I feel mixed about #BellLetsTalk today. Is it a start? Yes. Is it enough? Hardly.

We need a lot more than just talk. We need practical ways to support one another through times of crisis. We need to teach people emotional coping skills (preferably as children). We need actual answers to why our brains sometimes go off kilter. We need medication that isn’t just a guessing game and that so often comes with heavy negative side effects.

I’m not the only one I know who feels frustrated hearing “if you feel suicidal, reach out and talk to someone.” Friends and family can only do so much and find it very frightening and overwhelming. And crisis lines and emergency psychiatric services aren’t much better. Generally you get held until the intensity of the moment passes and you’re sent home, maybe to follow up with your GP. You’re alive, yes, but the root of the problem hasn’t gone anywhere and you might be less likely to reach out next time if you feel there is no hope of actually feeling differently, not just being forced to stay safe.

There isn’t a whole lot that can be done to get to the root of why some people feel suicidal so often (or even just occasionally) unless we have more funding for research and adequate treatment. Far too many people are given 6-8 weeks with a therapist or psychiatrist and that just doesn’t cut it.

The wait list for DBT (the recommended treatment for Borderline Personality Disorder) in Hamilton is now over a year long. And while DBT services are expanding, its not nearly quick enough for the number of people being diagnosed and referred to the treatment. It is available in just a handful of cities, meaning hundreds if not thousands of people who would benefit don’t even get a chance. For someone who is acutely in crisis, suicidal, impulsive, behaving dangerously and feels like life is intolerable this is NOT acceptable. We need funding, and that doesn’t come from just talking about mental illness.

Bell Let’s Talk seems to focus on anxiety and depression. Yes, we need to talk about those – but we also need better understanding of schizophrenia, eating disorders, bipolar disorder, personality disorders, and so many more. And we need to understand the complexities of mental illness, abuse, addiction, poverty, gender and race. It’s not just rich white people who struggle. And far too often the people who need treatment the most can’t afford the costly private services available and have to wait on the long waitlists.

I am so grateful to have what many others don’t – a support system I can fall back on, a net to catch me when I need it. And the resources to pay for the treatment I need (with the support of my family). What about those who don’t have either of these things? How can we expect them to reach out if we’re not reaching back?

Ultimately, awareness campaigns like Bell’s leave me desperate for so much more. My friend Kathleen said it best, “No one should have to bombard social media with free advertising for a corporation to get basic health care from our government.” Mental health care is basic health care and we need to start providing better services now, and that takes more than just talk.

If You Feel Too Much

Jamie Tworkowski, founder of TWLOHA

If you feel too much, there’s still a place for you here.
If you feel too much, don’t go.
If this world is too painful, stop and rest.
It’s okay to stop and rest.
If you need a break, it’s okay to say you need a break.
This life – it’s not a contest, not a race, not a performance, not a thing that you win.
It’s okay to slow down.
You are here for more than grades, more than a job, more than a promotion, more than keeping up, more than getting by.
This life is not about status or opinion or appearance.
You don’t have to fake it.
You do not have to fake it.
Other people feel this way too.
If your heart is broken, it’s okay to say your heart is broken.
If you feel stuck, it’s okay to say you feel stuck.
If you can’t let go, it’s okay to say you can’t let go.
You are not alone in these places.
Other people feel how you feel.
You are more than just your pain. You are more than wounds, more than drugs, more than death and silence.
There is still some time to be surprised.
There is still some time to ask for help.
There is still some time to start again.
There is still some time for love to find you.
It’s not too late.
You’re not alone.
It’s okay – whatever you need and however long it takes – it’s okay.
It’s okay.
If you feel too much, there’s still a place for you here.
If you feel too much, don’t go.
There is still some time.

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I held an atlas in my lap
ran my fingers across the whole world
and whispered
where does it hurt?

It answered
everywhere
everywhere
everywhere.

– Warsan Shire, from “What They Did Yesterday Afternoon”

As I wake to the news of the election results in America, I pray these words with heartache and hope.

God of the universe who holds all things together:

Let us be instruments of peace.
Where there is hatred, may we bring love.
Where there is hurt, may we forgive.
Where there is doubt, may we bring faith.
Where there is despair, may we bring hope.
Where there is darkness, may we bring light.
Where there is sadness, may we bring joy.

May we seek to comfort rather than to be comforted;
to understand, rather than to be understood;
to love, rather than to be loved.
For it is in giving that we receive.
It is by forgiving that we find forgiveness.
It is in death that we find new life.

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Prayer written by Saint Francis of Assisi

How can I sleep when I can’t trust my own mind?

It takes me down dark paths, wandering into woods I know I’ve been lost in before.

