is helpful.

If you have any other questions, or if you have any other insights from your own experience that you think might be helpful to someone else, leave them in the comments or you can e-mail me. I don’t claim to be an expert, but between all of us I bet there’s a lot of really good information out there.

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TMS (Transcranial Magnetic Stimulation)

Transcranial magnetic stimulation, or TMS, is a new, non-medication non-invasive depression and anxiety treatment that uses MRI waves to target and stimulate areas of the brain responsible for regulating neurotransmitters. Dysfunctional neurotransmitter communication is the closest known cause of depression and other mental illnesses, so TMS is a way to potentially treat the source of the problem without using medicated stimulation of the same neurotransmitters. TMS is performed without anesthetic and is reportedly pain free. Insurance will cover it if at least 5 other medications have failed to treat depression successfully. It’s a less invasive procedure than ECT, which is more intense treatment and is done under general anesthesia.

It does not appear to be a magic cure that Pharma’s been keeping a secret from us because the success rate is about 30%, the same as for medications. Supposedly if you have tried several medications without success TMS is less likely to work for you. In the last two years alone I have failed on at least 5 medications. I’m currently on six different medications that are helping marginally but creating serious side effect problems.

The weight gain that is common with some antidepressants and bipolar medications is causing more serious problems than just making me uncomfortable. The medications make me crave sweets and my appetite is through the roof. It’s bigger than self discipline. I’ve gained 30 pounds since starting two different medications, and because I am so hungry all the time my blood sugars are out of control. 400 – 600 mg/dL high. Daily. I should be able to just not eat so much, and I should be able to control myself since it’s actually making me face my own mortality, but I can’t.

I need something to clear itself up – the bipolar, the depression, the insatiable hunger, the grief, the foggy brain, the sleep problems, the kidney damage caused by not only the lithium I’m taking but now my extremely high blood sugars. Something! Help! I’m tired of watching myself die.

So I’m trying TMS. The success rate isn’t as close to 100% as I would like, but it’s not going to hurt me. It might be a little expensive, but insurance covers part of it. Incidentally I learned that TMS can treat anxiety too, but it’s not approved by the FDA. This means that insurance won’t cover it and it’s around $11k.

The treatments take 30 minutes a day, and you go every Monday through Friday for seven weeks. I’ll be awake, there will be scalp discomfort for the first few days and I might get a headache afterward for the first few days. That’s the worst of it. If this can help me get off even one of these meds I’m on I will be grateful. I’d like to get off most or all of them, but I’m cautiously optimistic. It’s something I’ve never tried, and I’m pretty damn close to having tried everything and still feeling very depressed. It’s my normal. What if it could be different?

I’m willing to venture an answer to that question by trying TMS. The answer might be “It can’t be different,” and I’m prepared for that. If it’s anything other than that I’ll be thrilled. I am so tired of trying the same things over and over and getting the same results. I do not want to accept that this will be the rest of my life.

I am going for a final consult with my doctor today. Assuming I go forward with the procedure I will report the progress and the things I learn along the way. Here’s to voluntary brain zaps!

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Plan B

How many people are really living out their Plan A in life? How many people are doing what they always planned to do, living life the way they want to, haven’t had to rebuild themselves, maybe a few times, in their life? If those people are out there, just give them time. Their Plan B is coming. Personally, I ran out of letters for the amount of backup plans I’ve had to scramble together in my life. Even if I prepare for something, it often proves to be a wasted effort.

I recently got back from a vacation that involved a two day road trip. On the way back I stayed in a hotel after about 13 hours of driving, and around 3am my insulin pump alarm woke me up saying that the pump was dead and needed a new battery. If I don’t have insulin within a couple hours, my organs will start shutting down. So I guess it was important that I change the battery, or whatever.

I had packed batteries for just such an emergency, but it turned out I had AAA when I needed AA. I was going to have to come up with Plan B. I drove through the Virginia/Tennessee border in the middle of the night by myself without a bra. To my intense relief there was a gas station down the street from the hotel and I went in.

“I’m sorry, I can’t take any customers right now, I’m doing my nightly close,” said the gas station attendant. But what if I might literally die? Sorry, won’t have registers for another 20 minutes. Oh, I am sooo going to write a blog post about this, I thought as I grudgingly started forming Plan C.

