The Effects of Trauma

For me, this was the effect of a very traumatic childhood and some events that happened when I was about twenty or twenty-one. Over the years, I have had a lot of therapy, and not a lot of it was that helpful-and the majority of that is on me. When you’re not even being honest with yourself, you won’t be honest with the therapist and you are wasting your money. May as well light it on fire.

In learning to make peace with the past, time does help heal. Revisiting trauma in therapy time and time again may be helpful for some but for others, you are reliving it. I met criteria for PTSD in my twenties because I witnessed a murder, and it was pretty violent. And then that person also tried to kill me in the same fashion. Murder is by definition violent, but it was exceptionally violent even as far as murder goes. And it does haunt you.

Due to insurance coverage (see the entry, An Atrocious Mental Health System https://hopeandsecondchances.com/2021/11/07/an-atrocious-mental-health-system/), I never until recently, had the EMDR that would have helped me years ago. And a few years ago, a provider did not believe me when I told them what I had seen, and it was treated like a case of psychosis. I actually had an involuntary hold placed on me and forced antipsychotic treatment for several days. Being a liar and being delusional are two very different things.

And sometimes, you need therapy for the therapy.

Where was God when that happened? He was all over it. And I am alive because of it. More people were not injured or killed. The murder I saw did not cause my disorder but it certainly made things worse for me. It’s funny how we punish ourselves for someone else’s shortcomings. I realized I also had a choice, I could continue to destroy myself because of it, but the man who did that does not deserve it. Neither do the adults in my childhood who put me through what they did. And I am not referring strictly to family members.

Forgiveness does not come easy. As I said, time heals, but the wound does not go away, not overnight. A scar remains, and it tells your story-but even that fades with time. For me, I had to ask God to help me forgive the person who hurt me and the others involved. And I had to do it more than once. And over a lengthy period of time. I realized also that it could have been much worse than it was-more people could have been hurt. And some good came of it (the perpetrator was killed by police, suicide by cop), some changes were made in how things were done. Granted, those changes came at a very steep price. Too steep.

Forgiving yourself is even harder than forgiving another person. In my experience at least. And yes, in part, I refer to my actions as a result of my disorder. When I fully realized the impact of what I had done to others as a result of my addictions, I wanted to take my own life. And the tears did not stop for some time. One may say I was hysterical for a while, and panicked. I was also at the acute end of my first manic episode following a traumatic brain injury (a real one). And the guilt worked its way into my delusional system. It wasn’t pretty. I also had to learn to view myself as a sick person. Mentally and especially, spiritually. AA helped with that.

As time went on, and with God’s help, forgiveness takes hold. It allows you to start to let go of the past. Some therapy did help (EMDR was the most helpful).

An Atrocious Mental Health System

“We have an atrocious mental health system,” someone once said to me, followed moments later by, “We’re going to require psychiatry of you.”

My, you make it sound so attractive. 😉

Unfortunately, it’s a very true statement. Some areas are better than others. I feel badly for people living in Texas. The care given for the mentally ill is done at the same place as the care given for people with developmental disabilities. It is known as the Texas Department of Mental Health and Mental Retardation: https://www.tshaonline.org/handbook/entries/texas-department-of-mental-health-and-mental-retardation. With all due respect to everyone involved, it’s not the same thing. This is only my opinion, but it’s incredibly disrespectful to all parties involved. Not all persons with developmental disabilities have severe mental illness and many with mental illness are incredibly intelligent people. And offering services for both from the same agency contributes to the stigma on mental illness.

I’ve been involved with the public mental health agencies for years (until I recovered from FD and BPD), and at times, fairly intensively. And much of it was not helpful, some of it is on me for not being honest with them, but not all of it. You sacrifice a lot of privacy in so many areas of your life. On a disability, it is difficult to afford to find a place to live where you can afford to pay the rent, so you’re frequently in public housing. I had to give them my bank statements. At times, the housing came from services offered by mental health agencies. The good part is having a place to live, and help you do need.

But often, I felt like I had little to no control over my life. When you are living in housing offered though both HUD and the mental health center, they are involved in nearly every aspect of your life. I’m no longer angry or resentful. But a boundary is where I stop and you start. So there were few, if any, boundaries. And sometimes though services are necessary, they are not of the best quality.

