Dear Pathological Narcissist

Dear Pathological Narcissist,

It is not my job to make you feel good
about abusing me.

Therefore:

I will not pretend you don’t lie.

I will not pretend you’re moral.

I will not pretend you’re just joking.

I will not pretend you love me.

I will not pretend it’s OK for you
to destroy me.

When it is Time to go to the Hospital: 11 Steps to Take Before and After Admission

I don’t do well in mental health settings.

I don’t look sick.

I don’t act like a ‘mental patient’.

Not all people with mental illness end up homeless and hallucinating
on the street.

I also have expectations.

I expect my treatment providers to be as passionate as I was when I worked in the field of mental health.

If you have Dissociative Identity Disorder and you are you are about to enter treatment at a Behavioral Health facility it’s a good idea to prepare.

(1)

Don’t assume that behavioral health professionals are trained psychotherapists. Psychotherapy treats the mind. Behavioral Health
treats behaviors.


(2)

If your primary treatment provider is an outside therapist, ask him or
her to communicate your treatment status and history to the facility.

(3)

Confirm that the counselors at the treatment facility have spoken to
your primary therapist when you arrive for your first day.

(4)

Ask if the staff knows how to treat trauma symptoms.

(5)

Do not enable staff ignorance; you have every right to expect your treatment providers to know what they’re treating and to know how to treat it. Speak to the attending psychiatrist if you have concerns. If that fails, make use of grievance procedures to get the most out of your treatment.

(6)

Do treat the staff with respect and consideration. Most people want
to do a good job.

(7)

Do tell the staff about suicidal thoughts or self-destructive alternates.

(8)

Discuss your physical health and if one is needed, ask for a physical.

(9)

If you are diabetic or have high blood pressure, ask the staff to check your blood pressure and sugar levels. Diabetes and high blood pressure affect mood.

(10)

Ask for a medication assessment.  Mention all unusual side effects or problems.

(11)

Don’t enter a hospital or day clinic alone. Ask your partner and friends to call and ask about your progress.  Make sure that you sign the releases the clinic needs to discuss your case with friends and family.

(c) Rob Goldstein 2017

This post is specific to people with Dissociative and other Trauma
related disorders.

Some of this information may not apply to you.

More reading:

Advocacy for mental health: roles for consumer and family organizations and governments

The Importance of Self-Advocacy in Mental Health Recovery


The Self Advocacy Toolkit

stand up against stigma, no health without mental health

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Dissociative Identity Disorder: A Week in the Valley of Shadows

Repulsion and Trauma

First posted 2/24/2016

Decompensation: Psychology, a loss of ability to keep up normal psychological defenses, sometimes resulting in depression, anxiety, or delusions. Dictionary.com

One of my favorite literary descriptions of decompensation is from the 1933 short story, Miss Lonely Hearts by Nathanael West.

Miss Lonelyhearts is an advice columnist who slowly loses his mind from the suffering that he reads and responds to. This is toward the close of the story:

“After a long night and morning, towards noon, Miss Lonelyhearts welcomed the arrival of fever. It promised heat and mentally unmotivated violence. The promise was soon fulfilled; the rock became a furnace.

He fastened his eyes on the Christ that hung on the wall opposite his bed.

As he stared at it, it became a bright fly, spinning with quick grace on a background of blood velvet sprinkled with tiny nerve stars.

Everything else in the room was dead–chairs, table, pencils, clothes, books. He thought of this black world of things as a fish. And he was right, for it suddenly rose to the bright bait on the wall. It rose with a splash of music and he saw its shining silver belly.

Christ is life and light.

“Christ! Christ!” This shout echoed through the innermost cells of his body.

He moved his head to a cooler spot on the pillow and the vein in his forehead became less swollen. He felt clean and fresh. His heart was a rose and in his skull another rose bloomed.

The room was full of grace. A sweet, clean grace, not washed clean, but clean as the inner sides of the inner petals of a newly forced rosebud.

Delight was also in the room. It was like a gentle wind, and his nerves rippled under it like small blue flowers in a pasture.

He was conscious of two rhythms that were slowly becoming one. When they became one, his identification with God was complete. His heart was the one heart, the heart of God. And his brain was likewise God’s.

God said, “Will you accept it, now?

And he replied, “I accept, I accept.”

He immediately began to plan a new life and his future conduct as Miss Lonelyhearts.

He submitted drafts of his column to God and God approved them. God approved his every thought.”

