Complex Post-Traumatic Stress Disorder, Transference, and Loss of Bladder Control

Just a little background in the form of a timeline:

Sept. 16 - After a short argument with my husband, I was overwhelmed with terror and panic and peed my pants all over the kitchen floor.

Sept. 24 - In a therapy session, toward the end, I became panicked with a feeling of being trapped and left prior to usual "end of therapy" rituals. We had been discussing my feelings of being trapped during my argument with my husband....I think.

When I got home from therapy, "I" wrote this:

I can't understand the directions to the student's house where I have to do homebound instruction tomorrow.

I can't remember what we talked about right before I left therapy.

I don't know how to organize my lessons on the SmartBoard - it's new technology and I've used it every day since the school year began but now it doesn't make sense.

I deleted an important memo on my tablet and I don't know how or when I did. I just know it's gone.

I can't remember why I've held on this long. I can't remember why I chose life in the past.

I don't understand how to back off the intensity when the intensity is nuclear melt-down.

I pissed my pants. ON THE FUCKING KITCHEN FLOOR.

I need a haircut, but every day is hellishly long and weekends are a nightmare of trying to sleep, do school work, clean the house, and not go fucking insane.

I hate all of my clothes.

I didn't recognize my face in the mirror today. It was so puffy and fat. And the lips were weird.

I don't understand shy I'm not actually trapped if I can't control myself, the people around me, and the feeling of being trapped.

I don't understand how I'm supposed to work on getting better if I don't have the energy to stay up past 8PM.

I don't remember most of today.

If I feel so unsafe that I want to kill myself, then I really am actually unsafe.

If I wet myself, then I really shouldn't be in charge of kids all day.

I had a lot of trouble taking attendance today, because the kids were unrecognizable and the names unfamiliar.

I feel like I should know a lot of things I don't know, and so I fake it.

People don't get that sometimes I cry so hard my whole body hurts, and that even though I act normal, I piss my pants.

I am powerless in the face of overwhelming terror and panic. I see what I'm doing but can't control it. I could hear the urine hit the floor, even though I was also screaming, and I couldn't stop doing either.

I get really dizzy when I try to understand that I don't need to feel ashamed.

All I have to do is work 8 hours a day and I can't - at least I can't and feel ok. I am exhausted.

There's no reason for me to be so exhausted, yet I am.

There's no reason for me to be so afraid, yet I am.

There's no reason for me to be depressed, yet I am.

There's no reason for me to panic and feel terrified, yet I peed my fucking pants in terror.

I have trouble breathing.

My muscles hurt because I tense, and release, and tense, and release, and tense, and repeat forever.

I fucking hate my life - yet shouldn't because I have a pretty nice life.

I can't stop seeing me blowing my head off.

If I try to stop seeing me blowing my head off, I then see me hanging from the garage ceiling.

I forgot why people love me.

I forgot what I love about people.

I wish I could hold Danny's future baby, but I don't deserve to love.

I shouldn't have had a family- I should have killed myself back when I first became obsessed with suicide at age 12.

I hate. I fucking. Hate.

Sept. 25 - Oct. 5 - I went to work, I went to sleep, I went to work, I went to sleep, I went to work....you get the idea.

And now, today, I have a thought forming. I was thinking about the post about my little dog and how it's obvious I am feeling things about myself through my pets. I also am annoyed that one strategy my therapist was discussing with me was how to get up and leave a situation when I became aware that it was triggering. And how that seemed impossible as I become paralyzed with terror when triggered and I feel trapped. And how I was feeling trapped in his office, and overwhelmed. And then I left. The annoying part is that I play-act in therapy the skills I need to transfer into my life, i.e. walking away when overwhelmed. It annoys me because I know I practice this kind of shit in therapy all the time - my therapist being a stand-in for all sorts of people in my life now and in the past. It annoys me because I walked out, truly angry and overwhelmed, and yet it's FUCKING THERAPY. It's not real. And he suggested it.

So, for weeks really, I've wanted to end my therapy, enact the righteous "walk away" skill. The thought is seductive and terrifying, empowering and ridiculous. I couldn't survive without therapy.

