1. CLOSE YOUR MOUTH AND BREATHE THROUGH YOUR NOSE.
This will make you realize you CAN breathe just fine and immediately stop the panic.
2. WHILE BREATHING THROUGH YOUR NOSE, gently try to push the food item back up into your mouth, or swallow it if you can.
I figured this out while living alone. I would panic when I felt myself choking. It works like a miracle, because it is usually a spasm in the upper throat, near your mouth, and not a closed off pharynx that causes coking sensationss. You just have to understand that you CAN still breathe through your nose and that will end the panic. Once the panicky feelings are over, everything is easier to deal with and you can usually spit out the food or even find a way to swallow it. But at least you realize that you are not imminently going to die, which is a good thing to know.
Hope this advice helps someone. If it does, I would love some feedback. I have offered it to friends, and they have loved it, found it useful too, so I know it works.
Best wishes to all,
ON NOT SPEAKING
When I went temporarily mute at age sixty,
it sparked no visual wonders.
After decades schooled by dictionaries,
vocabulary categorized the world:
“precipice,” “acrid,” “blanch;”
words even defined my senses.
But one can fall into
speechlessness for reasons
though these may not seem reasonable
to people who believe that only talking things out
or about them makes sense.
Speaking or not, I knew
when silence was less insane
than trying to be heard
by those who would rather hurt me
than pay attention.
But if, as they say, silence is so eloquent,
why couldn’t anyone hear
what I so desperately didn’t say?
As my time here comes to an end, I will miss it and my neighbors terribly., I don’t know what I will do without them, and Lydia my wonderful companion. Returning to Connecticut with its horrible hospitals and indifferent treatment just feels like a disaster waiting to happen. I want to move to Vermont but I don’t know how I can make that happen. I have felt amongst friends everywhere here, but isolated completely for years in CT, despite my lovely dear friends there, I wish I could bring them all up to VT with me!
Not sure what to make of this painting, but I enjoyed doing it…What do you think? It is 8 by 12 inches, approximately, in gouache on Ampersand board (essentially gessoed masonite).
I was told by Marc and Steffie, with whom I am staying, that the sea or water represents the unconscious in some schools of thought. Which certainly makes sense to me, given how I titled this very small painting. I painted the blackbird in the stormy sky last, and can see that as a sort of link between the world of life and death, like Van Gogh’s black birds in the fields in his final paintings. But also the notion that the rocking chair can calm the stormy waters, indeed the raging tidal wave of waters outside the room, so that they become only waves but not so disturbing inside, seems to me significant. So, two questions for the pychologically or analytically minded: Why is the room red, one, and why is the chair empty? (I am serious. If you have any ideas or suggestions, I would be curious and eager for your and any interpretation. No need, just interested.)
In any event, in my sleeplessness last niight, I panicked, because I “knew” I couldn’t paint. so I put aside my decent ampersand boards, coated this bit of matboard with black to “ruin” it first, then just went to town, painting the first thing that came to mind. The chair was in the living room, but the rest was purely my imagination. If I knew what I was doing, I confess I would have painted the chair last, ON TOP of the background, but of course, I had no idea what I was doing, so I had to paint it and repaint it as ideas came to me…Hence the messiness! Hope you enjoy!
© Max Ehrmann 1927 ?
Go placidly amid the noise and haste, and remember what peace there may be in silence.
Enjoy your achievements as well as your plans.
Take kindly the counsel of the years, gracefully surrendering the things of youth.
You are a child of the universe, no less than the trees and the stars;
Therefore be at peace with God, whatever you conceive Him to be,
“Desiderata” defined means things wanted or needed. A partial version of the poem hangs on the wall of the place where I will be staying for a while and while the piece is well-known, and indeed I have seen it before, the painted version here caught my eye and moved me. For some reason, however, I suspected that this particular version was a quotation only in part, so I looked up the entire poem. What I found struck me to tears.
Well, let me explain.
There are important lines that are missing in the poem on the wall here (important to me):
“You are a child of the universe, no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you, no doubt the universe is unfolding as it should.”
Also this stanza is followed by the critical word, “Therefore…be at peace with God…” whereas on the wall, the “therefore” has been taken out. But what a difference it makes to keep it in.
The important thing to me in reading the poem in its entirety is that I do not feel I have a right to be here, do not feel I am in any sense “a child of the universe.” I feel instead that I have ruined the universe, and that if I had not been born the world would have been better off by far. That is one critical thing.
The other salient point the poet makes, which made me weep, was his belief, stated well before anyone thought about global warming, but presumably he would have said the same thing even so, if he truly had the courage of his convictions that “no doubt the universe is unfolding as it should.”
TO the contrary, it feels to me completely tragic that the world should be ending in our geologic time, that we should be living in the end days, not something that was meant to be or unfolding as it should. ( I say “end times” without any religious intention to those words, only the sense that we have brought about the end of the living world upon ourselves by over-consumption and massively pig-headed over-population.) Of course, the “universe” is much bigger than humanity or even generally speaking the living blue planet called earth, but as a human living on it I have no other way to feel or see but from my puny human perspective. To lose Life on earth, all or most of it at any rate, to global warming feels utterly devastating. Who or what gave humans the right to destroy what might have been the tiniest fraction of a chance at existence, life itself, to throw it all away through the over-consumption of fossil fuel (in the brief span of 2 centuries) and making too many babies, and eating too many cows?
It sickens me that I am so much at fault, that I ought not to have existed at all, that much of this could have been avoided by my never having been born. But it also sickens me that as a species, humans have collectively, since my birth, ignored all the consequences of our “eating the earth” and now we have no earth for our children’s children to inherit…
Vis a vis another line in the poem, I cannot “be gentle” with myself. I do not deserve gentleness! That way disaster lies!
“With all its sham, drudgery and broken dreams, it is still a beautiful world.” Maybe… But the world is fast losing its beauty and sometimes i think it is only beautiful to those wealthy enough to be able to willfully blind themselves to all the ugliness and injustice around them: blinding themselves to the dying oceans and all the starving homeless people…to name just two out of many.
Nevertheless, the poem is still a miracle of inspiration and remains so after nearly a century. Though not really new to me, it newly struck a chord, though I am sure that people in the know would call it an “old chestnut” of a poem, nearly hackneyed and familiar as that other O.C., “Invictus”by William Ernest Henley, though I suggest Desiderata has always been far better written than Henley’s “chest-beater” of a poem (for all that it is a favorite of many thousands..).
CLick to enlarge
FROM BPD CENTRAL:
Hallmarks of BPD
Following are hallmarks of borderline personality disorder:
1)Intense fear of abandonment, real or imaginary.
I do not fear abandonment. Many friends have passed through my life on their ways to distant ports of call in their lives’s journeys and I have always said, Well that is fine, we will simply continue to be friends on paper. I love letter writing and these days,what with email and skyping it is easier than ever to stay in touch. I still have a friend I met at folk dancing in 1972 who lives in Arizona, and we still talk occasionally and even meet every ten years or so. The thing is, we still consider ourselves friends. When my surrogate mother Lynn Levine died, I admit I cried, it was a very sad day and we had grown closer than ever over the two years of her dying. I was sad that she was gone, but not fearful that she was abandoning me. (Dr Mary B O’Malley, in her insane need to brand me with the BPD diagnosis, before she removed it altogether in a letter to Dr Angela, unbeknownst to me, insisted angrily to me in a session that my tears were symptomatic, right then and there of my “intense fear of abandonment.” Rather than understandable grief than a lovely woman had stood in for my own mother during the years when she, my mother, had largely abandoned me due to my real mental illness of schizophrenia. (About this Dr Mary B O’Malley said nothing, zilch…Why say anything about a real abandonment that i had handled as well as anyone could?)
Having intense relationships with lots of conflict, and seeing the other person as “all-good” or “all bad.”
I have one friend who has dominated me for many years, and she may indeed have borderline personality disorder and suffers from it greatly. She demands that I not have other friends, despite the fact that I have many. And she bad mouths the ones Ido. She wants my narcolepsy drugs because they are stimulants and she believes these drugs are the only things in the world that make her “happy” but in fact NOTHING makes her happy. With all my other friends — my 60 birthday party was filled with 16 good personal friends who came to celebrate, not boyfriends and wives to fill in the space, but just my own friends. And they loved each other, though they had rarely met. I do not have conflict with any of my friends, and they would be appalled to have anyone insist that our relationships were filled with such extremes. They all tell me they love me dearly and that the biggest problem is that I do not love myself.
If the below is true about BPD, count me out. I do not feel empty. I feel too full of ideas of things to do and think about. I feel sad about the environment and the world, which I feel is dying due to humanity;s lack of caring and concern. But I definitely do not feel EMPTY. Hardly. I wake each morning feeling ready to start the day and having much to do and excited to do it.
The behaviors in this next paragraph mean NOTHING to me. I hav never done anything impulsive, except when driven to flinging shit in hospitals, because of their extreme trauma behavior. Engaging in impulsive “pain management” behaviors, such as going on spending sprees, having promiscuous sex, driving recklessly, abusing drugs or alcohol, binge eating, breaking the law, threatening suicide or making attempts, and engaging in self-harm — NONE have ever occurred to me. (When I harm myself it is exclusively in response to voices i hear telling me to do so, or when I hear people telling me to that I mistake for real people instead of understanding they are the voices.
I take Topomax, a seizure control drug, for a SEIZURE disorder and NOT for a mood disorder, despite what Michael Balkunas wrote on my discharge summary. I have never taken a seizure drug for mood stabilization. ONLY for temporal lobe epilepsy.