There was a Wal Mart down the street from the gas station, and while driving there I chickened out and didn’t go in. I had nothing to defend myself with, and I felt there was a distinct possibility I would need to. To keep the anxiety at bay, I did, however, speculate about what kind of people would be in a Virginia Walmart at 3am. 400lb men in motorized carts and long, unwashed hair. Shift workers buying bulk Cup O Soup, being neither terribly happy or terribly unhappy with their lives. Groups of twenty year olds with neck tattoos glistening in the methamphetamine sweat, wearing wife beaters and dirty black jeans. I get really specific with my speculations.

I asked my GPS where the next gas station was, and it said Sure I will save you! Let’s go four miles! But after 12 miles of driving through unlit woods with sketchy looking streets, I ended up on a highway and recognized my exit for the hotel. In other words, back to exactly where I started. There was the gas station I just left.

I figured I might as well go back in and see if she could unconstipate her customer service. Fortunately she could take my money that I gave her in exchange for saving my life. She went from Plan A to Plan D in a matter of 30 minutes. I went back to the hotel and changed my pump battery and got a shaky 45 minutes of sleep before I had to get up and hit the road again to come home.

The thing about losing your Plan A is that while it’s a surprise and it’s jarring, life doesn’t stop there. I don’t know how long I started at that gas station attendant with my mouth open when she told me she couldn’t help me, but also there was that thing about how I would die without making a new plan. I considered shoplifting, but I’m not that graceful and didn’t want to get arrested while not wearing a bra. So Plan B makes itself. Same with Plan C and etc.

I was anxious but didn’t panic because batteries existed somewhere, I’d find them one way or another. Another thing I have learned is that I will be okay, no matter what happens.*  I’m not dead yet, and until I am I will be okay. I’ve faced my greatest fears, more than once, and I am still here. Being out of batteries in the middle of nowhere can’t scare me anymore.

*Unless it’s the zombie apocalypse, in which case I’m screwed.

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The Greys and Army Greens

Why does reading about someone who has bipolar give me a start? Why does hearing about someone who committed suicide make me feel just a little bit jealous? It doesn’t mean I’m a bad person and it doesn’t mean I’m crazy, that’s just the nature of triggers I guess. I’m reading a book that mentions someone’s family member who had bipolar (by the way I’m careful to say “has” bipolar as opposed to the more commonly used “is” bipolar because our conditions do not define us) and refused to take medications because they didn’t want to be “dulled.”

The person ultimately killed themselves, and it sounds like they had a lot of struggles in life. I can relate very much to not wanting to be dulled. Taking the relatively large number of medications, in addition to making me fat, turn my brain into fog. My feelings are dull and I don’t get as much enjoyment out of things I normally enjoy, but when I feel sad I feel it too strongly. The thought of getting off my medications just so I can feel something again is very appealing. But the consequence of doing that is that I will probably end up either hurting everyone I love, putting myself on the streets, or dead. At least I would feel life again, though!

I’m not going to go off my meds, but it will never stop sounding appealing. I think of the days when I wasn’t on medications or wasn’t taking my meds like I was supposed to, and though I had huge mood swings on a daily basis, I felt love like fire, I felt joy doing the things I loved, even the lows that I felt so strongly made me feel alive. I was connected to life. Sure, I wasn’t sleeping or eating much, and I would have days at a time where I would cry in bed barely getting up to pee much less function like a human. But that’s part of what made me feel alive.

Now I’m taking all the handfuls of meds like I’m supposed to, but I feel a muted sense of being alive. There are many things that make me happy: my boyfriend, my dog, my friends whom I cherish. The love for those things runs deep. But everything feels muted. I still have the mood swings, but they’re not as extreme. The “even keel,” the “baseline” doctors want me to stay on feels Okay. I am Okay. Life doesn’t have the reds and blues and purples and lively yellows anymore, just greys and army greens. My memory is shot, focus is a challenge, I often feel like my personality has gone into hiding, my hands shake, my energy is in short supply and I’m often too tired to function, but I am Okay.

Not fantastic let’s-get-up-and-go-I-don’t-care-where. Not terrible, hopeless, I’d be better off dead. Just okay. I am so lucky to have people who care about me and are always there to help me through the days, even the days when the high/low extremes come back and I’m not Okay anymore. In the meantime I’m living in the fog and reminiscing about the times when I felt like I was living in brighter colors.

