WillSpirit!


∞ Where Mental Skills Heal Mental Ills ∞

A former physician writes about mental health and recovery using insights from life, science, and spiritual practice.








  • Red_Exclamation_DotDisclaimer
    • Dear Visitors:
      Although I trained and practiced as a physician, my background does not include formal instruction in psychiatry beyond basic medical education. This journal presents ideas about treatment philosophy, but must not be considered therapeutic advice. Abrupt changes in one's psychiatric medications can trigger profound cognitive, emotional, and physical symptoms, including suicidal thoughts and actions. Consequently, pharmaceutical agents should not be increased or decreased without supervision by a mental health clinician.

    • ON THE OTHER HAND, your brain belongs to you, and your opinion counts. If you decide that changing your medication regimen will serve your best interest, then I believe your providers have an obligation to help you try to achieve your goals. I want everyone to be educated about their options, and do what will be most helpful for themselves. No one should feel pushed around by dogmatic and/or limited viewpoints, whether those of psychiatrists, anti-psychiatry advocates, or myself.


Personality Problems & Self-Hatred After Childhood Trauma

Hieronymus Bosch: "HELL"

Almost a week has passed since I last posted something on the blog. I’ve been engaged in a pitched battle with some of my worst demons. Trying to survive. Living minute to minute. That sort of thing.

Seems like I should check-in with everyone. I haven’t the courage to look at my web-stats, but even though I’m sure the number of visitors is way, way down, I know there are several readers who do care. I want to reassure them I am still kicking, albeit less strongly all the time.

I’m pretty much out of ideas for how to get out of this pit, which mostly is one of very low self-esteem. I don’t mind the anxious, sad, and angry feelings like I used to. But I am sick of my personality and see little chance of change…

About half my therapists have been willing to give me the diagnosis of a personality disorder. Of those, at least two seemed to enjoy slapping me with that accusation. Of the ones who have held back, I suspect there has been a sense of not wanting to further lower my opinion of myself, or further anger me, or somehow make things worse. One psychiatrist said she thought there might be a difference between ‘borderline’ characteristics that are reactive and defensive, but not necessarily integral to the personality, and true BP disorder. That seemed like a nice way of saying that I sure look like someone doomed to eternal conflict with others, but maybe there’s a small chance I can improve.

One of my curses is being so self-aware. I can see all the hostile and counterproductive things I do and even understand why I do them, but I can’t seem to stop. I’m not someone who puts the blame on others or thinks that if only people around me would cooperate I’d be fine. I see myself do and say the most appalling things sometimes, and yet I have no more ability to redirect my actions than I would of turning a train running on a straight track.

The sad thing about so-called ‘borderline personality disorder’ is that it mostly results from childhood abuse. So you get rejected and mistreated as a child, then grow up into a confused and mistrustful adult who invites rejection and mistreatment. The only way I can manage self-forgiveness is to recognize that almost anyone who lived through a childhood as traumatic as mine would turn out just as badly messed up. Perhaps a few abused children escape without major personality flaws, but most suffer with rage, shame, and mistrust. I suspect close to half end up imprisoned, on the street, or dead.

So just surviving, remaining outside institutions, and having one close relationship must be counted as a kind of success. There was a time when I could point to my surgical career to prove I had beaten the odds. But time has mocked that victory. So now I just try to be OK with making it from day to day, sustaining a marriage, and continuing my efforts to improve. I think some would question how hard I try (“If you really wanted to change, you could”), but I know how many years I’ve spent in therapy, how many groups I’ve attended, and how many books I’ve read. I didn’t do those things just to piss off people who tried to help me. I really wanted (want) to improve, but somehow couldn’t get past all the obstacles. Just because I built the many of the barriers myself does not mean they aren’t there.

This was supposed to be a one-paragraph check-in to let others know I’m still alive and fighting. It ended up a rant on my current despair. I hope it somehow helps others feel less alone. At least I feel that way, even if all my readers have long since gone.