I have indeed been date raped under very unfortunate situations three times in my 20s when I was extremely innocent and did not understand that I had a right to be rescued by the security guards who asked me, and had any right to say No.
I have also been extremely traumatized and abused by caregivers and major people in my life whom I trusted and gave myself into their care. I should not have,. They were therapists and doctors. but I did not know better and suffered greatly. Now, I suffer under the ministrations of abusive doctors like Michael Balkunas who reads my PAD and decides to abrogate every single part of it because he KNOWS ME BETTER THAN I KNOW MYSELF.
To his dismay, I became loud and combative and fought his “help” every step of the way. So to take revenge, he added the BPD to my diagnosis. But it is a lie. He knows nothing about me, no more than any other abusive in hospital doctor who have read what Mary O Malley Md PhD wrote in her discharge summaries when she was playing the nurses’ game at Norwalk Hospital and decided to let them treat me, who did not, even in her opinion, have BPD, with extreme behavioral protocols and seclusion and restraints. and dismissive ignoring of everything I said. Even today it resounds in my care. I feel it, I know it. Nothing is fair because of what she did, but she got a way with it…and I cannot litigate what she did more than a decade ago, lethal or nearly lethal though it was. But some day I will write her a letter and let her know the consequences of her actions.I do not believe she will care. People like her do not have consciences. Not even the Rev Dr Mary B O’Malley. She got away with it, She even wrote Dr Angela a letter denying it. But I have the records, I know she was lying, or trying to color things in a different way.
Hope was right when she said BPD was a weapon used against the intelligent and the disliked in hospitals. She said,if you objected, you were displaying symptoms of the diagnosis, and were dismissed, and when you objected to being dismissed, you were being manipulative. You couldn’t win, and even your rage at being not listened to was symptomatic… It is enough to make me want to pound my head through a door! (you see how it goes…)
Thank god I am out of HOCC, and I hope that the blog post about Michael Balkunas has had some success at reaching them on the unit, I hope he and Jessica have had a chance to read it. Dismiss it though they certainly will, I want them to read it! Fuck them, I have something to say and they need to know what that is.
HOLY SHITE AND URINE TEAM
Her cool wordless RN face expresses nothing
as she scoops the ice cream turd and quickly disinfects.
But I think for her, thinking, knowing this:
“Asshole, shithead, you think
your shit don’t stink…” While I have no working sense of smell,
I know I’m an unofficial pain in the ass here
because no one can be officially PIA
on a psychiatric ward, not even I, the wild shit smearer
who knows no disgust first hand
for not smelling it.
What I know well and sadly is
the consequences of disgusting others,
the distancing, the shunning,
how killing the ultimate loneliness is, double-locked away
in a soundproof seclusion cell.
Shackled naked into leather 4-point restraints, I shriek my soul away,
from the bottom of my lungs for 20 minutes straight.
The illegally silenced intercom remains dumb.
Even the 1:1 monitor positioned behind the door.
peering lazily through the judas-eye of a small plexi-port-hole,
doesn’t really pay attention. Why bother, the shit smearer
gets what she deserves.
Oh, I know I disgust them, what with my out of control turd throwing
and my illegible scribbling with my feces on the wall
but they refuse me so much as a marker and board,
and they won’t sit down to listen when I speak.
Mute for 16 days, I will be heard now, one way or another.
But this is no way to think, and i think without thinking, just do with do do, mindlessly, enraged by trauma.
I foul myself because no one cares,
because their disgust is threaded, even so heat-felted with hatred
they have long forgotten I’m just another patient
with problems bigger than the shit I fling.
Instead, cucumber skinned nurses sneer their disgust,
Bad dog! Bad, bad dog!
But I know dog is just God spelled backwards.
And God created the living world
from dust and mud and excrement.
I am no god, I am Live backwards to Evil:
I create chaos from utter chaos within.
There are always turds to form and fling.
And in the end all they can do is kill me.
Fuck me! Do me a favor you turds, kill me!
But first, you have to silence the hate on your faces,
clean the smeared walls,
and pretend I am nothing to you.
When you came in to take me down,
restrain me for any excuse, even for just wanting a blanket.
you had to breath in my shit, that fear,
and knew what it could do to you.
You’d heard the stories, deadly E-coli, C diff.
Something in me might kill you,
I don’t know what scared you more, my wildyelling
or my excrement.
That was always the struggle. Shit stinks. I stank.
You hated me for my smell. You feared me for what I did.
I know your fear. It was: what would happen if you
lost control of yourself.
Would you, control freaks,
too dance naked in dung?
FROM: THE NEW HAVEN REGISTER May 31, 2014
As Connecticut works to improve its mental health system, new federal data shows that hospitals in the state restrain psychiatric patients at more than double the average national rate, with elderly patients facing restraint at a rate seven times the national average.
In addition, the state lags behind in providing adequate post-discharge continuing care plans for psychiatric patients, especially teens and the elderly. Connecticut’s 28 inpatient psychiatric units and hospitals developed continuing-care plans for fewer than 70 percent of patients they discharged from October 2012 to March 2013 — indicating that thousands of patients may have left facilities without adequate treatment and medication plans.
A C-HIT analysis of the federal data, released by the Centers for Medicare & Medicaid Services for the first time, shows that Connecticut ranks in the top fourth of states (11th highest) in the use of physical restraints in inpatient psychiatric facilities — and is the third highest state in restraining patients 65 and older.
Two psychiatric units — at Bridgeport Hospital and Masonicare Health Center in Wallingford — have the 10th and 12th highest rates of restraint use, respectively, among the 1,753 psychiatric facilities nationwide that are included in the federal reports, which cover October 2012 through March 2013.
State and federal guidelines — tightened over the past 15 years, partly in reaction to deaths in Connecticut facilities — say that restraints should be used only in cases of imminent physical danger to a patient or others. They call for less restrictive interventions when patients are acting out aggressively.
But the data show that Bridgeport Hospital, Masonicare and three other Connecticut hospitals — Waterbury, Hartford, Danbury — restrain patients at more than triple the national rate.
James McGaughey, director of the state Office of Protection and Advocacy for Persons with Disabilities, said he was disturbed by both the high rate of restraint use and the low rate of post-discharge plans.
“The numbers are pretty compelling,” he said. “Some of our hospitals have done a significant amount of work on this, but clearly there’s more to be done.”
He suggested that the Department of Public Health, which oversees hospitals and is charged with reviewing annual reports of restraint and seclusion, should “get a little less timid in looking at this.” Hospitals rarely have been cited or penalized in recent years for improperly using restraints, a review of inspection reports shows.
McGaughey noted that the state-run Connecticut Valley Hospital in Middletown has pursued a reduction in restraints and seclusion that has cut its restraint rate significantly in the last five years. The new data show CVH’s rate at .52 hours per 1,000 patient hours — below the statewide rate of 1 hour per 1,000. The national average is .39.
“It’s ironic that our one remaining large state hospital has done such a good job of reducing restraint and seclusion, but you have some very different results at private institutions,” McGaughey said of CVH, which was cited for excessive restraint use in 2007 by the U.S. Justice Department. “What it shows is that it’s possible to address this issue, but you need leadership to effect this kind of culture change.”
Mental health advocates say seclusion and restraint should be avoided because they are traumatic and dangerous to patients and staff.
Alternatives include individualized aggression-management plans, the use of “comfort rooms” or time-out spaces, and one-on-one interventions. Among the innovations at CVH are 22 “comfort rooms,” designed to calm agitated patients, and a reduction in the time interval that a physician’s order of restraint or seclusion can remain in effect, according to a state report.
Yale-New Haven Hospital has a restraint rate of .36 hours per 1,000 patient hours — just below the national average of .39 hours. But its rate of developing care plans for discharged patients is relatively low — 50.36 percent, compared to a national average of 73.5 percent of cases.
Officials at Connecticut hospitals with high rates of restraint say they are working to reduce those incidents, and they stressed that even minimal mobility restrictions, such as soft wrist restraints or brief therapeutic holds, are counted in the federal numbers.
Robert Bernstein, executive director of the Bazelon Center for Mental Health Law, a national advocacy group that successfully sued Connecticut in 2006 to stop housing psychiatric patients in three nursing homes, said he worried that progress made in the early 2000s to reduce restraints might be slipping in some hospitals because of staff shortages and “pushback” from clinicians.
“Some of the procedures put in place may have been weakened, because it’s a lot of work” to use alternative interventions, he said.
Although patients subjected to improper restraint can file complaints, few speak out, Bernstein and others said. Among the exceptions in Connecticut is Pamela Spiro Wagner, a Wethersfield writer and artist with schizophrenia who has cycled in and out hospitals.
In an April “open letter” to the director of a Connecticut psychiatric hospital, Wagner readily conceded that she is a difficult patient — “easily roused to irritability and hostility” — but insisted that her behavior has not warranted her repeatedly being placed in restraints and seclusion, for hours at a time.
“Once you allow staff to use restraints a little, it only takes a little to use them a lot.”
CONNECTICUT VS. THE NATION
Nationally, the states with the highest restraint use are Minnesota, Washington, South Dakota, Tennessee and New Hampshire. For patients 65 and older, only Nevada and New Hampshire have rates higher than Connecticut, which restrains elderly patients at an average of 7.69 hours per 1,000 hours. Thirty-five states have rates of less than 1 per 1,000 hours; the national average is 1.01 hours per 1,000 hours.
The U.S. facility with the highest restraint rate is Park Ridge Health in North Carolina, which reports 722 hours of restraint use per 1,000 patient hours overall. Among facilities that report serving children ages 2 to 12, Lakeland Regional Medical Center in Florida has the highest restraint use, at 200 hours.