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Poetry in the Wild

I went on a hike through the forest the other day and I found this tree about a mile in. It says:
“It’s nice to know
That you’ve got so many choices
So many paths
So many things
To fiddle and play with
Enough so that you can drop one
And pick up another
No matter how you choose
You’re gonna be happy
 
It’s nice to know
That I’m the one
You chose to drop.
But that’s okay.
‘Cause now I realize
For now and forever
I am your loss and he is your gain.
So make the best of it.
You got one life.
So make your choices now
Before it’s too late
 
It’s nice to know that I can walk
Or even crawl
And – – – run
Well I keep going
Someday you’ll be a wall
And someday I’ll pass you.
 
And it’s nice to know
That I’ll never look
Back”
 
– The Forest
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When Anxiety Attacks

Anxiety and panic attacks are no joke. No matter how many times they happen, they are terrifying every time, and it’s easy to feel like you might die if you’re not able to talk yourself through it. I have them every week if I’m in a sustained hypo-manic state, and about once a month if I’m in a bad depressive episode. Still, even without the emotional extremes, they can happen seemingly out of nowhere, triggered by things I often don’t understand until after they’re over. A big thing in therapy is learning to recognize triggers, which is helpful for perspective, and sometimes helps in the moment. But still it’s only part of the anxiety picture.

I had an anxiety attack as recently as the other night when I was grocery shopping with my family. I had gone off on my own to look at a few different items and soon realized that I no longer had my phone on me. I rushed back to the cart and asked the family if the phone was in the cart. They glanced in the cart and said no, so I rushed back to each place I had been to look for it, not finding it anywhere. My pulse and breathing quickened, I couldn’t think about anything but my phone, focusing, oddly, on the panic of losing my shopping list. Then I lost my family and started crying. My vision blurred and I’m sure I caused other shoppers some concern. I made eye contact with a few of them (a mistake).

Finally I found the family and breathlessly started throwing things out of the cart until I finally saw my phone at the bottom. I grabbed it and left them gaping to try to walk off the physical symptoms. When my mind started clearing I found that I was in the freezer section staring at Eggo waffles with the freezer door open. I felt better eventually, I still had my shopping list, and my access to my supportive texting friends and family, and more importantly, my shopping list. I can’t go into a grocery store without a list or I become too anxious. Ah, yes, there was the trigger.

There’s no way I could have prepared for that, though I did try to talk myself through it as best I could. Mostly it sounded like, “Breathe slower you’re not going to die. Breathe slower. Breathe slower.” It didn’t work though because my panic brain replied, “MY LIST MY LIST MY LIST!” Afterward I was able to talk myself down better. “It’s going to be okay. I am okay. Everything will be okay. Let’s go get some waffles,” apparently.

The most severe panic attack I ever had lasted three days. I know therapists and doctors say that a panic attack can really only last 25 minutes because after that your body chemistry is depleted of panic chemicals. So sure, I had breaks from the actual panicking, usually when the Xanax allowed me to calm down. But as soon as it started wearing off I panicked again. Sobbing, blurred vision, hyperventilating, shaking uncontrollably.

It reminded me of when I was working in the veterinary field and we’d see severe epilepsy cases where we put them on the strongest medications to get them to stop seizing and as soon as it wore off the poor animal was in another seizure again.

I was in a situation where there were about 20 unexpected triggers hitting me all at once. None of which I saw coming. I almost missed the wedding of one of my favorite people in the whole world because I was trapped in a prison of my own panicking head. Anxiety does not care where you are, what you were planning on doing other than panicking, or who you are with. It’s coming in anyway.

I feel like I learn my triggers just in time to find out that I have a whole new set waiting for me. The work is never done with mental illness. Nothing is ever fixed, it just morphs into new challenges. That’s what makes people living with mental illness such badasses. They are constantly fighting invisible battles that threaten to take over their whole lives, but they still manage to wake up every single day to fight again. How much more badass can you get? And sometimes they get dressed, have jobs and relationships and friends, all while doing battle.

Fight on, you motherfucking badasses. I’m fighting right next to you. Let’s have a waffle together sometime.

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A Note on Being Socially Awkward

“Oh, excuse me,” I say to the person I’ve accidentally cut off in the hall leading to the ladies’ room.

“Haha, no problem. The squash at the mall is rough!” I think I hear.

Not wanting to make this crazy talker feel bad, I say, “Well, they can’t all be gems, can they? Haha!” and push past her and her disappeared smile and confused, slightly concerned eyes, and let myself into the bathroom ahead of her.

