Friday 22 January 2016

A Life Lost

I have written the below with consent from Stephens' mother:

This isn't my first time discussing the mental health services in our country, but sadly today I am not writing on my own behalf.

On Friday the 15th of January Stephen Byrne attended Beaumont A&E to seek medical assistance. He was 20, a devoted father and suicidal. A few days prior, he had attempted to hang himself multiple times while in police custody; at that time he was brought to the Mater but was released. Despite informing staff at Beaumont of his intent to commit suicide, he was discharged. The only help he was offered was that his file would be sent to his clinic in Ballymun.

On Tuesday the 19th of January Stephen went missing; his body was discovered two days later, on his daughter's second birthday. To date, nobody from the Ballymun clinic has made contact with Stephen's family.

As anyone with mental health difficulties knows, asking for help when you are at your lowest is incredibly difficult. It takes unbelievable strength to fight your own mind and reach out. This is especially true for young men, as historically our country has stigmatised those with mental illnesses as weak or failing in some way. Men are statistically less likely to seek treatment for mental health issues, but they are four times more likely to die by suicide then women. Yet, when a young man found the courage to walk into an A&E department he was turned away, with devastating consequences.

I know all too well the pain and desolation of reaching out when all you want to do is die, only to be dismissed and invalidated by the very people who are supposed to offer aid. It might sound histrionic to some, but they might as well help you to step onto the ledge.

After my last suicide attempt, as soon as I regained consciousness I was discharged from Beaumont A&E without ever speaking to a doctor, let alone a member of the psychiatric team. I know a young woman who just last week attempted suicide inside the hospital grounds, and was simply patched up and sent on her way. I know that there are many people with similar accounts, especially those with a history of self-harm or suicide attempts. This is because certain hospitals, as a result of overcrowding and staff shortages, have a policy whereby patients who present more than a handful of times with self-inflicted injuries, including suicide attempts, are no longer referred to the psychiatric team for assessment. We are seen as a waste of resources.

This is not just a local issue, across the nation there are thousands of people waiting for referrals, many of whom will have to travel for hours for an appointment as a result of hospital closures. In some areas the wait for a psychology referral is two years. In 2014 nearly 3000 children and adolescents were on waiting lists for psychiatric referrals and children are routinely admitted to adult psychiatric units.

As a country we are finally starting to break the draconian cycle of shame and secrecy that surrounds mental illness, but our mental health service remains inadequate, underdeveloped and underfunded. The government and politicians are quick to promise change and reforms, but while we wait for them to turn words into actions more and more lives will be lost. Sadly any improvements will be too late for Stephen, his family and his little girl Ava.

Stephen Byrne asked for help and he was rejected; someone decided he was not important enough for their time, their care or their compassion. At what point does someones life become dispensable? Who are we supposed to turn to if our own healthcare system deems us unworthy? They tell people suffering from mental health difficulties to ‘speak up’; to talk to a professional; to not suffer in silence. They ask for our trust, and then break it. Ask yourself, if you were living in hell; if you were in so much pain that you would take your own life to escape it, would you put your survival in the hands of an institution that will likely make your life even more unbearable?

Tuesday 19 January 2016

You're Too Pretty

A combination of sleep deprivation, anxiety and a sudden drop in my already low mood are impairing my cognitive functions, and one unfortunate consequence is that I have been finding it impossible to write. I can barely remember what I did 3 hours ago, so describing the next phase of my treatment is unfeasible. The irony is, writing is one of the positive coping strategies I use when in distress. I would sincerely like to not be defeated by my own mind, again, so I am going to deviate from my biographical timeline and write about something a bit easier. I apologise in advance for all grammatical errors, I've been up since 2am.