The federal data shows Connecticut psychiatric facilities fare well in some categories, including lower-than-average rates of restraint for children and teenagers. Five hospitals reported no use of restraints for any age group: Sharon, MidState Medical Center, Bristol, John Dempsey and Natchaug hospitals.
And Connecticut’s rate of keeping patients in seclusion is lower than the national average, with half of the state’s psychiatric facilities reporting that they did not use seclusion at all. Nationally, South Dakota, Montana and Washington report the highest use of seclusion, defined as involuntary confinement where a patient is prevented from leaving.
But the state’s over-65 restraint rate is fueled by excessive rates at Masonicare (35.99 hours), Bridgeport Hospital (37.92) and Hartford’s Institute of Living (9.19).
Officials at those hospitals say they have taken steps in the year since the data-reporting period ended to reduce restraint use.
This is the first time that quality measures from psychiatric facilities have been made available by CMS. The federal agency does not penalize facilities for high rates of restraint or inadequate discharge plans. Instead, an agency spokeswoman said, the public reporting is intended to encourage quality improvements and help consumers to make informed decisions.
At Bridgeport Hospital, Dr. Ryan O’Connell, vice president for performance and risk management, said the hospital’s geriatric psychiatric unit serves many patients with dementia and behavioral problems that cannot be managed in other facilities. About 18 months ago, he said, the hospital put in place an “action plan” to reduce restraints, including using “comfort” rooms. Also, in January, a new policy was implemented requiring that the nurse manager be called before any patient is restrained.
“We realized we were going in the wrong direction with restraints” and have since seen a “dramatic drop” in their usage, O’Connell said.
Hartford Hospital’s Institute of Living (IOL), which has a geriatric unit for complex dementia patients, has made similar changes over the past few years, nursing director Ellen Blair said. She said restraints are now rarely used, and only for patient safety. The IOL requires that a physician’s restraint order be reviewed every two hours, rather than every four, which is the standard of care.
“We look at our data every single day” to ensure that restraint and seclusion are being used only as “a last resort,” Blair said.
Masonicare’s acute psychiatric unit serves geriatric patients who frequently are referred because of difficult behaviors and aggression, said spokeswoman Margaret Steeves. When restraints are needed, the hospital uses “the least restrictive restraint, which is typically a seat belt,” she said. Masonicare has an interdisciplinary team reviewing restraint use.
Statewide, the Connecticut Hospital Association has been working with the state Department of Public Health to minimize the use of restraints, said Dr. Mary Cooper, the group’s vice president and chief quality officer. She said the new federal data “indicate that there is more work to be done in this area” and will help to identify best practices.
Nationally, the federal government tightened rules on the use of restraints and seclusion between 2001 and 2007, including time limits on physician orders and strict documentation requirements. The changes were prompted by a series in The Hartford Courant, “Deadly Restraint,” which documented restraint-related deaths in psychiatric facilities nationwide.
In 2007, the U.S. Department of Justice cited the state-run CVH for excessive overuse of unnecessary restraint and seclusion. Since then, policy and training initiatives have significantly reduced restraint episodes — from 26,290 hours in 2000, to 529 hours in 2012 — a state report shows.
State DPH spokesman Bill Gerrish said the agency collects restraint and seclusion reports from hospitals and works to “ensure that care is appropriate.”
LAGS IN DISCHARGE PLANNING
McGaughey and Bernstein said they were especially troubled by the failure of many hospitals to develop continuing care plans for discharged patients, and to transmit those plans to the next level of care.
Statewide, Connecticut facilities developed adequate discharge plans 69.4 percent of the time — lower than the national average of 73.5 percent. For teens, hospitals transmitted care plans only 55 percent of the time — lower than the national average of 74 percent — and for seniors, just 42.7 percent of the time, below the national average of 56 percent.
Discharged patients are supposed to receive care plans containing their diagnoses, reasons for hospitalization, medications and treatment recommendations.
The federal data shows that 10 Connecticut hospitals, including Waterbury Hospital, Masonicare and Yale-New Haven Hospital, properly transmitted care plans to the next provider in less than half of cases.
A few hospitals — St. Mary’s, Bristol, Norwalk, Natchaug Hospital and Southwest Connecticut Mental Health — transmitted care plans more than 90 percent of the time.
McGaughey said that without continuing care plans directing further treatment, many discharged patients may languish in nursing homes, shelters or land back in the hospital.
“The lack of continuity of care, to me, is a huge issue,” he said. “It’s a pretty brutal business — insurance companies want you to medicate and discharge as fast as possible. The question is, what happens after they’re out?”
Bernstein said the lack of attention to continuing care plans was “jaw-dropping.”
“Those numbers should be at 100 percent,” Bernstein said. “It’s shameful.”
Hospitals with low rates of discharge care plans blamed much of that lag on their failure to document that the paperwork was done.
At Masonicare, for example, Steeves said the 31.3 percent rate of developing care plans was due to problems with the “tracking of the discharge document . . . not that it wasn’t actually sent.”
This story was reported under a partnership with the Connecticut Health I-Team (www.c-hit.org).
This is the comment that I posted online at the paper a few days after the article was published, (as it happened, while I was a patient being tortured at the former New Britain General Hospital, the present day, Hospital Of Central Connecticut).
Pamela Spiro Wagner: “As someone who has been subjected to more use of seclusion and four-point restraints over the past “decade of change” than in the two decades previous it boggles my mind that anyone would even dare to state that things are improving in CT mental health care institutions. During my nearly month-long captivity in the winter of 2013, the Institute of Living in Hartford regularly restrained me to a bed for as long as 19 hours at a time, without ever releasing me for so much as a bathroom break — I had to defecate in my clothing. I was not even released to eat. When I was not in four point restraints “for not following directions, I was in seclusion, which they called the “Quiet Room” and not seclusion, but by CMS definitions, it was seclusion as I was separated from the rest of the patient population by force, and was not permitted to leave the room I was isolated in.
The one time I did actually saunter away, walk down the hall to look out the window, and return to my non-seclusion Quiet Room, I was punished with immediate use of four point restraints, into which I was placed without a struggle, hoping that would make it easier to win my freedom. Alas, for me, there was no way to earn freedom from restraints I never “deserved.” The entire point was discipline, and that would last as long as the staff wanted me to be in shackles to learn my lesson. There was literally nothing I could do, –stay calm, sleep, quietly ask for release — nothing, until they were finally satisfied that I was submissive enough to obey their orders, some 6-19 hours later. But I had to cry Uncle, and submit to a set of degrading humiliating “debriefing questions” that assured them that I took responsibility for my own being restrained and that my behavior would henceforth conform to their norms.
I was surprised to see Natchaug Hospital being given good ratings of any sort. One of their chief psychiatrists on the Adult Unit, a longtime presence their Emeritus psychiatrist you might say, was so insouciant about this job as to be nearly incompetent, but probably hard to fire even for negligence. HIs name I will not mention. He routinely did drive-by visits with his patients– a wave in the hallway might not be a completely standard morning meeting, but it happened often enough that peatients knew that would be all of this doctor they would see for the day. He routinely discharged patients with GAF scores at or around 60, the highest “global assessment of functioning” that one can have and still be rated “disabled” — not because he knew this level of functioning to be the case, but because it made him and his psychiatric ministrations at Natchaug look good. After all, if person comes in with a GAF in the 20s, and barely able to function, and you discharge him or her a week or two and some drive-by counseling sessions later with a GAF of 60, you must be doing a terrific job, esp for a 75 year old doctor not too keen on using anything like trauma-informed or patient-centered care. I had never left a hospital before Natchaug with a GAF higher than 40, but suddenly I rated a 60….by a doctor with whom I never spoke.
Natchaug Hospital, when the nursing director was Sharon B Hinton, APRN, was a decent place, because she made certain that abuses like restraints and seclusion rarely to almost never happened under her watch. I know, because I was there about three times during her administration. I also knew her when she was Hartford Hospital’s psychiatric Head Nurse at CB-3, where she and her never failing humanity and respect for the dignity of every patient made all the difference in the world. I might have come from an abusive hospital in the early 90s, like University of Connecticut’s Dempsey Hospital, which in those days four-pointed people to an iron bedstead, by shackling them spreadeagled to the four corners of the bed, a stress position that is not just tantamount to but is in fact torture. But I would be rescued by someone finding me a bed at Hartford Hospital, where Sharon would discover me arriving there in tears and tell me, unfailingly,”Its not you, Pam, you did nothing wrong, It is the hospital that treats you badly…We don’t have any problem with you, because we treat you well and you respond to it. When they treat you with cruelty, you respond badly…That’s very normal.”
But as to Natchaug…Bravo if they have done away with restraints completely. They had not done so when I was there last in 2012. Nor with seclusion, which was imposed in mostly a disciplinary and arbitrary fashion. Largely it was used to force medication on loud obstreperous patients or for angry fed-up senior nurses to take out their peeves on patients they didn’t particularly like (e.g. me). I still remember one APRN demanding that I be dragged to locked seclusion, and left there alone (despite all Sharon’s previous assurances that such would NEVER happen, that someone would ALWAYS remain in that room with me if I ever ended up there.. Alas, Sharon had left by then, so rogue nurses like D could have their way…) and when I peed on the floor in panic, and took off my clothes they rushed in to take them away from me, and inject me with punishment drugs, then made me stay for an hour alone on the pee-soaked mats, freezing cold, pretending to sleep and calm myself just to convince them I could leave and not bother anyone. I managed to do so, or at least the APRN D. got over her fit of pique and finally released me, but I was not really calm, and when they finally draped two johnnies over my naked body so I could decently traverse the distance to my room, I left, disrobing as I went…Who gave a damn about my flabby flat behind? I certainly did not. And it served them right if everyone got an eyeful…served them right..
