The truce

[self-harm, mention of sexual assault, suicidal thoughts]

I don’t really know why but I grew up hating my body. I hated how it looked and I hated how other people treated me because of how they thought it looked. I read somewhere when I was a young teenager that your body is just there to carry your mind around and that framing stayed with me. I never considered how it felt.

Black Truce by James Gleeson

I started self-harming when I was 14 years old. I mostly cut my abdomen with a razor blade. I also cut the tops of my thighs, my inner thighs, my hips, my left shoulder, my chest and my breasts; anywhere that was covered by my PE kit. I think I self-harmed because I didn’t know the words how to express my pain, frustration and anxiety from my untreated depression. I had also been extensively bullied at school for years. I had a lot of suicidal thoughts and plans too.

After eighteen months or so of self-harming, I finally went to my GP, was honest about my symptoms and I was given fluoxetine (Prozac) and weekly counselling (changed days to what people get today) which helped a lot. My GP was very matter of fact about my self-harm and focused on what I now know is called harm minimisation. I never felt even a flicker of shaming. I had been self-harming every day: every night in the bathroom before I had a shower. I always had wounds in various stages of healing. This is actually kind of horrifying me now to look at these memories from my current relationship with my body but it was so normal then. It felt like a logical and sensible response to my life. It fucking was a logical and sensible response to my life. But the self-harm just melted away as the depression melted away. I don’t remember any kind of fight to stop. It just naturally camed to an end. From the time I was 17 years old to now in my early forties, I have self-harmed less than a dozen times. When my mood is bad, thoughts of self-harm do come into my head but they feel miles away. It’s only in the worst of situations that I actually do go past thoughts and act on my body.

Can you only self-harm if you hate your body first? I don’t think that’s true. Sometimes things are just very desperate. There are no good choices available in some situations. But I did hate my body; almost as much as I hated myself. Those hatreds and despairs felt separate from very early on and remained separate until this year. Note that I’m not saying the hatred and despair has melted away but it feels like a frayed, stretched apart cloth between me and my body rather than a solid, impenetrable wall.

When I look down at my hands, there is still a tiny pause while I recognise them as mine. They don’t feel like mine but intellectually I know they must be. There is a much bigger pause when I look at body parts that I dislike more like my abdomen or my breasts (it still feels weird typing “my” there; my habit is to say “the abdomen” or “the breasts”).

That pause and the detachment were put there deliberately to protect my body from me. I can’t remember exactly what I read or what I heard that made me decide to pursue this detachment but I remember pushing it in my mind until feeling like I was quite separate from my body was a very natural state. It tied in well with my depersonalisation.

The next stage was a calling of a sort of truce between my body and myself. I think this happened in my early twenties. I had been sexually assaulted a few times by then though had convinced myself that it wasn’t affecting me. I was dealing with a lot of psychiatric medication side-effects. I was fat and finding that unacceptable to myself. My body didn’t feel like mine and I still hated it. I was reading about fat acceptance and I longed for the peace that the people I was reading about had found. It wasn’t this but I read something like this tweet from Michelle Allison (the Fat Nutritionist):

Your body is not an object, not a sculpture based on some universal and enduring Platonic ideal of beauty — it is a living creature, an animal in your care that needs care and compassion, that suffers and dies if neglected.— Michelle Allison (@fatnutritionist) December 20, 2017

It lead to a sort of ‘truce’ or ‘deal’ in my head: I won’t hurt you anymore and you will leave me alone. That was the basis of my relationship with my body for the great majority of my adult life. I did the basics to look after it, to some extent anyway, and the rest of the time I was free to ignore it. The best that can be said for this ‘truce’ or ‘deal’ is that it eased my relentless drive to kill myself which had been powered by my hatred of my body. The thoughts were still there but there was a distance too. I self-harmed very rarely. I gave up drinking alcohol entirely and I didn’t take drugs (I was very lucky in that I hadn’t developed addictions to either). I didn’t exercise and didn’t eat very nutritiously but I don’t think I had any disordered eating behaviours either. But it was a miserable, joyless way to live, I see now. Not taking any pleasure in my body, whether that was eating or sex or physical activity, etc, meant missing out on a lot of the experiences that make life worth living and make a human, human.

What changed was I read two books this year that profoundly challenged my thinking. The first was Come As You Are by Emily Nagoski about female sexuality which explained a lot of my past experiences to me, not just about sex but also about emotions and the stress responses. The second was Intuitive Eating by Evelyn Tribole and Elyse Resch which explained a lot about eating, hunger and fullness. Both of these books talked matter of factly about taking pleasure in your body and of being connected to your body. It probably sounds ridiculous but I’d never considered that was possible. I kind of knew that some people had strong, solid relationships with their bodies but I didn’t think that applied to any of the people in my life and certainly not to me. But these books were arguing that yes, it was possible for me too.