While I’m in the stall, I realize that she must have said, “Well, this hall is small enough!” and not whatever I thought she said about squash. My response made less sense to her than the squash mall made to me. Another missed connection.

I don’t hear very well, so add that to my momentary panic whenever someone tries to make small talk with me, my mind reeling, trying to force words out so I don’t completely mangle the transaction, and it’s a disaster. I’m starting to accept that I’m going to mangle it anyway, so I try to keep my tone light and hope for the best. I used OKCupid to date people after my divorce, and under What I’m Best At in my profile I said “Making it weird.” And I meant it with all my heart.

I have a lot of wonderful friends who love me very much, but even with them I’m socially awkward enough to make it weird on a daily basis. And it’s not just my hearing loss or loathing of small talk either. At first I didn’t think mental illness played into it at all, but now I’m not so sure. When I’m doing everything I can just to stay alive with the minimum amount of functioning, not to mention summon the courage to be around other humans when I feel like that, polite conversation is the last of my energy priorities.

I might be at a store in the checkout line and the friendly cashier will say something like, “Any big plans for the weekend?”

Dear god, that question. I hate that question.

My first instinct is to lie, desiring to be someone who does things on a weekend like normal people. It sounds something like this: “Oh yeah! We’re going paddle boarding at the lake. Standing paddle boarding. With Martha Stewart. She’s buying us beer. Then we’re all going off roading in her Jeep. In the mud. I’m very excited.”

My next instinct is the honest one. Let’s not waste time being polite, let’s just tell it like it is. It sounds like this: “Yeah. Big plans to not put pants on or shower or brush my teeth for two days. Just kidding it’s already been a month. I’ll probably lie in my bed sideways and watch The Office reruns for thirty hours while eating these four bags of dill pickle chips and wiping my hands on the dog. What will you be up to?”

There’s the third response and it’s one I call The Best I Can Do. It goes like this: “Is it the weekend? What day is it? Can you just… I’ve got to get home. Because…I have to.” and then I start to cry as I avoid eye contact while o wait for the cashier to finish scanning my items, imagining them judging me for buying dill pickle chips in bulk along with tampons and one single celery stalk.

No matter which choice I go with, I make it weird. The cashier, or whomever I’m talking to will give me a blank, confused, or pitying look. And that’s just the way it is. At one point in my life while working customer service, I learned to have a separate customer service personality. I was charming, helpful, funny, cheerful, and I could do it as long as I was getting paid for it. Afterward I didn’t want to talk at all. To anyone. About anything.

This feeling is the inspiration for my “today is a no talking day” sticker. I feel like that so many times when I am too busy fighting my own brain to have energy for conversation or even responses to simple questions. It costs me a lot of myself to survive depression, anxiety, bipolar, and type 1 diabetes. It would be nice to be able to enjoy being social instead of feeling like it’s an obstacle or a puzzle that’s too difficult for me to figure out most of the time. At least I also don’t have enough energy to care what these strangers think of me and my awkwardness. That’s an asset, especially when I know I’m doing the best I can. It’s an asset too when I’m writing a blog that talks about things that no one wants to talk about. I don’t care what you think of me because I know that there’s someone out there who will read this and not feel so alone anymore.

Weirdos, unite.

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A Note on Self Harm

Trigger warning: this post talks about cutting and self harm

This is probably the most difficult subject to talk about, but that might be why it’s the most important to talk about in order to fight the stigma of living with mental illness. That’s the theory I’m working from, anyway, because that way the pain of talking about it publicly has a purpose.

I have used cutting and other forms of self harm such as bruising myself and using diabetes as a weapon – binge eating without giving insulin, or even eating normally and purposefully not giving extra insulin – since I was a teenager. As a teen I was not allowed to ask for help when I needed it, so I would cut myself – usually on my face – to show people I needed help. I stopped doing this until I was in my early thirties.

I was in a toxic marriage and needed help but wasn’t getting it, so I started cutting again. The urges surprised me since they were so strong and I haven’t felt them since I was a kid. All of my pain in my marriage was invisible, so the cuts, the blood, the scars were all proof that I was in pain. It was outside of my head, which was a relief.

My marriage ended and I started cutting again. My life was suddenly in chaos. I lost everything: my house, my family (in laws), my job, my car (totaled it), my jobs (lost two in a row), my dog (liver failure), I almost lost my dad to complications of surgery, and I was trying to survive on my own in an upside down world. My depression was spiraling downward at an alarming rate, and I started cutting again. I dug into my legs with a sterile needle (always sterile, I don’t want to do damage, I just want the pain) as a way to gain a sense of control.

