Saturday, May 27, 2017

The world of personality disorders

There’s an area where very few want to go in mental health and that’s the world of personality disorders.  As with everything in this life, there’s a spectrum and we’re all on it in some shape or form. Stress can be defined in many ways, but one of my favourites is that stress is caused by unmet needs. And one of our most important needs is for our caregiver(s) to be present with us. This translates to someone being attuned to us and our needs, we then conclude that our needs and therefore we, matter.

There’s some research that shows that some people who have personality disorders were born that way. They didn’t suffer any childhood trauma that would explain why they are the way they are. But that’s assuming that any trauma was measured properly, based on experience not just events. Besides the more obvious physical and sexual abuse, more insidious and hidden forms of trauma often go undetected or minimised, like neglect. And let’s not forget about accidents and medical procedures. There is also the often overlooked area of trauma in utero which research has shown explains a lot of subsequent “unexplained” behaviour. We’d like to believe that all babies are born a blank slate but that is not the case at all, unfortunately.  And then there is the field of epigenetics which helps to explain the phenomenon of intergenerational trauma which is hypothesised to last for at least 7 generations. So even if we haven’t suffered any trauma in this life, which is extremely rare, our life in the womb and the life of our ancestors can explain a lot about our current behaviours.

In his book, Born for Love, Bruce Perry writes about interviewing a teenage boy called Ryan who had raped a 15 year old developmentally disabled girl and showed no remorse, in fact he said “I don’t know what the problem is really, she never would have gotten laid by anyone as good as us”. Perry said he was as cold, perhaps even colder, than any sociopath he had ever interviewed, including some killers. It turned out that by the time Ryan had turned 3, he had had 18 nannies. He would scream if his mother (who spent at most one hour a day with him) picked him up but at age 3, this had stopped. Perry says this is consistent with children who have disrupted attachments, they stop crying and give up trying to get their emotional needs met. He believed that Ryan had attached to 18 different “moms” and each one abandoned him in his eyes, in fact it was his mother who thought the nannies were getting too close to her son who then fired them. Before he started school, the relational part of his brain had become stunted and functioned abnormally according to Perry.

In a course on family trauma I did by Robert Rhoton, he lists a series of behaviours of sympathetic (angry, aggressive, reactive, hostile, self-centred, coercive, bossy, tantrums, impulsive) and parasympathetic (reactive, emotional and psychological distancing, self-centred) dominance (branches of the nervous system), that are consistent with many of the behaviours that we see in personality disorders. When a person is healthy, these two branches are switched on as needed, neither one is permanently on. A dysregulated nervous system is the basis for a lot of our ills, both mental and physical. One of the most defining and despised characteristics of anyone with a personality disorder is that of being self-centred, the extreme end being a complete lack of empathy for others. It’s like their mantra is “what about me?” and I say that as an observation, not a criticism.


I remember hearing Sebern Fisher saying of people with Borderline Personality Disorder that “they don’t have much sense of themselves beyond those feeling states”. Just imagine how that might feel? You’re stuck in sympathetic or parasympathetic dominance, or alternating between the two, and that’s basically your only sense of self. It must be hell on earth. We hear all the time that we should separate the behaviour from the person, especially when it comes to children. But we have very little compassion for that same child who, as an adult, has a mental health problem for whatever reason. How do we ever hope to help anyone rehabilitate if we don’t show them some compassion and understanding for what’s really going on with them?

There are many strong opinions on people with personality disorders, some believing that they are essentially unhelpable. I don’t believe that they are unhelpable or unreachable, maybe some are unreachable because they just can’t, or won’t, open themselves up to any outside input, it’s just too dangerous and risky. I can’t remember who said that children who have suffered developmental trauma usually become either overly responsible or under responsible and in my experience that is very true. I think many who fit into the category of personality disorders are usually under responsible. Very little is their responsibility, it’s like as if they feel they will be annihilated if they own up to anything. As adults, we need to take responsibility for the direction our life is taking, particularly if we don’t like where it’s going. Not taking responsibility is the bane of most people’s lives and the lives of those they touch.

We can’t make others be willing to take responsibility. Our responsibility to ourself is to take care of us first. We do no one any favours by rewarding bad behaviour, least of all ourself. We have a choice as adults to stay or go if we are being abused, though it’s not always an easy choice, but children don’t have any choice. That’s why developmental trauma at the hands of caregivers in particular, is so detrimental. The betrayal and wounds run deep and it takes time and care to repair them, but they can be repaired. As Peter Levine says, trauma is a fact of life but it doesn’t have to be a life sentence.