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Personality Problems & Self-Hatred After Childhood Trauma was published on August 26th, 2009 . 11 comments






What A Lifetime of Therapy and Self-Help Hasn’t Taught Me

AACA Cartoon

What does it take to transfer understanding in the rational part of the brain to the emotional part? The number of years I’ve spent in therapy, or support groups, is vast. Here’s a partial list of the therapy:

  • 15 sessions with a court-ordered counselor when I was sixteen.
  • 12 sessions with a PhD psychologist in college, after a suicidal gesture atop the campus bell tower.
  • 180 sessions with another PhD psychologist, who called himself a behaviorlist.
  • 20 sessions with a counselor in medical school, as I went through a divorce.
  • 24 sessions with a Jungian analyst.
  • 150 sessions with a psychiatrist during residency, who mostly had me talk about family-of-origin dynamics.
  • 250 sessions with a psychiatric nurse who specialized in recovery from child abuse
  • 20 sessions with a counselor who practiced sand tray therapy, among other things.
  • 2 psychiatric hospitalizations, of 12 days and 8 days.
  • 300 sessions with a psychiatrist who took me (again) through family-of-origin dynaymics
  • 100 days or so in intensive outpatient treatment.
  • 20 sessions or so with a social worker specializing in Cognitive Behavioral Therapy) CBT and mindfulness.
  • 12 sessions with a social worker specializing in Acceptance and Commitment Therapy (ACT)–ongoing.
  • Recent sessions with a social worker to deal with history of sexual abuse, and how damage from medication brings that up. (long story to be dealt with in another blog)

And here’s a partial list of the support groups:

  • Support group of medical students weekly for 18 months in medical school, then occasionally for 2 years.
  • Alcoholics Anonymous since 1987. Countless meetings.
  • Alanon since 1988. Countless meetings.
  • Adult Child of Alcoholics meetings weekly for one year while living in Manhattan. (These groups were often hard to take)
  • Adult Survivor of Child Abuse meetings weekly for two years.
  • An eighteen month intensive group therapy for child abuse survivors.
  • Numerous meetings, sporadically attended, of other 12-step programs (e.g., debtors anonymous, sex and love addicts anonymous, etc.)
  • Weekly meetings of a dual recovery group for 2 years ’06 to ’08.
  • Weekly meetings for people with a history of problems with prescription drugs, ’06-’08.

Now, you would think that after all that I would not spin out because my blog-stats dropped. But I did. So how do I take all the knowledge that I really do have about codependence, abandonment issues, self-esteem, acceptance, etc, and make myself well? How come it is so easy to know something with my mind but remain completely clueless in my heart? Is there anyway to transfer the knowledge? Can I build some kind of high-speed data connection between the two parts of my brain that deal with these things? (Aside: Don’t you just hate brain/computer comparisons?)

The only solution I can find is looking for improvement (‘progress, not perfection’ is what they say in AA). Yes, I did crash and burn about the web statistics, but I pulled myself out of it pretty quickly. I was even able to see the humor in my response. That is much better than ever before. What’s more, I opened up about what was going on with me, reached out for help, and was rewarded by many kind messages from those who’ve been reading my posts. (And this was true even though I’ve only been doing this with any regularity for 3-4 weeks; a real testament to the kindness of those who read mental health blogs.)

Thus, I look for signs that my emotional skills today are more honed than yesterday. But I am still puzzled about why I’m so dense. Therapy ‘should’ help the emotions. The unconscious ‘ought’ to learn, but mine obviously did not. Or maybe it sometimes learns, but other times forgets. One way or the other, I find my theoretical understanding far surpasses my practical application of what I know about how to be healthy. Hence, I find it easier to give advice than to live in a state of emotional balance and spiritual connection. It would be easy to blog about all the stuff I’ve been told, and never mention that it only works for me half the time. But that would not be honest, or fair, or helpful to others or to me. So here I am, admitting that the simplest things still trip me up, even though I was fortunate enough to have good insurance, the resources to pay for what insurance would not, and to live in an area with a surfeit of recovery and therapy groups.

I’ll end by asking if anyone knows some tricks for taking cognitive understanding, and turning it into emotional maturity. I am anxious to grow out of this phase and into something more enduringly healthy.

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What A Lifetime of Therapy and Self-Help Hasn’t Taught Me was published on July 28th, 2009 . 13 comments






High Emotional Reactivity and Self -Acceptance

http://www.flickr.com/photos/thatguyfromcchs08/2300190277

Just an hour or so ago I participated in a video taped conversation about mental health. When the show gets edited and completed I will post it here on my blog. Tom Wootton invited me to participate as a ‘client’ of his Bipolar Advantage program. Peter Forster, MD, the medical director of Bipolar Advantage, took a seat at the table. Our moderator was Barbara Meyers, who tapes a regular show on mental health, which I highly recommend.