When I lived in Washington state, most of the time, I was in housing that was funded through HUD and administered by the mental health center. And I hated it. But I had no place else to go. But around 2003 or 2004, I was told I made too much money (on a disability of about $600-700 a month). I no longer qualified for Medicaid. Well, I had to meet what is known as a spend-down. For a time it was only a few hundred bucks a month (still a lot of money when it is supposed to come straight out of your pocket (on $600-700/mo). In 2012, that spend down was $1200/mo when I only made $921 a month. And Washington state is a very expensive place to live (wore now than it was back then though). So I had no access to any mental health services. Not that it stopped anyone from telling me I should go.

When I was dying (for real) of a severe dental infection, and weighed about a hundred and twenty pounds at six foot, told me with a dismissive wave “I know how to fix this! Go to mental health and take your meds.” And denied the Medicaid that would have allowed me to go. Medicare doesn’t cover dental, few, if any take Medicaid and I had no money.

Meds were mostly what rotted my teeth (so did neglect and pain meds, but my psych meds had the biggest effect), I didn’t want them and they hadn’t even helped me much over the years. It also wasn’t going to fix the fact that unless the teeth were removed, I was going to eventually die. I was turned away from the teaching hospital in Seattle because I had no ability to pay, and lived in the wrong county-or so they said. But then they turned around and treated the buddy of a close friend. Their problem with me wasn’t that I lived in the wrong tax bracket. It was that I had a mental illness-the atrocious mental health system is so closely tied to the fact that there is a huge stigma on mental illness.

The only thing I can say is when you’re dying of a dental infection, it is not pretty. And it is accompanied by an indescribable amount of physical and mental suffering. The burning used to feel like it was coming from inside my head, and it was intense. And I could not even afford to see a therapist at the one place who would see me without Medicaid (you had to pay cash for the visits, a percentage based on income but it was a hundred dollars a month I didn’t have. And it would have been nice to have someone to talk to during that time.

The treatment for a FD is mental health. The things I found most helpful in terms of therapy was a limited amount of talk therapy, and EMDR. The rest was Alcoholics Anonymous. And some therapy is absolutely critical for the recovery of someone suffering from a FD. Or borderline. The development of these disorders is predominantly trauma related. The sad fact is the mental health system is ill equipped much of the time to treat the cause of these disorders. I have needed EMDR for years and could not get coverage for the EMDR until more recently when I moved to a state that has (in my own experience) a generous Medicaid program that paid for it.

We have an atrocious mental health system. You’re preaching to the choir. But what have we been doing to change that observation?

Honesty

Above all else, be honest.

It starts with being honest with yourself. You cannot be honest with someone else without being honest with yourself. Otherwise, everything you say and do is the fruit of a poisonous tree. Recovering from a factitious disorder involves getting honest with yourself and with another person about issues and experiences that are never easy to be honest about. Once you have, the rest will come easy.

For me, lying was like breathing-it also did not stop overnight. I tried many things to catch myself being dishonest. I even tried fining myself a quarter every time I caught myself in a lie-even a little one. What I got was a jar full of quarters. It was doing my nightly inventory (see below) that helped the most. You ask God for forgiveness and move on.

“When we retire at night, we constructively review our day. Were we resentful, selfish, dishonest or afraid? Do we owe an apology? Have we kept to ourselves something which should have been shared with another at once? Were we kind and loving toward all? What could we have done better? Were we thinking of ourselves most of the time? Or were we thinking of others, what we could pack into the stream of life? But we must be careful not to drift worry, remorse, or morbid self reflection, for that would diminish our usefulness to others. After making our review, we ask God’s forgiveness, and inquire what corrective measures should be taken.”

Alcoholics Anonymous, p. 86).

Lying about everything will cause you to lose everything. And you will have no one to blame but yourself. And will have amends to make as a result. Trust and honesty go hand in hand and are the foundations of a healthy relationship. And once you have lost someone’s trust, know that you may never fully regain it. Trust, honesty and respect go hand in hand.

Healthcare costs

Healthcare gets expensive. And public assistance footed the bill for my disorder for a lot of years-people with factitious disorders cost the healthcare system untold amounts of money every year-no question. And the reimbursements for public assistance is far lower than private insurances. This is the reason many providers have stopped accepting Medicare. The reimbursement is a fraction of the actual costs-something I gave little thought to when I was in active addiction. Alcohol, pills, weed and medical treatment were my master-I was the other.