So I stepped inside my body. Quite terrifying at times and very unsettling. These books made my thoughts safe enough and the meditation released my depersonalisation enough to make it possible. My medication and all the endless self-care I do controls my mood enough, at the moment at least. I still feel some detachment but I think that is fading as my new thoughts bed in. In some ways, I am convinced being connected to my body is a much better way to run things rather than my old detachment and ‘truce’ but in other ways, it feels riskier and more unstable.

I’m still afraid of my body and I still don’t like parts of it but the old hatred and despair has faded away mostly to nothing. I’ve seen it flare up a bit at times but not for long. Is this a new truce? Not really. This is very soppy but I feel like my body and me might be on the same side now. There is something very peaceful and lovely with that.

Self-esteem meditation

I started meditating in June using the Headspace app on my phone. I signed up and did the free meditations for the first few (four? ten?) days and then bought a subscription.

Meditating has made an astonishing difference to my depersonalization. It is literally the only technique that has made a significant difference though, to be fair, I have felt so hopeless about finding anything that helped that I don’t think I made a serious and sustained attempt at any technique. This wee app made a difference right from the early days. Never in a way that was too much of a shocking, painful change (snapping into hyper-reality from being very dissociated is profoundly fucking terrifying) but a feeling of control like if I push that particular part of my mind that the app targets and calls mindfulness, that particular part of my awareness, then the depersonalization recedes back. If I lift off that particular part of my mind then the depersonalization will drift back in. It might sound mind-boggling for it to be important to me that I can get the depersonalization back if I want it but it is important as it has helped me get through things that I don’t think I could have survived another way. Well, maybe. Maybe not. It’s mine though and I want to be able to send it away and call it back as I chose. That might not be possible and might require far too high a price but it’s what I want just now. The depersonalization is not my master these days, well, not all the time, and I am grateful to the meditation for that.

The Headspace app has has a huge library of meditations on topics from grief to sleep to productivity. There is a thirty episode course on self-esteem. Here is the introduction to episode 4 of the first ‘Learn’ ten episodes:

Now after a lifetime of thinking that we are not good enough: maybe we don’t like the way we look or the way we are or the way we feel or the way we think. Maybe we don’t like the way we think other people think we are. Low self-esteem can affect us in so many different ways. But it’s always looking for more fuel because all of these internal storylines that we have, it doesn’t matter if it’s low self-esteem or something else, they all require fuel and that fuel is thinking. So it’s quite normal when we come to an exercise, to learning something new, that we fuel it with whatever is most common in the mind. So for someone who gets very anxious when they’re learning a new exercise like this they might be very anxious about the exercise. Someone with low self-esteem learning a new exercise will probably think that they’re no good at it or that they wish that they could do it better or they wish that things were changing faster. And that’s just the nature of that storyline playing out. Again we don’t need to give it more attention and more credence than it deserves. It’s simply recognising that’s the habitual pattern of thought that has built up over time. It’s not who we are. The less we identify with it the less important, believable almost, it becomes in our life. So just something to bear in mind as you’re doing this each day. Coming to the exercise completely fresh, leaving behind any preconceived ideas as to whether you are good at it or bad at it, whether it’s going to work quickly or not. Simply watching the process. Being present with it as it unfolds.

Introduction to a Headspace self-esteem meditation episode 4

I think that is a fascinating way to think about self-esteem. I was expecting some nonsense about self-compassion (which isn’t nonsense; I just can’t get it to work for me) being the better way to consider or judge the self. But this idea of thinking just being fuel in an unwanted fire undercuts this and made me pause and really look at my assumptions. I don’t fully understand it yet but I will keep thinking about it and finish the course. Things that I thought were self-evident, obvious, solid premises might actually not be true or even just actually not that useful. It’s so lovely to come across something new that gives me some hope that things might be different. Of course, I am a psychiatric patient of twenty-five years standing so I know that hope is heady stuff except heads aren’t often involved (to paraphrase Terry Pratchett) and I’m not going to call myself cured quite just yet. Put a button in front of me and say “press this and you’ll never have existed” and the only delay to me pressing it is my formerly middle class upbringing that will make me pause to say “thank you”. I’m almost entirely convinced that I don’t deserve good self-esteem. That things are bad because that is they way they should be. I really don’t know what makes me keep trying things like meditation. It’s certainly not logical. Well, that tangent went a bit dark. Aren’t you glad you are wasting your life reading this blog?

‘Self Esteem’ by Betsy Cook

It’s just so fluffy… meditation, mindfulness. How can you take such simple concepts seriously? Dissociation is so huge and complex. Abnormal mood is so huge and complex. How can something as beyond basic as focusing on your breath help such severe, profound, overwhelming symptoms? A huge and complex problem needs a huge and complex solution, right? Turns out that that assumption has done me a lot of harm over the years. Here’s an analogy: you spend six hours making a hugely complex and fantastic meal. It should have a rich interplay of exquisite tastes and textures. But it’s just bland and flat and sits in the mouth like stale bread. Less interesting than stale bread, even. You’re fucked, right? Nothing simple is going to save this meal, all this work, you’re going to have to start again. Wrong. Turns out the very simple addition of half a teaspoon of salt brings these flavours to life. Sometimes something simple is all that is needed. I’ll add to that though: sometimes a series of simple things is all that is needed.

