Book review: Shattered

Book cover: Shattered by Patricia J Grace

In Shattered: A Memoir, Patricia J Grace tells her story of the lasting impact of childhood sexual abuse.  This abuse occurred at the hands of multiple brothers, as well as others, after the death of her father.  While her mother was aware of the abuse, she did not intervene to try to stop it.  In fact, when she became infected with public lice, her mother gave her DDT to apply, adding that her brother had already been treated.

Patricia writes about the body image issues she developed as a result of the abuse.  She believed fat=ugly=safer, although of course it didn’t work out that way.  As an adult, her weight continued to rise as attempted to fake her way through her various role functions.  Her mother pressured her to have weight loss surgery, and she went ahead with this.  She later realized: “Without changing the internal messages of badness or dealing with the fear of others, I would continue to turn to food and fatness to feel safe.”  This reminds me of Roxane Gay’s book Hunger, in which she wrote about overeating to seek safety, and try to make herself less vulnerable to abuse.

Patricia eloquently describes the psychological torment that resulted from the abuse she experienced.  The abuse battered her sense of self, leaving her feeling like “a ghost of a person undeserving of the same rights, voice, or worth as others.”  She had learned to remain silent, and she felt emotionally stunted and without a centre.  She felt “trapped alive in a coffin with nails hammered down, scraping and clawing for a way out, fighting for a life with my head up and heart full.”

The difficulties Patricia faced in getting effective therapy will sound sadly familiar to many.  It was challenging to overcome the taboo and break the unwritten rules of silence instilled in her.  Heartbreakingly, like so many other childhood abuse victims there was also a great deal of guilt, “as if I were the abuser not the victim.”  One therapist commented “oh, so you were a precocious child” when Patricia disclosed her childhood sexual abuse.  Another would regularly disrupt sessions to take calls on his cell phone.

I find it so gut-wrenching to hear how even non-abusing parents can be complicit in covering up abuse and allowing it to happen.  Unlike her brothers, who were trusted to maintain silence, Patricia’s mother “needed to work diligently in shaping me”.  She explains simply that “It’s not hard to silence a child. Just threaten to abandon, not in words but in actions. Do this, you’ll be loved. Don’t and you’re not.  The message hit home over time. It took repeated lashings of, “You should be ashamed of yourself” to brand that scar into me, burned so expertly into the template of who I was to become that shame replaced wholeness like a headstone.”  Her mother even went so far as repeatedly pressing her to forgive one of his brothers, minimizing what he had done to her when she was a child.

She explained how she became split in two, with a part of her that remembered and a part of her that had repressed the memories until they became inaccessible.  She felt like Humpty Dumpty with no idea how to put herself back together.  In the end, it was Buddhist meditation that helped for to find peace and connect with herself.  She has come to accept that what happened is inescapable.  She writes that “Moments of peace, internal connectedness, and the late blooming birth of self-acceptance make aliveness worthwhile.”  She has found that she is worthy, and she is okay, and this really is an amazing story of healing.


You can find Patricia on her blog Grace to survive


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Book review: Living With Vaginismus

book cover: Living with Vaginismus by Victoria Johnston

In Living with Vaginismus: Dealing with the World’s Most Painful Pleasure, Victoria Johnston provides a comprehensive overview of this pelvic pain condition.  She opens up about her own personal experience in order to try to raise awareness about an issue that most people either don’t know about and/or aren’t comfortable talking about.

Vaginismus involves the involuntary contraction of pelvic muscles (the pubococcygeus or PC muscles) making it difficult or even impossible to penetrate the vagina with even small objects like a tampon.  It refers specifically to the muscle contractions, and doesn’t encompass other sexual difficulties related to things like desire or ability to orgasm.  One physiotherapist cited in the book describes vaginismus as panic attacks of the vagina, and Victoria describes sex as feeling “like you are being ripped apart”.

Unfortunately, even many medical practitioners have a poor understanding of vaginismus, and the book includes multiple stories of negative experiences with health care providers.  The causes of vaginismus can be complex and multifactorial, and the book describes various physical and psychological factors that have been identified.  The book also includes stories about the often devastating effects the disorder can have, including strain on relationships and problems with mental health.

Victoria describes the various treatments that are available, taking a holistic view and explaining that what’s most effective can vary greatly from person to person.  Treatments include the use of dilators slowly progressing in size, physiotherapy, counselling, and medication.  There is a chapter devoted to physiotherapy exercises, complete with photos to demonstrate.  Another chapter describes Botox, a promising approach that isn’t yet commonly performed and is quite expensive.

The book includes contributions from a number of other women who live with pelvic pain.  Many felt invalidated by their health care providers, and a common theme running through their stories was how alone they felt in their experience.  The book also includes the stories of men whose partners have vaginismus.  I was surprised by how many partner stories Victoria was able to gather, and how openly these men spoke.  It really illustrated how this disorder isn’t just an individual problem; it’s an issue that couples need to face together.

Victoria calls out the many unreasonable societal expectations around sex, including the idea that is the only way of truly achieving closeness and connection, and the expectation that it’s normal for females to have pain during sex.  She advocates for more realistic, open conversations about sex, something I heartily agree with.

