Twenty: And then some

At the age of 22 it feels like I'm finally coming to terms with what it might be like to be an adult.

Being dependable.  Having people of my very own to look after, albeit only my boyfriend and our cat.  Visiting Ikea to buy wardrobes for his room.  Having to plan meals in advance and cook. Cleaning and doing laundry not because someone tells you to but because actually, if you don't, it starts to get to you.  Keeping in touch with family.  Learning to express your needs in moderation, and to give a fair hearing to those of others.  Leaving difficult situations in time to keep yourself safe when you feel overwhelmed.

Only four months ago things were very different.  Loneliness combined with perverse "coping mechanisms" I've had a lifetime to learn and perfect imposed a Jekyll and Hyde like structure onto my existence.  The days would be spent pushing down tempests of anxiety -  an almost compulsive fear that worsened if any sort of attention was paid to it. I felt, almost always, on the edge of calamity.  Danger lay in every unoccupied moment, and no matter how carefully I planned my day, there would always be more than one. My classes done, at night (or, on bad days, late afternoon), I dived into chaos.  I was exhausted and I just couldn't contain myself anymore.  The GP on campus had told me that if I continued to starve myself I would not be able to remain at university, and for once I had listened.   During the day I would eat enough to satisfy my appetite and give me the energy to work - but I managed this partly (and problematically) only by shutting my eyes to it. 

I knew the nutritional content of what I was eating.  I knew what constituted a healthy, balanced diet, and I aimed towards it.  My body, however, was aiming for more.  It was aiming for curves, periods, and everything else a healthy woman should have - but for me these things also possess unpalatable and still mostly unexplainable psychological implications.  As soon as it got dark I let go.  I would spend £10 to £20 on food and spend the next two hours eating and vomiting  - gorging also on the kind of trashy tv my day-time schedule would never allow for.  When I was done, and I was reassured that my stomach was entirely empty, I would eat a small meal and go to bed.  Ultimately I knew I couldn't afford to lose weight. 

But it was draining.  Sustaining any sense of self in the midst of a raging war between bits of you that you still don't really understand and  that insist on their fulfillment with ceaseless cruelty is difficult.  It's even harder when you're trying to work towards a first-class degree.  Luckily I was able to get through the term.  Two arterial bleeds and two visits to A&E in ambulance, days when I just couldn't muster the energy to get out of bed and clear up the mess (blood, food and vomit) of the night before and recommendations to take leave of absence from university -  regardless,  I got through.  But my God - it feels a world away from now.  I have enjoyed four of the most healthy months I have had since I was sixteen,  and I'm terrified - terrified - to let them go.

Term begins on October the 10th.  I may have more support  in York than previously, since the psychiatrist I saw on Thursday who works for the psychotherapy service thinks I do need psychiatric reviews and a support worker and is writing to the CMHT in support of both.  Briefly, I would say that this was the single positive of  a difficult and frustrating meeting.  More will follow later.

Eight: A Cigarette is Like a Kiss

A return to the personal.

A cigarette is like a kiss.

Each toxic puff wastes dizzyingly

Into the stratosphere,

The light getting shorter, you fight for breath

Alone in the fag-end of morning.

One kiss is never enough.

Cling to my lips in familiar grip,

Cling and never let me go.

Who hears  our kisses,

Who holds us to account?

An-ever changing sky watches, receives,

Arranges its clouds in storm-spun silence.

Taste, and taste again the death of morning.

Let you into my heart, my mouth, my lungs

You burnt out too fast for a possible last time -  

But It  did happen.

I  have the smell of you.

The Personality Police would be happy with this one, I think.  It ticks all the borderline boxes.  Which is fine, since it’s a nonsense diagnosis anyway.  Is it not the case that I feel only what every other bloody human being on this planet feels?  I love my transience and despise it at the same time, I want to hold on to all that keeps me fixed and safe,  but I have to let it go or risk a living death.  Somewhere in the holding on or the letting go lies the problem.  It is a problem for me.  But I won’t accept that it could ever be solved – no one has the solution, just the offer of a thicker skin.  And that will come to me in time.

