I am fine….
I AM FINE!
I. AM. FINE.
However which way I say these three words they are always a lie. Not a vicious deceitful lie, but a lie which serves me well whilst simultaneously crushing me emotionally; with each utterance. This little sentence has become a habitual response to the question:
How are you?
Which is a very common occurrence, most people do not divulge their entire life story when asked how they are, it is just an extension to how we greet one another, a politeness (especially in England) to reply:
I am fine, thank you. And how are you?
However when you are really asked this question by a close member of your family, your partner, a close friend or even your therapist and you still only ever say:
I am fine.
Well this kind of situation is what I am talking about and is what this art piece represents. This is about how self preservation means losing part of your identity, emotionally but more importantly the denial of your present state. Never allowing your armour to be compromised, focusing on other peoples problems and absorbing them, when asked about yourself you divert conversations as if they were on-coming traffic; as if your life depends on it – because it does.
The majority of the time I do not look “sick”, I have mainly unseen illnesses and my most debilitating of ailments is completely invisible to the eye. As well as this many people do not “believe” in mental illness or recognise certain neurological conditions, saying things such as:
It’s all in your head!
It’s mind over matter.
You don’t look sick.
These statements are very unhelpful and also redundant in this context. Saying it is all in ones head is a correct statement, mental illness is in our encasement’s which we call heads, in our brains – our minds. It is not in our legs, nor our arms, it is very much a head thing. However saying it to someone as a dismissive statement is not a logical statement as it suggests that your mental illness or neurological condition should not be “in your head”. Suggesting that it maybe make believe or a lie to gain sympathy (which if you are a person who suffers from mental illness you will know this is an insult as there is no sympathy granted to the mentally ill, instead it is stigmatised). As for “you don’t look sick” this one is nothing more than an ignorant judgement, looking at someone with just ones eyes and not a full body CT scanner (which also can not see everything) there is no way to determine someones health or disability status.
Due to all this added conjecture to this particular scenario , it is not hard to understand why the “I am fine” mantra is a fail safe for so many. You get tired of explaining yourself, defending your diagnosis and dealing with people saying things like:
I don’t really believe in mental illness.
Mental illness is a conspiracy to control and label us.
Mental illness is just mental weakness.
So the simple solution is to pretend that you are fine, that you do not need help, that you are not “weak” or “dangerous”, for every mental illness denier there is another person who believes we should all be locked up and not trusted due to the stigmatisation and misinformation on both the mentally ill and those with criminal intent.
This may be the simplest of solutions but it comes at a cost to most. You see there is only a finite amount of space in ones emotional storage unit and the continuous throwing anything and everything that you wish to hide in there can mean that you reach a time you can’t shut the door anymore, let alone lock it. This can lead to you bursting and spilling out onto everything around you or it can mean you just implode – self detonate.
Truthfully for me it is a constant battle inside my head, of not wanting to alienate people or scare people with my overwhelming emotional instability and behavioural abnormalities – having to remain stoic by being the person who people come to, the provider, the rescuer. Against letting it all out, a completely “no shits given” attitude, a liberating freedom of being able to just be me, all parts of me at all levels of intensity. This of course is very black and white and a thought process due to my borderline personality disorder, the middle ground does not tend to exist in my world, it sometimes appears but rarely when experiencing high emotions. To pass off the “strong” persona I have to use the “I am fine” line a lot, which is a kind of middle ground, at least it is when one is trying to manage social boundaries and interpersonal relationships – which to me are like alien concepts that cause feelings of being an outsider.
There have been times in my past when “I am fine” was a defence mechanism as I was in denial about my illnesses and wished to hide the entire idea from myself, blaming my emotions and behaviours on alcohol, drugs and being a “bitch”, that crazy girl thing was easy to flip and present myself to the world as a “bad” person in my twenties – so I stuck to it. People even liked this persona, some celebrated it by telling me they loved my “fuck you attitude” and loved to see me being abusive to others or violent. If the other side, the vulnerable side – was presented (which was me during my teens, from 11 yrs to 20 yrs old) people looked at me as an emotional drain, a liability, dangerous, scary, I became an undesirable human. At these times of no control self harm, suicide attempts, eating disorders, psychosis, machiavellianism, disinhibition and an emotional sensitivity that was never-ending was my way of life. I learnt valuable lessons on survival and how to mimic other humans as a visiting entity from the planet “strange”, using manipulation to gain friends and taking on other identities which were visible to me as ideals, I could be the most popular person in the room or the most disliked, this was not up to my audience or friends, this was up to me and my chameleon like personality. The important thing is I have forgiven myself for being this way, knowing now this was and still is a neurological condition and a perfectly OK way to survive when you have only ever known trauma.
Now that I am in my thirties things have got to a point that my life is more introspective and having the perspective of an “adult” allows me to look at my teens and twenties more objectively and see how and why I had to survive this way when there were no adults parenting me and keeping me safe. Being an adult in this way means that when I look back I ask different questions than I did before, such as:
Where were your parents?
How long were you left on your own?
How was it looking after yourself at such a young age?
Did you have to grow up quickly?