While vaginismus manifests itself physically, mental health is often involved, either as a contributing factor or as a consequence.  As such, it’s important to raise awareness in the realm of mental health as well as sexual health, which is why I thought it was important to review this book on my blog.  I would definitely recommend it.


You can find Victoria on her blog Girl with the Paw Print Tattoo.


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Falling head over heels for Italy

Despite the happy-sounding title, I’m talking about falling in a very little sense. The combination of lithium-induced clumsiness and cobblestone streets was bound to catch up to me. It was around 6am and I was walking to the train station to catch an early train to Pompeii. I was crossing a street and completely wiped out. There were only a couple other pedestrians around, but they ignored pathetic me sprawled on the cobblestones.

I was sore, but thought there was no lasting damage. It was only later that I realized that I’d scraped up my foot and knee and sprained my ankle. Sprained ankle and walking around ruins isn’t really the best combination. The picture above is a plaster cast of a body buried in the ashes from Mt Vesuvius at Pompeii, and that’s kind of how I was feeling.

Yesterday morning I went to this tiny little cafe (maybe 6 tables), and the staff totally ignored me. I sat there for around 45 minutes and they didn’t even acknowledge my existence, much less take my order. During that time I was waiting I saw a triggering email from work. Cue public cry fest.

Anyhow, this morning I leave Rome and catch the super-fast train to Florence. Who knows, maybe when I’m there I’ll get hit by a bus, followed by falling into a canal in Venice…

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • My mood has been shit.
  • I got exempted from jury duty, which is good.  I couldn’t make a decision about what to do about the jury summons, so I did an exemption request but explained that I didn’t know if I should actually be asking for an exemption.  I guess they figured someone who’s too nutty to make a decision about a jury duty exemption is too nutty to be making a decision about someone’s guilt or innocence.
  • Although my follower numbers have gotten higher than I had ever expected and are steadily increasing, my actual visitors and views numbers have been steadily dropping.  I don’t blog for the purpose of stats, but it’s hard not to feel discouraged by that kind of mismatch in numbers.
  • I’m so not impressed with my new job.  They’re pretty sporadic when it comes to actually responding to emails, and the pay is shit, although they seem to be in denial about that.
  • I didn’t work much this week, and I’ve been having a bit of a hard time keeping myself occupied because I just don’t feel like doing anything.  I find myself wishing I could just sleep 24 hours a day.
  • My regular doctor was away so I ended up seeing a different doctor to get my meds refilled.  Without even so much as a “how are you?” she refilled my meds for 9 months.  Last week my naturopath was away so the other naturopath in the clinic did my methylfolate/B12 injection.  She also didn’t ask how I was doing.  I don’t actually have any desire to talk to health care professionals I don’t know, but I’m sensing a theme here.
  • I went to yoga twice hoping it would give me a bit of an escape from myself.  It didn’t.


How has your week been?


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How trauma-informed practice can improve mental health care

person lying on the floor in a dark room

So, what is it to be trauma-informed?  Trauma-informed practice recognizes the intersectionality of trauma, mental health, and substance abuse, and involves an awareness that anyone may have experienced trauma, whether they have disclosed it or not.  Trauma-informed practice aims to create environments that prevent re-traumatization and promote a sense of safety.  The individual client’s safety, choice, and control is prioritized throughout services, and an approach of collaboration, learning, and building trust is used.  There should be a non-hierarchical and supportive organizational culture, and there is a focus on strengths and building resiliency, and hope that recovery is possible.

One area where being trauma-informed has the potential to make a huge difference is when it comes to seclusion and restraints.  The use of seclusion and restraints can lead to significant psychological or physical harm, and can be a major source of traumatization or re-traumatization.  The British Columbia Centre of Excellence for Women’s Health identified several strategies for a trauma-informed approach to seclusion and restraints:

  • staff training in de-escalation
  • have comfort rooms with low sensory stimulation
  • promote the development of crisis plans or advance directives to identify triggers and preferred interventions
  • assess for and address any unmet needs that may be influencing behaviour
  • debriefing following any use of seclusion or restraint to identify why it happened and what was learned.

When I was doing my masters degree one of my classmates was working in a psychiatric intensive care unit where they had instituted changes in their approach to seclusion and restraints in order to provide trauma-informed care.  My classmate had nothing but good things to say about this, and the unit had achieved very significant reductions in trauma and restraint utilization.

My most memorable occasion of being in seclusion was when I had taken myself into hospital, with the support of my community psychiatrist, and said that I was feeling suicidal and needed ECT.  They decided to commit me under the Mental Health Act and put me in seclusion, even though I had gone in voluntarily.  When I was informed I would be locked in seclusion I asked to be sedated, because I didn’t want to be trapped with nothing but my thoughts.  The nurse said there was nothing ordered.  I asked if it would make a difference if I told her that I’d throw my tiny tube of hand cream at her.  She disappeared, I heard a “code white” (aka violent patient aka me) being called over the PA system, and she returned a few minutes later with a bunch of security guards to give me the injection I’d asked for in the first place.  How very therapeutic.

