12 Deadly Sins: Secrets behind Self Harm

Warning: Some people may find this post triggering. For help with self harm please refer to resources such as Headspace, Helpguide, Lifeline, or call your local crisis helpline. 

When I was 15 I was diagnosed with major depression, panic disorder and an eating disorder. Because I wasn’t confused enough, later on I was also diagnosed with obsessive compulsive disorder, generalised anxiety disorder, borderline personality disorder, and numerous other unpleasant sounding things ending in “disorder”. Basically, no one knew what was going on.

It was a bit of a shithouse time really, culminating in a hospitalisation, threatened subsequent hospitalisations, and a fair amount of general chaos. Medication never worked because, obviously, I actually had Bipolar disorder, and prescribing anti-depressants without a mood stabiliser to someone with Bipolar disorder will usually just make things worse. But the doctors never picked up on that. So…one of my coping strategies was self harm.

I remember the first time I hurt myself. I had just come home from lunch at a cafe. I was freaking out over what I had eaten – not because I was afraid of becoming fat, but because I thought the kitchen staff were trying to poison me (and despite telling the doctors this concern every single frigging week, the professionals never picked up on my psychosis either. Probably because middle class, skinny, teenage, perfectionistic, high achieving, introverted girls don’t have psychosis. They have Anorexia.) Anyway, I tried to make myself puke. That was a fail. So out of pure frustration I grabbed a pair of scissors and scratched myself.

Immediately I felt relief. And about 10 seconds after that; shame.

Harming myself was like a weird drug. I started doing it more and more. I became addicted to it. I am not going to go into morbid detail because I know how triggering this kind of stuff can be. But hurting myself felt like the one control I had in my life. It felt like I was externalising all the pain inside and making it visible. It was my punishment. It was my reward. It was my secret.

This topic is not something I have ever really written about on here. To be honest with you, I don’t really like thinking about what I did to myself. But I think this is a topic worth discussing. There is so much controversy over self harm. And so much disrespect. Those who self harm are mocked, seen as attention seekers, and dismissed.

I can’t speak for others, but I never self harmed for attention. Attention was the last thing I wanted, even going to the extent of self harming in places only I would see, or wearing long sleeved tops on even the hottest of days. I self harmed because I didn’t know what else to do. I self harmed because it was a release. I self harmed because I was unwell.

That’s another thing: there is a myth that self harming is a kind of suicide attempt. I didn’t want to kill myself. Well, I did, at times. But my self harm wasn’t a symptom of suicidality. My self harming behaviour was a tool, a destructive tool, that got me through some of the most difficult days of my life. For me, it wasn’t a step towards ending it all.

Then one day I realised that I was running the risk of permanently scarring my body, in a way that would be eternally difficult to explain. I realised that I wanted to wear a bikini. That one day I would walk down the aisle and may want a sleeveless wedding dress. That I might have a kid who would ask what I did to myself. That it just wasn’t a healthy way of behaving. So I stopped. I say it like it was easy. It wasn’t. There was a long period after I self harmed regularly where it would be my “go-to” strategy if I was upset. It took a long time to change my behaviour. But I did it. And aside from the freak out I had in the locked ward last year, which I don’t tend to count as I was rampantly psychotic and actually set on killing myself as opposed to harming myself , I haven’t self harmed in years.

Luckily I don’t have many noticeable scars. But the ones I do remind me every day on how far I have come, and the path I have walked.

When I was a teenager I wrote a lot of poetry and songs. Today I came across this poem, and it stuck out to me. For me this explains perfectly the allure, horror and truth behind self harming.

12 deadly sins

Feels like fire

My opened flesh

Secrets exposed

How I like it best.

Razor sharp

Indulge my skin

But it’s never enough

To purge my sins

1 because I’m not good enough for you

2 for all the wrongs I do

3 for keeping back the truth

4 for the way that I treat you

5 for my ugly face

6 for this unwanted space

7 for the lies I’ve told

8 for this razor I hold

9 for the pain inside

10 for my hopes to die

11 because I can’t stop now

12 because I don’t know how.