The constant questing, nagging, demanding fear is this: what if I’m wrong?

What if what I think will help me only makes things worse?

What if this attempt for peace of mind is really just a desperate plea for attention, for a demonstration of being loved?

Am I worth the concern that others show for me when I struggle most with my illness?

Am I just escaping my responsibilities by curling back into illness or I am actually challenging this illness with the hope for better treatment?

Aspects of hospitalization feel addictive – the safety of being surrounded by people, checked on every 30 minutes to ensure I’m not doing something to harm myself.

Nearly every trigger and method of suicide removed, a near risk-free environment.

Pressure to be productive and responsible and healthy all eased.

An enforced and regular schedule of meals and sleep, all without the challenges of cooking and tidying.

And of course, the outpouring of concern from friends and family.

But what is the cost?

Loneliness and boredom and too much time to think.

All the negative judgments of myself find evidence to support themselves.

I could curl up in this darkness, and just… stay.

Will being here really help me create long-term stability or is this just the start of another cycle of regression?

Am I actually ill or is this all in my mind?

A recent conversation with a friend led me to describe a technique Kathryn and I use regularly when I’m feeling overwhelmed. It is especially helpful when I experience the kind of panic that leads to racing thoughts and quick shallow breathing.

Often this feeling will race out of my body in frantic movements. I might rush from room to room with no purpose, fling pillows and blankets around on the bed, squeeze my eyes and fists and chest as tight as I can, hold my breath until I am desperate for air and start hyperventilating, or flail about in other unpredictable ways. Sometimes I’ve even acted in destructive or intimidating ways because of the rushing surge of panic that flows through me, and of course, this leads to greater problems in the long run.

This is, quite logically, distressing for Kathryn to witness. One time when feeling this way, I stood out on the balcony of our old apartment during a massive storm and let the wind and rain and thunder swirl and panic with me. The image of the wind blowing through the open door behind me and swirling around Kathryn too helped me understand just how this chaos spreads from me to her.

The chaos flows through us both.

She gets overwhelmed by a rushing desire to help me calm down, to ‘fix’ what I’m feeling.  And so she offers solutions – try ice, cold water, let’s go for a drive, just sit for a second, put lotion on your skin, play piano – on and on. She lists mindfulness skills that often help but seem useless to me in these moments. All she wants is to help us both settle, to prevent further escalation, and to begin the process of problem solving the source of the emotion. The real trouble, though, is that in these most frantic moments I seem to lack the ability to grab hold of a coping skill and stay focused. And her hurried attempts to help me calm only heighten my sense of anxiety. As I watch her begin to feel the chaos, guilt only increases my panic further.

And then about six months ago, she came up with a new idea seemingly out of nowhere. “Blow up a balloon.” That’s all she said and then she started doing it herself, imitating the kind of inhale and exhale one would use to inflate a large balloon. She has told me to take deep breaths many times before with little improvement to the sense of panic or my breathing, but somehow this clicked.

Just blow up balloons.

I don’t have to solve the current problem that is leading to the panic. I don’t have to convince myself to feel differently. I don’t have to focus on relaxing muscles or consciously slowing my breath. I just have to blow up balloons. I just have to imagine a balloon in my hand, and try to blow it up. My initial attempts are usually meagre at best, hurried little puffs that would do little to inflate a balloon. But then I take a deeper breath in, and blow again… and then again… and again.

And if I start to turn back to the panic, we just say it again. “Blow up a balloon.” I tell Kathryn the colour. I imagine the shape and how it would feel against my fingers, my lips. I get to the point that my inhaled breath is massive, deep into my belly, and my exhale is long, slow and forced through pursed lips. I feel my chest rising and falling with my breath, and as if by magic, my body and mind begin to calm too.

Calm.

As these balloons get bigger, I relax my breath – the sense of hurry leaves, and I find I am now casually blowing up balloons, no longer as if in a race. The tension in my muscles reduces, my movements slow down, the storm in my mind begins to clear and usually at this point I become much more able to focus on those coping skills and problem solving skills that will actually help whatever situation is causing the sense of panic.

As I told my friend Rob all of this, I realized why the skill works so well. Blowing up balloons is such a simple concept – it’s so easy to connect to it, regardless of a person’s emotional state of mind. And it’s a visual activity, our minds can picture it even when we are just pretending. It doesn’t take patience or a great deal of focus (which is lacking in these moments of panic), and anyone who is being triggered by someone else’s panic can model it, helping themselves stay calm in the process.

Anyone can use it as a skill.

About a week later, Rob, who is a nurse, told me that he pulled over at the scene of a car accident and one of the drivers was in a state of shock and panic. He took charge of the scene, pointed at her and said “Blow up balloons with me!” and demonstrated what he meant. They did this together for several minutes as he assessed her injuries and they waited for the ambulance to arrive on the scene. And somehow, incredibly, it helped.