Sometimes in the field of mental health care certain approaches or practices will become buzzwords, and many organizations will jump on board.  I think this has happened, at least to some extent, with trauma-informed practice, and it’s generally seen as something desirable.  Where the problem lies, though, is that there’s a difference between claiming to be trauma-informed and actually being trauma-informed.  I’m sure that the mental health and addictions program I work for would claim to be trauma-informed, just like they claim to be recovery-oriented.  But in practice, it’s just lip service, although I highly doubt the people running the place would see it that way.

I think all mental health care organizations should be trauma-informed, but it’s essential that it look trauma-informed from the client perspective, not just the staff or management’s perspective.  While individual care providers for the most part try (with varying degrees of success) to be empathetic, it’s difficult for some clinicians, and particularly for organizations, to have any real understanding of what the client perspective looks like.

Would you consider the mental health services that you’ve accessed to be trauma-informed?


Sources: British Columbia Centre of Excellence for Women’s Health Trauma-Informed Practice Guide and Trauma-Informed Approaches to Seclusion and Restraint Reduction


Photo by Hailey Kean on Unsplash

Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • I’ve been pretty slowed down, both mind and body.
  • I only had 2 patients to see this week.  One was for my new job, and they pay me a pre-determined amount per visit.  Except they seem to be calculating travel time based on an assumption that I am going to the patient’s home via magic carpet rather than driving through rush hour traffic, so the hourly rate this appointment worked out to was $13/hour less than the minimum they told me I’d be making.  I emailed the manager, and in response got a brush-off email saying they’d be sending out a memo next week about how the per-visit amounts are calculated.  Not impressed.
  • I went to yoga once this week, and had a massage with my lovely new massage therapist.
  • I’ve firmed up pet-setting arrangements for when I’m away next month, which is a relief.
  • I check my comment spam regularly to make sure I catch the legit comments that somehow end up in spam.  I had several spam comments that said “Don’t wear seat belts lest you drown in you own urine?”  Um, okay then.
  • I got a summons for jury duty in the mail yesterday.  I’m not sure yet if I’ll do it or apply for an exemption for medical reasons.  Probably the latter.


1 Year Anniversary Achievement It was my (sort-of) 1 year blog anniversary this week.  I say sort of because my go-public date wasn’t October last year.  It’s been a pretty cool journey that has introduced me to some amazing people!


How has your week been?


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What is… vulnerability

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: vulnerability

Wikipedia has a couple of different pages related to this topic: one on social vulnerability, the other on cognitive vulnerability.  It says that the work vulnerable derives from the Latin word vulnerare, which means to be wounded.  The diathesis-stress model explains psychological disorders as resulting from a combination of predisposed vulnerability and external stressful experiences; protective factors help to mitigate this risk.

Cognitive vulnerability results from erroneous patterns of thinking, which makes people more vulnerable to certain psychological problems, such as mood disorders.  Insecure attachment and stressful events contribute to this process.

Social vulnerability refers to the inability to handle the external stressors that one is faced with.  Structural factors, including social inequalities and political factors, can play a role.   Entire communities may be vulnerable in what’s known as collective vulnerability,  “a state in which the integrity and social fabric of a community is or was threatened through traumatic events or repeated collective violence.”

I don’t think it would be unfair to call author Brene Brown the queen of vulnerability.  She has written multiple books and given TED Talks, and is pretty all-around amazing.  In her book Daring Greatly, she challenges the idea that vulnerability represents weakness, and instead says that “vulnerability sounds like truth and feels like courage”.  She explains that vulnerability involves emotional exposure, and while this may not feel comfortable it is at the core of all emotions.  Daring to be vulnerable requires a sense of worthiness to combat shame and beliefs that we are not good enough.

I am highly selective about who I’m prepared to be vulnerable with.  I’ve had some negative experiences, and these are hard to overcome.  I suppose I’m vulnerable on my blog, but there’s really not much that could happen in terms of negative repercussions with that.  I suppose all I can do is look for ways that I can be vulnerable, and at least try to push myself.

Is being vulnerable something that you struggle with?



Daring Greatly by Brene Brown


Image credit: GDJ on Pixabay

How can we help those in mental health crisis?

"help me" marked on a foggy window

Recently I did a post expressing my concern about learning that a local police force routinely handcuffs people that they are taking to hospital under a Mental Health Act apprehension.  That got me thinking about what it shoulds look like to help people in mental health crisis.

The police force in the city where I live (different from the one referred to in my previous post) has a partnership with the local health authority to operate what’s referred to as car 87/88.  This involves an unmarked police car, a plainclothes police officer, and a mental health nurse.  They attend mental health emergency situations, and track down people who have been certified under the Mental Health Act in the community but left before they could be taken to hospital.  If they’re attending a call and someone needs to be taken to hospital involuntarily, either the police officer will do a Mental Health Act apprehension or the on-call psychiatrist will be called to assess the person and do a Mental Health Act medical certificate if appropriate.  An ambulance is then called, and the person is transported to hospital in the ambulance, with the car 87/88 police officer accompanying as needed and the nurse following behind in the police car.