12 purple scars

upon my thigh

I keep them well hidden

So you won’t ask why.

12 deadly sins

my punishment kept

12 000 tears

my cruel hands have wept.

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The Place I Chose To Die

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The other day we were driving back from my Immunology appointment at our local hospital , the same hospital where I was incarcerated for nine long weeks in The Dungeon. Anyway, we passed this little motel, the kind of establishment that is a mix between being super twee and super dodgy, and suddenly this chill spread through my body. I remembered the motel. But I couldn’t think of why.

I started to rack my brain for information. I was sure I had never stayed there. I mean, why would I want to stay in a slightly dodgy motel situated on a major road, in a slightly dodgy area of town, in my own city? I didn’t know anyone who had stayed there. I couldn’t recall ever visiting it for whatever reason. Then suddenly I broke through the ECT induced memory loss and the reason hit me like a tonne of bricks.

Of course. I thought. That was the place I chose to die.

You see, when I was admitted to the Dungeon I was suicidal. These feelings got worse and worse as time progressed. None of my meds were being absorbed due to the pesky autoimmune disease. Things were going rapidly downhill. I heard voices which told me to kill myself. I began to see people who followed me around and continually tried to convince me that my loved ones would be better off without me. That I was a burden. That if I REALLY wanted to help people I should get rid of the problem. Me.

Of course, when I expressed this to the medical staff they told me that the voices were wrong. But those voices…”The People” just used to ask me “Who ya gonna believe, Rachael? The doctor who has known you for five minutes? Or us, who have been with you for most of your life, know your intricacies and your family? We WANT to help you. Let us help you” These “people” were twisted but somehow they always made sense. And so they kind of grabbed hold of me.

So I began to make a plan. I managed to hack into the hospital university’s wi-fi through my own university. I searched the net and chose a place, this particular motel, to die. I decided how to do it. I had cash, a credit card, and a bus card. I was a voluntary patient on an open ward. I knew I could walk out at any moment and just never return.

Somehow, and I don’t recall how, around this time the doctors twigged that I was losing grip. I was placed on one-to-one supervision, and much to my frustration at the time, my plan was foiled. Thank god.

I find it very awkward to write about this. I feel an intense shame that I even THOUGHT about killing myself – much less making an elaborate plan. I feel like someone reading this is going to shout out “See! Unfit mother! Disgrace to society!” This is such a difficult topic to talk about.

Suicide is such a stigmatised issue. I mean, God, it’s a HORRIBLE issue. There’s no doubt about it. But it’s real. And it should be talked about.

The leading cause of death in Australians aged 15 to 44 is suicide. And, you know, that’s just looking at “successful” suicides (and wow, I hate that term). For every death around 30 people attempt to end their lives. This is MASSIVE issue. (see Lifeline for more horrifying statistics https://www.lifeline.org.au/About-Lifeline/Media-Centre/Suicide-Statistics-in-Australia/Suicide-Statistics)

But we don’t like to talk about it, because those who kill themselves, or try to kill themselves are selfish. They are weak willed. People who attempt suicide are looking for attention. They are all sorts of negative things that  definitely do not encourage those struggling with suicidality to seek help.

Let me just make something clear. When I was meticulously plotting my own death in hospital I was not looking for attention. Quite frankly, that was the last thing I wanted. Also logic doesn’t come into it when you are suicidal. Although it is true that “suicide is a permanent solution to a temporary problem”, in the depths of despair you don’t think that way. All of your thoughts become warped. I truly believed it was my best option, and would be kindest to those I loved. Obviously, I was also, and this is really important, very very sick.

People who are well generally do not want to kill themselves. There is this thing called human survival instinct. Against the odds, humans want to survive. That’s why people fight and fight through terrible adversity and illness. We WANT to live.

People who decide that the best option for them is suicide are generally very unwell and urgently need help. I truly believe that if the issue wasn’t so stigmatised, people may feel more able to ask for help when they need it, and perhaps unnecessary deaths could be prevented.