It hit me this morning that yet once again my preoccupation with therapy is simply a stand-in for the real issue - the real issue being that I couldn't leave my abuser as a child of 2 because my abuser was my caregiver at that time. And then, my real caregiver came and got me and did everything "wrong" and I still couldn't leave. And my husband is now my caregiver and I can't live without him. And my therapist is my lifeline to not blowing my head off and I want to leave therapy but I can't because then I'd die.

I guess I became a history teacher because history repeats itself and in learning about history a person can make better decisions in the present to avoid the mistakes of the past. But life is a paradox, and as I try to resolve the deep issues of a 2 year old getting sadistically tortured by her caregiver, I relive the situation over and over and over because there is NO FUCKING RESOLUTION.  A 2 year old CAN'T leave her caregiver, she CAN'T walk away, she CAN'T cope with the overwhelming sensations and feelings and CAN'T cognitively interpret the situation. Of course she pissed herself.

I can't leave the man I love who helps me live, I can't leave therapy, and I can't cope with the overwhelming feelings left over from the overwhelming and impossible-to-interpret situation I keep reliving in various ways. I can't understand it. I can't walk away, because it's locked inside in the form of a vague and undefined shadow that disappears with every light and every darkness. Shadows don't exist in the light, and they don't exist in the darkness, either.

In the hospital we received a kind of therapy in which we set up a scenario and acted out the scenario both as ourselves and as some "other" in the scenario. I set up a scenario in which a little girl played on the living room floor (me) and I as an adult that knew what was coming next took the girl away from the horrible living room chair before the man entered the room. Someone else played the little girl, and someone else was supposed to play the man. I say "supposed to play the man" because in the scenario, the man never entered the room. Every time the therapist had the man take a step toward the door I dissociated. The therapist was really good at his job, because the signs of me dissociating were so subtle I didn't realize it was happening at all - I just knew he would stop the man from entering for some reason over and over. I finally realized that he was watching me closely, and when he said to the man "step forward toward the doorway" I got foggy. So, the scenario was all about the little girl playing and the adult me stepping in to lead her away. It is what I wish could have happened. I wish I could take her hand and help her walk away. But it was just a dumb fucking scenario played out in a dumb group therapy room in a dumb fucking psychiatric hospital. In reality, the man came in, sat on the chair, and the same Chain of Events that I still replay in my mind 43 years later actually happened. The little girl didn't walk away because she fucking can't.

So how am I supposed to walk away from a triggering fight with my husband who I love and who takes care of me? How am I supposed to continue therapy when it has become the thing that terrifies me? And keeps me alive? Like the issue of sexual abuse of a child....a never ending Chain of Events that replays over and over and I can never take her hand and lead her out because that's not what happened.

I can back off the intensity of the shame of peeing on the floor as a 46 year old woman. I can do that. Because peeing your pants in the face of terror makes sense to a 46 year old woman. But I can't take the little girl's hand and help her walk away because that's impossible. And she will never understand what happened, because she's fucking 2 years old.

Sensory Integration

Epiphany in the sauna! Rae and Sarah do a lot of communicating in there, and Rae was telling Sarah how much she appreciated her work with Doug and just her insistence that something needed to be done to figure out a bit of a solution to the the work stress problem. Having 15 minutes of lights out, very quiet time in the middle of the day to breathe and look out the window and feel and watch the stream go by with so many leaves in it, floating and moving, relaxing.....is going to make a huge, positive difference in System Management.

The epiphany was that sensory integration and emotional integration are very, very intimately connected.

Sarah gets easily overwhelmed by both emotions and sensory input. Too much sensory input, and all the energy of the system has to go into overdrive to make sense of it all, as well as determine what input can be dismissed and what input must be addressed and what input is pleasant, dangerous, tolerable, etc. If Sarah has access to too much sensory input, she gets frustrated because everyone else in the system can, for the most part, integrate it quickly and efficiently and move on. She can't. Also, if any of the inputs are potentially dangerous Sarah's frustration quickly becomes rage and then not only is she overwhelmed, the whole system is overwhelmed. To make matters more complicated, if any event has happened (and by event we mean anything from a comment of a co-worker in passing, to a joke over heard, to a touch, to a triggering word...anything) that might potentially be dangerous, Sarah's energy is spent dealing with the overwhelming fear and shame and panic and rage which easily spills into the rest of the system and then the rest of the system has to work to function appropriately under the looming shadow of threat and chaos and disaster.