I really like this system, and the biggest problem I see is that there is only one car for afternoon shift and one for night shift in a large urban centre.  It seems much more civilized to have a more subtle police presence (unmarked car, no uniform), a highly experienced mental health nurse, and transportation in an ambulance (what with mental illness being a medical issue).  I understand why police need to be involved sometimes if someone is being taken to hospital on an involuntary basis, but I don’t think that’s any excuse to take the health out of health care.  Mental illness crisis is an emergency medical issue, and I strongly police should be involved in a primarily supportive role unless there is an imminent safety risk.

Speaking of which, I think it’s crucial that police attending situations where a mentally ill person poses an imminent threat be well trained in the use of less lethal force options, such as weapons that fire rubber bullets or bean bags.  A number of years ago at a mental health clinic where I worked, a client had come in who was highly suicidal and wished to commit “suicide by cop” (i.e. goad police into shooting and killing him).  The team of police officers that attended handled the situation extremely well trained and were able to utilize these less lethal options to make sure that nobody got hurt, including the client.

Because mental illness is unpredictable, mental illness crisis situations are equally unpredictable.  However, I think having a well-designed crisis response system can go a long in in both promoting safety and preserving dignity of the mentally ill person in crisis.  A system that further traumatizes mentally ill individuals does no one any favours, and we need to do better than that.


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Book review: I Am the Architect of My Own Destruction

book cover: I Am the Architect of My Own Destruction by Juansen Dizon

I Am the Architect of My Own Destruction is Juansen Dizon’s second book of poetry.  The book opens with a letter to the reader, which begins “It’s hard to write when you want to kill yourself. It’s harder when you don’t really know the reason as to why.”  Throughout the book I felt like I as a reader was being directly spoken to.

The poems capture the darkness and depth of mental illness, and often I was left thinking wow, that’s exactly how I have felt.  Thoughts of suicide are shared in a way that feels very genuine and non-triggering.  The book touches on a range of topics including body image and the difficulty of self-love.  Along with the difficult part of mental illness, Juansen also writes about healing and happiness.  This provides a good balance to some of the darker poems.

Many of the poems were quite short, which I really appreciated because as I was reading the book depression was doing a number on my concentration.  Some are only one line, but carry profound meaning in those few words, like Numb and Casket.  I was impressed by the emotional depth that could be captured in just a few words.

The book explores love and navigating relationships, and how challenging this can be when in the depths of mental illness.  Juansen clearly bares his soul as he writes about this.  The book also includes touching letters to his girlfriend and his brother.

I particularly liked the one-line poem Seraphim: “Melancholy is an angel that fell in love with a demon.”  Another favourite was Warriors, which talks about the strength it can take to stay alive.

This book carries the reader on a poetic journey into the author’s mind and heart, giving an intimate look at the experience of mental illness.  The poems are very accessible, in the sense that even people who don’t normally read much poetry would likely find it easy to engage with this book.  It’s well worth checking out.


You can find Juansen on his blog Lonely Blue Boy.


Note: I was provided with a free copy of this book in exchange for an honest review.

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Is the law of attraction real?

diagram of a brain with magnets attracting

At one point I had come home from an extended stay in hospital, and because ECT had wiped out a chunk of memory, I discovered things in my house that I had no idea how they had gotten there.  One of those things I found was a book on the law of attraction.

On first glance, the idea of the law of attraction is very appealing – you get back from the universe whatever you put out into it, because like energy attracts like energy.  According to the film The Secret, it’s not only thinking about what you want to get back but also pouring emotion into it that will get results.  But when you poke at it a bit, the whole idea starts to crumble.

I watched The Secret for the first time recently and thought there were a number of things that seemed unreasonable, such as the idea that the universe is like catalog shopping, and as long as you think and feel a wish for something, you just need to sit back and wait because the universe will turn your thoughts into things and just drop them in your lap.  Apparently “the law of attraction will give you what you want every time”.  Are you getting bills in the mail?  Well, that’s not because you owe money, it’s because you’re expecting to get more bills.  Change your thinking to expect a cheque, and your credit card company will just forget about those overdue payments and some random person will start sending you money on behalf of the universe!  No need to worry about how it will happen; the universe is going to figure that out for you.

The Secret contains some fishy ideas about how the brain works.  Some examples: “Every thought has a frequency”; “Thoughts are sending out the magnetic signal that’s drawing the parallel back to you”; “It has been proven now scientifically that an affirmative thought is hundreds of times more powerful than a negative thought”.  A 2007 issue of Scientific American questioned the accuracy of how the law of attraction represents brainwave electrical activity, and multiple authors have questioned other aspects of its purported scientific basis.  According to a 2010 New York Times book review cited by Wikipedia, The Secret is pseudoscience and an “illusion of knowledge”.

I’m not questioning the power of positive thinking to shape our experience.  While the law of attraction may have some similarities to positive psychology concepts, there are some fundamental differences.  Let’s consider Elie Wiesel, a remarkable, Nobel prize-winning Jewish author who survived detention in Nazi concentration camps.  He is a powerful example of maintaining a positive attitude in order to survive unimaginable horrors.  Did his attitude make the horrors go away and attract only positive things?  Of course not.  But it changed the framework of meaning through which he interpreted his experience.  However, this does not seem to be what the Law of Attraction is getting at.  The law of attraction seems to suggest that people ended up in concentration camps because somehow that’s what they were asking the universe for, and they stayed there and suffered because they just weren’t asking the universe properly to be free.