Natchaug’s biggest problem was and probably still is a lack of staff cohesiveness and bad morale between the staff nurses and the well-educated techs/mental health workers who were all very dedicated college grads but were treated like grunts…The MHW’s did most of the important patient contact, but were not trusted to write patient notes, or the notes they wrote were never read, or accorded any import. This was not just despicable but very unfortunate in more than one instance during my stay, as the notes they took personally might have saved me from some terrible misunderstandings and outrageous misdiagnoses that harmed me terribly..
Most places use techs who are trained by shadowing for a day or two, which means, badly trained, if at all…
You have to take all such in-hospital diagnoses with such a heavy grain of salt, you know, even when they are labeled with the words, “THIS IS A LEGAL DOCUMENT.” Because they get so much of fact-checkable, factual material garbled that you cannot believe a word it says. And as for diagnosis, well it is all of it opinion, one, and two, it depends largely upon whether you are a likable patient or a disliked one, what they finally say about you on any given day. No one should have that sort of power over another human being, frankly. And the idea that they can brand one for life with certain psychiatric diagnoses just sickens me.
Be that as it may, my recent last experience was beyond the beyond, at Hospital of Central Connecticut, The old New Britain General…and I expect to go back to talk to someone there about it. I always do And I have much to say to them, after the pain and rawness have worn off a little. They considered it SOP to strip me naked and leave me alone in a freezing seclusion cell without any access to human contact, unless they chose to speak to me over a loudspeaker hidden in the ceiling. If not, I was utterly abandoned, no contact or even view of another human being for as long as they wanted to keep me secluded. They also restrained me, having male security guards four-point me stark naked to the bed, before they had the decency to cover me with a light sheet, even though I begged for a blanket for warmth. (A nurse manager came in and shivered, saying “Brrr its cold in here!” but did they relent and let me have a blanket…No, clearly I was not human, didn’t need warmth.)
This is just the tip of the SR iceberg in CT in the current years, Remember this is happening right now, not ten years ago, or before the so-called reforms. Nothing is getting better. Things are worse than ever, And when you are a patient in these hospitals, you have no help, no recourse, anything and everything can be done to you and you have no way to refuse or say “no”. No one will help you, or offer assistance. They can just grab you and seclude you or restrain you without your having the power to stop them or any recourse to make them pause and reconsider. You are powerless to stop anything…And so they get away with it every time. And once it is done, who will fight for you? What lawyer will take your case if the guards hurt your shoulder rotator cuff, or bruise you up, or degrade or humiliate you? No one….so you are deprived of your human and civil rights, completely, but the hospital knows that no one cares enough to fight for you, so they get away with it each and every time, and they know this when they do it. They have nothing to worry about,….You are just another mental patient, a nobody, a nothing.
That’s what you are if you are diagnosed with schizophrenia and hospitalized in CT hospitals in 2014. A nobody that the hospitals can abuse with impunity and will. Just wait and see if any of this changes…I doubt it highly. They have no motivation to change. They don’t think they are doing anything wrong now.”
When I lose you,
will you remember the leaves
of my brown name?
Not like an oak, which clings
snow after snow
but like the poplar
spilling her yellow dress
to the insistent fingertips of fall
The mother of grief
is a kind forgetting
and I tell you now
that I will forget everything
I will forget even you, beloved
like a leaf stilled in limestone
who would have thought
we could weigh so little?
I THOUGHT THIS WAS INCREDIBLY WELL WRITTEN AND IMPORTANT INFORMATION. SEE CREDITS AT THE BOTTOM. Posted on January 12, 2014 by annecwoodlen THINGS YOUR DOCTOR SHOULD TELL YOU ABOUT ANTIDEPRESSANTS September 12, 2012 By Paul W. Andrews, Lyndsey Gott & J. Anderson Thomson, Jr. Antidepressant medication is the most commonly prescribed treatment for people with depression. They are also commonly prescribed for other conditions, including bipolar depression, post-traumatic stress disorder, obsessive-compulsive disorder, chronic pain syndromes, substance abuse and anxiety and eating disorders. According to a 2011 report released by the US Centers for Disease Control and Prevention, about one out of every ten people (11%) over the age of 12 in the US is on antidepressant medications. Between 2005 and 2008, antidepressants were the third most common type of prescription drug taken by people of all ages, and they were the most frequently used medication by people between the ages of 18 and 44. In other words, millions of people are prescribed antidepressants and are affected by them each year. The conventional wisdom is that antidepressant medications are effective and safe. However, the scientific literature shows that the conventional wisdom is flawed. While all prescription medications have side effects, antidepressant medications appear to do more harm than good as treatments for depression. We reviewed this evidence in a recent article published in the journal Frontiers in Psychology (freely available here). The widespread use of antidepressants is a serious public health problem, and it raises a number of ethical and legal issues for prescribers (physicians, nurse practitioners). Here, we summarize some of the most important points that prescribers should ethically tell their patients before they prescribe antidepressant medications. We also discuss the ways that prescribers could be held legally liable for prescribing antidepressants. Finally, we implore practitioners to update the informed consent procedure for antidepressant medication to reflect current research and exercise greater caution in the prescription of antidepressants.
- How antidepressant medication works
Most antidepressants are designed to alter mechanisms regulating serotonin, an evolutionarily ancient biochemical found throughout the brain and the rest of the body. In the brain, serotonin acts as a neurotransmitter—a chemical that controls the firing of neurons (brain cells that regulate how we think, feel, and behave). However, serotonin evolved to regulate many other important processes, including neuronal growth and death, digestion, muscle movement, development, blood clotting, and reproductive function. Antidepressants are most commonly taken orally in pill form. After they enter the bloodstream, they travel throughout the body. Most antidepressants, such as the selective serotonin reuptake inhibitors (SSRIs), are intended to bind to a molecule in the brain called the serotonin transporter that regulates levels of serotonin. When they bind to the transporter, they prevent neurons from reabsorbing serotonin, which causes a buildup of serotonin outside of neurons. In other words, antidepressants alter the balance of serotonin in the brain, increasing the concentration outside of neurons. With long-term antidepressant use, the brain pushes back against these drugs and eventually restores the balance of serotonin outside of the neuron with a number of compensatory changes. It is important to realize that the serotonin transporter is not only found in the brain—it is also found at all the major sites in the body where serotonin is produced and transported, including the gut and blood cells called platelets. Since antidepressants travel throughout the body and bind to the serotonin transporter wherever it is found, they can interfere with the important, diverse processes regulated by serotonin throughout the body. While physicians and their patients are typically only interested in the effects of antidepressants on mood, the harmful effects on other processes in the body (digestion, sexual function, abnormal bleeding, etc.) are perfectly expectable when you consider how these drugs work.
- Antidepressants are only moderately effective during treatment and relapse is common Since the brain pushes back against the effects of antidepressants, the ability of these drugs to reduce depressive symptoms is limited (see our article for a review). While there is some debate over precisely how much antidepressants reduce depressive symptoms in the first six to eight weeks of treatment, the consistent finding is that the effect is quite modest.
Many people who have suffered from depression report a substantial symptom-reducing benefit while taking antidepressants. The problem is that symptoms are also substantially reduced when people are given a placebo—a sugar pill that lacks the chemical properties of antidepressant medications. In fact, most of the improvement that takes place during antidepressant treatment (approximately 80%) also takes place with a placebo. Of course, antidepressants are slightly more effective than placebo in reducing symptoms, but this difference is relatively small, which is what we mean when we say that antidepressants have a “modest” ability to reduce depressive symptoms. The pushback of the brain increases over months of antidepressant treatment, and depressive symptoms commonly return (frequently resulting in full blown relapse). Often this compels practitioners to increase the dose or switch the patient to a more powerful drug. Prescribers fail to appreciate that the return of symptoms often occurs because the brain is pushing back against the effect of antidepressants. 3. The risk of relapse is increased after antidepressant medication has been discontinued Another effect of the brain pushing back against antidepressants is that the pushback can cause a relapse when you stop taking the drug. This pushback effect is analogous to the action of a spring. Imagine a spring with one end attached to a wall. An antidepressant suppresses the symptoms of depression in a way that is similar to compressing the spring with your hand. When you stop taking the drug (like taking your hand off the spring from its compressed position), there is a surge in the symptoms of depression (like the overshoot of the spring before it returns to its resting position). The three month risk of relapse for people who took a placebo is about 21%. But the three month risk of relapse after you stop taking an SSRI is 43%—twice the risk. For stronger antidepressants, the three month risk is even higher.
- Antidepressants have been found to cause neuronal damage and death in rodents, and they can cause involuntary, repetitive movements in humans.
Antidepressants can kill neurons (see our article for a review). Many medical practitioners will be surprised by this fact because it is widely believed in the medical community that antidepressants promote the growth of new neurons. However, this belief is based on flawed evidence—a point that we address in detail in our article. One way antidepressants could kill neurons is by causing structural damage of the sort often found in Parkinson’s disease. This neurological damage might explain why some people taking antidepressant medication can develop Parkinsonian symptoms and tardive dyskinesia, which is characterized by involuntary and repetitive body movements. Many prescribers mistakenly think these syndromes only occur in patients taking antipsychotic medications.
- Antidepressants may increase the risks of breast cancer, but may protect against brain cancers .
Recent research indicates that antidepressants may increase the risk of cancer outside of the brain, such as breast cancer. However, the neuron-killing properties of antidepressants may make them potentially useful as treatments for brain cancers, and current research is testing this possibility.