There is a draw back to being older however, my emotions get buried deeper, I detach more and say “I am fine” even more than ever. Wanting to be liked for me, not wanting to buy friends or manipulate them to like me, not wanting to be the extreme me who needs someone to safeguard them at all times, not wanting to be the rescuer and the “strong” one all the time. Wanting people to understand my pain more, I want and need actual medical support for my disabilities but am not at a vulnerable age anymore, so am taken less seriously. Hiding in medication and being likeable and not too intense feels like a life sentence:
But still all I can say is:
I am fine!
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Somewhere Among the Clouds – By Charlotte Farhan
Somewhere among the clouds
my mind reflects back at me
creating faces in moments
telling stories with whipped cream
floating overhead they enshroud
changing colours of our family tree
searching for every branches atonement
shadows engulf my daydreams
Somewhere among the leaves
I am laid down to rest
foliage surrounds my anatomy
craving the light from beneath
rustling below my knees
knowing I am dispossessed
with the numbness of apathy
as the earth moves underneath
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My emotions are encased in glass,
self preservation enclosed them there,
in a mason jar
for safe keeping,
fear like a snake in the grass,
simply to scare,
in my jar
I am left weeping.
Fragility is never a choice,
does the ant get to choose it’s height?
does a butterfly design it’s wings?
I hear “stay safe”
from my little voice,
“this jar is airtight”,
Outside is not for me
for I see the sadness it brings.
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Now I lay me down to sleep
Art and Poetry
by Charlotte Farhan
Now I lay me down to sleep,
eyes wide open and thoughts a plenty,
to numb to even weep,
my mind full but my soul empty.
If I should die before I wake,
please know I tried with all my might,
but could not survive the heartbreak,
I have been waiting too long for daylight.
This art and poetry portrays the ordeal of intrusive thoughts which are brought on due to mental illness, specifically complex trauma, anxiety disorders, personality disorders and psychosis.
My intrusive thoughts have been dominating my life since I can remember. As young as 5 I recall laying in my bed and reasoning with myself, internally bargaining:
“If I die in my sleep, I wont know, I will just die and then it will be over”.
Scary things had always happened at night in my world, the dark couldn’t be trusted and nor could most adults.
As I got older my intrusive thoughts took on an internal shaming ritual, whereby ripping myself to shreds about how I looked, how I had acted or how no one loved me and I would be alone forever – hence why these thoughts turned suicidal. Repeating to myself again and again:
“you are fat, you are ugly”,
as if I were counting maniacal sheep – one named fat the other ugly.
Sometimes the thoughts can turn external and onto others, fearing you may hurt someone or even kill someone – not because you want to but because you fear you will lose your mind. I used to fear that one day whilst travelling to school or college that I would push someone onto the railway tracks. Visualising it was horrifying, playing it out scene for scene , watching others scream in horror and watching myself be carted away by the “men in white coats”.
With psychosis the intrusive thoughts are there but take on a hallucinogenic dimension. In the dark seeing evil angels looming over me or small fairy like creatures guiding me to safety, another world would open up – but what if I got trapped there? What if I wanted to stay? Reflections in mirrors can cause dysmorphic appearances, my eyes would disappear into my sockets, skin looked to be hanging off my face and seeing other people as myself.
Traumatic experiences cause flash backs which take you back to your trauma and hold you there in order to relive the ordeal again and again. Or you try and recreate the trauma and imagine a new ending – all the while punishing yourself internally, blaming yourself for what has happened to you or for what others have done to you.
Medication can help but it can be so much worse if you miss a dose or have to come off your meds for whatever reason, as well as very unpleasant side effects. There are so many drugs I have tried over the years and the ones that worked best were always the ones which left me like a zombie during the day, which is fine if you wish to be a zombie and there have been times this has suited me, to barely exist. However when you want to survive and possibly even live you can’t compromise on the “being awake” part.
The important thing to remember when dealing with intrusive thoughts or if a loved one is experiencing them, is to take this seriously – it is like any other health concern, such as finding a lump or a cough that just wont go away. Intrusive thoughts are an anxiety driven issue due to:
“THE AMYGDALA CONSTANTLY SENDING US FALSE SIGNALS THAT WE ARE IN DANGER”
Fight or flight is triggered with the obsession (the intrusive thoughts) and then the compulsion (is the bargaining – the fear) and the cycle repeats like groundhog day. Many people suffer in silence with these feelings and become trapped in their own isolation created due to living this way. So if you feel this is you or someone you know – please know first and foremost:
YOU ARE NOT ALONE!
There is support out there for you and your loved ones.
Here are some helpful links:
END THE STIGMA!
Leave me a comment or ask me a question:
AM I REAL?
The nature of reality perplexes most,
nothing can “be . . . ” and “not be . . . “,
so when I tell you I feel like a ghost,
please believe me.
Anything outside your mind can be unsure,
but how does something exist?
Does one have to have thunk it – to be sure,
of flesh and bone is all I consist.
Am I mentally constructed,
are my thoughts my own?
or possibly I came to this earth abducted,
or maybe I arose from my tombstone.
Is my conscious mental state related to my body?
for I see myself below,
separating self as I disembody,
left behind is but a puppet show.
The earth is like water inside a fishbowl,
diminished in size and dimensions,
all unreachable as it slips into a black hole,
staring at my own reflection.