One area where the law of attraction really falls apart for me is serious illness, be it mental or physical.  “Everything that’s coming into your life, you’re attracting into your life” says “philosopher” Bob Proctor in The Secret (I could find no evidence of him having no background in philosophy).  So what, have we somehow put crazy energy out there into the world in order to attract mental illness our way?  If we are gripped by psychosis, is that because of something we’ve put out there into the ether?  And when we try to end our lives, is that because we’re not shooting out enough good vibes?

I get that it’s good to try to be positive.  There’s a whole field of positive psychology that leans in that direction without the pseudo-scientific talk of thoughts radiating frequencies and positive and negative energies attracting each other.  But how far can thinking/emoting get you without action?  I can think wealthy thoughts all I want, but unless that spurs me to work on money management and pursue opportunities for growing wealth, it seems rather implausible that the universe would a) care, and b) throw money down from heaven and say “this is for you!”  If the positive thought acts as a motivator for action, I can see how that would be very powerful.  But just hanging out eating, peeing, and sleeping dollars seems unlikely to get me very far in the wealth department.

I’m not interested in mincing words, so I’ll conclude that the law of attraction as a whole is a load of BS, but there are still some positive things to take away from it.  Make sure your attitude is helping you, not getting in your way.  The vibes that you put out towards other people are likely to end up being reflected back to you in some way, so follow the golden rule and do unto others, etc.

Do you think the law of attraction is real?


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My experiences of going off meds

red pills in the shape of an X

I have never had  a problem with medications in general, and in my work as a nurse I’ve seen how much good they can do.  Despite that, I’ve gone off the meds I take for depression a few times, and that’s what this post is about.

My first episode of depression was in 2007.  I ended up hospitalized following a suicide attempt, and spent 2 months in hospital.  I continued taking my meds for a few months and I then I had another suicide attempt, this time by overdosing on my psych meds.  I didn’t do any significant damage, so I chose not to tell anybody at the time.  I decided that to hell with it, if I was on meds and still feeling shitty, what was the point of continuing meds?  Continuing on my deceptive theme, I didn’t want my treatment team to know I wasn’t taking meds, so I continued to pick them up regularly from the pharmacy.  I ended up getting into full remission without meds, and I remained well for almost 4 years.

My plan all along was that if I started to have signs of getting worse, I would restart meds.  When the depression started to hit me in 2011, I quickly recognized the red flags of poor sleep and low mood, and made an appointment to see my GP.  I had to practically beg for meds, and he begrudgingly gave me 10mg of citalopram, although his preference was that I attend group therapy.  2 weeks later I ended up in hospital.

It took a year and a half to get fully well again, and I ended up on multiple weight gain-inducing meds (lithium, quetiapine, and mirtazapine).  The weight gain was hard to adjust to, although I recognized it was probably a fair price to pay for being well.  After 2 years in full remission, I decided I wanted to try going off the quetiapine, and my psychiatrist was agreeable.  We tapered down the dose gradually, and at first it seemed like I was going ok, until suddenly it wasn’t.  I got really slowed down, and ended up having to go back on the quetiapine as well as up my dose of lithium.  Clearly I needed my full med cocktail.

It wasn’t too long afterwards that my workplace bullying debacle began.  This culminated in me deciding to quit my job, and I became quite depressed again.  My psychiatrist ‘s reaction was tremendously invalidating, so I stopped seeing him.  I had recently begun seeing a new GP, and when I told her why I wasn’t seeing the psychiatrist any more, she came out with the same invalidating comments he did.  I refused to see her again, so she booked me in to see another GP at the same clinic, who ended up being even worse.  I couldn’t bear the  thought of going to see another doctor, so I decided that with the meds I still had at home I would do a gradual taper and then stope them.   It wasn’t that I wanted to stop taking meds, I just wasn’t willing to see another doctor.  Not surprisingly, that strategy didn’t work out very well for me.  I was barely sleeping despite taking everything over-the-counter I could think of.

It was when I decided that I needed to go back on meds that I found my current GP, who’s very reasonable and pragmatic.  Even so, there have been a couple of times that I’ve thought screw it, there’s no point going in to get my meds reordered because I just feel like crap anyway.

My logical mind is very adamant that I need meds.  Unfortunately, sometimes depression sneaks in and twists things around, and for me I don’t think that’s something that will ever go away no matter how pro-meds I am most of the time.

Have you gone off meds before?  What was the experience like?