If I cut I bleed. If I bleed there’s pain. Cause, effect. Very straightforward. Absolutely nothing in my life was straightforward, I was in control of nothing, none of the causes had effects that made any sense. Surgery is supposed to heal, not try to kill. Working hard is supposed to give you job security, not take it away. Dogs are supposed to live forever. But I know exactly what happens when I put a needle on my skin. This year when my marriage ended and I lost everything was what led me to my second ever psych-hospital experience, but I will go into that story more another time.

I had a counselor recently whose response to me talking about my cutting was, “Most people grow out of these urges eventually. Almost no one continues to cut after age 30.” Yeah, well first of all, you’re talking to one of us over 30, so check your facts. Second of all, that’s not true at all, there are many adults who self harm. But people over 30, this arbitrary age when life is supposed to magically get better, don’t feel like they’re allowed to talk about it. I told this counselor, “I don’t know what you’re trying to tell me. Do you think I’m doing something wrong?” She said no, I was doing nothing wrong, I was just using an old coping mechanism. She said the urges should be getting fewer and further between. I said they’re not, they’re more frequent and getting stronger. And I know I’m not the only one. I’m not an anomaly of her inaccurate statistic.

There are many many many adults who hurt themselves in secret, suffering in a very painful silence. There’s an Instagram account I follow that is called Faces of Fortitude: “This project lays a foundation of healing thru portraits of those affected by Suicide & Mental illness.” A photographer takes pictures of people who have survived depression, suicide attempts, trauma, and self harm, and tells their story in the caption. There are amazing stories and powerful photos, and it is inspiring to read. In one of the stories the person advised against tattooing over or hiding your self harm scars, but advised wearing them proudly because they are reminders of what you survived and of how far you’ve come.

I respect this sentiment, and if it were anything but self-inflicted scars I would agree. But I still have times when my own scars can be triggers for me to want to hurt myself. I have gotten several tattoos that cover my scars, and I did it because I wanted to turn something painful into something beautiful. That is what I would rather look at than scars, reminders, of painful moments. When I have the urges to hurt myself, they are difficult to shake. The pain is actually what brings me relief. Totally intuitive, right?? So when I see the scars, the memory of the pain makes me want to cut again. It’s all complicated.

Cutting and self harm are complicated. We don’t do it for attention. We do it because the pain, the blood, the bruises, the scars give us something that we need so desperately that we have to hurt ourselves in order to get it. Maybe it’s validation we need, or a way to ease our depressive thoughts without trying to kill ourselves, or maybe we need to get the pain out of our heads and into the outside world. Whatever our reasons are, we don’t have to be teens. We are mature, fully functioning adults with hidden pain that we don’t know how to express otherwise.

When you see us in the wild, don’t judge us. Just know we are in pain, or at one time we were in pain. You can understand and relate to that. That’s all it is, so I wish it didn’t have to be a secret. Thank you for letting me share a little bit about my experience.

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In the Moment

I wake up early. I never used to, but, and I guess I’ll blame age, now I wake up at around 5:00am every day, no matter what time I go to bed. This morning I was an overachiever and woke up at 4:30 feeling fully rested and ready to start the day. We are vacationing at the beach right now, and when I got up early I realized that the ocean also gets up early while the seagulls sleep in.

Time to go to the beach.

Despite the inclement weather and the fog and the inability to see the sunrise, the ocean was beautiful. The waves rumbled and crashed against the shore, the fog blurred the horizon, the low tide painted the sand with rivulets still streaming with salt water, and there were seashells everywhere. No one had come to pick them over yet and I decided to collect them.

I hesitated, though, before walking out to the surf, and tried to pinpoint why. The ocean is larger and more powerful than anything else my brain can imagine. When I’m not face to face with it, I can’t even imagine the depth of its power – one wrong move, all alone on the beach, and I could be erased. I took that in before deciding to carefully begin my shell hunt and getting lost in the moment.

Except I hesitated again because the first shell I found still had a creature in it, and that was more terrifying than somehow getting sucked into the ocean. To my credit, I did not scream, and I fully own that I am a wuss. But I began finding shell after shell.

Former homes of unknown animals peeked out from under the sand, and I rushed over to dig them up. The more I walked the more numerous they became and I got better at spotting them. The only thing I could hear was the waves, the only thing I thought about was spotting shells, the only thing I felt was happiness. I was so wrapped up in my activity that I even got physically lost, which is hard to do when you’re walking in a straight line. I was one hundred percent in that moment.