As I said before, I started self-harming at the age of 12. I don't know what made me try it for the first time, but over the last 19 years I have become something of an expert on the subject. To be clear, I am an expert about why I self-harm; you can't be an expert on another person's pain. We are the product of our genetics, our environment and most importantly, our life experiences; and as we are all individuals, everything we see, hear or experience is specific to us. Our perception shapes our reality, so in a sense, we are each living in our own separate universes. For example, have you ever received a text from someone and come to the conclusion they are being rude, that you must have done something to annoy or upset them. Maybe they only used one exclamation mark, or their usual winking face was missing. But if you ask them about it, they have no idea what you are talking about. Of course they aren't angry with you, it was a perfectly pleasant and friendly text. Then you feel like a bit of a jackass, because unless someone actually says something direct, it is almost impossible to determine the tone of a text. One text, two completely different experiences of it.

I realise I went slightly off point, but what I am trying to convey is that while I can (hopefully) provide you with some insight on self-harm, I can only truly understand how it affects me. There will be some overlap, but there is no 'one size fits all' answer. I have yet to find a situation where one size actually fits all, I'm currently wearing a pair of socks that claim to fit all feet, and yet my ankles are completely exposed to the cold air. I have once again digressed from the matter at hand, Lisa's guide to self-harm.

1. What exactly is self-harm?
Self-harm is when you deliberately inflict physical harm on yourself. There are a long list of behaviours that are used to self-harm such as cutting or scratching your skin; burning yourself; hitting yourself or banging your head; swallowing poisonous substances; purging or restricting(yes these are eating disorder behaviours, but are also used as a way of hurting oneself); driving recklessly etc. Someone might only engage in one of these destructive behaviours, or several. My weapons of choice are cutting, scratching, burning, purging and occasionally throwing my fist or whole body into a wall.

2. Why the hell would you do it?
Excellent question, sadly the answer is not so black and white. Self-harming is a coping mechanism, a negative one, but in the short term it is very effective. People self-harm for many reasons, and often in an individual it will serve more than one purpose. However over the years I have noticed that for most people it will serve at least one of the following functions:
- To punish yourself. When I feel worthless or stupid, or when I hate myself for being such a terrible daughter/friend/sibling, I feel like I deserve to be punished. I am such a terrible human being that I should suffer, I should be in pain, pain is all I deserve. I am so ugly inside that I have to make my outside ugly to. I have on one occasion been filled with such self-loathing that I stabbed myself in the stomach.
- Control. When you feel like completely powerless in life - your emotions, your past, your present are all spinning wildly into oblivion and you can't get a hold of them - your body is the one thing you hold dominion over. You choose to pick up that razor, or take those laxatives. In that moment, you are in control of at least one thing in your life. It's like a life raft you desperately cling onto to ride out the storm.
- Release. All that pain, sadness, anger or despair is trapped inside you causing you to be in such emotional pain that you would do anything to let some of it out. But either you don't know how or you're afraid that they are too big for you, they will swallow you whole if they burst through. Like a pot of boiling water that is just about to spill over, and at the last second you lift it up and lower the heat until it reduces to a simmer. Hurting yourself is the emotional equivalent, it brings the intensity down just enough so you can survive. The problem is, it is only a temporary reprieve. So you have to do it again, and again, to stop yourself from erupting. For me, when I feel like I'm being suffocated by my emotions, cutting is like taking a big, deep breath and allows me to breathe normally for a little while. I don't self-harm because I want to die, I am doing it to stay alive.