Monday, May 22, 2017

Learned helplessness

Trauma often leaves us helpless and powerless and while our response comes from the autonomic nervous system, as in we have no voluntary control over it, there is such a thing as ‘learned helplessness’. We then learn to default to this conditioned state when we perceive threat, even though actual danger/threat might not be present.

Because of learned helplessness, we can cede our power over to people, particularly those that society calls experts, or those we feel have more authority than us. But there are no experts, there are only people with expertise*, the difference between the two in my opinion, is that experts think they know everything there is to know and in that arrogance, try to set everyone straight. People with expertise on the other hand realise that just like everyone, they’re always learning. With an expert you’ll feel less than, with a person who has expertise, you’ll feel equal to. We need guidance, but what we don’t need is to be told what to do or what it is we need, we know that already on some level and a good practitioner will guide us back to that knowing, if we’ve lost trust in it.

St Declan's cliff walk, Ardmore, Co. Waterford, Ireland
Trauma informed care is important. What it means in reality is that someone has been trained to work with trauma or someone has been trained to recognise the signs of trauma and refer on. Many things help us on our journeys through trauma, if it has helped you, it counts, whether it’s yoga, walking, meditation, painting, swimming, reading etc. By utilising whatever it is, you are not saying it is the panacea, you are saying that it is making your life that bit easier and more pleasant. It really can be the ‘small’ things that can add up to the big things in life.

Maybe we’d like aha/breakthrough moments more often, or even just once ;-) and maybe even a magic wand wouldn’t hurt once in a while. Or maybe we do have aha moments and go forward 10 steps only to take 3 steps back. None of our journeys are linear, they look more like the back of a tapestry; a bit of a mess. But we forget that on the front of our tapestry, we’re creating our own unique picture.

We need to remember to count the good in our lives so we get to actually view the real picture every now and then, this will help us through the difficult times by inspiring us and giving us much needed hope and a bit of a break from trying to fix ourselves all the time. This is not a false or forced positivity but a genuine acknowledgement of the good in us and our lives. I think without this balance, we can easily despair and feel hopeless.

* I first heard of the distinction between expertise and experts from a lecturer I had in university.

Monday, May 15, 2017

The bladder meridian

Inflammation, the language of stress, can show up in lots of different ways and in different organs and in this week’s blog post, I’m going to discuss the bladder meridian (bladder 2), the eyebrow point in EFT. The bladder meridian is paired with the kidney meridian, which governs fear. The bladder meridian is the guardian of peace and the longest and most complex meridian in the body.


We can get quite overwhelmed when we think of everything that can go wrong, or that has gone wrong, with our health, but if we keep it simple and think in terms of relieving our stress whenever we can, we can really make some big improvements.

Where dis-ease shows up in our body and mind can be symbolic and tapping on the symptoms can be a doorway in to the root cause (which is nearly always a dysregulated nervous system due to undischarged traumatic stress). For example, imbalances in the bladder meridian can show up as excessive urination, interstitial cystitis, pain in the eyes, colds, blurred vision, nasal congestion, abdominal distension and so on. The key is to listen and follow the golden thread that leads us to resolution.

Monday, May 08, 2017

I am worthy just for existing

So many of us value ourselves and are valued by others for what we do, not who we are. This drives us to push, force and struggle but we never feel we’re enough or have done enough.

Try saying “I’m enough” out loud, how true does it feel on scale of 0 to 10? 10 being true and 0 being not true at all. Or if you find it difficult to rate how you feel by numbers, what does it feel like in your body when you say these words? How do you know it’s true, not true, or half true etc?


Or try saying it the opposite way “I’m not enough”. Do you have “evidence” to back this belief up? Try tapping on the following and change it to suit you and how you feel. You can download the EFT shortcut in the menu on the right hand side of this page.

