Mental Health: An Autobiography in Five Short Chapters for People with PTSD and CPTSD.

The “Autobiography in Five Short Chapters,” by Portia Nelson is a mainstay of 12 Step Programs.
It is primarily used as an allegory to describe the addictive process. i.e. the insanity of repeatedly and consciously making the same mistake with the hope of getting different results.
The “Autobiography” goes like this:
“I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost… I am helpless.
It isn’t my fault.
It takes forever to find a way out.
I walk down the same street.
There is a deep hole in the sidewalk.
I pretend I don’t see it.
I fall in again.
I can’t believe I am in the same place.
But, it isn’t my fault.
It still takes me a long time to get out.
I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in. It’s a habit.
My eyes are open.
I know where I am.
It is my fault. I get out immediately.
I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.
I walk down another street.”
Portia Nelson, There’s a Hole in My Sidewalk: The Romance of Self-Discovery

I received my copy of “Autobiography in Five Short Chapters” in a clinical setting, as part of a treatment group for people with C-PTSD.

For me, that’s a problem. Here’s why:

In my experience, people with primary substance abuse disorders know they are in a hole, even in their denial. They not only know where the hole is, they know how they fell in, and they know the way out.

Our for profit medical system sees “behavioral” health and 12-Step Programs as a cheap alternative to providing the more expensive services required by people with mental illnesses.

Some people with severe mental illnesses have substance abuse disorders, but they are secondary to our illness, and to the artificially induced poverty, that forces us into slum housing and into the arms of aggressive drug dealers.

I did not fall into a hole.

I was placed in a hole as an infant.

Any attempt to crawl out that hole was met with violent beatings.

After she solemnly read the ‘Autobiography in Five Short Chapters’ to us, the therapist who was running the group asked us what we thought.

I raised my hand:

“What if we were stuffed into a hole before we knew we were alive?”

She had no answer.

Behaviorism has few answers for people who need intensive psychotherapy.

***

For those of us with mental illnesses related to childhood sexual assault and trauma, I offer this Autobiography in Five Short Chapters for People with PTSD and CPTSD.”


Chapter One
“I wake up and I am in a hole. I don’t know that I am in a hole. The hole forms the circumference of my world. I base my options in life on its width and depth. It is uncomfortable but the hole is all I know.
I feel constrained and helpless.
One day I look up and see that light enters the hole through an opening at the top.
My eyes are so dazzled I cover them.
***
Chapter Two:
I live in a hole in the sidewalk but I am not certain of this.
I try to pretend that It isn’t true but I see that there are edges at the top of the hole through which the Sun shines.
I decide to climb toward the light to look beyond the edge.
I climb to the top.
It takes a long time.
I see that beyond the hole is a vista that is more rich with possibility than anything I have ever imagined.
My fear is so profound I fall back into the hole where I know I am safe.
***
Chapter Three:
I live in a whole in the sidewalk, which is where I was placed as an infant.
I try to forget what I saw when I climbed toward the light and looked over the edge.  The hole feels small and cramped but the thought of leaving fills me with dread.
I try to pretend that I don’t know that I am stuck but pretending doesn’t work anymore.
I am furious.
Why am I in this hole?
 It isn’t my fault.
I contemplate climbing out
***
Chapter Four:
I live in a hole in the sidewalk. My world is in this hole yet I feel I must leave this tiny world for the larger one above: the real world.
I slowly climb to the top of the hole and slowly pull myself out.
I stand at the edge of the hole, terrified and uncertain of what to do next.
***
Chapter Five:
There is a hole in the sidewalk. I’ve spent my life in this hole and once believed  it was the entire World. I am terrified and want to throw myself back into the hole, but enter psychotherapy instead.
Rob Goldstein 2014 – 2019

Dissociative Identity Disorder: Learning to Trust

The patients’ job in intensive psychotherapy is to ask why.

Why do I seek out women who are devoid of the capacity for love?

Why do I veer from an extreme identification with the middle class to an extreme identification with the poor?

Why do I force myself to fail economically just as I get closest to winning?

Why do I sometimes behave as if I hate myself?

I first grappled with the problem of internalized stigma during the early days of the AIDS epidemic when I wondered if the AIDS was God’s judgment.

None of the intellectual and political constructions that served me as gay activist in the 1970’s could defeat the internalized homophobia unleashed by AIDS.

I watched men die from grief, self-hatred, and fear and I was nearly one of them.

This was when I realized the true function of any ‘ism’ is to convince the target to self-destruct.