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Weekend wrap-up

wrapping paper, ribbon, and twine

Here’s what happened in my life over the past week:

  • Mood-wise I’ve been better than last week.  Concentration is still not very good, and I get very easily overwhelmed.
  • I had to switch massage therapists last month because my previous therapist had left the clinic.  I wasn’t happy with the new therapist, so this week I saw another therapist at a different clinic.  She was fabulous, and she used a weighted heated blanket, which I really liked.
  • I spent more time in the kitchen this week.  Fall is such a nice time to make hearty foods like soup.
  • I saw my first patient for my new job.  I was teaching her to self-inject a medication that I was already familiar with, so there was no reason for me to be nervous, but I just felt really overwhelmed.  I had an odd experience when I was there.  We were both sitting on the couch, and then she had gotten up to look for her reading glasses.  I felt the cushions moving behind me, as though there was a cat walking across the top of them.  I looked behind me.  Nothing.  It happened several more times, and I kept looking back.  Still nothing.  And that got me thinking on my drive home that this isn’t the first time I’ve had weird perceptual stuff going on.  Like sometimes I feel my bed vibrate and the thought that comes to mind is that the guinea pigs caused it, which makes no sense.  Is it mild psychosis?  Friendly ghosts?  I really don’t know.
  • I continue to struggle with a good friend who unintentionally does things that upset me.  It’s exhausting.
  • I’ve got reservations/tickets for everything that I wanted to book ahead of time for my Italy trip.  I’m a bit concerned that if I’m feeling so overwhelmed by not much of anything at home, I’ll be really overwhelmed by dealing with all the daily logistics while I’m away.


How has your week been?


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What is… invalidation

psychology word graphic in the shape of a brain

In this series, I dig a little deeper into the meaning of psychological terms.

This week’s term: Invalidation

According to Psychology Today, validation involves conveying acceptance, and recognizing that the person’s thoughts/feelings/reactions are understandable.  It also serves to communicate that the relationship is important.  It doesn’t necessarily mean agreeing or approving, something I think is a major stumbling block for people who aren’t very familiar with the idea of emotional validation.

The developer of dialectical behaviour therapy (DBT), Marsha Linehan, identified six levels of validation, with the level called for varying depending on the situation:

  1. Being fully present
  2. Accurate reflection from a non-judgmental stance
  3. Mind-reading: unlike the cognitive distortion that’s also called mind-reading, this involves trying to read the person’s behaviour and imagining what they could be feeling/thinking, and then checking for understanding
  4. Understand the person’s behaviour on the basis of their history and biology
  5. Normalizing the person’s emotional experiencce
  6. Radical genuineness, accepting the person how they are while seeing their struggles and pain

Psychology Today explains that invalidation happens when “a person’s thoughts and feelings are rejected, ignored, or judged”.  This creates emotional distance in relationships, and self-invalidation makes it difficult to construct one’s own identity.  People are more likely to be able to acknowledge when they are self-invalidating as opposed to invalidating others.

Emotional invalidation may contribute to the development of emotional disorders.  According to an article on Very Well Mind, Marsha Linehan proposed that when children with a biological predisposition to intense emotions have those emotional experiences invalidated by caregivers, they may be prone to developing borderline personality disorder.

A doctoral dissertion I came across on emotional invalidation proposed a 3-step process: invalidating behaviour (consisting of minimizing, ignoring, blaming, or neglecting) can lead to perceived invalidation (the person interprets that their feelings are unimportant, inconsequential, incorrect, or incompetent), which then leads to emotional invalidation.  From this perspective, invalidating behaviour may not lead to a subjective sense of being invalidation depending on the individual’s response.

People may be invalidating in a variety of different ways.  They may mistakenly assume that they can’t validate if they don’t agree with whatever it is the other person is expression.  They may want to try to fix your problems, or lie trying to avoid hurting your feelings.  More overtly harmful ways of invalidating including blaming, minimizing, judging, or denying.

I was lucky in that I grew up in a very validating environment.  I’ve become a lot more sensitive to invalidation after the workplace bullying I experienced a couple of years ago.   The overt invalidation directly related to the bullying was bad enough, but I also struggled a great deal with the people who supposedly supported me being very invalidating, albeit in a very well-intentioned way.  It probably would never have crossed their mind that “It’s not that bad” or “Everything will be ok” would be invalidating, but it was.  My psychiatrist at the time was invalidating in much the same way.  So I ended up with this mass forced exodus of people out of my life, and that fear of invalidation is a big part of why I don’t want to let people back in.

What role has validation or invalidation played in your life?



Elzy, M.B. (2013). Emotional Invalidation: An investigation into its definition, measurement, and effects. Doctoral dissertation.

Psychology Today

Very Well Mind


Image credit: GDJ on Pixabay

Why isn’t Complex PTSD in the DSM-5?

woman partially hidden behind a curtain

While many sources of trauma are time-limited, some occur repeatedly over prolonged periods of time.  The term complex PTSD is used to capture the profound psychological harm these people exposed to the latter have experienced, including changes in self-concept, problems with emotional regulation, distorted perceptions of the perpetrator, and impaired relationships with others.

There are two major diagnostic symptoms used in psychiatry.  These are used to standardize diagnostic criteria, and are used for such things as insurance billing.  The American Psychiatric Association puts out the Diagnostic and Statistical Manual (DSM), which is currently in its 5th edition.  It is the diagnostic system that tends to be used in North America.  The World Health Organization publishes the International Classification of Diseases, which is now in its 11th edition, and it is used in various areas worldwide.  The recently released ICD-11 considers complex PTSD to be a distinct diagnosis from PTSD, but the DSM-5 does not.  Why is that?