There is magic in our breath. Grab ahold of yours in a moment of panic. Just blow up balloons.

To feel understood in their pain,

For compassionate people who can truly listen,

For a real safety plan that reduces the vulnerability they and family feel,

For peace during the long wait for mental health services,

For the root of this pain to be addressed and not masked,

And endurance for the road ahead,

These things I pray.

A few days ago, I spent 24 hours in the ER due to a medication overdose.  It was a combination of feeling extremely impulsive and moderately suicidal that led me to swallow the medication. Extreme impulsivity often goes hand-in-hand with Borderline Personality Disorder, and I know it very well.

I quickly regretted it but also didn’t know what else I could have done in my emotional state that would have been better.  This is a scary thought because when I am calm and feeling well I can see a great many options that would have been better, but in that moment I felt blinded to anything else but the pills as a solution.

For those who have no idea what this kind of impulse feels like, I present an examination of an impulse. This is a description of what went through my head and the choices I made that led to the behaviour. Keep in mind this occurred after a few weeks of stressors and triggers building, reduced coping skills and growing severity of impulsive acts.

Sometimes I do have these impulses and I very successfully cope with them. Myself, my wife, and my therapist were all actively working to reduce the vulnerability and intensity and very aware of the growing concern, but it just was moving faster than we were. We had identified many possible impulsive acts, but it had not occurred (at least not strongly) to them or me that overdosing on my medication was one of them. I just didn’t think things were that severe yet.

I was alone at the time and it all took about five minutes. This may be painful to read if you know me well, but I am still sharing it in the hopes that you may grow in your understanding of what I and many others experience.

If you would rather not read the following because of a potential trigger for yourself, please consider skipping it. Here is a picture of my adorable cats, Gus and Elliot, so you can take a moment to choose if you should walk away (please do if you think you should!!!).

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“I need some water,” I think as I open the cupboard. I was not even thinking of overdosing at this point but I knew I was very stressed and impulsive and moderately suicidal. Moments ago I called Kathryn to tell her this and she is now on her way home. I have told her and myself that I can promise to be safe for twenty minutes until she arrives and I believe that I can be. Water at this point will very much help.

I notice the pills in the cupboard where the water glasses are, and the quietest voice in my mind thinks, “I could take them all.” Instantly I react with an internal firm “No.” I close the cupboard but I do not let go of the knob. I think I should call Kathryn. I don’t pick up my phone which is directly beside me on the counter. Sometimes I think I ignore these warnings because this feeling of being on the edge of impulsiveness can be kind of addictive, like an adrenaline rush, and this thought briefly occurs to me but I quickly ignore it because I don’t want to give up the feeling of adrenaline or the possibility of a solution to the stress I feel, even if I rationally know this version of a solution is extremely flawed.

I re-open the cupboard. I am still telling myself “No, walk away now.” I pick up the bottle, just to see how many are in it – which again I recognize as a signal to walk away and immediately call for help but again, I ignore it. Next thing I know the pills are dumped out on the counter so I can count them. This is almost like a ritualized behaviour that I have done before when I’ve felt impulsive about overdosing – I have still walked away at this point in the past, but it’s getting exponentially more difficult as the impulse and adrenaline build. It is a slow and methodical count, not a frenzied rush. I want to be accurate so I even count again. 76. I know if I do take them, the hospital will ask how many and I want to be sure they know I am not exaggerating. I am clearly aware of the consequences of this action but I still am not walking away.

I don’t know if I really want to be dead, but I think I do. I know I’ve felt this way before and it has gone away, I also know I’ve been very ambivalent about wanting and not wanting to die at the very same moment. I don’t know if this is more about impulse and self-punishment, and maybe alerting others to the danger I am in through a very risky action, or if it is actually about the chance that this could kill me. I think it likely won’t because I’ve done it before and I know a lot about the risks associated with my medication in overdose, but I realize I am playing with fire. These thoughts are not so much conscious words in my head, but I am very aware that this is now a very serious situation.

“I could pick up a few,” I think. I feel the weight of five in my hand, then add five more, and two more and a few more after that until I have 25. I shift them around a bit, consider the size of the handful and wonder if I could swallow them. I am hoping my phone will ring or Kathryn will walk through the door but I still don’t make a move towards walking away or calling for help. With my other hand I pick up a glass and get some water. As I do my hand with the pills moves slowly toward my mouth. The pills are in my mouth and I think, “I could still spit them out. Do I really want to do this?” I avoid imagining what will happen next and I swallow them with water. I feel a decent amount of regret instantly but also some pleasure that comes from the adrenaline of taking a very big risk. I begin slowly counting out 25 more, even though I am incredibly aware that it would be better to stop now. The same thing happens with these 25 and I only now start to grow scared that Kathryn will “catch” me. I quickly pick up the rest with next to no regret or concern for the consequences, shove them in my mouth and swallow.