This piece of art and poetry addresses how it feels to be in a state of depersonalisation or derealisation. I experience both as symptoms of my anxiety disorders (OCD, GAD, CPTSD and AGORAPHOBIA) as well as my borderline personality disorder.
Find out more HERE
These sensations and feelings of being unreal or not being able to know what is real or not – have been causing me issues since I was a very young child. The worst times were when my voice used to speed up and I would hear myself speaking a million miles per hour, but others around me heard me speaking at a normal speed, or when I felt objects were to large or too small causing me to question all perspective, but by far the most disturbing is when you feel like an illusion, like a left over imprint.
As someone who has a degree in philosophy and who has studied philosophy for over 10 years now, “the theory of mind” was and still is one of my favourite subjects within philosophy. It has simultaneously helped me to accept that none of us truly know what reality is, as well as further perplex me and leave me questioning everything even more.
There is not a lot of understanding when it comes to these disorders, often when people do not understand something or have not felt the things being described – it is easy for them to dismiss. However – why would anyone assume their reality is the same as another? There is evidence that we all experience the world differently without having any kind of mental illness or neurological damage.
How am I to know what you see… and how are you to know what I see…?
When I am touched does it feel the same as when you are touched?
When I eat do I taste the same flavours and interpret the textures the same as you?
Do I see the world as a “glass half empty kind of place or half full”?
Do I think the same thoughts?
The list goes on and on…
It is never as simple as “reality is reality”.
So question these ideas more, never judge another persons reality to be wrong or fake and remember that 1 in 5 people will have a mental illness at some point in their lives and some of us will have it for life.
End the stigma and learn how to better understand others and their reality.
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Like moths among the whisperings
by Charlotte Farhan
Anxiety can make one very small,
compressing you within,
it can keep you away like a mothball,
with depression as its conjoined twin.
The light draws us out,
but not for long,
however we stay alert – on the look out,
not sure if we belong.
We see others as butterflies,
fluttering with ease,
with their calm – we idealise,
where as we would be lost in a strong breeze.
When waking our hearts burst,
our minds race,
life pulling at us – being coerced,
forced to adorn our poker face.
We are like moths among the whisperings,
manoeuvring through the polite conversation,
like candles pulling us in – glistening,
so familiar – marking the end of our adaptation.
This painting and poem were prompted by a line in the Great Gatsby ,
but the line “like moths among the whisperings” made me think of how it feels to live with anxiety disorders whilst among others who don’t. It conjured up this image of anxious people as moths and non-anxious people as butterflies.
The irony is that most of the people who visited the parties in The Great Gatsby were probably butterflies. However even there I am sure a few moths anxiously found there way around , maybe with some dutch courage to aid their cause.
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Piers Morgan who is a rent a gob for the Daily Fail newspaper has taken to twitter over the weekend to comment on Lady Gaga’s rape and her suffering of PTSD. In his comments he suggests that as Lady Gaga is a celebrity that her claim of rape and mental illness is a ploy to gain fans and further her brand. Further more Piers has said that he believes it is an illness which only military veterans can experience.
You would be forgiven for thinking (if unaware of this man) that this maybe someone who suffers from PTSD or who has been raped or possibly that they have a medical degree specialising in neurology or psychiatry. However your assumption would be wrong, this man has NO authority on these matters, he is just a hypocrite who ironically has done the very thing he criticises others of doing. He uses his platform to be controversial and his articles are click bate for anyone who wishes to be angry at “the other” in society.
As you may already be aware (if you follow my blog or art) that I suffer from C-PTSD and have done so most of my life, due to sexual abuse in childhood and then being raped at 15 and then a further 2 times being sexually assaulted in a psychiatric hospital by two male patients. I was first diagnosed with PTSD when I was 15 and later with C-PTSD, with this condition you are affected to a degree that life is no longer functional. We have flash backs which rob us of the opportunity to “move on”, night terrors, hallucinations, dissociation. I have sever pain in my genitalia due to the injuries I suffered and the operations I had due to the violent rape, I developed other mental illnesses like anxiety disorders and depersonalization, as well as having sensory disorders and neurological processing problems.
Read my survivor story here: Confronting my own blood – the aftermath of sexual violence
Here are the tweets that Piers Morgan tweeted:
As you can read for yourself these tweets are rife with misogyny, male privilege, and able privilege as well as perpetuating rape culture, victim blaming and creating more stigma for those who speak out about rape, sexual abuse and violence – as well as those with mental illness and/or neurological disorders.
When people such as this man use their platform to spew opinion as fact and relish in controversy it is as usual the most vulnerable who suffer. These people think that “we” the “victims” are getting some kind of glory from our suffering and illnesses, that we wish to be treated as special little “snowflakes” when in fact all we are faced with is shame, blame and being disbelieved. Piers and others like him, sit in their ivory towers, with no real understanding of what marginalised /minority groups have to deal with and just vomit their privilege upon us from great heights.
As someone who is classed as disabled due to my conditions which all stem from my C-PTSD including my neurological damage, I know what it is to have less rights, visibility, opportunity, earning ability, access to healthcare, being thought of as a danger to others etc.