According to the ICD-11, complex PTSD is:

“a disorder that may develop following exposure to an event or series of events of an extremely threatening or horrific nature, most commonly prolonged or repetitive events from which escape is difficult or impossible… The disorder is characterized by the core symptoms of PTSD; that is, all diagnostic requirements for PTSD have been met at some point during the course of the disorder. In addition, Complex PTSD is characterized by:

1) severe and pervasive problems in affect regulation;

2) persistent beliefs about oneself as diminished, defeated or worthless, accompanied by deep and pervasive feelings of shame, guilt or failure related to the traumatic event; and

3) persistent difficulties in sustaining relationships and in feeling close to others.

The disturbance causes significant impairment in personal, family, social, educational, occupational or other important areas of functioning.”

There were a number of changes in the diagnostic criteria for PTSD in the DSM-5 compared to the DSM-IV.  The DSM-5 added a symptom cluster of negative alterations in cognition and mood, along with symptoms related to intrusion, avoidance, and alterations in arousal and reactivity.  This new symptom cluster includes:

  • “Overly negative thoughts and assumptions about oneself or the world;
  • Exaggerated blame of self or others for causing the trauma;
  • Negative affect;
  • Decreased interest in activities;
  • Feeling isolated;
  • Difficulty experiencing positive affect”

There is some overlap with the symptoms described in the ICD-11, but the DSM-5 doesn’t seem to fully capture those symptoms.

According to the National Center for PTSD, complex PTSD was not included as a separate diagnosis in the DSM-5 because 92% of those with C-PTSD also met the criteria for PTSD.  A review of the literature by Resick in 2012 found insufficient evidence to support complex PTSD as a distinct diagnosis from PTSD as defined in the DSM-5.  This is in spite of a significant body of research literature supporting complex PTSD as a separate diagnosis.  For example, a study by Powers et al. of African women found “clear, clinically-relevant differences” between the two conditions.  C-PTSD was associated with lower likelihood of having secure attachment, greater comorbidity with other mental illnesses, increased emotional dysregulation and dissociation.

Of course the DSM needs to consider research evidence in making decisions about what diagnoses to include, but I’m concerned that their choices with regards to research findings may have been biased.  Solely from a common sense perspective it seems like someone who was a victim of incest throughout their childhood will probably have a different presentation than a soldier returning from war.  Whether complex PTSD is considered its own diagnosis or a subtype of PTSD, it seems useful to make that distinction in order to ensure people living with post-traumatic stress disorders are getting the best possible services.

What are your thoughts on whether PTSD and complex PTSD are distinct entities?


If you’re interested in reading about some of the individual research studies on the topic, the National Center for PTSD has a concise overview of the literature.



Photo by Claudia Soraya on Unsplash

Book review: Be There For Me

Book cover: Be There For Me by Faith Trent

Faith Trent explains that she wrote Be There For Me: An Insight Into My Journey With Depression to “1. Show sufferers they are not alone. 2. Provide advice and guidance for those trying to support a sufferer. 3. Try to remove some stigma around depression.”  At the time of writing she was in the midst of a depressive episode and was off work, and she thought writing would be a good way to make something positive out of something horribly difficult.

The author’s depression journey captures common elements shared by many of us living with depression.  When she first became depressed, she had no idea what was happening, especially since there was no identifiable trigger or reason for her to be depressed.  She was initially reluctant to try medication, a view that she’d picked up from her mother.  There are chapters devoted to various different features of her illness, including anxiety and self-harm.  For her, self-harm was a way to somehow legitimize the way she was feeling.

She describes what it feels like to live with depressive symptoms such as fatigue, apathy, poor concentration, and the pervasive shadow of guilt.  She also explains common thought patterns in depression, including self-doubting, feeling like a burden, and drowning in shoulds.  These are not textbook definitions, but rather descriptions of the subjective experience.

She writes about the challenges of parenting young children with depression, and how the illness makes the daily parenting tasks feel like a mountain that must be climbed.  She finds it hard to be fully present with her children, and she regrets the distance from them that has created.  She also crying in front of them.  I’ve always wondered, though, if there isn’t benefit in children seeing what mental illness actually looks like, and perhaps this helps to prevent the propagation of stigma.

She identifies the essential elements she has found for managing her illness: becoming aware of her triggers and early red flags of worsening illness, maintaining work-life balance, getting enough rest, talking to a close circle of friends, exercising, and doing things that make her happy.  When her illness hits hard, she says “it cripples my whole life…  It causes me to question every part of my life, doubt my value, and make me feel like I am a burden to all I encounter.”  This struck me as such classic depressive thinking.

As is far too often the case for those of us living with mental illness, the author has experienced stigma directly.  Some people made her feel “truly inadequate and small for suffering from something that I feel they didn’t believe was real. I was patronised and made to feel like I was making it up at times.”  It was disturbing to read that a teaching colleague of hers questioned whether she should be allowed to be at work because she might pose a danger to her students.  As a nurse I have faced questions about my safety to my patients, but somehow no one realizes (or cares?) that with depression most often the real risk is to ourselves.

The main focus of the book is breaking down stigma.  She concludes that the only way to do this is for people with depression to share their stories to counter the misconceptions others may have.  I wholeheartedly agree.