This was why any novel written about gays before Stonewall usually ended with suicide or the impoverished death of the gay character.

AIDS was the greatest tragic ending, infused with the dissonant myth of a loving, yet vengeful God.


Internalized homophobia was the least of my problems.

AIDS was trauma on trauma.

I didn’t know I had a dissociative disorder.

I was living in the worst possible place at the worst possible time
for someone with Dissociative Identity Disorder.

Any spot on my arm sent me into panic, so much, so I became a frequent
flyer at the local crisis clinics.

The shrinks eventually gave me a prescription for Xanax.

Xanax
                                 Xanax

The only thing I knew about Xanax was it made the fear go away.

The pharmaceutical industry reported Xanax had an anti-depressant effect.

By 1986 I was on a prescribed dose of eight milligrams a day.

A seizure when I decided to stop the drug was how I learned  Xanax is addictive.

2011 photograph of a mannequin in a shop window on Mission Street taken in 2011 with a Blackberry
Xanax

My DID allows parts of me to form attachments while protecting the parts that are fragile and afraid.

One goal of my treatment is for me to learn to trust a woman.

This process of building trust with a woman who wants what’s best for me and who acts in my interests is a path to becoming whole.

John C. Calhoun Homes
A digitally altered snapshot of one of my childhood homes.

As I enter my 8th year of intensive psychotherapy, the questions I must
ask are less confounding.

When I entered treatment in October of 2011, I felt like a helpless child.

It is now October 2018.

I feel more whole.

(c) Rob Goldstein 2015-2018
The Photo of Xanax found on Google Images

First posted November 1, 2015-updated November 8, 2017 – Rewritten and Updated October 21, 2018

 

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Dissociative Identity Disorder: A Week in the Valley of Shadows

This article is also published on Surviving My Past

Repulsion and Trauma

First posted 2/24/2016-Revised October 2018

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

A favorite literary description of a psychiatric decompensation is in the 1933 short story, Miss Lonely Hearts by Nathanael West.

Miss Lonelyhearts is an advice columnist who slowly loses his mind from the suffering he reads. This passage 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 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, 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

  • Learn to anticipate stressful or triggering events

  • Learn  to calm the body and mind

  • Learn to distinguish past from present reality and how to stay “in the present”

The Work of Stabilization In Trauma Treatment

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

This is not easy, and 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 her Sister leaves for a week-long holiday we enter the 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.

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

We see her increased sense of disconnection from her environment.

Later, as her paranoia and hyper-vigilance 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.

My emotions were everywhere this week.

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

It involved lost time and laying in bed watching Repulsion followed by
non-stop episodes 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.

If you have a counselor or psychotherapist let that person know what is happening if you think you entering a crisis.

You can also call the National Suicide Prevention Hotline: 1-800-273-8255

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

When you have a panic attack stop and pace your breathing.

If you start to relive the past remind yourself of 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.

People with PTSD and CPTSD also have depressive episodes.

If the acuity lasts for more than a few days seek help.

If you think you are a danger to yourself or others call 911 or go to an emergency room.

Rob Goldstein 2016 revised October 2018

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

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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Peter – Morning with the Captain

Warning: The content may be triggering

When Mother turns on the television, Peter sits tensely
with his tiny hands clenched tightly into fists.

Mother says slouching is bad and boys that slouch must
be punished.

The Captain lectures Mr. Bunny Rabbit for stealing carrots.

Peter wonders why the Captain doesn’t burn Mr. Bunny
Rabbit’s arms.

Stealing is bad.

A bunny rabbit that steals must be punished.

Lions stalk the plains of Africa.

They roar and eat up the deer.

When they finish eating they stretch out their claws
and shake out their bloody manes.

Jim, the man on TV says; if a deer is too young and too weak,
it ends up as food.

Then he says, “As a mother lion protects her cubs, you can protect
your kids with insurance from Mutual of Omaha.”

Suddenly, Peter’s heart speeds up; he cocks his head and listens:

Mother’s in the kitchen boiling water.

Peter must sit very still and be extra quiet.

Mother says squirming and being loud is bad.

Loud little boys that squirm must be punished.

A black and white screenshot of avatars staged to represent a child alternate named Peter and protector alternate named Bobby.
A screenshot of avatars staged to represent a child alternate named Peter and a protector alternate named Bobby. Please click the link for more about my alternates and their function.

(C) Rob Goldstein 2017 All Rights Reserved

The stuffed bear in the photo was made by Second Life artist, AM Radio

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