When I consciously thought about what I’d been doing, I was mortified that I had behaved in such a fashion. And my first thought, I need to work!!! And I have not stopped working since. It keeps my mind off my troubles, and has done wonders for my mental health. And I now have started providing my own health insurance. So more money comes from my own pocket to pay for my healthcare. This is the way it should be. Paying for your own healthcare has a great way of helping you decide what is truly necessary.

And it is an amends too-for being a drain on the system. Getting a job should in my mind, be a requirement for the treatment of factitious disorders. For those truly interested in change and getting well. My first job in recovery was stocking shelves. And keeping in mind, years of bad habits (showing up was a problem for years), it ended in being fired-and they were right to do it. But I got back up and got a job as a cashier. I have since returned to nursing-it is my hope and prayer that the good I can do will help balance the scales for my actions in active addiction. And with that comes premiums for my health insurance (I dis-enrolled from Medicare Part B, and only have kept the Part A and D by default, and I pay the premiums for Part D).

I recently injured my knee, and the surgery I had was medically necessary-and it will also be at my own expense. And I am perfectly okay with that. To me, it seems appropriate-and drives home how expensive that medically necessary treatment is. And serves as a reminder how expensive it is to the rest of us how expensive medically unnecessary treatment is.

The little boy who cried wolf

This old wive’s tale doesn’t need to be retold. When you’ve cried wolf, consciously or unconscously, over and over again, once you’ve decided to start getting well, though you haven’t had an episode in some time, though the people you are dealing with are new-once they know, they are not prepared to take anything you say seriously. It’s not a good feeling. It’s a lot like wearing a tag that says “mental.”

So when I was in the Emergency Room one afternoon with some legitimate issues, which they were treating (labs help that process, if I remember correctly), the medications I was taking began to cause seizures. One was Marinol, or the “weed pill” to treat legitimate nausea from GI issues, the nausea for this particular issue gets very intense. The other was benedryl, and neither of these medications prior to my brain injury had this effect. I was aware of what was happening, but unable to respond to anyone-I could not even push the call light. There were tonic-clonic movements, ones I was never able to reproduce. This is known as a partial awareness seizure.

The nurse and a lab technician came into the room while this was happening, and the response left me with the most helpless feeling. The nurse waved her hand and said, “Oh, will you please stop?” She was not prepared to believe anything beyond what they could see with the tests they’d already run. The seizure continued while the two of them stood there impatiently until it finally stopped. I had tears in my eyes, and once the seizure had stopped, they went about their jobs as if nothing had happened. And I said nothing at all about it. It would not have done any good.

Regardless of the cause (when it was figured out what was causing this, stopping was easy-some problems I don’t need or want). Drug-induced or not, the seizure was no less real. And it served as a lesson. That goes back to the old wive’s tale that drives home an important lesson: cry wolf so many times, even with new people, once they know, nothing you do will be taken seriously.

Real problems get overlooked.

12 Step programs

There is a 12 step organization or program for just about any bad habit. And for other things, such as codependency, emotional health, and numerous chemical dependencies. Even self-harm now has one! And this is by no means, an all-inclusive list:

Alcoholics Anonymous – http://www.aa.org/

Adult Children of Alcoholics – http://www.adultchildren.org/

Al-Anon/Alateen – http://www.al-anon.alateen.org/

Co-Anon/ Cocaine Anonymous – http://www.co-anon.org/

Cocaine Anonymous – http://www.ca.org/

Co-Dependents Anonymous – http://www.codependents.org/

Debtors Anonymous – http://debtorsanonymous.org/

Emotions Anonymous – http://www.emotionsanonymous.org/

Families Anonymous – http://www.familiesanonymous.org/

Gamblers Anonymous – http://www.gamblersanonymous.org/

Marijuana Anonymous – http://www.marijuana-anonymous.org/

Nar-Anon – http://nar-anon.org/

Narcotics Anonymous – http://www.na.org/

Parents Anonymous – http://www.parentsanonymous.org/

Self Mutilators Anonymous – http://www.selfmutilatorsanonymous.org/

Sex and Love Addicts Anonymous – http://www.slaafws.org/

Sex Addicts Anonymous – http://www.sexaa.org/

Sexaholics Anonymous – http://www.sa.org

 Spenders Anonymous – http://www.spenders.org/

Workaholics Anonymous – http://www.workaholics-anonymous.org/

More 12 Step organizations: https://en.wikipedia.org/wiki/List_of_twelve-step_groups

Be Careful what you wish for…

I remember sitting across from a psychiatrist my mother used to work with in, of all places, a mental health clinic she worked in, and he looked at me and said, “Be careful what you wish for.”