- Antidepressants may cause cognitive decline.
Since neurons are required for proper brain functioning, the neuron-killing effects of antidepressants can be expected to have negative effects on cognition. In rodents, experiments have found that prolonged antidepressant use impairs the ability to learn a variety of tasks. Similar problems may exist in humans. Numerous studies have found that antidepressants impair driving performance, and they may increase the risk of car accidents. Recent research on older women also indicates that prolonged antidepressant use is associated with a 70% increase in the risk of mild cognitive impairment and an increase in the risk of probable dementia. 7.Antidepressants are associated with impaired gastrointestinal functioning The action of antidepressants results in elevated levels of serotonin in the intestinal lining, which is associated with irritable bowel syndrome. Indeed, antidepressants have been found to cause the same symptoms as irritable bowel syndrome—pain, diarrhea, constipation, indigestion, bloating and headache. In a recent study, 14-23% of people taking antidepressants suffered these side effects. 8. Antidepressants cause sexual dysfunction and have adverse effects on sperm quality. Depression commonly causes problems in sexual functioning. However, many antidepressants make the problem worse, impairing sexual desire, arousal, and orgasm. The most widely studied and commonly prescribed antidepressants—Celexa, Effexor, Paxil, Prozac, and Zoloft—have been found to increase the risk of sexual dysfunction by six times or more. Evidence from case studies suggests that antidepressants may also interfere with attachment and romantic love. Some antidepressants have been found to negatively impact sperm structure, volume, and mobility. 9. Antidepressant use is associated with developmental problems Antidepressant medication is frequently prescribed to pregnant and lactating mothers. Since SSRIs can pass through the placental barrier and maternal milk, they can affect fetal and neonatal development. Generally, if SSRIs are taken during pregnancy, there is an increased risk of preterm delivery and low birth weight. Exposure during the first trimester can increase the risk of congenital defects and developing an autism spectrum disorder, such as Asperger’s Syndrome. Third trimester SSRI exposure is associated with an increased risk of persistent pulmonary hypertension in the newborn (10% mortality rate) and medication withdrawal symptoms such as crying, irritability, and convulsions. Prenatal exposure to SSRIs is also associated with an increased risk of respiratory distress, which is the leading cause of death of premature infants. 11\\10. Antidepressant use is associated with an increased risk of abnormal bleeding and stroke Serotonin is crucial to platelet function and promotes blood clotting, which is important when one has a bleeding injury. Patients taking SSRIs and other antidepressants are more likely to have abnormal bleeding problems (for a review see our article). They are more likely to have a hemorrhagic stroke (caused by a ruptured blood vessel in the brain) and be hospitalized for an upper gastrointestinal bleed. The bleeding risks are likely to increase when SSRIs are taken with other medications that reduce clotting, such as aspirin, ibuprofen, or Coumadin . 11. Antidepressants are associated with an increased risk of death in older people. Depression itself is associated with an increased risk of death in older people—primarily due to cardiovascular problems. However, antidepressants make the problem worse. Five recent studies have shown that antidepressant use is associated with an increased risk of death in older people (50 years and older), over and above the risk associated with depression. Four of the studies were published in reputable medical journals—The British Journal of Psychiatry, Archives of Internal Medicine, Plos One, and the British Medical Journal—by different research groups. The fifth study was presented this year at the American Thoracic Society conference in San Francisco. In these studies, the estimated risk of death was substantial. For instance, in the Women’s Health Initiative study, antidepressant drugs were estimated to cause about five deaths out of a 1000 people over a year’s time. This is the same study that previously identified the dangers of hormonal replacement therapy for postmenopausal women. In the study published in the British Medical Journal, antidepressants were estimated to cause 10 to 44 deaths out of a 1000 people over a year, depending on the type of antidepressant. In comparison, the painkiller Vioxx was taken off the market in the face of evidence that it caused 7 cardiac events out of 1000 people over a year. Since cardiac events are not necessarily fatal, the number of deaths estimated to be caused by antidepressants is arguably of much greater concern. An important caveat is that these studies were not placebo-controlled experiments in which depressed participants were randomly assigned to placebo or antidepressant treatment. For this reason, one potential problem is that perhaps the people who were taking antidepressants were more likely to die because they had more severe depression. However, the paper published in the British Medical Journal was able to rule out that possibility because they controlled for the pre-medication level of depressive symptoms. In other words, even among people who had similar levels of depression without medication, the subsequent use of antidepressant medications was associated with a higher risk of death. These studies were limited to older men and women. But many people start taking antidepressants in adolescence or young adulthood. Moreover, since the risk of a relapse is often increased when one attempts to go off an antidepressant (see point 3 above), people may remain on medication for years or decades. Unfortunately, we have no idea how the cumulative impact of taking antidepressants for such a long time affects the expected lifespan. In principle, long-term antidepressant use could shave off years of life. It is commonly argued that antidepressants are needed to prevent depressed patients from committing suicide. Yet there is a well-known controversy over whether antidepressants promote suicidal behavior. Consequently, it is not possible to reach any firm conclusions about how antidepressants affect the risk of suicidal behavior. However, most deaths attributed to antidepressants are not suicides. In other words, antidepressants appear to increase the risk of death regardless of their effects on suicidal behavior. We suggest that antidepressants increase the risk of death by degrading the overall functioning of the body. This is suggested by the fact that antidepressants have adverse effects on every major process in the body regulated by serotonin. 12. Antidepressants have many negative effects on older people Most of the research on the adverse health effects of antidepressants has been conducted on older patients. Consequently, our conclusions are strongest for this age group. In addition to cognitive decline, stroke and death, antidepressant use in older people is associated with an increased risk of falling and bone fracture. Older people taking SSRIs are also at an increased risk of developing hyponatremia (low sodium in the blood plasma). This condition is characterized by nausea, headache, lethargy, muscle cramps and disorientation. In severe cases, hyponatremia can cause seizures, coma, respiratory arrest and death. The fact that most research has been conducted on older people does not mean that antidepressants do not have harmful effects on the young. As previously discussed, antidepressants can have harmful effects on development. Moreover, many people start taking these drugs when they are young and remain on them for years or decades. In principle, the negative effects of these drugs could be substantial over such long periods of time. Altogether, the evidence leads us to conclude that antidepressants generally do more harm than good as treatments for depression. On the benefit side, the drugs have a limited ability to reduce symptoms. On the cost side, there is a significant and unappreciated list of negative health effects because these drugs affect all the processes regulated by serotonin throughout the body. While the negative effects are unintended by the physician and the patient, they are perfectly expectable once you understand how these drugs work. Taken together, the evidence suggests that these drugs degrade the overall functioning of the body. It is difficult to argue that a drug that increases the risk of death is generally helping people. There may be conditions other than depression where antidepressants are generally beneficial (e.g., as treatments for brain tumors and facilitating recovery after a stroke), but further research in these areas is needed (see our article). Ethical and Legal Issues Physicians and other medical practitioners have an ethical obligation to avoid causing greater harm to their patients. The Latin phrase primum non nocere (“first, do no harm”) that all medical students are taught means that it may be better to do nothing than to risk causing a greater harm to a patient. Although all prescription medications have adverse side effects that can cause harm, practitioners have an ethical obligation to not prescribe medications that do more harm than good. The evidence we have reviewed suggests practitioners should exercise much greater caution in the prescription of antidepressants and to reconsider their use as a first line of treatment for depression. Additionally, we suggest that physicians and other medical practitioners should consider their potential legal liability. Legal liability for prescribing antidepressants Medical practitioners can be sued for prescribing antidepressant medications if doing so violates their state’s standard of care laws. In most states, the standard of care is what a “reasonably prudent” practitioner in the same or similar field would do. The standard of practice is not defined by what the majority of physicians do because it is possible for an entire field to be negligent. Since studies on the health risks associated with antidepressant use (e.g., stroke, death) have been published in well-respected medical journals, medical practitioners could possibly be vulnerable to malpractice lawsuits. For instance, it seems likely that a reasonably prudent physician should be aware of the medical literature and avoid prescribing medications that could increase the risk of stroke and death. Prescribers can also be held liable for not discussing information about medical risks so that patients can give informed consent for medical treatments and procedures. Prescribers have a duty to discuss the benefits and risks of any recommended treatment. Consequently, medical practitioners should discuss with their patients that antidepressant medication is only modestly more effective than placebo and could increase the risk of neurological damage, attentional impairments, gastrointestinal problems, sexual difficulties, abnormal bleeding, cognitive impairment, dementia, stroke, death, and the risk of relapse after discontinuation. Antidepressants must cause harm to create liability A medical malpractice lawsuit can only succeed if the antidepressant caused harm to the patient. It is important to realize that the antidepressant does not need to be the only cause of the harm—it only needs to contribute to or exacerbate the harm. As we have argued, antidepressants play a causal role in many adverse health outcomes because they disrupt serotonin, which regulates so many important processes throughout the body. This may make it particularly difficult for a medical practitioner to defend against a medical malpractice suit from a patient who experiences any of a number of adverse health effects while taking an antidepressant. For instance, if a patient has a stroke while taking an antidepressant, the evidence that antidepressants increase the risk of stroke suggests that the antidepressant may have contributed to the patient’s stroke, even if it was not the only cause. Conclusion The evidence now indicates that antidepressants are less effective and more toxic than commonly believed. From ethical, health, and legal perspectives, it seems prudent for individual practitioners and professional medical organizations to revise informed consent guidelines and reconsider the status of antidepressants in standards of care for many diagnoses and as the front line treatment for depression. With older people, for instance, the current data suggest informed consent must include a discussion of the increased risk of hemorrhagic stroke and even early death. We suspect that if prescribers realized they were placing themselves at legal risk for failing to discuss the adverse health effects of antidepressants with their patients, not only would they be more likely to discuss such information, they would be less likely to recommend these drugs in the first place. Paul W. Andrews is an assistant professor in the Department of Psychology, Neuroscience & Behaviour at McMaster University in Canada. He has a PhD in Biology from the University of New Mexico and a law degree from the University of Illinois at Urbana-Champaign. His work on the evolution of depression with J. Anderson Thomson, Jr. has been featured in the New York Times Sunday Magazine and Scientific American Mind. Taken with respect and gratitude. directly from ANNECWOODLEN’s Blog BEHIND THE LOCKED DOORS OF INPATIENTS PSYCHIATRY. http://behindthelockeddoors.wordpress.com/2014/01/12/you-and-your-antidepressant-2/
I have been diagnosed with schizophrenia for nearly forty years and was forcibly medicated and involuntarily hospitalized many times over those decades. Ordering me to take an “anti-psychotic” medication and then physically compelling me to submit to IM injections never got me to a point where I saw the “error of my ways” much less helped me to recover. How can that be? Take my 3-week stay at Yale New Haven Psychiatric Hospital in the summer of 2013. Because I refused the prescribed Zyprexa, I was repeatedly held down and forcibly injected with IM Haldol, a so-called first-generation “anti-psychotic.” Call Haldol an antipsychotic if you will or be honest and just call it a behavioral management drug, it subdued me, yes, it did indeed. It stupefied me. And in the end I cried “Uncle.” But before I surrendered and submitted to their demands, I only got worse, regressing to a degree so pathetic I find it hard to believe it now. But that this happened was a connection the doctors and staff never made,, not even when after I was forcibly injected, I would strip, defecate and write on the wall with my feces.