While I was in hospital I was afraid to tell the staff the extent of my suicidality. I was scared to tell them because the last time I felt suicidal I presented to the emergency department and was seen by a bored psychiatrist who said to me “You have a roof over your head. You have a husband. You have a baby. Why would you want to kill yourself?”

Yeah that made me feel great.

This type of experience, which is unfortunately, so very common for people with suicidal thoughts, just encourages stigma, and perpetuates the cycle. Different doctor, different place, but I was still scared of talking about how I felt.

I was really lucky though. I got the help I needed. I had a hospital keep me safe. Many other people aren’t this lucky. There are so many deaths out there that could be prevented.

But still, despite my feelings on stigma, I feel the shame. This is not something I will ever discuss, even with those closest to me. It feels like a dirty aspect of my life that I wish I could change, and this post feels like a confession.

I hope that one day I will be able to accept myself, and my experiences. I hope that I will learn to stop the self stigma. I hope that one day society will be able to talk about the issue that is killing so many people.

The Medication Police

Every Saturday morning I  trudge down to the local pharmacy where my Pharmacist doles out my medication for the week. If I don’t take my medication or, presumably, don’t show up, my mental health team are called. At nearly thirty years old, as a mother and PhD candidate I can’t be trusted to take my own medication. There is an interesting story about that.

When I was first released from the hospital I had a team of mental health nurses visiting daily. One of the nurses, Lynda, was a middle aged, extremely chatty woman who said “fuck” a lot. You couldn’t help but like her. After two weeks I knew everything from the miscarriages she suffered as a young mother to the details of her menopausal symptoms. Her chattiness suited me as it meant I didn’t need to talk much.

One day she asked to take a look at my medication. Obediently, I went and got The Box: a large metal container housing all of my medications, which the Hubster occasionally took it upon himself to lock if I was in a particularly dour mood.

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“Hubster. Seriously. I’m having a bad day – I’m hardly going to kill myself.”
“Yeah well. This makes me feel better about things.”
“You know if I REALLY wanted to top myself I could just go and buy a load of painkillers, right?” I tried to reason with him.
“You can’t drive at the moment.”
“Ok. Well. You know if I REALLY wanted to kill myself I wouldn’t take pills.” I tried again.
“Why not?”
“Because overdose is a particularly risky….Gah! Why are we even having this morbid conversation?! The point is, I am allowed to be sad sometimes. I am allowed to cry. It doesn’t mean I am suicidal. And I don’t need to be treated like a child.”
“Ok. But I’m still locking the box.”

So it seems I have some trust to build.

Anyway, Hubster wasn’t the only one mistrustful of my intentions. Back to The Box. Lynda was half impressed, half horrified by the contents of The Box. My seventeen or so medications where in there, neatly organised by Hubster according to dosage and coded by expiration date.

“I’ve never seen anything like this! This is…shit…this is ORGANISED!” she exclaimed, pawing through my stocks.
“Yeah…Hubster did it because of the ECT…I kept forgetting what to take.”

“You have FOUR packets of Oxycontin in here”.
“Do I? Well at least I won’t need any more in a hurry…”
“Bloody hell. You must RATTLE,” She interjected.

“I guess?”
“Drake will have to see this!”

Now Drake I had heard a lot about. He was the head pharmacist at the State Psychiatric Facility, and the nurses tended to swoon about him. “Drake is so NICE”. “Drake is a LOVELY man.” Yes. I had to meet the famous Drake.

So the next day Lynda appeared with Drake and what appeared to be his small entourage. I was a little confused as to why the head pharmacist of the state wide psychiatric institution was sitting in my living room commenting on my medication, but hey, he seemed  impressed with The Box, telling me he was going to tell his other patients to organise their medications in a similar fashion. Hubster would be chuffed.

But suddenly there was some sort of intervention.

“You know we can’t let you keep all of this in your house, Rachael.” Drake said.
“Erm. Well. I’ve paid for it so -”

“It’s too much of a risk.” Lynda joined in. The rest of the entourage nodded.

“A risk? Well. I’m not suicidal. And besides,” I said, pointing at the lock, “Hubster can always lock it if needed.”