Even though I feel that my worth is what I do, not who I am, I accept myself anyway

Even though I don’t feel enough because … I completely accept how I feel

Even though I don’t feel worthy (of …) I am open to that changing

TH: I’m not enough
Eyebrow: Because … (what memories/people pop up?)
Side of eye: Who I am isn’t enough
Under eye: And that feels …
Under nose: So I have to keep doing …
Under chin: To feel worthy
Collar bone: But it’s never enough
Under arm: I never get “there”

TH: Where is there?
Eyebrow: Love from others?
Side of eye: Love for myself?
Under eye: Acceptance?
Under nose: Validation?
Under chin: How would that feel?
Collar bone: That I’m enough?
Under arm: It would feel …

TH: When did I first feel I wasn’t enough? (Guess, if you don’t know)
Eyebrow: Just as I am
Side of eye: How would it feel
Under eye: Not to have to do anything
Under nose:  To be worthy (of …)
Under chin: I could do it because I wanted to
Collar bone: Not because I feel I have to
Under arm: And that would feel …

Saturday, April 29, 2017

Dissociation as a root cause

As Karla Mc Laren says in her book, Language of Emotions, emotions nearly always arise in clusters. It’s rare that neat well-behaved emotions come up one at a time, patiently waiting their turn to be felt. No, life is messier than that and of course when emotions such as anger, fear and sadness come up together, we can easily become flooded, especially the younger we are, and so we leave the premises as Tara Brach says. The premises being our body and mind.

Leaving the premises is another way of saying dissociation. Currently, there are distinctions between psychic and somatic dissociation which reflects the current mind/body split. But where does psychological dissociation begin and where does somatic dissociation end? I think it’s impossible to say this person has 48% psychic dissociation and is 52% somatically dissociated, that is, if anyone is ever 100% dissociated. All we can really look at is how dissociation, in any form, adversely impacts the life of someone and help them accordingly.

Paul Dell, for example, calls psychological dissociation, ‘clinical' dissociation and somatic dissociation, ‘animal defenses’, at least from my understandings of his writings. Dell argues that clinical/psychological dissociation is 'abnormal' whereas animal defenses are 'normal' and part of our evolution. I think both phenomena mirror the evolutionary development of our brains, bodies and minds and are normal and adaptive when we are faced with threat. Issues arise when dissociation, both psychological and somatic, becomes chronic and persistent. The mind, brain and body are linked in an interconnected system, when they are treated separately, disaster can result, especially for the person suffering.

Humans are animals the last I checked. These distinctions illustrate just how far removed we’ve become from our animal nature, body and instincts, which has done our nervous systems no favours whatsoever. If a wild animal does not discharge the freeze response (tonic immobility), if they survive being eaten by a predator, they remain in a startled and hypervigilant state which makes their chance of survival very poor. Remaining hypervigilant, they perceive threat where there is none and become less sensitised to real and present threat. This hyperaroused state also creates exhaustion, so when they do need to act, they don’t have the energy or stamina to outrun the predator. The exact same thing happens to what we call ‘civilised’ humans who have been traumatised. Too many of us have lost our knowledge and ability to shake vigorously after receiving a shock, to howl, cry and scream when we’ve lost a loved one and so on. Many of us have had to learn to keep it all in to survive and not rock the boat.

This mind/body split is also mirrored in current measurement scales for psychic and somatic dissociation. There is the well known Dissociative Experiences Scale (DES) which measures psychological dissociation. Out of 28 questions, there is one nod to the body, question 13. Then there is the Tonic Immobility Scale* and the Somatoform Dissociation Questionnaire (SDQ20), which both measure somatic dissociation. There have been some steps forward in the field, a recent paper by Nijenhuis (2017) recommended that conversion disorders be recategorised as dissociative sensorimotor disorders in DSM-5. (He uses the terms cognitive-emotional and sensorimotor dissociation in this paper in place of psychic or somatic dissociation).

*Click on image to see larger view of Tonic Immobility Scale

I know there is debate over whether dissociation is a process or a state, I think it can be both. I haven’t yet heard a term that better describes leaving our bodies and minds and the resulting split, or splits, that can result (what Nijenhuis and van der Hart (2011) refer to as structural dissociation of the personality). I believe that anxiety arises when we’re overwhelmed by years worth of stuff, it’s a compounded state consisting of unfelt emotions (and physical sensations etc), that we’ve dissociated from, consciously and unconsciously.

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So many ‘disorders’ stem from dissociation and trauma, which is why I believe it is so important to normalise the terms themselves and the experience of them. They are the root cause for so many so-called different ‘disorders’. All of us are somewhere on the dissociation continuum, as we are on any continuum. Who among us hasn’t been hurt (traumatised) or wanted/needed to avoid (dissociate from) pain?  Isn’t it about time that we started looking for and healing the root cause instead of being blinded by symptoms? Isn’t that what science is supposed to do? Concepts like dissociation can really frighten people, but with education and normalisation they don’t have to.