You can find the author on her blog Shatter the Stigma.


You can find my other book reviews on my blog index.

Image credit:

Some thoughts on suicide

AFSP National Suicide prevention week 2018

Content warning: This post openly discusses suicide and suicide attempts

You can find info here on where to reach out for help if you’re in crisis.


It’s suicide prevention week, so it seems like an appropriate time to talk about suicide in all its ugliness.  I have attempted suicide multiple times; most were associated with my first episode of depression just over 10 years ago.  Suicidal thinking is a symptom of my illness, and one that will most likely continue to pop up when things get really dark.  It’s something abnormal that unfortunately has come to be all too familiar.

In 2007 I had three suicide attempts outside of hospital, plus multiple attempts while in hospital that resulted in me being sent to psych ICU.  At the time of the first attempt. I hadn’t been diagnosed with depression yet, but I was fairly certain that’s what was going on.  The suicidal thinking had been building, and then it got to the point where I had a plan.  The next step was getting pills, and finally I ended up taking those pills.  Each of these steps was well thought out and took some time; there was nothing impulsive about any of it.  I tried to hold off as long as I could out of a sense of responsibility to my family and other people in my life, but things were just so bleak and hopeless that the idea of remaining alive seemed totally untolerable.  The suicidal thinking was something new to me at that point in my life, so it was hard to figure out ways to cope with it.  I went through a brief phase of cutting in an attempt to find an alternate way to deal with the pain.

When I became depressed in 2010, initially suicidality wasn’t among the symptoms I was experiencing.  However, as the episode extended over the next year I began having ever-increasing thoughts of suicide.  I took myself to hospital voluntarily, but had a very negative experience and ended up being discharged without feeling any better.  I developed a suicide plan involving my psych meds.  At the time, I was working Monday to Friday with every other Friday off, and my plan was to take the pills on one of my Fridays off so no one would notice anything out of the ordinary until Monday.  Each Friday off, I would evaluate whether or not I thought I could make it through until the next Friday off.  Eventually one Friday I decided I just couldn’t take the pain anymore, and I took the pills.  Over the next few days I alternated between sleeping and wandering around delirious, and then when I didn’t show up for work on Monday they called the police.  When the police showed up at my door I was totally loopy, and they hauled me off to hospital.

I haven’t attempted suicide since then, but there have been a few occasions when I have taken steps towards enacting a plan to kill myself.  What has stopped me has been fear – not fear of dying, but fear of “failing” to kill myself.  I generally don’t tell people when I feel suicidal, partly because I don’t feel like talking will help, and partly because I have a strong aversion to going to hospital.  I’ve come to the conclusion that given the history of my illness, chances are fairly good that I will eventually, at some nebulous point in the future, end up dying by suicide.  I don’t say this because I desire this outcome or because I’m suicidal right now, but in terms of simple probability it seems the most likely.

That brings me back to what I said in my post yesterday.  To really decrease the risk of suicide in those of us living with mental illness, we need better treatment.  We need more than just an ear to listen to us; we need something tangible that will truly make a difference and create a bright light of hope.  And that can’t come soon enough.


Image credit: American Foundation for Suicide Prevention

How do we prevent suicide?

AFSP world suicide prevention day

You can find info here on where to reach out for help if you’re in crisis.

Today is World Suicide Prevention Day.  It’s great to raise awareness, but the problem is, people are still dying.  We can talk until we’re blue in the face about why and how people should reach out, and there are lots of great crisis lines out there doing excellent work, but why is there still a gap between that talk and the actual statistics?

The way I see it, there are two broad groups of people that it’s important to connect with when we consider suicide risk.  One is the people who are suffering in silence, and not reaching out for help because of stigma, fear, or whatever the reason may be.  I think initiatives such as World Suicide prevention Day can potentially do a lot of good in reaching this segment of the population and encouraging them to access support.

Then there are those of us who are living with a mental illness diagnosis and doing our best to access the services that are available to us, but we are still suffering.  If you’re like me, maybe the talk about suicide prevention further reminds you of the role that suicidal thinking has played and will continue to play in your life.  It’s important that we talk about it and get it out in the open, but talking isn’t enough.

To truly prevent suicide, we need better treatment for mental illness, and faster access to existing treatment.  The current treatments we have available for mood disorders are okay, but a lot of us are still experiencing symptoms, and that shouldn’t be the only outcome possible.  It can be very hard to maintain hope  when the best available treatment doesn’t take the suicidal thoughts away.  Me calling a crisis line changes nothing about my depression, so why would I even consider it?  My doctor is happy to see me more frequently when the suicidal thoughts come up, and I appreciate that, but there’s not all that much we can really do about them other than me riding them out.  Sadly, I’ve come to accept that this is part of my reality.

So if we are truly going to prevent suicide, we need a multi-pronged approach.  Yes, we need to get people talking and break down stigma.  Yes, we need to make people aware of existing crisis resources.  But we also need better treatment for mental illness, and that means more research dollars.  Because talk doesn’t do much for the many people in the same boat as I am and many of us in the mentally healthy blogging community are.


Image credit: American Foundation for Suicide Prevention