Panic sets in but I force it away and start thinking about how I will cover up what I did or if I should be honest immediately with Kathryn. I want time to decide, so I put the bottle back, behind her medication so that she is unlikely to notice that it is empty if she happens to open the cupboard, and I go into the bathroom to stare at myself in the mirror.

The look is a mixture of terror, shame, hatred and yes – even pride. I feel courageous at the very same moment I feel overwhelmingly stupid, ashamed, regretful and worried. I consider trying to throw up but that has never gone well for me in the past. I start to run a bath so I can “relax” and appear normal, and have some private space when Kathryn gets home, so I can decide what to do. Having a bath will appear to her like a very skillful thing to be doing so she will be less suspicious of whether I was impulsive. She arrives home within 5-10 minutes and we talk briefly. I know I sound depressed and suicidal, I know she can tell in my voice and demeanour that everything is not okay, but I hope she just thinks it is because I feel like crap and not because I did something.

About ten minutes later I look at her with an honest and scared expression and I can see that she instantly knows I did something bad – we’ve been through this before. I quietly say, “I took all of my pills.” I see the split second moment when she wonders if she heard me correctly and then the fear, panic and even a bit of anger. At first she asks if I am lying, but very quickly she can tell by my behaviour and expression that we are about to be on our way to the hospital…

Obviously this is riddled with examples of distorted thinking and opportunities to intervene. One thing I’ve learned from writing this examination is that I should very strongly consider saying “No, walk away now” out loud, very firmly, even if I am alone.  If it feels too hard to give up the plan altogether, delay as much as possible to give more opportunity to call for help or take very small steps away from the plan in the hopes that it will get easier to move away further.

Delaying for me would look like listing all the states I can think of, naming every city I have ever been to, recapping the plot of a funny episode I’ve seen recently out loud to myself. Any emotional delaying (crying or really imagining the consequences or even noisy but kind of anxious yelling) could make things worse, so it has to be calm, based on memory, and something that can involve a lot of unemotional detail (i.e. cognitive distraction). I may not move away from the pills or put them down doing these things, but it’s more likely Kathryn would have arrived or I would have slowly reached for my phone.

For the next several months and maybe ongoing for as long as I’m on medication, I will be given a very small supply of my medication by the pharmacy, as my doctor is very aware of the risks and is incredibly supportive without being punitive. And Kathryn and I have agreed that at least for the next few weeks, maybe longer, the pills will stay in her purse. If she isn’t home, they aren’t home. I only need them at bedtime and it would be extremely rare that she is not home then, and she could always leave one or two if necessary.

The reality is that I will never be able to eliminate all potential triggers and risks for impulsive acts – but absolutely the more safety measures we can put in place, the more we recognize a growing impulsivity, and the quicker I choose to help myself or ask for help, the less likely it will be that I make a decision I will deeply regret. And I absolutely, deeply regret what unfolded on that day.

“Put down the weight of your aloneness and ease into the conversation… all the birds and creatures of the world are unutterably themselves. Everything is waiting for you.” 
– David Wyte

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(Photo Credit: Brandon Mitchell)

I got to be near some pigs that were “unutterably themselves” this weekend.

I watched them cool themselves in some pretty nasty mud. I watched them root through fresh straw. I fed them corn cobs and scratched their heads and even grunted a few replies to their curious questions. I marvelled at their long eyelashes and the density of their bodies and how fast they could run in circles. I laughed and turned away disgusted as they shit and pissed right there in front of me.

I loved these pigs a little bit this weekend. I loved them even though we are so different, even though our interaction was so limited. I loved them because they showed me something I didn’t know, or maybe had just forgotten.

Along with these pigs were the dogs and the chickens; the gardens and the grass; the lake and the rain; the ants and the mosquitos; the sun and the sky – all reminding me of the hope and resiliency of creation,

the hope and resiliency of God in creation,

the hope and resiliency of creation in me.

Here is the question:

“If you really knew your own worth, if you knew you would not fail or be judged, what risks would you take?”

The following is my response:

Be bold. Speak life and light into our personal and collective brokenness.

Admit. Own and apologize for when I’ve been mean, hurtful, racist or selfish. For when I’ve judged another person, and assumed less about them than who they truly are.

Reconcile. Seek and offer forgiveness. Seek and offer grace. Seek and offer peace.

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