So, where do you start on your healing journey, wherever you find yourself? You start slowly, taking one step at a time. As Martin Luther King Jnr says: A journey of a thousand miles, begins with one step. You start by being as kind as possible to yourself as you go inside to reconnect with what remains unexperienced so you can experience it as slowly and as gently as you need to. Don’t forget to resource and support yourself wherever and whenever you can. This isn’t about pushing through and going fast, in fact the more urgent you feel, I think the more slowly you should take things or you risk being overwhelmed and even retraumatising yourself.

References
Bernstein, E. M. and Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale, Journal of Nervous and Mental Disease 174(12): 727-735.
Fuse, T., Forsyth, J. P., Marx, B., Gallup, G. G. and Weaver, S. (2007). Factor structure of the Tonic Immobility Scale in female sexual assault survivors: An exploratory and confirmatory factor analysis, Journal of Anxiety Disorders 21(3): 265-283.
Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., & Vanderlinden, J. (1996). The development and the psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20), Journal of Nervous and Mental Disease, 184, 688-694.
Nijenhuis, E. R. S. and van der Hart, O. (2011). Dissociation in trauma: A new definition and comparison with previous formulations, Journal of Trauma & Dissociation 12(4): 416-445.
Nijenhuis, E. R. S. (2017). Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder, European Journal of Trauma & Dissociation 1: 47-61.

Monday, April 24, 2017

Let me count the names

Can you think of any physical disease where people might have insults hurled at them just because they had the physical disease? I certainly can’t. People would think it cruel and unkind, yet it’s okay for people with mental illness to be insulted and derided. It’s even called ‘joking’ by some. The sheer amount of insults hurled at anyone who has a mental illness speaks for itself, this is a short list and it’s only in English. The name calling and consequent shaming, illustrates the fear and ignorance of mental illness (or indeed any condition related to mind and brain health such as intellectual disabilities) is still alive and kicking. Ask anyone how the stigma affects their day to day life and unfortunately, they and their families will have plenty of stories.

In the case of schizophrenia and bipolar disorder (formerly known as manic depression), people are/were called schizophrenic and manic depressive, which I think is absolutely appalling. I can think of only one physical disease in which that happens which is diabetes, people who have this condition are often referred to as diabetics. Are people their illness now, is there nothing else to them except the illness?


Many so-called mental disorders are actually caused by trauma. Just imagine stigmatising someone because they’ve been through tough times? Hard to believe that that could happen isn’t it? But maybe that’s because many people haven’t made the link between adverse experiences and poor mental health. They might still believe the outdated claim that it’s a “chemical imbalance”. So where does the chemical imbalance originate from then? You’ll get very few satisfactory answers to that simple question in mainstream medicine. Or maybe it’s because the shame of mental illness goes so deep that we prefer to deflect and project our fears that it could be us onto others. Name calling, it’s sad to say, is only part of the stigma, discrimination in all its different forms can really inflict untold suffering.

Another major cause of mental illness is inflammation, especially in our gut which is intimately tied to our brain, the health of our gut affects our brain’s health and vice versa. And what is one of the biggest sources of inflammation? Stress; biological, emotional, environmental etc. So traumatised people are especially vulnerable to any chronic disease, both mental and physical, because their stress levels are usually high, as the ACE study and many other studies have showed.

I have never heard someone with schizophrenia say “I am schizophrenic”, instead they usually say “I have schizophrenia”, it’s others who usually refer to them as schizophrenics, and surprisingly a lot of them are mental health professionals. Leaving space for who you are beyond any diagnosis or label is crucial. This isn’t about being politically correct, as that terrain is always changing, it’s about how we see people who are suffering with mental health issues and how they feel as a result. And more importantly, how they feel as a result of how they see themselves.

When I’m tapping, I often use ‘I am’ and ‘I feel’ sentences which I find really useful. Take the statements, I am bad or I feel bad, for example. Feeling bad is (hopefully) temporary, whereas I am bad, is permanent. It’s a belief, a “truth”, but not “the” truth. It’s always good to differentiate between ‘I feel’ and ‘I am’.