I have learnt that these kinds of people are just as dangerous as the rapists, the abusers, the paedophiles, the gas-lighters, this is because they open you up again, they re-rape you, abuse you, hit you, torture you, with their ignorance, the erasure they cause and the perpetuation of archaic rhetoric which stigmatises and marginalises people. They are the little helpers to these criminals, with their spreading of misinformation and opinion dressed as fact.
Here were my tweets to Piers Morgan:
Upon waking this morning after a disturbed nights sleep from anxiety and intrusive thoughts, these tweets which flashed up in my twitter feed, re-tweeted by other survivors I know, it felt like another day I had to fight through, another day I felt shamed and judged – my C-PTSD was triggered and the adrenaline started to mount in my body, gulping down the tears and anger. Then I remembered my only role now is that of my activism, in speaking out against people and ideas like this. To survive everyday is a battle, personally I am very grateful to people like Lady Gaga for speaking out, for making people like me feel heard or at least a little more visible and not the shameful secret which society would like us to remain. As a victim who has survived I know that Piers Morgans comments will have hurt Lady Gaga as they did for me, and “hurt” is an understatement – there is no word to describe how these comments contribute to the silencing of survivors and how they normalise rape culture.
So if like Piers you are confused about what PTSD and C-PTSD is, please read this information below.
In our everyday lives, any of us can have an experience that is overwhelming, frightening, and beyond our control. We could find ourselves in a car crash, be the victim of an assault, or see an accident. Police, fire brigade or ambulance workers are more likely to have such experiences – they often have to deal with horrifying scenes. Soldiers may be shot or blown up, and see friends killed or injured.
Most people, in time, get over experiences like this without needing help. In some people, though, traumatic experiences set off a reaction that can last for many months or years. This is called Post-traumatic Stress Disorder, or PTSD for short.
People who have repeatedly experienced:
severe neglect or abuse as an adult or as a child
severe repeated violence or abuse as an adult, such as torture or abusive imprisonment
can have a similar set of reactions. This is called ‘complex PTSD’ and is described later on in this leaflet.
How does PTSD start?
PTSD can start after any traumatic event. A traumatic event is one where you see that you are in danger, your life is threatened, or where you see other people dying or being injured. Typical traumatic events would be:
violent personal assault (sexual assault, physical attack, abuse, robbery, mugging)
being taken hostage
being a prisoner-of-war
natural or man-made disasters
being diagnosed with a life-threatening illness.
Even hearing about the unexpected injury or violent death of a family member or close friend can start PTSD.
When does PTSD start?
The symptoms of PTSD can start immediately or after a delay of weeks or months, but usually within 6 months of the traumatic event.
What does PTSD feel like?
Many people feel grief-stricken, depressed, anxious, guilty and angry after a traumatic experience. As well as these understandable emotional reactions, there are three main types of symptoms:
1. Flashbacks & nightmares
You find yourself re-living the event, again and again. This can happen both as a ‘flashback’ in the day and as nightmares when you are asleep. These can be so realistic that it feels as though you are living through the experience all over again. You see it in your mind, but may also feel the emotions and physical sensations of what happened – fear, sweating, smells, sounds, pain.
Ordinary things can trigger off flashbacks. For instance, if you had a car crash in the rain, a rainy day might start a flashback.
2. Avoidance & numbing
It can be just too upsetting to re-live your experience over and over again. So you distract yourself. You keep your mind busy by losing yourself in a hobby, working very hard, or spending your time absorbed in crosswords or jigsaw puzzles. You avoid places and people that remind you of the trauma, and try not to talk about it.
You may deal with the pain of your feelings by trying to feel nothing at all – by becoming emotionally numb. You communicate less with other people who then find it hard to live or work with you.
3. Being ‘on guard’
You find that you stay alert all the time, as if you are looking out for danger. You can’t relax. This is called ‘hypervigilance’. You feel anxious and find it hard to sleep. Other people will notice that you are jumpy and irritable.
muscle aches and pains
feelings of panic and fear
drinking too much alcohol
using drugs (including painkillers).
Why are traumatic events so shocking?
They undermine our sense that life is fair, that it is reasonably safe and that we are secure. A traumatic experience makes it very clear that we can die at any time. The symptoms of PTSD are part of a normal reaction to narrowly-avoided death.
Does everyone get PTSD after a traumatic experience?
No. But nearly everyone will have the symptoms of post-traumatic stress for the first month or so. This is because they can help to keep you going, and help you to understand the experience you have been through. This is an ‘acute stress reaction’. Over a few weeks, most people slowly come to terms with what has happened, and their stress symptoms start to disappear.
Not everyone is so lucky. About 1 in 3 people will find that their symptoms just carry on and that they can’t come to terms with what has happened. It is as though the process has got stuck. The symptoms of post-traumatic stress, although normal in themselves, become a problem – or Post-traumatic Stress Disorder – when they go on for too long.
What makes PTSD worse?
The more disturbing the experience, the more likely you are to develop PTSD. The most traumatic events:
are sudden and unexpected
go on for a long time
are when you are trapped and can’t get away
cause many deaths
cause mutilation and loss of arms or legs
If you continue to be exposed to stress and uncertainty, this will make it difficult or impossible for your PTSD symptoms to improve.
What about ordinary ‘stress’?