Bipolar disorder (and in junior high, ADHD, but I was never medicated) was one of the first things I spent any time faking. And not very effectively. I had a borderline personality, which comes with severe mood swings, but they come and go in a few days (usually). I guess I thought maybe someone would care about me if I were sick, be it with bipolar or anything else. It was less about getting some kind of attention (because negative attention is better than no attention), and more about simply feeling like someone cared, even if it was someone I did not know.

Five-and a half years ago, I had a traumatic brain injury (a real one) from an electrolyte abnormality that causes brain swelling, so the injury was a global one. After TBI, anything goes, you can see anything from depression and anxiety to mania and psychosis. And I was delirious for two months. After that, I had my first real manic episode. Back home where everyone was already familiar with my BS, the reaction would have been “same old &$@#, different day.” And it would likely have gone untreated.

Fortunately I had just moved (again, but this time to put down roots, which I have done). And I live close to a well-known hospital system and their doctors diagnosed me with bipolar I disorder. And yes, I disclosed the FD to them, but stated I was working a 12 Step program and I wanted all my cards on the table. And that I wanted a clean evaluation. I stayed about a week and they observed the legitimate signs (objectively observed things that others see) of bipolar disorder, and I was then placed on medication, which I have done well on since.

God has an excellent sense of humor.

Last year, my family doctor diagnosed ADD (inattentive), and no, I am not a fad faker as I call it. If I do not take my medication, I will literally stare at the same page for thirty minutes. Makes grad school a challenge.

Be careful what you wish for-you may get it. Bipolar and ADHD are no picnic when you are working a 12-Step program presents the challenge of managing them without the use of addictive substances. It can’t always be avoided but in working with your doctor and being honest about your addiction, you can still manage without it being considered a relapse.

And when you tell a member of the opposite sex whom you are dating (at the appropriate time in the relationship) that you have it (honesty is best), it can be a mood killer-and you may find that they move on after finding out. Mental health has a huge stigma, as you undoubtedly know.

As many are who have had history of a FD, you wind up with legitimate and often serious medical (and in my case, mental) conditions that require treatment. No better way to muck up your legitimate health issues that to feign something else-you can frequently make the legitimate stuff worse.

Treatment

One of the things I am focusing on is what can be done for factitious disorders. This disorder is typically seen as not being amendable to treatment. Granted, the co-morbid personality disorders that usually accompany FD’s, some really are not. Of the three main ones seen in FD’s, they are Borderline Personality Disorder (BPD), Narcissistic Personality Disorder (NPD) and Antisocial Personality Disorder (APD). Both APD and NPD are not typically associated with change and are not usually considered amendable to treatment. Borderline personality disorder is while serious, one that can be associated with a positive outcome.

Someone’s ability to recover from a FD is going to be determined by seeing something wrong with what they’re doing. Often, many do not “see the error of their ways.” For those people, little can be done until they realize the need and have the desire for change. As serious as these problems are, I don’t believe they are beyond hope. But one has to want change. Some of the possible treatments I feel can be helpful for someone suffering from a FD are (and will be discussed in detail in my book):

  • DBT (Dialectical Behavioral Therapy)
  • Insight oriented therapy to identify how the FD came about and what coping strategies can be helpful if a relapse happens (and this does not stop overnight.
  • STEPPS (Systems Training for Emotional Predictability and Problem Solving)
  • EMDR (Eye Movement and Desensitization Reprocessing)
  • Medical treatment for existing (legitimate) medical problems, including pain (pain will make you mental) but it is my belief that if possible, it be managed without the use of narcotics

There are many conventional therapies that can be of benefit for someone with a FD or even someone who has non-suicidal self-injury (NSSI). But in my mind, the most critical one for factitious disorders is a 12 step program (such as Alcoholics Anonymous, Narcotics Anonymous, or any of the others). For someone who has a basic problem with a lack of honesty-these are all programs of rigorous honesty.