Miss Lonleyhearts by Nathanael West

My episodes of decomposition are less dramatic, but no less frightening.

It’s frightening to lose the ability to sleep and concentrate.

It’s frightening to lose the ability to distinguish between reality and fantasy.

It’s frightening to wake-up tired and hopeless and thinking that it never gets better.

Decompensation is not necessarily a bad thing if it is part of the therapeutic process.

“…anxiety and panic symptoms are almost invariably “feeling flashbacks” triggered by a relatively benign event in the here-and-now, such as being alone in a room at twilight.” The Work of Stabilization In Trauma Treatment

The basic skills a trauma patient needs are these:

  • grounding and centering techniques
  • coping strategies for dealing with suicidal and self-abusive impulses
  • contracting for safety with themselves and others
  • anticipate stressful or triggering events
  • learn how to calm the body and mind
  • distinguish past from present reality and how to stay “in the present”

The Work of Stabilization In Trauma Treatment

If the trauma symptoms include dissociative alters the alters must know about and communicate with each other.

This is not easy and my recent attempts to communicate broke through memory barriers and lead to this most recent period of decomposition and regression.

Regression is an unconscious defensive process by which the patient reverts to a previous level of functioning, usually to a certain infantile or juvenile stage.”

One of the best portrayals of regressive decomposition is in the film Repulsion by Roman Polanski.

Catherine Deneuve portrays Carol, a sexually conflicted young Belgian woman.

Carol lives in London with her older sister. .

The film suggests that either Carol’s father or some other man sexually abused her as a child.

I first saw Repulsion when I was in my 20’s.

Watching it again this week during an episode of decompesation was a revelation.

Polanski shows us Carol’s anguish and her rapid decline with brilliant accuracy; when the Sister leaves for a week-long holiday we enter the dangerous territory of Carol’s mind.

“…the most common effect of sexual abuse is Post Traumatic Stress Disorder. Symptoms can extend far into adulthood and can include withdrawn behavior, reenactment of the traumatic event, avoidance of circumstances that remind one of the event, and physiological hyper-reactivity.” Psychology Today

We see these symptoms when Carol’s boyfriend tries to kiss her. She reacts with disgust, runs into her apartment in a panic and obsessively brushes her teeth.

According to American Nurse Today,Those with a history of childhood sexual abuse have increased reports of fear, anxiety, insomnia, headaches, aggression, anger, hostility, poor self-esteem, and suicide attempts. Higher rates of depression are reported. Depression has also been shown to be associated with impaired immune functioning. Increased cytokines (inflammation) and cortisol (stress) have been identified as mechanisms by which immune system function is impaired and related to depression.”

My body is constantly pumping out stress hormones which lead me to suspect that the decompensation is as much physical as it is psychological.

I become so physically exhausted that I can’t function.

This is especially true when I’m alone.

I can organize around the needs of the people I love when they are present.

According to the Institute of Psychiatry, Psychology and Neuroscience in South London,

“The symptoms of psychosis and the symptoms of PTSD are alike. The vivid flashbacks of PTSD can be similar to, or the same as, hallucinations. The intense fear and ‘re-experiencing’ symptoms of PTSD can be akin to delusions that people who have psychosis experience.”

Both PTSD and psychosis can lead to disturbed sleep patterns, difficulty concentrating, personal neglect and withdrawal from other people. The paranoia (see Paranoia page) often associated with psychosis can mirror the hyper-vigilance that people with PTSD may experience.

If someone is hearing voices or other sounds, or seeing and smelling things that others cannot see or smell, they may be re-experiencing a trauma and not experiencing the symptoms of psychosis.

However, GPs and mental health professionals may attribute the voices and other symptoms to psychosis and not consider PTSD as a possible diagnosis.

Researchers think people may sometimes be misdiagnosed, particularly if GPs and mental health professionals don’t ask about past traumatic events.

Misdiagnosis can lead to mistreatment: patients are often given high doses of anti-psychotic medication, which is not the recommended treatment for PTSD.

Among the trauma symptoms depicted in Repulsion are the loss of time
which begins almost as soon as Carol is alone.

We see her increased sense of disconnection from her environemnt.

Later, as her paranoia and hypervigilance escalates Carol re-lives her assault.

By the end of the week Carol is lost to herself and the film closes with a snapshot of Carol as a child, gazing angrily at her Father.

Kim Morgan of the Huffington Post calls Repulsion one of the most frightening studies of madness ever filmed.