We don't quite understand this intimate connection of sensory and emotional integration yet, we just know that it's very important to explore both the connection and the role sense plays in the functioning of the system. Dealing with sensory integration does not seem scary or overwhelming, it seems exciting and doable and brings hope to everyone - even Sarah. In fact, suddenly, the system is quite motivated to seek weekly, controlled input and professional help in the form of massage one week, followed by acupuncture another (the dude does some great reiki and burns incense and plays soft music and there is candlelight), followed by the goofy chiro the next week.....

I dreamed last night about this. I dreamed I went to my psychiatrist with this epiphany and explained it to him. He was distant and withdrawn, with dark circles under his eyes. After trying unsuccessfully to connect with him, I asked him if something was wrong. He said "yes" and proceeded to rape me. He couldn't get an erection, so he did it with his fingers, while choking and hitting me in the face.

Fluff Balls, Death, Shame, and Forgiveness

Laying in bed, thinking about my kids, I began to feel stuff. So I continued, since my therapist said I need to feel stuff sometimes. I had fond memories of their childhoods, and fond memories of recent times, and hopeful feelings about their futures. I cried a little, thinking of how close we were and how warm it feels to be close to them. My thoughts moved to family in general, and how I love my family. Dad came to mind, and I missed him and felt sad about his death. I cried some more, all mixed up with loving feelings, sad feelings, and close feelings. Then I thought about Luke and his plans to meet his brother next summer. It's a huge thought, because not only is Luke going to meet a brother he didn't know he had, but he is the one who planned the visit. Here's the hugest part - he will also be seeing his dad who lives a block down from his brother.... a dad he hasn't seen since he was 6. I wondered, as I lay there, if my dad's death so recently was a catalyst for this. Luke had a lot of feelings himself during the days surrounding the funeral. Suddenly, I was overcome with shame as I realized that there were two sides to the story of my resentment harbored from funeral day. I realized that not only was Luke not "there" for me on that day, but I wasn't "there" for him either and he was in his own kind of turmoil. I suppose such a realization might not seem momentous, but for me it was. In a flash I had empathy, understanding, regret, forgiveness, and then FEAR and SHAME. I saw the panic coming, and for a moment even thought that I should try to stop the emotional overload, but then it was upon me and I was drowning under it and I cried and screamed. Luke came into my room and held my hand. I couldn't verbalize what had happened. I still don't understand why it turned to fear and shame and I panicked.

Switch gears with me.

Shortly after my dad died, my little dog of 16 years died. He was an emotional basket case, for the most part. He was nervous all the time. I loved him dearly and enabled his maladjustment. I felt sorry for him. I did not ever expect him to overcome his deep emotional issues (most certainly from abuse - he has always been afraid of men and was abandoned as a pup.) That's how some parts of me perceive other parts of me. With pity.

I have a German Shepherd as well, who came to me only a few years ago. She is stoic and smart and nosy. She and the little dog never bonded closely and remained aloof. I have never quite figured her out, but I know I expect a lot of her. I never planned to love her, she was supposed to be an outside guard dog. She currently is snoring on my couch, and I do love her. I don't feel sorry for her, but rather proud of her as she has moved from home to home which is particularly hard on a Shepherd and yet has bonded with our family and is content. She has overcome much, excelled in her capacity as "dog," and in her declining years continues to do her jobs for me - protecting, grounding, and keeping me company. That's how parts of me feel about parts of me. Proud, with high expectations.

