People will often avoid talking about their depression or hardships they are going through in fear of stigmatisation. It separates us from the group, as “other people are doing just fine”. For almost everyone, this is a lie – knowing that est. 90% of Poland was abusing alcohol in the 90’s it is statistically impossible for my age group to “be just fine”. Sure some people have issues of their own and may have no space for extra compassion. Other people may be struggling with depression too and keep it quiet. The trust is lost. In most cases, this is how high context communication gets established (like in the US in the last 20 years, not the same country that rose to be the empire). Things are no longer explicitly expressed or done. There are unspoken rules that are implied from the context, more often than not accompanied by fear of some sort. Sometimes such groups heal on their own, belonging is healing. In other cases, the level of tension exceeds a bearable threshold and the group disbands.
I would like to normalise talking about it. Like this blog does. We cannot solve other people’s problems for them, in fact we should not. Sometimes the only thing we can do is be there for one another, and maybe hold some space. Some stories need to be shared, feelings need to be felt, and having someone present for us, there to listen, that is huge.
Sometimes when you overcome some hardship, you also do not share. You don’t want any special treatment, you want to be able to function in a society like any other member. Some of that has to do with PTSD, one of the symptoms is being invisible, unheard. Society is created by its members. To a certain extent, this is understandable. You want to adhere to the norms of your home group.
“If you are going through hell, keep going.” – Winston Churchill
And it may be easier to keep going if you tell yourself things are really just fine. You may not want to admit there is a problem, in fear that this could break you. The “you” that meets the standards you have set for yourself has a greater chance of surviving if the standards don’t assume having a problem. In therapy for BPD the chances of improvement are far greater then the patient is told recovery is possible at all.
So when is it actually that there is a problem?
I really like referring to standards, such as DSM-5 or ICD-11, they are usually more rational than the subjective gut feeling. I went through this exercise with my therapist once, and I strongly feel that this way is much more accurate than reading forums or talking to a neighbour facebook friend. I mean… I think everyone should read that lovely book by Oprah, even to appreciate our lives are not as rosy as we lie to ourselves. It is good that some things can be measured. And that is when one should seek help from a trained professional.
Symptoms have to persist for longer than two weeks and differ from the previous state. Well, if someone has been depressed for several months or years, they may not know when it started… or what did it look like before.
One of the two:
- Depressed mood most of the day
- Loss of interest or pleasure in most of the daily activities
AND at least four from the list below:
- Significant weight loss or gain (without dieting or regime), marked change in appetite nearly every day. More than 5% change of body weight in a month. So if your number is 60kgs, 3 is already a lot.
- Insomnia or hypersomnia, where you either sleep less than 4 hours, wake up frequently (and for more than 10 minutes at a time) or sleep more than 10 hours per day, every day.
- Observable slow down of thoughts and reduction of physical movement or the opposite – restlessness and anxiety
- Fatigue
- Feelings of worthlessness or excessive guilt
- Diminished ability to think, focus or make decisions
- Recurrent thoughts of death
None of that should be explainable by another medical condition or substance abuse and all this has to be impairing your daily functioning. Otherwise you may consider the highly functioning depression, which is also a thing. You drink more alcohol than usual – it is a form of self-medicating, something masking the condition. Neglecting your self-care is a sign of feelings of worthlessness. More often than not, people also have alexythymia, which means disconnection from their own emotions.
Post-Traumatic Stress Disorder
DSM-5 does not include C-PTSD as a separate condition, as opposed to ICD-11. PTSD may develop in an individual after they are exposed to death or injury, including sexual violence. There are some behaviours characteristic to someone with this condition, like loss of trust in their own senses, or feeling invisible. There are often triggers, which they may not always be aware of (see Criterion C), that evoke automatic response. I spent years unaware of my own avoidance and phobias, I just labelled myself picky. So how come someone may meet all the diagnostic criteria except for Criterion A? Or maybe they do?
When we are kids, we depend on our caretakers to survive. If our bond is at risk, so is our survival. So if our parents fight, if they drink, or even if they do as little as smother us – we have to freeze or fawn to survive. We cannot speak up and break free. We cannot just move out. Our survival is indirectly threatened. We are forced to repeatedly experience that fear, which gets ingrained in our psyche in forms of knots, in the time most crucial for the development of our brains – early. But C-PTSD may develop when someone is already an adult, after being in a relationship with someone toxic and disturbed. Gaslighting more often than not works like brainwashing. ICD-11 is more specific about Complex PTSD and they are probably more accurate than me.
Criterion A (need one): The person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence:
- Direct exposure
- Witnessing the trauma
- Learning that someone close was exposed to a trauma (that is where we get infected with trauma after someone tells us about it)
- Indirect exposure to aversive details of the trauma (eg. first responders, medics)
Criterion B (need one): The traumatic event is persistently re-experienced:
- Unwanted upsetting memories
- Nightmares
- Flashbacks
- Emotional distress after exposure to traumatic reminders ie. triggers
- Physical reactivity after exposure to triggers
Criterion C (need one): Avoidance of trauma-related stimuli:
- Trauma-related thoughts or feelings
- Trauma-related reminders (I was avoiding relationships for years after the event)
Criterion D (need two): Negative thoughts or feelings that began or worsened after the trauma:
- Inability to recall key features of the trauma
- Overly negative thoughts and assumptions about oneself or the world
- Exaggerated blame of self or others for causing the trauma
- Negative affect
- Decreased interest in activities
- Feeling isolated
- Difficulty experiencing positive affect
Criterion E (need two): Trauma-related arousal and reactivity that began or worsened after the trauma:
- Irritability or aggression
- Risky or destructive behaviour (including binge-eating or binge-drinking)
- Hypervigilance
- Heightened startle reaction
- Difficulty concentrating
- Difficulty sleeping
Criterion F (required): Symptoms last for more than 1 month, and condition is usually diagnosed 6 months after the experience.
Criterion G (required): Symptoms create distress or functional impairment (withdrawal from social life, phobias).
Criterion H (required): Symptoms are not due to medication, substance use, or other illness (although many people self-medicate as means to cope with PTSD).
When you take medication related to your condition, the only thing you are getting is mental clarity for a limited period of time, which you can use to improve your overall situation and thinking patterns. Medication only buys time. Its effects wear off, you gain immunity to the substance and need to take more and more, and once you stop taking it, you get the yoyo effects. It is really not enough. Sure you may feel unwell due to your poor hygiene. More often than not, poor hygiene is caused by being unwell. Even rats addicted to heroin recover from addiction on their own as long as everything else is good for them, and there are studies to prove it. There are some studies on microdosing psychedelics that helps not only with the mood but also to move yourself out of that space – but nobody can do the work for you. You can use the boost from psychedelics to do the work or to get better at driving yourself crazy. It is still the work that needs to be done.
You do not know everything about others. Someone smiling, laughing – they may be trying to protect you from getting affected by their problems. They may be trying to protect the relationship they are having with you, also for their own sake. They may be trying to find some humour, fight with the disease and not give up just yet. Some people get in touch with friends, even just to distract themselves. Not to discuss death, they are not trained nor qualified to help with that. Not their responsibility, not their burden. It is not the world that sucks, it is the symptoms. Be gentle if someone texts you out of the blue with something incredibly awkward or stupid.