A colorful work of Abstract Art designed to represent a confusion of thought
A Flight of Ideas

The most lethal myth imposed on us by behaviorism  is that we are in complete control of everything we think and do.

This denial of unconscious memories and motivations is at odds with the real world symptomatology of someone with severe PTSD.

Everyone can benefit from using DBT, but recovery from a Post Traumatic Stress Disorder takes longer than 90 days and requires more intensive treatment strategies.

A psychotherapist is crucial for gaining control over the most severe and debilitating symptoms of PTSD and CPTSD.

Decompensation is an expected feature of any chronic and severe mental illness.

You have a complex and serious illness and can’t control every last aspect of it.

Recovery happens in steps. It is normal to have setbacks.

If you have a counselor or psychotherapist let that person know what is happening when you feel yourself entering a crisis.

Remind yourself that memories are just memories. It is more normal to remember a trauma than to forget it.

Remind yourself that panic attacks are not dangerous; if you find yourself
in the middle of one stop and pace your breathing.

Therapy is sometimes painful, especially when it is working.

You may notice more symptoms as you begin to have memories.

If you start to relive the past remind yourself of the present.

The trauma happened in the past, and you are in the present.

When you can’t sleep don’t lie in bed thinking or worrying; get up
and enjoy something soothing or pleasant.

If you have difficulty concentrating give yourself time to focus on what you need to do. You may also have symptoms of depression. It is not uncommon for people with PTSD and CPTSD to have depressive episodes.

If the acuity lasts for more than a few days or if you have serious suicidal thoughts and impulses call your therapist or counselor.

If you feel as if you are an immediate danger to yourself or to someone else call 911 or go to an emergency room.

My emotions were everywhere this week.

My decompensation is not as dramatic as Carol’s; it certainly doesn’t
have the narrative edge.

It involved lost time and laying in bed watching non-stop MST3K.

Thank God for that show and for the part of me that comes out to watch it.

The most difficult thing about surviving is surviving.

Rob Goldstein 2016

Video clips and still shots are from the film Repulsion and used
here for educational purposes.

‘A Flight of Ideas’ (c) Rob Goldstein 2016

Disclaimer: I am not a mental health professional. I write about my personal experience. What works for me may not work for you. If you think you are having a psychiatric episode please see a professional.

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Virtual Reality and The Dissociative Spectrum

Studies of people who use Virtual Reality as their primary form of entertainment show a spectrum of dissociation.

This idea of a spectrum of dissociation emerges as virtual reality becomes increasingly immersive and the dissociative process becomes more complete and easier to see.

Clinical psychologist Sherry Turkle suggests that users of virtual reality are in a transition from “…a modernist culture of calculation toward a postmodernist culture of simulation.”

When Turkle made these observations in 1996 immersive virtual reality was not available to average users

Turkle wrote: “Windows have become a powerful metaphor for thinking about the self as a multiple, distributed system…The self is no longer simply playing different roles in different settings at different times. The life practice of windows is that of a decentered self that exists in many worlds, that plays many roles at the same time.” Now real life itself may be, as one of Turkle’s subjects says, “just one more window.”

A couple of studies suggest that virtual reality increases dissociative behavior and reduces one’s sense of presence in objective reality.

This is from the 2013 paper Sanity and Mental health in an Age of Augmented and Virtual Realities, by Gregory P. Garvey:

“In virtual worlds like Second Life, ‘residents’ may have multiple avatars having different genders through which they enact very different personalities. Such role-playing fits with the description of Dissociative Identity Disorder in the DSM-V. Users of Second Life have experiences akin to depersonalization, de-realization or even dissociative identity disorder.”

Garvey conducted a survey of 110 users of Second Life based on the Structured Clinical Interview for Depersonalization–De-realization Spectrum.

“Many users have multiple avatars, which enact distinct identities or personalities, and this fits the criteria for dissociative identity disorder. To experience any of these disorders in real life may be considered undesirable, even pathological. But for users of Second Life such dissociative experiences are considered normal, liberating, and even transcendent.” Gregory P. Garvey, Dissociation and Second Life: Pathology or Transcendence?

For healthy people the controlled use of the dissociative process is liberating; and virtual reality gives us new ways to express ourselves and learn.

But pathological dissociation compromises the brain’s ability to differentiate
the real from the imaginary.

To dissociate pathologically is to lose ones place in time.

Photo of a male avatar walking in the rain against the backdrop of a black and white snapshot of public housing
in the projects

 

(c) Rob Goldstein 2015-2017
First posted 2/28/2015

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