Monday, April 17, 2017

An important ingredient in resolving trauma

I think one of the most important ingredients in recovering from trauma is having support, and there is plenty of research to back this up. While having a sense of support and community can include animals and nature, among other things, I don’t think we can discount the importance of having the warmth and tenderness of a relational home that another human being can provide. Whatever internal and external resources we have, no matter how small or insignificant they might seem initially, we need to acknowledge and build upon all of them.

Without enough support and resources, our nervous system will find it too unsafe to discharge any trauma that it has been holding, which makes total sense when you think about it, after all its job is to protect us. This is especially true with early and developmental trauma, not only is support sometimes missing completely, or in part, there is often also neglect and abuse to contend with and this can and does stunt our growth and development.


However, as Peter Levine says, trauma is not a life sentence, it can be resolved. But at the same time it’s also important to acknowledge that developmental trauma is more complex than shock trauma because of the fact that our nervous system has been on high alert from a young age and our system has developed all sorts of strategies for coping, some healthy and some not so healthy. Developmental trauma affects everything, our view of ourselves, the way our brains and bodies develop, our relationships, everything, so persistence is definitely needed with resolving complex trauma.

By growing any support and resources, you can make your healing journey easier and more pleasant. You don’t have to be fixing yourself every moment of every day, that’s exhausting and depleting. You’re not broken, you’re hurt. You might feel broken but it is not your identity. Taking a break whenever you can, having fun, laughing, going for a walk, having a bath, is really important to lessen your stress load. Don’t wait until you feel overwhelmed, do something for yourself daily.

When you’re in physical and emotional pain, it can feel quite urgent to fix it or make it go away. So be kind to the part that feels that desperation to be free from pain. The great thing about tapping is that you can tap on anything and everything, just start with however you’re feeling right now. Don’t worry about being “negative” or “positive”, just be true to how you feel and tap on that, then watch your system release stress with yawns, sighs, burps and so on. Tapping on the truth of how you feel is extremely powerful.

These are some tapping phrases (see EFT shortcut diagram here) that you might start with:

Even though I feel desperate to … I completely accept how I feel

Even though I feel I don’t have any support*, I completely accept how that makes me feel

Even though I feel broken because … I accept myself anyway

*Be really specific here and look for both internal and external resources, whatever they may be; books, music, exercise. We can often feel unsupported if we don’t have close relationships with others, but support can come in a variety of ways and you can always reassure yourself that you’re moving towards connecting with others when it feels safe/comfortable enough for you.

Saturday, April 08, 2017

Tapping script for pushing through


Following on from last week's post, try this script for feeling the need to push through, sometimes at a high cost to your mental and physical health. Diagram for EFT Shortcut

Even though it’s too dangerous to stop trying, I completely accept how I feel

Even though I have to keep going because … I completely accept how I feel

Even though if I stopped trying, I fear … would happen, I completely accept this fear

Top of head: It’s not safe to stop
Eyebrow: But maybe I could take a break every now and then
Side of eye: That feels …
Under eye: I don’t trust that things will get better if I don’t keep trying
Under nose: But maybe I could try one thing at a time
Under chin: And not overwhelm myself by trying to do everything
Collar Bone: I could simplify things
Under arm: And take it easier on myself

Top of head: This urgency
Eyebrow: To get better
Side of eye: I understand it
Under eye: Because I don’t want to suffer
Under nose: But I’m suffering by struggling with too many things as well as everything else
Under Chin: I need to pare things down
Collar bone: To a manageable amount so I don’t get overwhelmed
Under arm: I’m still moving

Top of head: Just more slowly
Eyebrow: And that feels …
Side of eye: It’s ok to be kind to myself
Under eye: Or is it?
Under nose: Whose permission do I need to be kind to myself?
Under chin: Mine or someone else’s?
Collar bone: Can I get this permission?
Under arm: Because I know the value and power of kindness

Top of head: Whenever I’ve felt it
Eyebrow: It has felt good
Side of eye: Do I deserve to feel good?
Under eye: There’s no right answer here
Under nose: I can tap on however I feel
Under chin: Because it’s the truth
Collar bine: And the truth will set me free
Under arm: Even if it’s initially painful

Top of head: I know it’s more painful to live a lie
Eyebrow: I’m willing to tap on how I really feel
Side of eye: There’s huge power in honesty
Under eye: It lifts a weight from me
Under nose: And I feel freer
Under chin: To be me
Collar bone: I’m learning who I am
Under arm: And that feels …