It seems obvious, at least from my experiences, long and manifold, that involuntary treatment does not work, at least not the way people think it will or should. Over the short run, you can indeed make a person take medication (which is what this is all about in the end, drugs, not something like psychotherapy being forced on anyone…). You can threaten a person with hospitalization “or else,” and frighten her into swallowing pills. And if she does refuse, you can hospitalize someone for refusing and medicate her against will just as you do now to certain in-patients.
You can, if coercion is your game, put certain involuntary in-patients into 4-point restraints, pretending that her very resistance makes her a danger to others, punishing her for fighting the team that holds her down. You can even inject her with so-called “depot” drugs that once in the system continue to work for as long as a month.
Clearly, people break, faced with threats and coercion and many eventually come to accept treatment “voluntarily,” at least for a time. They may even appear to “get better”. Nevertheless this sort of improvement is often shaky at best.
Involuntary — forced — treatment is the worst possible thing you can do to a person with a serious psychiatric condition, especially schizophrenia. Symptom improvement will likely be temporary, even with medication “on board.” I have yet to meet anyone who actually gained that magical “insight” via coerced medication… And given the side effects of all the known drugs, very few people who are not voluntarily in the system consent to take them for long — for good reason.
Moreover, as recent research has shown, there is every reason to suspect that psychoactive drugs, especially the so-called antipsychotic drugs, are far less efficacious in promoting real and permanent recovery than we have been told. However, the effects of trauma and the aftermath of involuntary treatment can be disabling, even permanent. I know; I have been there. As a result of my experiences with forced treatment I now suffer from PTSD in addition to the diagnosis of schizophrenia.
Although at present I choose to attend outpatient treatment, I do not always comply with taking medication, especially when it make me feel bad. I won’t even take meds that others claim alleviate my symptoms. If a drug makes me feel horrible inside, I assert the right to refuse it. Sometimes treatment can be worse than the disease. Alas, because of this, I have, while in-patient, all too frequently been subjected to forced medication hearings, hearings which I believe I was pre-determined to lose, the deck being stacked against me.
At the former Hospital of St Raphael’s in New Haven in 2004, I was not only forced to take the atypical antipsychotic drug Zyprexa, despite the fact that the medication had caused me to gain 60 pounds, elevated my cholesterol and triglycerides sky-high, and made me pre-diabetic. The probate judge, on the instigation of my in-patient psychiatrist, also ordered that I undergo involuntary ECT otherwise known as electro-shock treatments. I was so terrified of the side effects and the real brain damage ECT was inflicting on me, that I literally awoke,mornings, with excrement in my underwear.
In the more recent past, my experience at Manchester Memorial Hospital ECHN in Manchester, CT was just as horrendous. This, along with an equally brutal experience, at Middlesex Hospital in Middletown, Connecticut 6 months later combined to such trauma that I was diagnosed with the additional problem of PTSD. As recently as the winter of 2013, at Hartford Hospital’s Institute of Living, I was threatened with forced ECT, kept in seclusion for three weeks and restrained for nearly twenty hours multiple times. Why? Because as the record states, I was unpredictable and “did not follow directions.”
I would like to tell you about the Manchester Hospital experience in a little detail, as I believe it will give you a “taste” of where IOC, when taken to its logical conclusion, can and will lead.
I was admitted there on a 15-day physician’s emergency certificate (PEC), and the attending, a certain Dr Benjamin Zigun, summarily took me off the two-antipsychotic drug combination, plus an anti-seizure medication and the anti-depressant I had come in on. This drug “cocktail” had worked for me since 2007 without distressing side effects. I was not only willing to take it but I felt it helped me function better than I had in years. But the psychiatrist at Manchester Hospital decided, and I quote, “since you are here, by definition your current meds aren’t working. I will put you on something else.” Did it matter to him that I had already been tried on nearly every other drug on the market, old and new, and none worked as well and with as few side effects as the Abilify/Geodon combination I was then taking? No, he was the doctor and the doctor’s decree was law.
As a result of his ministrations, the “offending meds” were removed and I was again ordered to take Zyprexa, despite its known and severe side effects. Over the next few days, I continued to refuse it. Naturally, having been abruptly withdrawn from all my usual medications, I began to decompensate further, having nothing in my system. A forced medication hearing was held. For some reason, Dr Zigun decided I would not be given Zyprexa after all, but one of the oldest neuroleptics in the PDR, Trilafon. When I objected, he said only that if I refused even a single dose, I would be injected in the buttocks with 5mg Haldol.
All too familiar with Trilafon’s side effects — from akathisia’s maddening restlessness to a constant fine tremor in my fingers, I refused to swallow the pills. But neither would I willingly lie down to take a needle full of “vitamin H,” Haldol being a drug just as awful as Trilafon if not worse. So I resisted, physically, when it came to the nursing staff grabbing me and pinning me to the floor. I fought them when they so much as approached me with the punishment hypodermic.
At first, they just overpowered me, injected me and walked away. But after a few such tussles they started calling “a code” to bring in the goon squad. I do not know how many times this happened but the goon squad consisted of several people including uniformed security guards . Without a pause, they would barge into the room, assault, restrain and inject me, despite my terrified screams.
This sort of violent encounter happened so many times, along with predictable and regular use of 4-point restraints and/or solitary confinement, where I would be locked in their dark, cold seclusion room, that I literally lost track of time. Indeed, but for whatever I managed to record in my journal after each episode, and from their single-viewpoint one-sided hospital chart, I would have no idea what happened during most of that entire three week period at Manchester Hospital, though from my bodily reaction when thinking about it, I know something very bad happened.
Why do I tell you this? Because this sort of aggression, even torture is what forced medication and involuntary treatment lead to much more often than you may want to believe.
If H.R. 4302 passes in the Senate and expanded IOC is instituted in the states where it is now allowed, how precisely do people intend to treat a person with a “mental illness” who does not to want treatment? If a person refuses to leave her apartment to be hospitalized, and is able bodied and physically strong, do they propose to assault, even Taser her, though innocent of a crime? Once she is unconscious and no longer able to resist, do they then intend to hospitalize her against her will so that she can be forcibly medicated, with the threat of 4-point restraints as a back-up if she continues to resist. Or perhaps they expect that trauma itself to scare any individual into compliance?
I am not against all psychiatric treatment. I am definitely not against all psychiatric residential treatment facilities ( including hospital psych units…) But we have curtailed the availability of in-patient beds at present to our detriment, even as we have allowed drug company research scientists and providers to focus almost to the point of tunnel vision on the medical model. This has brought us right to this notion that if we institute IOC, and can force a given individual to take medication, we will be working on a problem that has a real and objectively verified solution. In point of fact, however, there is absolutely no proof that antipsychotic drugs lower violence on the streets or have any effect at all on the incidence of violent crime. That said, if a national IOC law mandated forced treatment, and hospitalization, where are the psychiatric beds to follow through on that mandate? Downsized, in most states to ghosts of their former abundance.
If this is what supporters of H.R, 4302 anticipate and believe in: IM injections, four-point restraints and all, then I must ask: When will you learn that you cannot treat anyone with violence and expect the outcome to be a desirable one? What you propose to do is to subject persons with psychiatric disorders to more trauma and violence than ever. You want to expose them to a“treatment” that is just euphemism for brutality.
I fought back, tooth and nail, biting and clawing the goon squads that descended upon me and attacked me, intending to shackle me by the wrists and ankles to a bed, because as they told me, “ I didn’t follow directions. Yes, I resisted. Who would not have? I was terrified. What did they expect me to do, politely thank them?