3. People who self-harm are attention seekers
*Deep breath* This statement usually touches a nerve with people who self-harm. A very raw nerve, but please read the entire paragraph before coming at me with verbal pitchforks. The truth is, sometimes people self-harm for attention. The problem is with the definition of 'attention'. When most people refer to someone as an attention seeker it is used in a pejorative way, like a bold child running around a restaurant screaming and embarrassing you in front of your friends. To seek attention however, is trying to get someone to notice you or take care of you i.e. you fall and injure yourself and you seek medical attention. So when I say that some people self harm to get attention, they are doing it because they are crying out for help and they are unable to or don't know how to verbalise it. If someone self-harms and tells you about it, or has to go to A&E, or tells you they are going to self-harm, it is not to manipulate you, they are simply asking you to see their pain and tell them how to stop it. They do it because they are terrified of their own thoughts and emotions and they are desperately trying to communicate with you, with anyone. It is a cry for help, not some childish attempt to become the center of attention. The rest of the time, we aren't going to tell you anything. Self-harm is our secret. Firstly, we may have problems but we aren't idiots. We are fully aware that what we do is not 'normal', and many of us are ashamed of it. We know what people think about us, about the signs in A&E that say anyone who presents with self-injuries is to be sent away, the stereotype of the angst ridden teenager brooding over bad poetry. Why on earth would we let ourselves be pigeonholed unless it was inescapable? Second, self-harming is our main coping strategy. When thing's get really bad, or if something happens that leaves us vulnerable or sends our emotions into a tailspin, one quick jab of a cigarette will calm us down. Yes, it's not an ideal situation, but we know it will always work, even if it's just for a few minutes. If we tell you, you will probably try and stop us, take away our safety net. So yes, sometimes a person will self-harm to try and get your attention, but it will usually be because their situation is critical.

4. You're too pretty to do that to yourself
The first time I tried to kill myself I had to go to A&E to get my wrists stitched. I was very distressed as the nurse was bandaging me up, and she decided to offer me the following advice: "You're far too pretty to be doing this to yourself, so you just stop that now, okay?". I was so stunned I immediately stopped sobbing. I know she was trying to be kind, but what my face had to do with my mental state is beyond me. Over the years I have heard similar statements, 'You're too smart', 'You're too old', or my personal favourite, 'You should know better'. However well meaning, these are all ridiculous and unhelpful things to say to someone who uses knives to get through the day. I am neither an imbecile or a petulant child to be chastised or coddled. Mental illness does not know my age, race, sex or how wonderful I am at baking. My depression doesn't give a shit if I work hard, or spend my holiday's volunteering as an aid worker in a war torn country(I don't but you get the point). Try and imagine what it would take for you to pick up a piece of glass and tear at your own skin. And then imagine being told to 'snap out of it' or 'cop on'. It would probably make you feel like shit, and when you're down that low, you're an expert at making yourself feel like shit.

5. Don't stare
This is nothing more than good manners, it's rude to stare. Just because it looks like I went a few rounds with Edward Scissorhands, doesn't give you the right to look at me like I'm a sideshow freak. When your scars are visible it is incredibly difficult to not feel embarrassed all the time. When I started self harming, and even in my twenties when I did most of the damage to my arms, I didn't think of scars. You can't think of something so practical when your mind is imploding. I didn't know I would spend the rest of my life literally wearing my depression on my sleeve, because most of the time I didn't believe I had a future. I spent so much time hiding them, so much time being ashamed of my body and what I had done to it. I still cry sometimes when I look at what I have done to myself. But I am trying really hard to not feel so uncomfortable in my own skin, to not hide my battle scars from the world, so please don't make it harder. I can't speak for anyone else, but I would rather you asked me what happened than pointed me out to your friend on the Luas and eyeball me with horrified expressions. My scars might be ugly, but they are part of who I am. I wish I had never self-harmed, but I did, and without it I wouldn't be here right now.

I can't tell you I go out into the world every day, proud to be me, scars and all. I can't even say I do it once a week. But I am trying to see them for what they really are, proof that I went through hell and I am still here. That's what they are for all of us, because if you're reading this, you're still here and that's pretty damn impressive.