“We just don’t feel comfortable with you having this amount of pharmaceuticals in your home. You’re a smart girl. If you wanted to get in there you could.” Lynda pointed out.

“l hardly think so…I need Hubster to get the lids off jars for me. Besides, I’m not planning on being suicidal, so I really don’t’ think it’s an issue -” It would be far easier to just buy some more rather than getting all super sleuth and picking locks, I thought. But I didn’t say that as it would be marked down as “has a plan”.

“I’m sorry. But we really think it is best if we take this all to the pharmacy. They can give you your meds on a weekly basis.” Drake said.

“Hang on a sec! You were just saying how good and organised it was, and how you were going to tell your clients to manage their meds.”

“Yes, but most people don’t have the sheer amount of medication you do. And they don’t usually have multiple packs of high schedule painkillers and boxes and boxes of sleeping pills…aside from anything this is all highly addictive stuff Rachael.”

Well you were the ones who put me on it! I felt like shouting. But I didn’t. Because that would be marked down as “being unreasonable.”

So, obediently, I went down to the local Pharmacy with Lynda and handed over all of my medication bar my weekly doses and a few PRN, to be doled out every Saturday.

“I’m proud of you Rachael.” Lynda told me as we left. “Many people feel anxious about giving up their stockpile…their “emergency stash” Do you want a PRN Lorazapam to take the edge off?”

Bang. Head. Against. Wall. It wasn’t a stockpile. It wasn’t my “emergency stash”. I wasn’t intentionally collecting the medication that was prescribed to me.  It’s not my fault that I am on seventeen different frigging medications. I am NOT suicidal. I CAN be trusted. 

I didn’t say any of that though. Because that would be marked down as being “emotional.”

So instead I said. “Yeah. Well I guess it’s for the best. Lorazapam? Why the hell not.”

So every Saturday I show up to collect my weekly supply. I can’t take too many, I can’t take too few. The medication police are surely on my case.

I know my past. I know people want to protect me. I know there is probably some “Cover Your Arse” legalities out there that prevented me from keeping the medication. I know Hubster is scared of losing me.

But I hope that I will be able to gain back the trust of others some day.

Jail Break Version 3.0

It was less than 2 weeks after being discharged from The Dungeon that I ended up rehospitalized in the states psychiatric facility. my ‘Hospital in the Home’ nurses took me down to triage and I before I knew it, I ended up being admitted to an open mixed gender ward.

But I was on a path of self destruction, and the staff knew it. i can only remember snapshots of my time on the ward. The nurses caught me in the corner of my bathroom, a pair of leggings wrapped around my throat and my eyes bulging. So my clothes and shoes were confiscated. I was given a tear proof canvas sack to wear and moved to a single observation room with a camera in it. My sheets were made of tear proof canvas as well. I could only use plastic silverware.

Somehow I managed to get hold of a biro, and used the lid to gauge deep gashes into my thighs. Once again I was found out and this time was enough. I was moved to the locked “Psychiatric Intensive Care Unit” next door.

My first thoughts, when I arrived on the new ward were to escape. I had a brief Jurassic Park Moment where I attempted to climb the tall escape proof fence. Escape version 3.0. The nurses didn’t even bother trying to catch me- this fence was truly escape proof. Today was the day I ended up with a forced injection in my bum. I fell asleep, and woke up on ‘special’, where I had my very own nurse follow me around all day and all night.

I have never been so self destrucive. I didn’t care. Weeks later I look at the scars all over my legs and arms and think…why? What was it worth?

Now I carry scars I will hold forever. Scars to remind me where I have been, and where I will never go again.

Four Weeks and Nothing to Show

Sometimes I feel as though I am on a crazy roller coaster, where I just can’t catch a break. I know it could be worse, but it could be better as well.

I am now entering my fourth week of hospitalization. The only difference is that for the most part my diarrhea has stopped, and for the most part my psychiatric symptoms are worse.

Yep. Worse.