This sort of coercion and cruelty masquerading as care doesn’t help anyone get better, it only chases them the heck out of Dodge and as far away from “treatment” as they can get. Oddly enough, little do “Escapees” from treatment such as these know that they might be the lucky ones. As longitudinal studies of treated and untreated individuals with schizophrenia are coming to light, it has become apparent –even Thomas Insel, head of the NIMH admitted this on his blog — that treating – medicating — schizophrenia long-term has had unintended consequences, one of which has been to inhibit complete recovery. By contrast, those persons who walked out or were forced out of treatment, “back wards patients,” seemingly hopeless — it turns out that these people to a much greater degree than those who stayed in the system, recovered on their own, without help, largely by stopping their medications.
A majority of these “lost souls” found themselves only after they ceased taking medication and ceased consuming mental health services. Because they became wage-earning, productive citizens and not mental health service users, many are now “lost” to the mental health system. To experience so few symptoms as to be unknown the to provider community despite past illness, surely this must be accounted the best of all possible outcomes.
IOC works — or doesn’t work — according to a medical model that imposes medication on the unwilling, with no end point, insisting that mental illness is no different from diabetes. But as Dr Insel has admitted, this is not true and apparently never was. New models are needed. Violence is no solution, nor does it cure anyone to impose treatments of dubious value and great harm on those who are different from some mythical “norm. “
(I sent a version of this to Connecticut’s Senator Blumenthal and several other people, including the New York Times, without response, so I am posting it here for public consumption and comment.)
No music or sound, sorry. Best viewed in small screen as the conversion to Quick-time made the files smaller and hence less crisp when seen on a large screen…I’m sorry but this doesn’t seem to be viewable on an ipad..Dunno about android devices. At least I notice that the controls are unavailable on my ipad at any rate…Will try to find another format that will work and re do it…SO SORRY!
Youtube video with sound here :
Continued from yesterday:
Ah, what was Hope always saying? Life is a beach? He hadn’t quite understood her before, but now he did and it surely was. Life is a beach. But it isn’t any pure coral white beach, with sunny skies and clear azure waves. It’s just an old beach of a beach and then you die.
Prem rarely used profanity, so when he thought this word, it appeared in his mind separated out, as if in a paragraph of its own, highlighted, in bold.
What was the point in living if you were only going to die, ignominiously, and end up with your toe tagged in the morgue like any television corpse. It hardly seemed worth it. What was he doing, why did he bother worrying about all these people in Building 22, who were just going to die and end up tagged at the toe themselves? How was it worth it, trying to hold the building together that was trying to fall apart after a hundred years of being mortared and bricked into existence? And how worth it was it anyway, just to upkeep a community of twelve individuals who many of them had rarely-to-never paid a cent into society, but only drew from it like the proverbial parasites that some, like Martin the skinhead, called them.
Martin had hardly a peg-leg to tap out that tune with, however, being something of “parasite” himself, Prem observed. But being copper had never stopped one saucepan from calling another tarnished, not in Prem’s experience. And just why hadn’t the disabled paid into society? Had any of them ever tried to get off disability? Was it their fault? Or was it the fault of a society that encouraged, even forced permanent disabled status on them, and with it concomitant poverty? Who could get out of the disability snare once caught in it? No one who had lived in Building 22 had ever, so far as Prem knew, outgrown or out-earned disability. In fact, the residents were forever finagling ways to earn just up to, but not beyond the strict earning limits placed on them, just so they could maintain disability and their subsidies and their small but stable incomes.
What a miserable trap. You could get a regular but miserably small income for life, if you agreed to be disabled by the system. But in order to get out of the trap, in order to try to earn a living and make your own way, you would in a stroke lose both the place you lived and your regular income, all for a life of insecurity and instability. And this at a time when nothing was secure or stable except the fact that there was no safety net, and no one cared about people in need except a handful of overused charities and churches. So who could blame a disabled person for deciding not to even try to work but to stay on disability and remain impoverished? Who could blame them when that meant at a minimum a roof over their heads and food on the table. It was a devil’s bargain, but Prem could see how sometimes the devil could appear a better partner than the faceless ghoul of potential homelessness and hunger.
“Earth to Prem, earth to Prem,” called Ernie while Beanie smacked her bony hands and made a resounding clap in the tiled lobby, startling Prem from continuing his thoughts. He stared at them, realizing that of course the two women in their own persons made hash of his argument: They had both had had long working lives and deserved more rather than less of what they got out of the system. Nevertheless, it did not completely detract from his argument that two elderly women on social security were trapped in poverty just as the non-working disabled were.
“What were you thinking that took you so far away?” demanded Ernie, never one to keep questions to herself.
“I, I,–“ Prem didn’t know how to respond.
“Aha! You really were thinking something. It must have been juicy!” Together the two ladies crowed.
Suddenly, Prem decided to take the question seriously. “Actually I was thinking about something. It wasn’t juicy, not the way you think, but it was – I don’t know how to put it. Can I ask you a question?”
“Sure.” The two spoke at one time.
“Okay, then. Tell me when you disagree with me. First of all, this is a society of “haves” and “have-nots,” right? I mean, we have huge inequality, you can see it right here — this building, Number 22, compared to others down the street is just one example.” Prem stopped as if one of the women had spoken. But he saw at once that they were simply waiting for him to go on so he continued, “Clearly it’s no good simply to give a “have-not” everything he or she needs. That’s just what we do now, and in my opinion it leads nowhere but to misery and protracted disability.”
“What if the “have-not” isn’t disabled, but just old? What if the “have-not” works full-time but isn’t paid enough to live on? There are a lot of other ways to be a “have-not” than to be disabled.” These objections came from Beatrice Bean, whose fingers held an imaginary cigarette. She pretended to suck on it, then flick the ashes.
“You’re right. I guess I am a little obsessed with the disability issue. But let me go with just that part of it. If the “haves” somehow could help the disabled “have-nots” gain a set of skills – any set of skills — to become “haves” like themselves, wouldn’t that be better? There are plenty of skills that can be marketed. You don’t need to go to a regular workplace these days to earn a living.”
“I really hate that word, ‘marketed’,” Ernie interjected. “Why does everything have to be for sale? Why must everything be reduced to a matter of money?”
“Because it’s a capitalistic world, that’s why. You and I may not agree with it but we’re stuck with it, and until we can live in a world without money, the have-nots need to learn how to earn.” For all the conviction in his voice, Prem was not that comfortable defending capitalism, especially knowing how avarice had despoiled the natural world he loved so much. But he knew that capitalism had ruled for centuries, and that it wasn’t going to change in his lifetime or the lives of these two women, so it was to all intents and purposes, a fact of life.
“So you are going to teach all the disabled people in Building 22 how to get a paying job? Good luck!” said Beanie with a wry smile. “I don’t personally think anyone here is going to thank you very kindly for it.”
“But don’t you see? That’s precisely what I mean.”
“What do you mean? Why should anyone thank you? If you have an apartment, a social worker, food stamps…you have it made in the shade. Why should you want to work?”
“Because people would feel better about themselves if they could work, that’s why…” Prem said, lamely. He then realized that he had made the mistake of so many do-gooder liberals, believing he knew what was good for those he wanted to help better than they did themselves. But how could he know how they felt without asking them? How could he know whether they felt bad about themselves now or would feel better about themselves working? He hadn’t spoken to most of the residents about the matter. In fact, it had only been Hope, the second floor resident and artist, with whom he had spoken in any depth. It was she who had been so passionately outspoken about feeling trapped in “the System.”
Even as he thought about it Prem realized that things were complicated. Yes, Hope was an artist, and he felt she should be able to sell her work and keep the income at the same time, but wasn’t she also often ill and unstable? It seemed to him that she was hospitalized for weeks at a time, and as frequently as twice a year. What would she do without disability payments when she was ill, he wondered, and how would she survive or cope even as an artist during the inevitable lean times if her disability payments were cut off? Yet she was the tenant who resisted staying on disability, even as it was clear to him that she could not afford to chance getting off it, not unless she could sell paintings regularly or for large sums of money, something that was not likely to happen. People like Hope weren’t discovered by museums or fêted by the rich and famous to be made rich and famous. No, they simply did art and made art alone, steadily, keeping the faith that it was worth it simply because art to them was like food for the rest of us.
Hope wasn’t going to quit painting or making her sculptures just because no one “discovered” her. Hope did art because she had to do art or die. Period. If it sold, well then, good. But so far as Prem knew, Hope had never tried to advertise or sell in the manifold ways that “working artists” sold their art: by marketing themselves and their art in such a way that people come looking to buy. It wasn’t that she would not sell. Prem thought she might be very happy if someone wanted to buy a piece of her artwork. It was simply that she had other things on her mind than making art in order to suit the purchasing public. And what about the others in Building 22 – were they so very different? What did he know? Did he know enough to draw any conclusions at all?
“It’s just such a vicious cycle,” he said, as if finishing a thought he had started aloud.
Beanie seemed to have followed him. “Yah, I agree. But some of these folks have two or three strikes against them before they started out in life. Can you blame them for seeing a tiny fixed income for life better than the insecurity of not knowing whether you can earn anything at all?”
Ernestine Baker seemed to disagree. She counted off on her fingers, as if reciting a litany, “Darryl, Kashina, Bryony, Giorgio, Feder…and that strange woman, Hope. What cases. I wouldn’t want to be in their shoes for a second. I can’t imagine being one of them for a day, not even if you paid me. Talk about unfulfilled lives and unrealized potential!”