Recently, a new little fluff ball joined the family. He is boisterous, cheerful, wanting to please, smart, funny, adorable, and joyous. He is also resilient. I am amazed at his resiliency. I see it when he is denied something he wants.... he asks, he asks again, he goes for it, and then he accepts the outcome and moves on. He does this all the time. He is intensely interested in a bone, for instance, that the Shep has. I won't let him take it, and in moments he rolls over on his back, runs for a doggie toy, and plays. We spent weeks together this summer, getting to know each other and bonding. When I had to return to work, he stayed with the Shep all day in the entryway of the house. When I got home, he was cheerful, energetic, and loving. He adapted to the routine with little stress. He's so cute and lovable and good natured I am constantly amazed.

At one point I became distraught over a belief that I could never measure up to what this little guy deserved in life. This belief brought on shame. I tried to trace the path of this shame. It's unclear, but goes something like this:

1.He is sweet and innocent and accepting and curious and wonderful.
2. I will never be able to give him the care and love he deserves.
3. What if he doesn't get the care and love he deserves?
4. How could anyone hurt such a sweet little thing?
5. No one is hurting him.
6. He's obviously not hurting because he is so full of joy.
7. He's so full of joy, how can I ever give him the care and love he deserves?
8. I don't deserve such sweetness.
9. He deserves so much more than I can give him.
10. Is he hurting? How would I know?

This is how some parts of me perceive some parts of me. It makes my stomach hurt and it makes me dizzy. I don't understand it, so I have to turn it off.

Opportunity Cost

Sitting in an economics class, listening to passionate discourse about the role of cost-benefit analysis and opportunity cost in forming economic policy, noticing the salt and pepper beard's motion and the sexy laugh lines around his eyes. I turn my head ever so slightly to move my gaze out the window and start performing my own little cost-benefit exercise quietly in my mind. Prowler gave a cold and accurate summation of his opportunity cost analysis regarding suicide to Dr. Sudak once. She was discussing some health action or another, I can't remember exactly what, and said "If it helps, do it! I mean, the alternative  right now might be suicide and what good does that do anybody!?" I think she meant it to be a rhetorical question, but that kind of assumption is only made by people untouched by suicide. Prowler looked her straight in the eyes and said "What good? Suicide is ultimately an effective way to end the pain."

But other respected professionals argue the opportunity cost analysis to be more three-dimensional, and we, as a system, get that. So what are the benefits of suicide?
1. effectively end pain and suffering
2.
3.

I can't think of any others. What are the costs of suicide?
1. The years unlived, which might have been meaningful but most definitely would have included pain.
2.
3.

I once did an activity with my students, trying to get them to understand economic opportunity cost analysis. I had a tray of "prizes" and asked for 10 volunteers to come up in front of the class. I started at the front of the line and held out the tray and told them each in turn to choose a prize, any prize, no strings attached. The prizes were jolly ranchers, mechanical pencils, stickers, post-it notes, and extra credit coupons. You could watch the students' faces quickly calculate the cost-benefit of the items, especially as the tray got to them and their choices might have changed due to the first students' choices. Every now and then a student would exclaim "Darn! I wanted that!" as the last jolly rancher was chosen, or "I got what I wanted!" if the pencil they wanted remained. Once all students had a prize, I asked the first student, who chose a jolly rancher, what the cost of the jolly rancher was to them.

 "Nothing."

I dug deeper. "Jolly Ranchers are free?"

"Well, no, maybe a couple cents."

"So, you paid a couple cents for that?"

"No! I didn't pay anything. It was free."

"Anyone have a different idea of what the Jolly Rancher cost Johnny?" I asked the class. No one had any ideas. They were engaged....I do this kind of thing a lot, ask questions and they try to figure out the 'right' answer and so often I have a little surprise at the end of it all. It's a fun and effective way to teach a concept, almost a kind of game, and they like it.

"So," I ask Johnny, "why did you pick the Jolly Rancher and not the mechanical pencil? Sue was fourth in line and she grabbed the pencil and was happy about it."

Johnny had a quick answer. "I don't need a mechanical pencil. I don't need anything in the tray, but I wanted a Jolly Rancher so I took it."

"Sue, why did you take the mechanical pencil?"