I had suicidal ideation when I was admitted. I now have voices telling me to kill myself. I was depressed when I was admitted. I now feel very little at all. I had psychosis when I was admitted. I now have trouble telling reality.

Doubtlessly, my psych symptoms are worse because of the steroids I have to take for my gut. I have no option. There is no luxury of medication choice. It is the steroids or nothing. The effect they have on me psychiatrically extends my hospital stay. While I am in hospital I can’t access the nutritional changes I need for my gut to heal (steroids will tame the inflammation but not fix the problem)…THIS is an issue I will address in another post. So basically I am forced to ‘poison’ my gut with food that irritates it…the gastro team thus unlikely to reduce the steroid dose..my psychiatric symptoms remain extreme…and I cant go home.

I miss my little boy and my husband.

Fuck it all.

What the Dickens is Bipolar Disorder?!

Bipolar disorder is a universal mental illness. It doesn’t discriminate. People of all ages, nationalities and from all walks of life can experience bipolar. Perhaps this is due to the genetic component of the disorder. Scientists have identified several genes, including the Dysbindin, Neuregulin and G72  genes which when damaged contribute to Bipolar disorder. As such, bipolar tends to run in families, although episodes can be triggered by significant stressors, and in women, childbirth. It is estimated that about 1.1% of the population suffer from bipolar disorder

People with bipolar disorder are 50 times more likely to commit suicide than the general population. That is huge. The suicide rate for the average population is around 0.01%, in the Bipolar population it is around 13%. What’s more, nearly half of individuals with Bipolar disorder will attempt suicide at least once. Extreme depression and psychosis resulting from lack of treatment are the usual cause for suicide. IF YOU FEEL SUICIDAL PLEASE REACH OUT FOR HELP BY CALLING YOUR LOCAL EMERGENCY NUMBER OR PRESENTING AT A HOSPITAL EMERGENCY DEPARTMENT!

A bipolar depression is nothing less of horrific. Unlike Major Depression, often there is no apparent cause for bipolar depression. A bipolar depression can persist for months and may become so severe that psychosis results. Traditional anti-depressants used alone generally have little effect, and can even trigger manic episodes. Unfortunately, because many individuals affected by bipolar seek help during depression rather than mania (which may be enjoyable), they are often misdiagnosed with Major Depression and treated accordingly. Individuals who present with mania may be misdiagnosed with Schizophrenia. Consequently bipolar is one of the most difficult mental illnesses to correctly diagnose.

Symptoms of mania can include pressured speech (or talking REALLY fast), racing thoughts, needing less sleep and not feeling tired, grandiose beliefs (for example, I started to believe that I was superior to everyone else because I didn’t need sleep to function but they did), and general euphoria. People may become impulsive (e.g. spending lots of money, quitting their job) and promiscuous.  But there is a dark side to mania; during a manic episode people can quickly turn irritable and even aggressive. They may experience hallucinations and delusions.

Sometimes individuals experience mania and depression at the same time, for example, a deep depression fueled with energy. This is termed a ‘mixed state’ and is one of the most dangerous psychological states to be in.

Bipolar is generally shuffled into three types: Bipolar Type I, Bipolar Type II and Cyclothymia.

Bipolar Type I is often referred to as the more ‘severe’ disorder in that individuals in that people’s  high’s tend to be higher, and they are more more likely to experience psychosis and be hospitalised.

In Bipolar Type II the high’s are less severe and are termed hypomania. While the mood, cognitions and energy is still elevated, there is no psychosis, and usually little need for hospitalisation. However, depression can be crippling in those who experience Bipolar II, and affected individuals are more likely to rapid cycle between episodes.

Cyclothymia (or ‘Bipolar Lite’ as Stephen Fry once described it), is a milder of form bipolar where individuals experience mood swings from mild depression to emotional highs chronically over many years.

A Mixed State

 

 

I just couldn’t stop moving. I tossed, I turned, I paced, I jittered. I got up in the night to pace. I wrung my hands and jogged my legs and drove everyone around me up the wall.

“Stop! Tell me what’s bothering you.” Hubster would say. “I don’t know!” I would reply.