Everybody feels stressed from time to time. Unfortunately, the word ‘stress’ is used to mean two rather different things:
our inner sense of worry, feeling tense or feeling burdened
the problems in our life that are giving us these feelings. This could be work, relationships, maybe just trying to get by without much money.
Unlike PTSD, these things are with us, day in and day out. They are part of normal, everyday life, but can produce anxiety, depression, tiredness, and headaches. They can also make some physical problems worse, such as stomach ulcers and skin problems. These are certainly troublesome, but they are not the same as PTSD.
Why does PTSD happen?
We don’t know for certain. There are a several possible explanations for why PTSD occurs.
When we are frightened, we remember things very clearly. Although it can be distressing to remember these things, it can help us to understand what happened and, in the long run, help us to survive.
The flashbacks can be seen as replays of what happened. They force us to think about what has happened so we might be better prepared if it were to happen again.
It is tiring and distressing to remember a trauma. Avoidance and numbing keep the number of replays down to a manageable level.
Being ‘on guard’ means that we can react quickly if another crisis happens. We sometimes see this happening with survivors of an earthquake, when there may be second or third shocks. It can also give us the energy for the work that’s needed after an accident or crisis.
But we don’t want to spend the rest of our life going over it. We only want to think about it when we have to – if we find ourselves in a similar situation.
Adrenaline is a hormone our bodies produce when we are under stress. It ‘pumps up’ the body to prepare it for action. When the stress disappears, the level of adrenaline should go back to normal. In PTSD, it may be that the vivid memories of the trauma keep the levels of adrenaline high. This will make a person tense, irritable, and unable to relax or sleep well.
The hippocampus is a part of the brain that processes memories. High levels of stress hormones, like adrenaline, can stop it from working properly – like ‘blowing a fuse’. This means that flashbacks and nightmares continue because the memories of the trauma can’t be processed. If the stress goes away, and the adrenaline levels get back to normal, the brain is able to repair the damage itself, like other natural healing processes in the body. The disturbing memories can then be processed and the flashbacks and nightmares will slowly disappear.
How do I know when I’ve got over a traumatic experience?
When you can:
think about it without becoming distressed
not feel constantly under threat
not think about it at inappropriate times.
Why is PTSD often not recognised?
None of us like to talk about upsetting events and feelings.
We may not want to admit to having symptoms because we don’t want to be thought of as weak or mentally unstable.
Doctors and other professionals are human. They may feel uncomfortable if we try to talk about gruesome or horrifying events.
People with PTSD often find it easier to talk about the other problems that go along with it – headache, sleep problems, irritability, depression, tension, substance abuse, family or work-related problems.
How can I tell if I have PTSD?
Have you experienced a traumatic event of the sort described at the start of this leaflet? If you have, do you:
have vivid memories, flashbacks or nightmares?
avoid things that remind you of the event?
feel emotionally numb at times?
feel irritable and constantly on edge, but can’t see why?
eat more than usual, or use more drink or drugs than usual?
feel out of control of your mood?
find it more difficult to get on with other people?
have to keep very busy to cope?
feel depressed or exhausted?
If it is less than 6 weeks since the traumatic event and these experiences are slowly improving, they may be part of the normal process of adjustment.
If it is more than 6 weeks since the event, and these experiences don’t seem to be getting better, it is worth talking it over with your doctor.
Children and PTSD
PTSD can develop at any age. Younger children may have upsetting dreams of the actual trauma, which then change into nightmares of monsters. They often re-live the trauma in their play. For example, a child involved in a serious road traffic accident might re-enact the crash with toy cars, over and over again.
They may lose interest in things they used to enjoy. They may find it hard to believe that they will live long enough to grow up.
They often complain of stomach aches and headaches.
How can PTSD be helped?
keep life as normal as possible
get back to your usual routine
talk about what happened to someone you trust
try relaxation exercises
go back to work
eat and exercise regularly
go back to where the traumatic event happened
take time to be with family and friends
be careful when driving – your concentration may be poor
be more careful generally – accidents are more likely at this time
speak to a doctor
expect to get better.
beat yourself up about it – PTSD symptoms are not a sign of weakness. They are a normal reaction of a normal person to terrifying experiences.
bottle up your feelings. If you have developed PTSD symptoms, don’t keep it to yourself because treatment is usually very successful.
avoid talking about it
expect the memories to go away immediately; they may be with you for quite some time
expect too much of yourself. Cut yourself a bit of slack while you adjust to what has happened.
stay away from other people
drink lots of alcohol or coffee or smoke more
take holidays on your own.
What can interfere with getting better?
You may find that other people may:
not let you talk about it
be angry with you
think of you as weak
These are all ways in which other people protect themselves from thinking about gruesome or horrifying events. It won’t help you because it doesn’t give you the chance to talk over what has happened to you. And it is hard to talk about such things.
A traumatic event can put you into a trance-like state which makes the situation seem unreal or bewildering. It is harder to deal with if you can’t remember what happened, can’t put it into words, or can’t make sense of it.
Just as there are both psychological and physical aspects to PTSD, so there are both psychological and physical treatments for it.
All the effective psychotherapies for PTSD focus on the traumatic experience – or experiences – rather than your past life. You cannot change or forget what has happened. You can learn to think differently about it, about the world, and about your life.