"I just lost mine this morning. And I like pink. I hate Jolly Ranchers and I have an "A" in this class so the extra credit was pointless."

"What did the pencil cost you, Sue?"

"Nothing. It was free. You gave it to me."

Someone from the class blurts (I'm ok with "participatory blurts") "The pencil cost the other stuff in the tray."

Bingo! That's the concept. I went on to explain that the cost of the Jolly Rancher to Johnny was the post-it notes, or the mechanical pencil, or the extra credit points. He made a choice based on his needs and wants. His opportunity cost was different from Sue's, who also made a choice based on needs and wants. Sue needed something different than Johnny, and so her cost-benefit analysis was based on that.

What does this have to do with suicide? Suicide is a deeply personal decision, and as such most likely confounds the individual who has no need for it or who has a life framework from which to operate that doesn't include suicide as a choice 'in the tray of prizes' so to speak. But suicide is in my tray. It's got a neon sign over it, with red arrows flashing on it. The other choices are dim comparatively. I can't think of why I would need or want extra years....The cost of suicide is unclear. Perhaps there is meaning in the future, perhaps some laughs, some children's lives improved as they enjoy a class....I'm glad my family and friends find me worthy of life, find some benefit in being around me, but that is their choice. The cost of suicide to me, personally, is years unlived and those years may or may not be meaningful/joyful/peaceful. The benefit of suicide is most succinctly stated by Prowler, an effective end to suffering. It's beautiful in its simplicity, and as far as I'm concerned unarguable. The other choices in the prize tray have held promise over the years - psychological treatment, psychiatric treatment, Buddhism, sex, drugs, dissociation. But either their effectiveness has waned or their cost has become too high. When Sue lost her pencil, getting another one was her dominant need. When I suffer psychological pain, ending the suffering is mine.

The psychiatrist I spoke with during a recent hospitalization once said "Take pictures of yourself happy. Take video of yourself having fun and laughing. Watch them when you are suicidal. Depression sucks a person in and they feel that suffering has always been and always will be. But despite how it feels, it's not true. I hate to see a depressed person kill themself when relief is a day away." I guess he was trying to add 'hope' to the prize tray. What's the cost of hope? Endless suffering.....endless suffering is the cost of hope.

Trust

A doctor stands over a trauma patient, unsure of what the exact wounds are. They have been covered in layers of bandages, scabs, scars, and dried blood. To know how to heal the patient, the doctor has to remove bandages, move limbs, ask questions. It's a nearly impossible task, as he doesn't know for sure which bandages will come off easily and which ones will tear away vital scabs causing bleeding, possible fatal bleeding. The patient, sometimes conscious, sometimes not, can only effectively answer a part of the time. Other questions are lost in the pain of old wounds made fresh, broken limbs moved so that the nerves are all pinched, and terror in the face of death.

I'm trying to answer your questions. Your words are the touches of the doctor, and almost every word hurts. I'm so raw even your glance feels like a stab in my soul. It feels like a violation.

I hear your explanation to those around me, the explanation about how Luke didn't mean to tear open the wounds. I hear you explain that the intention is not to violate or abandon. What difference does it make, what his intention is, if it feels like violation and abandonment? The guy who carried the trauma patient into the ER to the doctor didn't mean to hurt the patient, but in his amateur handling he caused so much more pain, opened old wounds, it might as well have been the original trauma. So what difference does his intention make to the suffering of the patient?

You discuss hope, share a vision of what tomorrow might feel like, and next week, possibly next month. You ask me to trust you in so many words. I do. We all do, except LA. What you're asking feels like a violation to her. In order to heal, that bandage has to be taken off and it causes bleeding just to move the bandage, just to touch the bandage. Your words are the doctor's touch, and LA is the patient. The bleeding might be fatal. It feels that way. To her, it seems there are only two choices - violation or abandonment. She cannot make the choice so we make it for her - we will always choose violation and we always have. Your words feel like violation. To trust you feels like you're violating us. I don't know how our action (to trust) can feel like you're taking an action (violation).

I hate that I trust you.