“Stop! Take some deep breaths and try to keep still” My doctor would say. “I can’t!” I would say, before pacing around the room again.

It had begun about a week before I was admitted to hospital, and it was unlike anything I had ever experienced before. In my experience, depression is accompanied by lethargy. A complete inertia and apathy towards life itself. You don’t want to *do* anything when you are depressed. Merely getting up in the morning is a mammoth task.

But this wasn’t like that. I was acutely depressed. Suicidal. Hopeless. Yet, for the life of me, and despite the plethora of psychoactive medications I was offered, I just couldn’t stop moving.

I was moved to the most secure room on the ward. The bathroom door had a peep hole. This disturbed me. Though looking back the peep hole should have been the least of my concerns. Under ‘special’ supervision a nurse was required to be present every time I used the bathroom anyway. Although I was admitted to hospital as a voluntary patient, I was informed in no uncertain terms that if I were to attempt to leave the premises I would be sectioned under the Mental Health Act.

One morning I woke up to find three nurses conducting what appeared to be a sweep of my room. “We’re just giving your room a bit of a clean” they told me. “Umm, okay then” I said. I didn’t really think much about it until I had my shower and wanted to dry my hair. My hairdryer was gone, and when I questioned the nurse about it she told me it was for my own protection. On closer inspection I noticed that all my power cords were missing as well as my shaver, scissors and nail clippers (ok fair enough), dressing gown cord (lethal weapon there…) and my shoes (seriously?!). Hubster later told me that women’s bra’s are often removed in institutions. How he knows this I’m not entirely sure. Thankfully my underwear was left safely in my drawer. Small mercies!

Although I understood that the hospital was taking my safety into their own hands, I wasn’t entirely sure why. I mean, I knew I was suicidal. I knew I was severely depressed. But most of the other women in the ward were depressed. Yet they didn’t need a special room, or 24 hour supervision. They were allowed to go for walks alone, and wear dressing gowns with a cord. On a few occasions I felt angry about this perceived inequality, sometimes I felt upset. But mostly I was so depressed that I just didn’t care. I didn’t care that my rights, dignity and privacy had been taken from me. It just gave me one less thing to think about.

All of this happened well over a month before the manic episode that confirmed my diagnosis of bipolar disorder. But at this point in time the doctors were already suspicious that I had bipolar. You see, somewhere in between mania and depression there is a strange phenomenon clinically termed a ‘mixed state’. You have symptoms of depression and of mania at the same time. The agitation of mania without the euphoria. The chronic low mood of depression without the apathy. A mixed state is one of the most dangerous psychological states to be in, and many suicides associated with bipolar disorder occur during a mixed state. Somewhat ironically, the lethargy that accompanies depression acts as a  kind of safety net. A depressed individual may simply not have the energy to execute a suicide attempt. During a mixed state individuals are seriously depressed, but fuelled with energy – a deadly combination.

What I know now is that I was experiencing a mixed state, and this went on for many painful weeks. No amount of anti-psychotic or anti-anxiety medication dampened my agitation. No amount of anti-depressants lessened my depression. I barely slept, despite the copious sleeping pills I was offered.  My son was almost exclusively cared for by the nurses and my husband. To this day I have very few memories of this point in time and rely on my doctor’s and husbands recollections of how I was.

A mixed state is such an appropriate term. Because I really was mixed up, and I really was in a state. I was experiencing symptoms of depression, mania and psychosis all at the same time. I couldn’t explain my past and I couldn’t think about the future. I wanted to live, but I wanted to die. I wasn’t sane but I wasn’t crazy.

While I was in hospital I marvelled at my baby boy’s development. I watched him pull himself along on the floor, start to crawl, and finally pull himself up to stand. And as is the way of things, the mixed state passed, and transformed into something else completely. I was taken off ‘special’ supervision and onto 15 minute checks, and then half hour checks, then hourly. Soon I even got to go for walks, and was moved to a different room (without a peephole!).  Then finally, like my son, and with the encouragement of Hubster and the medical staff, I reached up and stood on my own two feet.