Wednesday 6 January 2016

Treatment Part Two

In January 2015 I entered a private residential facility for treatment of my eating disorder. After a lengthy assessment with the consultant, I was diagnosed with EDNOS - eating disorder not otherwise specified. Another ridiculous sounding disorder, bloody psychiatrists. Basically, I engaged in behaviours attributed to bulimia and anorexia nervosa, but didn't tick enough boxes on either side to fit neatly into one box. Boxes are very important to most mental health professionals; once they can give someone a definitive diagnosis they can use the 'one size fits all' treatment plan that has been recommended for that disorder. I have found this to be particularly true of private psychiatrists; you stop being an individual and are completely defined by your diagnosis. You are no longer Lisa, a 30 year old woman with unique life experiences, beliefs or feelings; you are Borderline Personality Disorder and everything you say or do is because of it. You don't hate the taste of mushrooms, you are anorexic(I'm not exaggerating, I had to have 3 meetings in hospital in order to have 'no mushrooms' written on my chart).

When I entered the facility in January I was terrified, but I also knew that I needed help. For me, there is always a conflict between what I want and what the eating disorder wants. It is not as simple as asking for help and embracing it; my eating disorder had become the one thing I could depend on in my life. When everything around me, and inside me, was spiraling out of control, I would use food and weight to anchor myself to the world. So while I voluntarily agreed to treatment, a part of me wanted to cling to my ED, because I was afraid of what would happen if I gave it up. Better the devil you know...

The first priority in any ED programme is to feed the patient, a starved body and mind is not able to engage in the therapies used to treat the psychological side of the disorder. That first day, it took me an hour and a half to eat my half portion of dinner. With every morsel that passed my lips the ED voice grew louder and louder. The rage, disgust and shame were all consuming; I remember nothing else of my first week there. During the day we would have group sessions - Art therapy, craft groups, CBT based groups, nutritional therapy, interpersonal therapy etc; and in the evenings we had weekly individual therapy sessions. Any free time between groups and meals was spent in a communal living room, hiding away in your room was not permitted. Bathrooms were locked for an hour after meals, condiments and spices were restricted, as was liquid intake. We were weighed twice a week, had our bloods checked daily at first and then twice weekly, and we were not allowed to leave unsupervised until the consultant was satisfied that we were committed to the programme.

My referral to the programme had included a detailed history and description of my diagnoses, and I had discussed my BPD during my initial consultation. However after about two weeks the consultant began to question, and eventually dismiss, the BPD diagnosis. The characteristics and behaviours I exhibit that are attributed to my BPD did not fit into the ED mold. So it was simply ignored, and I was now EDNOS. Unsurprisingly, I repeatedly stepped over this new line; and while my actions and thoughts were ignored in terms of my treatment, they had to be dealt with on a practical level. So for the 40 days I was in the facility, I never left the house unaccompanied or ate so much as a biscuit without a nurse present.

Some of the therapies proved quite beneficial to me and none more so than my individual sessions with a CAT therapist, whom I still work with. I met wonderful people, staff and patients alike. I gained some weight and my health improved. I self-harmed and attempted suicide, and on one occasion absconded. I learned about portion sizes, healthy diet and how to make banana bread. But when I was discharged, I returned home and immediately began to restrict again. Suddenly alone for most of the day, I found I didn't have the willpower, and if I'm honest, the desire, to eat without supervision. We had been taught to weigh everything we ate; on my first day home I dutifully weighed out 40g of porridge and cooked it with water. On my second day, I weighed out 35g. My third, I decided the bowl looked too full and threw several spoonfulls into the bin. And so on and so forth until there was no porridge.

My relapse occurred so quickly, and totally, that my depression worsened. I had let my family and friends down, I was a failure and I was weak. Worse, now I was a fat failure. There was nothing I could do, or was willing to do, to make amends with my family but I could do something about my weight.

Just like that, I was back at the beginning. Within a few weeks my weight was back to where it was before treatment, food and numbers were the sole focus of my life, and my depression pulled me lower and lower. I had been discharged at the end of February, and on the 31st of March I turned 30 and tried(poorly) to cut my wrists in a pub toilet. I had given up on myself and given in to the hunger and darkness.