“But what are you saying?” remonstrated Prem. “That their lives are wasted? And if they are wasted, whose fault is that? Why have the disabled been allowed not to do something with their lives? That’s my entire point. Look at Giorgio. He was a talented auto mechanic. He wasn’t in the system all his life. He has skills. He just can’t use those skills right now. Feder has savant expertise that surely could be used somewhere productively. Bryony already works three days a week, and Kashinda is so young that it would indeed be a terrible waste if she never learned to do something with her life, except smoke pot. We created a real monster with Federal disability benefits: the same limitations that promote permanent poverty promote never getting better.” Prem could feel himself getting passionate, and wondered just where that came from. Why did he care so much? Why he sounded almost hysterical…
“Okay, what’s going on, Prem?” asked Beanie, peering at him with more than a little concern. “Why don’t you draw up a chair, sit down with us, take a load off…”
Baker, abashed, chimed in, “You want a drink, Prem? The beer is on me.”
His face warm, Prem had felt a sudden but urgent need to be gone. To be anywhere but here. Ashamed of himself, he apologized to the two older women and literally backed away even he spoke, forgetting entirely why he had returned to Building 22 at such an hour in the first place. By the time he remembered the water pressure situation that had occurred just that morning, he was halfway down the block with an old cassette tape playing Dave Mallett’s “Pennsylvania Sunrise,” a song that always made him yearn to hop a train and go places, never to return.
Pennsylvania sunrise…ten degrees at best.
Peerin’ from the window of a club car heading west.
After mornin’ glory…money for the miles.
Someone said I’ll do this for a while.
I promise more action in the segments I will share in upcoming days. I won’t share the entire novel but I will share some parts of it, enough to entice. I now have c 120 pp. double spaced 37000wds.
I just wanted to alert readers to a new journal that Kayla Bowen is starting at Dreamrly. She is asking for submissions up through January 14, 2014, so there is still plenty of time for art and writing of all sorts. See this link. http://dreamrly.com/2013/10/22/collective-dream-arts-journal-call-for-submissions/
Here is what Kayla asks for:
“High-quality visual arts projects (submitted in digital format), poetry, creative nonfiction, comics,short fiction, book reviews, essays, creative dream recordings, etc. by January 14, 2014. Not all submissions will be accepted, but I encourage everyone to submit his/her work.
This is a great opportunity to showcase your creative work – and, once the journal is completed, you’ll have the opportunity to see it in published format and to purchase a copy of the magazine (likely for around $15, but I’ll know for sure as it gets closer to publication).
Email submissions or questions to firstname.lastname@example.org by January 15, 2014.”
Why not submit your best art/ writing samples if you happen do work on the subject of dreaming or dreams? Or try to do something for the journal now. It can’t hurt, and you have a chance at publication online, and maybe even in hard copy!
More to come but for now I just wanted to report that I am doing great. There are clear reasons for this, and they are not what you may think or wish to think. But though it is true that “it is what it is,” whatever is now, needn’t be the same thing tomorrow. Yeah, I know, that’s completely cryptic, but I cannot say any more right now.
I will only say that things are much better today than last week, and a thousand times better than the week before. Which is what matters. That things are looking up and that I am looking up and outward at the world, not curled up, shriveled up and looking only inward.
I am assembling my own private, so to speak, “treatment team” for recovery. This is because it turns out that to go to any facility for real no-drug no medication recovery, somewhere like Windhorse in Northampton, Massachusetts, or Cooper-Riis in NorthCarolina, you have essentially to be filthy rich. Neither place so much as returned my application email (supplication) once they knew I “only” had about — well, let’s just say that I could not afford their fees of up to $20,000 per month, and certainly not for the requisite six month program just to start with! So essentially, you have to be wealthy as Croesus in this country to get any help whatsoever to recover, or you are on your own.
Luckily a little family assistance does permit me to hire a few people to help me — which I know some people are not fortunate enough to do. So I did — I hired an art therapist this past week and I meet with her next thursday! This is something I really look forward to. While I do art daily, I do not usually express my feelings easily or spontaneously doing art. I have to think things through doing art. But i want to do it quickly and find out things or learn to let go and feel my way doing art. And I have never done art therapy, at all so I dunno even what it can offer, except that I cannot believe it won’t be helpful, esp now that I am done to 5mg Abilify as of Saturday. And no abilify at all by the following Saturday, if it turns out that I can tolerate the drop to nothing.
Now, I do take Geodon as well, so I think it will be fine. But we will see. So far so good. But I did say that I would take it more slowly if I ran into problems. Once the Abilify is out of my system, I will wait a little while, then start reducing the Geodon. No sense in waiting too long. If I have no difficulties apparent from the loss of Abilify, why wait? THEY thought i decompensated almost immediately at Yale New Haven Hospital from having “nothing on board.” My contention is that I decompensated due to the abuse I suffered at their hands, and as a result of their megadosing me with IM Haldol, torture for anyone.
That’s about all the news I have for now. And it is getting late so I’d better go to bed.
Oh, by the way, if the pictures look a bit different, it is because they are done with markers, copic markers for the most part, and not with colored pencils….So you are noticing my use of a different medium.
When Monica Cassani posted this video (see below) on her wonderful blog, BEYOND MEDS.com today, I was not sure I would watch it, mostly because I often do not have the patience to watch videos, no matter who recommends them. (Sorry about yesterday’s recommendation, an hourlong one no less, but it is vitally important to me and my topic…I still highly recommend it, if you cannot read Anatomy of an Epidemic…). Nevertheless, something about a video on treating trauma, perhaps the face of McElheran on Youtube, perhaps just my mood at the beginning of this day, impelled me to click on the little triangle that started it playing. I was pulled in almost at once. In fact, I was soon in tears, because McElheran may speak to us all, but most importantly she spoke to me…her words on trauma included me, personally, for once.
That she did so, moved me beyond words, because at that moment she validated my own manifold experiences of trauma, which were mostly NOT of potentially mortal events, even if I may have believed them to be so (when paranoid or psychotic). I will embed the video here, so you can watch it now, and come back to my blog post afterwards if you so choose. Or watch it whenever you like. It is — truly! — only 16 minutes long, and very compelling, so do not worry that it will take a lot of time.
Something about what she talks about reminds me that “Nothing human is alien to me…” We are all capable of everything, and anything, given the proper circumstances. Her compassion for human behavior is astonishing and moving beyond words.
I need to say this because no one who “knows me” thinks I am “capable” of things like calling people such vile names as those I called the aides and nurses regularly at YNHPH, or of stripping and defecating and smearing feces without even thinking or considering the consequences… But those are important words: “without thinking” and “without considering the consequences” because they indicate that I was behaving wildly impulsively, as indeed I was. Think about the situation: Six to eight people, some of them security guards (self-professed former police officers) had just violently and brutally assaulted me, thrown me onto a bed, held me down (causing physical pain to the point that I screamed in reaction) and pulled down my pants, giving me three intramuscular injections into the buttocks, then holding me down some more until they felt “safe” to let go…(One of them actually telling me they would press charges for my kicking her in the stomach while she was restraining my knees!)
Once i was freed, I made a dash to get out of the room, wanting to “do laps” around the “square” hallway that gave the Washington Square 2 unit its name. No deal. They physically prevented me from leaving the small single room, that had nothing in it but a hospital bed and tray table. I recoiled, enraged and manically in need of doing something, anything! Suddenly, I felt my bowels engage, roil, want “to go.” But the bathroom was down the hall…No matter, what the F—! Who gives a shit, in fact.
Without thinking a second thought about it, I simply pulled down my pants, squatted, and unloaded on the floor, to not so silent on-lookers astonishment and incredibility. Then I removed my clothing altogether. But another WTF moment seized me, then. The steaming pile of sh-t was there, and suddenly I “knew” what to do with it…and I did not give a sh-t that this meant using my hands or getting it all over me or anything. I just didn’t give a flying femtogram. I do not know why. I didn’t even smell anything. I just picked up handsful of the feces and smeared it across the walls. But not blindly and wildly, no, I was writing something, I remember now, I wrote something on the walls with it, though I do not know what any longer. And I do not think anyone took the time to read it. I do not believe anyone bothered to notice that I was not merely smearing but writing in shit...
The point is, I did this as a response to trauma, small as you might say it was. I felt traumatized. I felt brutalized. And I felt and was out of control as a result. This is not to say that my impulsive behavior served any purpose other than venting rage and sheer revenge at my abusers. It certainly won me no friends and no compassionate understanding from anyone. It could have, someone might have understood it for what it was, and seen that what they were doing to me was in fact brutality and traumatizing…They had after all diagnosed me with PTSD, so WTF did they think they were doing?
It doesn’t help, frankly, that “Dr Angela” believes that they were “on my side” and “doing their best” and “actually helping me” all along. I do not agree. I do not believe that. I think they were hidebound in their determination to break me, and if they could not see that they were perpetuating harm, they should have.
Okay, okay, okay Pam. Calm down. Calm down. Remember you are practicing forgiveness, not worrying the sore into an infected mess! 8)
This is hard. It is so difficult to forgive and let go of harm that no one admits to having done, one, and two, claims was actually for my own good. To help me!
Bull feathers! I still have exquisite backside piriformis muscle pain when I move in certain ways or even sit down on my right hip. And if I take off a T-shirt with the usual crossed arm movement, it causes agony in my deltoid muscles from the injections they gave me there too.
But forgive and move on, forgive and move on…I need to take a deep breath. Think about other things. Get ready to go out for coffee as I have made a date with an old friend of mine I haven’t seen since that debacle at the Institute of Living last winter. We always have great talks. It will be good to see her!
Yes, I will leave this on that note. The fact that I do not isolate myself, but that I have lots of friends and do things to keep myself busy and fulfilled and purposeful in life. Trauma and memories and flashbacks of trauma may still get me, and they get me in the gut a lot, but they haven’t got me completely over a barrel the way they might have. There was a time when I was more isolative and friendless but not any more. Not anymore.