The other reason I resisted mindfulness and meditation is that is so goddamn fashionable and pushed on us psychiatric patients. Another simple concept: what works for one person’s problem might or might not work for another person’s apparently similar problem. Don’t we get to chose where to spend our (very limited) energies? I came to meditation of my own volition. I kind of fell into it naturally, first through a real life friend and then by enjoying how well written the app was and then by being astonished by the results. It has just happened. Just happened because of lots of little choices that I made. So it feels like it is mine. I told my current psychiatrist recently that I had started meditating and he said “good on you” but didn’t push. I felt pleased. Going by twitter, a lot of people have bad experiences of psychiatric services almost insisting that they spend chunks of their time and using up chunks of their energy on techniques that were, at best, useless and, at worst, actively harmful. So that put me off too.

This feeling of being able to make choices and make good things happen in my life is valuable and precious to me. Not quite as much as the relief in my symptoms but it has been an unexpected bonus. That’s unexpectedly boosted my self-esteem as well. I can do something! I’m not 100% hopeless! (Just 95% replies my brain.) Did the people who wrote the app mean for that to happen? Who knows, but it’s good anyway.

What is depersonalization?

I have suffered (and I deliberately use that word rather than experienced) from chronic depersonalization since I was a teenager. Sometimes it is worse than others and I did have a time when I was completely free of it for a summer about fifteen years ago. It is currently abating as I do more and more mindfulness meditation. That has been a surprise to me.

Only credit I can find for this is “The Ojays”. Line drawing of a person sitting on chair looking through a giant eyeball into the real world.

Depersonalization isn’t often talked about and I think that’s not because it is rare but because it so difficult to put the experience into words. I feel it as a distance between what I consider to be me, my self, and what I am sensing of myself. It is a detachment of something that should be seamless. I feel happiness and it is far away. I look down at my hands and see I am touching something and I don’t connect to that sensation. I look at something beautiful and it is as if it is happening to someone else. Things that should be familiar instead feel strange and unreal, like they are not really happening.

According to Simeon and Abugel’s Feeling Unreal, about half of adults will have had a single brief experience of depersonalization usually following something severely stressful. About one third of people who experience a life-threatening danger will have a “transient episode of depersonalization”. Approximately 10% of people who are admitted to a psychiatric hospital will also experience depersonalization.

Depersonalization is closely related to and is most likely on the same spectrum as derealization which is a detachment and distance from the outside world, i.e. other people and objects don’t look real. I used to have a lot more derealization as a teenager with only a little depersonalization but the proportions gradually swapped over as I got older.

In both depersonalization and derealization (I bet another reason these experiences aren’t talked about that much is because these are such fucking clumsy names) reality testing is intact meaning that you know that while your feelings or interactions with the outside world don’t feel entirely real, they actually are real. You know that your experience is entirely subjective. You can tell the difference. If you didn’t know that then this would be called psychosis. So it’s a pretty fundamental point, in the world of psychiatry at least.

Like all mental health symptoms or experiences, if they are intense, frequent or upsetting enough then they ‘count’ as an illness. My god, that sentence is doing a lot of heavy lifting! In the case of depersonalization, the ICD-10 uses the diagnosis depersonalization-derealization syndrome and categorises it in “mental and behavioural disorders: other neurotic disorders” and the DSM-5 uses the diagnosis depersonalization/derealization disorder and categorizes it as a type of dissociative disorder alongside dissociative identity disorder (previously called multiple personality disorder). There is some consensus and overlap about what ‘counts’ as an illness but there is a lot of unknown, grey area between the core diagnositic criteria and normal experience. This isn’t just academic. There will be people out in the world denied treatment or having their treatment changed because of these diagnostic criteria. Hopefully, clinicians are flexible enough to adapt things to suit their patients/clients but I guarantee that not all are.

I’ve asked several psychiatrists, psychiatric nurses and psychologists over the last twenty plus years about their opinions on depersonalization. I find it very hard to describe so never felt like I gave a good account of myself. My favourite psychiatrist said she thought what I was describing was a “remnant” of my psychosis. I don’t think she was right. Nurses were more likely to say the depersonalization was a manifestation of my anxiety. I think every nurse I asked said that, but I’m not sure. Other professionals talked about it as a distinct symptom that they basically didn’t know what to do with because so little is known about it. I think this is the position of my current psychiatrist. I have never been offered specific treatment for my depersonalization by any of the professionals that I’ve asked.

Many people find depersonalization and derealization hard to talk about as our language doesn’t really accommodate these experiences. You end up talking in metaphors and seeing confused expressions on the other person’s face. So my apologies if you have a confused expression on your face just now. I am still trying to organise my thoughts. Perhaps things will become more clear in the future.