You need to be able to remember what happened, as fully as possible, without being overwhelmed by fear and distress. These therapies help you to put your experiences into words. By remembering the event, going over it and making sense of it, your mind can do its normal job of storing the memories away, and moving on to other things.
When you start to feel safer, and more in control of your feelings, you won’t need to avoid the memories as much. You will be able to only think about them when you want to, rather than having them burst into your mind out of the blue.
All these treatments should all be given by PTSD specialists. The sessions should be at least weekly, with the same therapist, for 8-12 weeks. Although sessions will usually last around an hour, they can sometimes last up to 90 minutes.
Cognitive Behavioural Therapy (CBT) is a talking treatment which can help us to understand how ‘habits of thinking’ can make the PTSD worse – or even cause it. CBT can help you change these ‘extreme’ ways of thinking, which can also help you to feel better and to behave differently.
EMDR (Eye Movement Desensitisation & Reprocessing):
This is a technique which uses eye movements to help the brain to process flashbacks and to make sense of the traumatic experience. It may sound odd, but it has been shown to work.
This involves meeting with a group of other people who have been through the same, or a similar traumatic event. It can be easier to talk about what happened if you are with other people who have been through a similar experience.
SSRI antidepressant tablets may help to reduce the strength of PTSD symptoms and relieve any depression that is also present. They will need to be prescribed by a doctor.
This type of medication should not make you sleepy, although they all have some side-effects in some people. They may also produce unpleasant symptoms if stopped too quickly, so the dose should usually be reduced gradually. If they are helpful, you should carry on taking them for around 12 months. Soon after starting an antidepressant, some people may find that they feel more:
These feeling usually pass in a few days, but you should see a doctor regularly.
If these don’t work for you, tricyclic and MAOI antidepressants may still be helpful. For further information, see our leaflet on antidepressants.
Occasionally, if someone is so distressed that they cannot sleep or think clearly, anxiety-reducing medication may be necessary. These tablets should usually not be prescribed for more than 10 days or so.
These don’t help PTSD directly, but can help to control your distress and hyperarousal, the feeling of being ‘on guard’ all the time. These include physiotherapy and osteopathy, but also complementary therapies such as massage, acupuncture, reflexology, yoga, meditation and tai chi. They can help you to develop ways of relaxing and managing stress.
What works best?
At present, there is evidence that EMDR, Cognitive Behavioural Therapy, behaviour therapy and antidepressants are all effective. There is not enough information for us to show that one of these treatments is better than another. There is not yet any evidence that other forms of psychotherapy or counselling are helpful for PTSD.
Which treatment first?
Guidelines from the National Institute for Health and Care Excellence (NICE) suggest that trauma-focussed psychological therapies (CBT or EMDR) should be offered before medication, wherever possible.
For friends, relatives & colleagues
watch out for any changes in behaviour – poor performance at work, lateness, taking sick leave, minor accidents
watch for anger, irritability, depression, lack of interest, lack of concentration
take time to allow a trauma survivor to tell their story
ask general questions
let them talk, don’t interrupt the flow or come back with your own experiences.
tell a survivor you know how they feel – you don’t
tell a survivor they’re lucky to be alive – it doesn’t feel like that to them
minimise their experience – “it’s not that bad, surely …”
suggest that they just need to “pull themselves together”.
This can start weeks or months after the traumatic event, but may take years to be recognised.
Trauma affects a child’s development – the earlier the trauma, the more harm it does. Some children cope by being defensive or aggressive. Others cut themselves off from what is going on around them, and grow up with a sense of shame and guilt rather than feeling confident and good about themselves.
Adults who have been abused or tortured over a period of time develop a similar sense of separation from others, and a lack of trust in the world and other people.
As well as many of the symptoms of PTSD described above, you may find that you:
feel shame and guilt
have a sense of numbness, a lack of feelings in your body
can’t enjoy anything
control your emotions by using street drugs, alcohol, or by harming yourself
cut yourself off from what is going on around you (dissociation)
have physical symptoms caused by your distress
find that you can’t put your emotions into words
want to kill yourself
take risks and do things on the ‘spur of the moment’.
It is worse if:
it happens at an early age – the earlier the age, the worse the trauma
it is caused by a parent or other care giver
the trauma is severe
the trauma goes on for a long time
you are isolated
you are still in touch with the abuser and/or threats to your safety.
Try to start doing the normal things of life that have nothing to do with your past experiences of trauma. This could include finding friends, getting a job, doing regular exercise, learning relaxation techniques, developing a hobby or having pets. This helps you slowly to trust the world around you.
Lack of trust in other people – and the world in general – is central to complex PTSD. Treatment often needs to be longer to allow you to develop a secure relationship with a therapist – to experience that it is possible to trust someone in this world without being hurt or abused. The work will often happen in 3 stages:
learn how to understand and control your distress and emotional cutting-off, or ‘dissociation’. This can involve ‘grounding’ techniques to help you to stay in the present – concentrating on ordinary physical feelings to remind you that you are living in the present, not the abusive and traumatic past.
start to ‘disconnect’ your physical symptoms of fear and anxiety from the memories and emotions that produce them, making them less frightening.
start to be able to tolerate day-to-day life without experiencing anxiety or flashbacks.