Whew! I got all those links in place for those three!! I respect them all, by the way. They each do unique, good work for the mental health community.

The taping went by fast. Having thought through my answers (I knew the questions in advance), I was shocked when the show came to a close before the end of my question list. I took too long to answer the first three questions, so the last one or two got dropped. Predictably, I ended up feeling bad. Fact is, I’ve never liked cameras. I love to write; I feel OK on a stage; but I get quite uncomfortable when filmed. Even though that has always been true, I did not expect to feel nervous this time, since my general stage fright has reduced so much since my eighteen months of working as a public speaker. No such luck. I ended up feeling just as self-conscious as the first time a stranger shoved a video camera in my face after a movie premier in New York and asked for my reaction to the film.

In fact, my point in writing tonight is the jumpiness of my response, my incredibly high reactivity. In one of my answers on the show I said (I think) something to the effect that sensitive moods can be an advantage (an idea that is a pillar of the Bipolar Advantage concept), giving us a wide range of experience of the human condition. Yet it is hard to believe anything very advantageous comes out of having a gas pedal that gets shoved to the floor at the slightest challenge. Much as I tried to remember breathing, staying relaxed, and visualizing calm scenery, the instant I started talking my mind went into the stratosphere, and I was on autopilot. My emotions have always had hair-triggers, but my moods have gotten even more touchy since my breakdown, followed by nine years of powerful drugs, punctuated by a series of failed enterprises. So tonight became a reminder that I still have the same old issues, waiting to lift their irritating little heads when I reach beyond my comfort zone.

Much of my jumpiness, I am sure, comes from the trauma of my upbringing. One major source of over-reactivity was my stepmother’s habit of sneaking up on me in my bed at night, and shaking me awake with her hands clenched around my neck. Yes, she really did that. Fairly often, actually. As a variation she would clamp her palm over my mouth. After a while, I learned not to make a noise when she came to get me, and she gradually quit the histrionics of mock suffocation. (After she woke me, the next step was for us to go out back where she could hit me or abuse me however she wanted without my dad awakening–kind of like going to the second location with a serial killer.) Even though I learned silence then, now that I am an adult it is impossible, apparently, for me to keep from shouting if someone wakes me up at night. Even at age fifty, I still awake in full screaming terror if my wife just taps on the door to the guest room. (Sometimes I go to sleep in that room while she reads in bed, and then she comes to get me when she turns out the light.) Thanks, Della (that was the name of my late stepmother), for leaving me with nerves of glass.

So now I contend with this high-voltage response to the equivalent of turning on a AAA penlight. Back in my days as a surgeon (pretty hard to imagine doing that kind of thing now), I had very measured responses to acute situations in the operating room. I think it was because my attention was on high-alert already when I was operating, so there was none of that pounding acceleration from zero to one-hundred-and-ninety that leaves me so disoriented. In the O.R., everything moved at a speed that made sense, and I was able to remain focused and calm come what may (except for one dreadful day that I will no doubt write about eventually, when I ended up quite agitated after a big mistake on a small procedure). The night after a tough case I might lay awake replaying whatever happened. Or the night before I might be sleepless in anticipation of a challenging case. But during the time of the actual work, I stayed in a centered zone.

There is no situation like that now, and I would never dream of trying anything as stressful as surgery again. But despite that caution, I still find ways to demonstrate my limitations to myself and then feel bad about them. I share this because it may be that someone else out there beats himself or herself up like that. Maybe someone else gets embarrassed about nervousness. Maybe someone else can understand.

Sometimes, I am fine with where I am in life. Happy with what sometimes seems like a lot of wisdom (purchased at great price, but mine nevertheless). Lately, I have felt less accepting. Maybe now that I am writing more, I can find my way back to that place of spiritual openness that works so well, that soulful space that is the only worthwhile destination.

That is my goal. Not performance; not looking good on TV; not making a living, even. Just finding connection with whatever it is that embraces me when I let all the expectations go.

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High Emotional Reactivity and Self -Acceptance was published on July 15th, 2009 . 1 comment






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