Last week (when I wrote the above) was an angry one.  From (another) letter that I didn't send, the following:

I am horrifically angry at the moment.  I feel let down by everyone and everything.  It disturbs me how angry I am.  I’ve been having some really nasty, graphic thoughts.  Violent images that seem to leap into my mind from nowhere like dreams (I wish they were).   One of these flashes involved me turning up to the Tavistock in a wheelchair, having amputated both my legs.  In another I saw myself  slash one of [ my consultant psychiatrist in the adolescent unit's] arms.  Possibly exhaustion is the cause.  My conscious mind doesn’t usually make such savage leaps to the unacceptable – of if it does, it contains the violence firmly within the boundaries of my own body.  I enact my fury bodily without ever really having to confront it.  Sometimes I think self-harm is the safest outlet for me after all.  The safest for the people who I co-habit this planet with too.  Something must insulate the live wire, or impede the flow of current it conveys.

I come to this conclusion, and then I remember Dylan Thomas: 

Do not go gentle into that good night.

Rage, rage against the dying of the light.

Rage for raging’s sake, even if all I will ever have to make a fuss about is a storm in the smallest of tea cups?

Instead of sending the above to my therapist, as intended, I ended up writing a letter to the psychiatrist aforementioned.  When I left the adolescent unit, she told me that I could write to her and that she would always write back.  Over the years, I have written less.  I had sent her one letter previously this year.  But we are now well and truly in anniversary month (My Dad would have turned 52 today, and next wednesday is the 4th anniversary of his death), and I wanted to send her a card.  Enclosed in the card was a letter, mostly focusing on my achievements and other positive aspects of my life, though I couldn't resist whinging a bit about the psychotherapy funding situation.

I'm still reaching out, however cautiously.

Five - A taste of my own Medicine

Last night, my phone alerted me to a text message at 1.30 in the morning.  It was from a girl on my course who I have got to know slightly over the past few weeks – let’s call her Ellen.

The message read: 

“I’m in hospital, taken an overdose”.

Ellen and I originally got talking when she sat next to me in our first workshop of the current term.  She was in one of my classes last term too, and she told me she had been really worried about me when she saw a bandage on my arm.  Apparently she had tried to catch me up after class to ask if I was okay, but I was walking too fast (I do, particularly when I’m on edge.  Ellen has bad knees so she didn’t really stand a chance).   I was surprised that she had noticed, and rather gratified that she cared enough to worry.  Despite the very obvious signs of self-injury I display, including one memorable day last term when I was really out of it and walked around campus with clothes soaked in the arterial blood I had spilled the night before, no one here has asked any questions.  I do appreciate the respect of my privacy, but for me there is a fine balance between an intrusive and an uncaring reaction. The fact that not a word was said by anyone about the scars on my arms had an unexpected isolating effect.   In some ways, I think I have grown reliant on remarks from others about the scarring to affirm my more hidden suffering.  I have felt for a long time the existence of a “split” in myself, the emotionally unstable hurting core armoured by a shell of social enthusiasm, rational capability and intellectual interests that seeks to distract and divert attention from the “real” me.  But while this attention is terrifying, I also crave it.  It proves that I exist, or at least, that the part of me that is often overlooked exists.  When this recognition or “attention” does not take place, it has a greatly destabilising effect, barely discernable at first but increasingly apparent over time – last term, it got to the point where I felt SO divided, SO unacknowledged that I began to doubt my sanity.