With anxiety and other mental illnesses, it’s hard to lose yourself in a moment. There’s always that part of us that is screaming, demanding our energy and attention or even altering our perception of the world so that we can never be fully present in any given moment. Even in the important ones, and it’s a big burden to carry.

This beach moment wasn’t a ceremonial rite, or a significant event in my life, but it was important to me because for that small piece of time, the negative messages paused, the gnawing worry dissipated, the weight of depression lifted. I didn’t want to hurt myself, and I didn’t want to go back to bed. I got a break from all of that. It’s even held off a little since then.

If you can’t find an ocean today, I hope you can find a moment where you get a break. I hope you can lose yourself, even if only for a few seconds, in something that brings you joy. If you can’t, just remember that you’re not alone. I’m over here in your corner, cheering for you.

Remember – you woke up today! You are a badass!

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Even When I’m High Maintenance

People like traveling with me because I’m very laid back and adaptable. I can be as happy staying in a fancy hotel (I get unreasonably excited if there are more than two TVs in the room and at least one of them is in the bathroom) as I am staying in a cheap motel as I am sleeping on the forest floor under the stars as I am camping out on a near-stranger’s floor in the middle of a city I’ve never been to. I can navigate a very wide range of social situations, I can pack like a man, and I can get as sweaty as anyone else while hooking up a trailer to the back of a truck. So I’m popular with travelers because I appear to be not needy at all.

The truth is that I can take care of my own needs, and when I can’t, first I try to suck it up and push forward anyway before I will finally ask for help. I hate holding up group plans by needing something weird, like a trip back to my hotel room for a bottle of insulin, or something with sugar in it to treat a low blood sugar which may require half an hour out of everyone’s way to find me a soft drink. I try to plan for everything, but inevitably something weird and 99% diabetes related will happen that I can’t plan for.

Lately, too, in my healing but still weakened mental health state, my needs have increased. I am traveling right now, and my usual laid back, adaptable self has been replaced with some kind of high maintenance needy woman that I never wanted to be. Outwardly I am still flexible, but my inner monologue has kicked it up about ten notches. “How am I supposed to sleep with only ONE pillow? I can’t find ANYTHING, who packed this backpack? Whyyyyyyyyy can’t we be there yet?!”

Outwardly I’m like, “We’re not stopping for 4 hours? Cool.”

We stayed the night with my boyfriend’s family last night. Granted I had met them before, so there was no first impression pressure, but we had also been driving for about twenty four hours and we were all exhausted and cranky. Also, I was on my period, which will become relevant soon.

We ate dinner with the family, watched a little TV, caught up a little, then a few of us excused ourselves to go to bed early. My boyfriend and I and our two dogs were staying in one of the kids’ rooms on a twin bed and a twin trundle bed on the floor. I was so tired and cranky that I laid down and cried because I had to poop and I didn’t want to poop in someone else’s house. (high maintenance)

I was also terrified to go to bed because I was on my period and didn’t want to bleed on a kid’s bed sheets. I decided to delay the pooping and change my insulin pump, which involves needles but very rarely involves bleeding. I changed the pump and realized I was bleeding, which only happens once out of every 30 or so times I change it. And I bled a lot. Right onto the kid sheets. Right where my ass would be if I was laying down. I was terrified for the wrong blood. But now so what, the worst has already happened, I can sleep sound.

Until I pooped in the kids’ bathroom and clogged the toilet. And the 12 year old had to bring me a plunger with a look on his face that said, “I know what you did and it’s gross and I don’t want to talk to you ever again.” Or maybe I’m reading into that. But I spent several minutes unclogging the toilet and sobbing a little to myself until I came out of the bathroom and made a poop joke, laughed, and went to bed still sobbing a little.

I know how to suck it up. On a road trip there’s not much choice but to endure and do the best you can. Sometimes I have to admit that I have needs, and sometimes I have to change other people’s plans to get those needs met. Always I have to be okay with that because what’s the alternative? Making myself miserable stewing over it while everyone else has moved on.

We finally arrived at our destination, and I can breathe a little bit. The toilets I clog from now on will be our own. And even though there’s still only one pillow for me to sleep on, the ocean is about 500 feet from where I’m sitting, so no matter what, everything is going to be okay.

Now I’m going to go take a fucking shower.