This may sometimes be the only help that is needed.
EMDR or Cognitive Behavioural Therapy can help you to remember your traumatic experiences with less distress and more control. Other psychotherapies, including psychodynamic psychotherapy, can also be helpful. Care needs to be taken in complex PTSD because these treatments can make the situation worse if not used properly.
You begin to develop a new life for yourself. You become able to use your skills or learn new ones, and to make satisfying relationships in the real world.
Medication can be used if you feel too distressed or unsafe, or if psychotherapy is not possible. It can include both antidepressants and antipsychotic medication – but not usually tranquillisers or sleeping tablets.
UK Psychological Trauma Society (formerly UK Trauma Group): clinical network of UK Traumatic Stress Services.
PILOTS database of the National Center for PTSD (USA): published international literature on PTSD.
Post-traumatic Stress Disorder – The Invisible Injury ( 2002). David Kinchin. Successunlimited.
Effective Treatments for PTSD: Practice Guidelines from the International Society of Traumatic Stress Studies (2nd edition) (2010). Eds. Foa E, Keane T, Friedman M & Cohen JA.
Treating Trauma: Survivors with PTSD (2002). Ed. Yehuda, R. Washington DC. American Publishing.
Adshead G and Ferris S. Treatment of victims of trauma. Advances in Psychiatric Treatment (September 2007) 13:358-368.
Bisson JI, Pharmacological treatment of post-traumatic stress disorder. Advances in Psychiatric Treatment (March 2007) 13:119-126.
Coetzee RH and Regel S, Eye movement desensitisation and reprocessing: an update. Advances in Psychiatric Treatment (March 2005) 11:347-354.
Hull, A.M., Alexander, D.A. & Klein, S. Survivors of the Piper Alpha oil platform disaster: long-term follow-up study (2002). Br. J. Psychiatry, 181: 433 – 438
NICE guidelines (update 2012): Post-traumatic stress disorder: the management of PTSD in adults and children in primary and secondary care.
Lab, D., Santos, I. & de Zulueta, F.Treating post-traumatic stress disorder in the ‘real world’: evaluation of a specialist trauma service and adaptations to standard treatment approaches (2008). Psychiatric Bulletin, 32: 8-12.
Frueh BC, Grubaugh AL, Yeager DE and Magruder KM. Delayed-onset post-traumatic stress disorder among war veterans in primary care clinics (2009). The British Journal of Psychiatry, 194, 515–520.
With this unseen malady,
the world is set to a different frequency,
faces move past with only apathy,
when they can’t fit you into a box,
intelligent, irrational, focused, erratic…
you seem a paradox.
Knowing people question me,
life feels scrutinised,
under the microscope,
wishing to be disguised,
not made to walk this tightrope.
Being able to be free,
not continuously analysed,
a participant, not an absentee,
hearing my voice,
without having to be patronised,
without having to prove my disabilities,
they love to give you the third degree,
have I not proved my invincibility?
We the stigmatised,
are not your problem to fix,
not here to be tamed and civilised,
neither will I be cured by your crucifix ,
“God only gives us what we can handle”
is this a joke – a chance to poke,
superstition and dogma we must dismantle,
instead with these ideas they provoke.
Everyone is watching me,
no longer left alone to recover,
my life is not something you can disagree,
they want to rip it away – uncover,
these things you can’t see,
no one would want this,
so with this plea,
stop watching me.
If you would like any information or would like to give feedback, please use this contact form:
Over 3 weeks ago I wrote an open letter to the NHS and the Adult Mental Health Services: https://charlottefarhanartactivism.com/2016/09/06/open-letter-to-the-mental-health-services-england-nhs/
Since this letter things started to look up, after tweeting my desperation and crisis live to the world and my followers, the NHS services in my area contacted me and so did the patient liaison services at my GP surgery.
However it has now become clear that my plea for help and my right to basic medical care was in fact interpreted as an invitation for further discrimination and stigmatisation from NHS staff, leaving me defeated, suicidal and so very ill. Ableism reared its ugly head, as did the neurotypical privilege of the service providers. Surprisingly after all I have been through – I was shocked, naive some may say, but when you are desperate – hope is all you have. My hope is almost non existent now.
The main issue seems to be a complete lack of understanding for complex mental illness and disabilities as well as a lack of empathy. I understand that these bureaucrats are not medical professionals, however if they do not have the knowledge – they can get it, and if they are un-empathetic – should they be put in these roles?
Another problematic situation was the abrupt stopping of access to my medication which happened which left me without medication for several months and no doctor at my practice seemed concerned that this had happened due to me not being able to attend a review which they set for my medication, so due to my lack of ability to attend (which they were well aware of) they just stopped it. Now there are not many meds I can take for my mental illnesses, anti-psychotics make me zombie like, mood stabilisers seem to make me physically sick, most anti-depressants do not work for me, however Citalopram is a drug which minimises my anxiety disorders (C-PTSD, Generalised Anxiety Disorder, OCD, Body Dysmorphic Disorder and Agoraphobia) I take the 40g dose which is the highest (when not in hospital) – it takes the intense feelings away, the feelings which cause me to be in constant fight or flight – a hyper vigilant mind, which feels like your entire body is trying to kill you and save you from imagined danger all at once. Even though it is not a miracle cure and does not make me more able, it allows me to exist in a calmer mind set, which is a life line when dealing with complex illnesses.