I have had most of the above treatments and while they were helpful, they did not change the underlying problems, the chronic self-pity or the resentments that caused me to use them as an excuse to use or self-harm. For me, AA is what changed all of that.

Try it, it will change your life.

Recovery Directional Sign – 3D Rendering

Stigma and self-harm

There is a huge stigma associated with mental illness. Of living with a diagnosis such as borderline personality disorder. There are a lot of misperceptions.

We have riots and demonstrations when the “n-word” is used and rightfully so. The term is offensive to me and abusive to the recipient. It is the terminology of hate. Which in my mind has no place in today’s society-it comminucates hatred of those who are perceived as being different. Ironic that whites are going to eventually be in the minority. What that is is short-sighted, amongst other things.

However, if you call someone a “psycho” or “mental” no one cares. It is business as usual. Because it is a mental health issue, it is considered socially acceptable. Why else would it continue? With no understandable outrage over it, the message sent when no one reacts serves to reinforce that same stigma. I feel calling someone mental or a psycho is hateful and mean, and just as abusive to the recipient as is the n-word. And it is equally as offensive as the n-word.

The stigma of mental illness is the negative views associated with the terminology of mental health (Mayo Clinic, 2017). And it has far reaching consequences. Some of them include:

Some of the harmful effects of stigma can include:

  • “Reluctance to seek help or treatment
  • Lack of understanding by family, friends, co-workers or others
  • Fewer opportunities for work, school or social activities or trouble finding housing
  • Bullying, physical violence or harassment
  • Health insurance that doesn’t adequately cover your mental illness treatment
  • The belief that you’ll never succeed at certain challenges or that you can’t improve your situation”

(Mayo Clinic, 2017)

And as I recently found out when trying to purchase mortgage protection insurance and life insurance, no one wants to sell you that either.

A FD is a severe form of self-harm. And self-harm has an even greater stigma associated with it. And non-suicidal self-injury (NSSI) can trigger a vicious cycle of negative consequences that include low self-esteem, economic consequences (job loss or not being hired), and social distancing-it is these consequences that cause the individual with NSSI increased stress which puts them at increased risk of using NSSI as a coping mechanism (Burke, Piccinilo, Moore-Berg, Alloy, & Heimberg, 2019). And this stigma can also cause the above consequences, such as making it difficult to seek help when someone has an episode.

I know it kept me from admitting the truth for many years. Which kept me from seeking help and developing coping strategies. I am not convinced that self-harm is completely a conscious decision, as the literature on FD’s states. Why is that? You must make a conscious decision to stop. And even then, it doesn’t happen overnight.

A considerable amount of literature exists that links NSSI to addiction. I know the last time (a year ago) that I had a craving for it, it was so strong I had to do something. It did not feel like a choice. Instead of seeking unnecessary treatment, I called an advice line. Seems stupid when academically, I am qualified to be answering those calls. But it kept me from following through. My addiction to medical treatment extended to procedures (no unnecessary ones for over 5 years), medical testing and seeking unnecessary medications and other treatments.

When I think about it, it seems like the definition of insanity. But I have seen how my own brother looks at what I was doing with disgust. Time heals, right? I’m not so sure. But self-harm feels like a double-whammy as far as stigma goes.

And what is so stupid about the stigma on mental illness? All mental means, is that you are a human being. No reactions to life evens such as death of a loved one, marriage or divorce, being assaulted with depression or anxiety, or other mood symptoms, would be something I would worry about. Having a mental reaction to stress is normal. One should not be denied health coverage for treatment of it if needed or life insurance for that matter for reacting to life as a human being. The message that sends, is my life is less valuable because I have a mental illness. No one is denied health coverage because of race (as far as I know). Sadly, that is not how life works.

Black lives matter. ALL lives matter!!!

REFERENCES

Burke, T.A., Piccirillo, M.L., Moore-Berg, S.L., Alloy, L.B., & Heimberg, R.G. (2019) The stigmatization of non-suicidal self-injury; Journal of Clinical Psychology; 75(3); 481-498; Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679979/

Mayo Clinic (2017); Mental health: overcoming the stigma of mental illness. Retrieved from: https://www.mayoclinic.org/diseases-conditions/mental-illness/in-depth/mental-health/art-20046477