This is a rather long-winded way of explaining that Ellen’s interest was valuable to me, and that I felt disposed to encourage a friendship between the two of us. There was (and is) however, a complicating factor.  Ellen of course has her own problems, problems which I have come to realise she presupposes I can intimately identify with. I have come to expect the appeals “You know how it is, you know what it’s like” to pepper a sizable proportion of our conversation – which, more often than not, is about her.  Ellen is diagnosed with Asperger’s Syndrome, as well as depression, and I do wonder if the nature of our exchanges has something to do with this.  It may be a case of pot and kettle to suggest that she is particularly self- absorbed, but while I too tend to feel my existence as particularly isolated, I (perhaps overly) compensate for this by showing a pronounced interest in other people when I spend time with them.  Ellen feels that she “does not exist” when she is alone, that she needs other people to make her exist.  When I am on my own, I am all too real – it’s the rest of the world that disappears.  If it is possible to form such a comparative hypothesis, perhaps then this  explains why Ellen is “larger than life” (she has informed me that people have told her she comes across as “intense” and “frightening”) around others,  the only time she is able to realise the concreteness of her existence, whilst I am overwhelmed by other people’s needs when I engage with them, to the extent that in order to recuperate, I have to cut off from a recollection of these completely when I am alone.

The more I think about it, the more it sounds like two sides of the same coin – though I do not think I fit the diagnostic criteria for Asperger’s, I think Ellen could quite easily be diagnosed with BPD.  The irritation, as well as concern I felt when I received her text message was an important reminder of how my poorly integrated outside and inside worlds have worked to cause a lot of damage to my relationships, hurting those who I fail to realise (until too late) love me.  Ellen is fine.  The overdose she took does not sound substantial enough to have caused any damage, if her reports of the lack of medical treatment she was given in hospital are anything to go by.  Ellen, I think, wants me to help her, if only through the understanding she thinks I possess of how she feels.  She offers, unasked, details of her self-harming behaviour and watches closely for my reaction.  I cannot help but be responsive, but I am very wary of getting too involved.  For various reasons, which I won’t go into now, I think some of her recent behaviour has been modelled on what she knows of my history.  A few days ago, before her recent overdose, she told me she had once again taken a few too many of her citalopram pills.  I was bemused, and asked her what she had wanted to achieve – assuming she knew, as I do, that (whilst not a great thing to do) a small SSRI overdose is not particularly dangerous.    I can’t help but wonder if my reaction played some part in the fact that last night she appears to have taken paracetamol as well as citalopram.

I am annoyed partly because I hardly know her, and in some ways I do feel the text was an imposition. I was also angry because it took no account whatsoever of my possible feelings, and gave me only enough information to make me feel worried (disproportionately, considering the situation wasn’t in the end dangerous) and powerless.  It did make me think, though, of how my own self harm and suicide attempts must have affected those close to me – if I felt the way I did about Ellen, who after all is only really an acquaintance, how much worse it must be if you have a greater personal investment in someone who seems to behave towards themselves, and towards you, in such a cruel, careless way.  Those are emotionally loaded words, and my anger towards Ellen was almost entirely an emotional response.  While it may not be the most useful reaction, it is human – it is human to hurt when someone, particularly someone you love, hurts.  My experience of re- gaining consciousness in intensive care, hooked up to a million tubes, my mum, her face ashen, standing over me; or of my mother telling me how my Dad (he was still alive then) had cried when I was being treated for my first serious overdose and they were still waiting to find out if I would pull through, has a flip-side.  A flip-side which is at heart no less caring, but requires more insight, and in my case personal experience of being on the other side, to understand.

It is the frustration with a friend who has once again put herself in hospital, the friend you were relying on that weekend to come to see you on your Erasmus placement abroad.  It is the bewildered, frightened fury you feel when she goes out to celebrate a birthday with you only to spend an hour vomiting in the toilets of a bar and then sits down in the middle of the road, and you have to call an ambulance.  It is my mother’s terror, as she finds me hurting myself once again – the terror that provokes a hysterical “you don’t have to kill yourself; I’ll do it for you”.  It is my therapist's questioning of why I am “tormenting” her by making her watch me lose a dangerous amount of weight, yet again.   It is all this, and so much more. 

Thank you, Ellen, for helping me to see.