As you may be aware it is dangerous to stop medication abruptly as it can cause side effects and withdrawal symptoms. Personally my withdrawal was hell and life threatening, some are lucky enough to not even experience any issues, however there is no way of knowing.
The danger I was put in by the doctors stopping my medication access abruptly led to: suicidal thoughts and plans, anxiety, panic attacks, brain fog, concentration problems, insomnia, migraines, confusion, depression, dizziness, nausea, mood swings, fatigue and irritability.
This then had a knock on effect to my other illnesses, being under so much stress led to my diabetes and PCOS symptoms to become worse, my borderline personality disorder became more intense and more dangerous for me, intensifying my suicidal desires and my inability to regulate emotions. Also I experienced psychosis – with delusions and hallucinations due to my psychotic depression.
The ridiculousness of this is once I started to complain on social media, the doctors were made to give me an emergency prescription of 30 days, but with no accommodations being made for me to access my GP and as this is not on a repeat prescription in exactly 15 days time I shall be in the same predicament and have to go through this ordeal again, which I fear I will not survive.
In my correspondence with the NHS several things were said to me which constitute as discrimination, ableism and some were just unhelpful in a stressful situation.
Some of the most frustrating things said to me:
“it is a shame your husband can not attend evening appointments”.
Well as far as I am aware just from all the people I know in this country, none of them can access evening appointments due to normal working hours, with only one evening being made open for late appointments, this is ridiculous and very unhelpful to me a disabled person – house bound, with only my husband as my access to the world outside.
“you say you are out of medication”
This may be semantics, however saying “you say” indicates a lack of belief, what would be wrong in saying, “you have no medication, we can help with this”, this was very triggering for me and my conditions as it made me feel unheard and disbelieved.
“There are other surgeries which may offer what you need”
This made me feel so angry and discriminated against. As no real effort has been made here for my disabilities. A ramp is put in place for wheelchair users, WHERE IS MY RAMP! If they are suggesting that some one like me is so difficult and must be put through the added stress of finding another GP surgery just because a GP can not message me via email or text when they are on their way to my house, so that I can answer the door to them, well this is disgusting! This is what we are talking about… Nothing more!
“This appointment could have been had by another patient needing a home visit”
Now this is called victim blaming as well as ableism. I made it very clear that my disabilities mean my communication skills are impaired so I can not answer the phone or make phone calls, I also stated that due to my disabilities I can not go outside alone, sometimes not at all, that a handful of people are safe enough for me to go outside with (all of whom work during surgery hours), and that I can not answer the front door if I have no idea who it is (giving me a time or texting when outside is how I can open the door). Saying that another patient could have had the appointment I so desperately need is so discriminatory against my mental illnesses and has put unnecessary stress onto me when already so unwell.
This is why it has taken me 3 weeks to write another article, as I feel defeated. My only motivation is that by fighting for myself I can fight for others, as so many people have messaged me in the last 3 weeks telling me how they are in similar situations, so holding on by a thread my mission is to create change. However when the next wave of withdrawal happens whether this fight is sustained is anyone’s guess. As there are times when I am not in control of myself. For now my fight is waning but still intact.
Here are my email correspondence with the NHS (this is done for full transparency):
For more information on Citalaopram please follow these links:
- Brain zaps: Most SSRIs can lead to a person experiencing “brain zaps” or electrical shock sensations upon withdrawal.
- Concentration problems: a person may feel mentally slow and/or foggy when they stop the medication – this is likely due to changes in levels of neurotransmitters.
- Confusion: Your cognitive functioning can become impaired to the point of experiencing general confusion. This confusion may be a result of memory retrieval problems, but could also just be confused thinking.
- Crying spells: Some people report increased depression to the point of crying spells. Low serotonin can cause people to cry excessively.
- Depression: This is a result of their brain no longer inhibiting the re-uptake of serotonin to the degree that occurred on the medication.
- Dizziness: Feeling dizzy is one of the most common symptoms to experience during SSRI withdrawal.
- Fatigue: It may be difficult to get out of bed in the morning or even make it through a work day. The tiredness and lethargy may be pretty severe.
- Headaches: This is another classic symptom of SSRI withdrawal.
- Irritability: This is because the brain no longer is receiving the calming effect of the drug and it can be difficult to regulate emotions.
- Memory problems: It is common to experience memory problems to the point that you think you have lost your memory.
- Mood swings: They may persist for a long time, but will eventually subside.
- Nausea: You may feel nauseated all day and in some cases, want to vomit.
- Sleep changes: It is very likely that your sleep cycle will be affected when you withdraw from this drug.
- Suicidal thoughts: It is very common to experience suicidal thoughts when discontinuing an antidepressant. Any SSRI that is withdrawn from is likely to lead a person to feeling suicidal.
If you have experienced anything similar with the NHS or you wish to help me and want to know how? Please fill in this form:
If you have an emergency due to your mental illness please be safe and contact Sane: http://www.sane.org.uk/what_we_do/support/