Psychoeducation - And I Don't Mean Education About Psychos.

Lately I’ve been shaking my head a lot, wondering why I waited so long to insist that I needed more help than I was getting.

Maybe part of the reason was that I’ve had SO MUCH support. So many people involved. And I certainly didn’t feel like I deserved to ask for more..

I know I’m not alone in finding it very hard to ask for what I need – let alone for what I feel is more than I need. Hands up any of you who are reading this who find it hard and avoid asking for help, or have found it hard and now are practising asking despite feeling undeserving?

In a way, I’m actually very fortunate that I became so sick, and that I had no family support whatsoever. I have often asked my treatment team members why I got so much support – when I had friends just as sick who seemed to get none. The answer was usually that they had family and I didn’t.

I know, too well, that just because one has family around, doesn’t mean that they are actually supportive. Or that they are prepared, or equipped to be your support person through such a serious illness.

So yes – I’m very lucky. It meant that the public health system – from which getting adequate treatment and support services is like extracting blood from a stone – decided I needed more and I ended up with an extensive treatment team – consultant psychiatrist, up to two mental health case managers, GP, physiotherapist, endocrinologist (changing to bone specialist now), private psychiatrist, dietician when needed, and also the help of Non Government Organisations (NGO’s) for help with everyday living. On top of all that, over 100 admissions to hospital.  Very, very lucky.

Before I go on with my post, I just wanted to give a call out to Fed Up NSW Health. A friend of mine has been searching high and low for treatment for months now – and she’s critically ill with her ED. Is there help to be had? NO. Not just that, but she’s constantly told she’s ‘not sick enough’. Finally, fed up with the health system, she started rallying.

I would really appreciate as many people as possible supporting Ella’s cause. You can sign a petition, and read a recent article about Ella and her cause here.

If you are living with an eating disorder, you know just how hard it is to ask for help. The battle doesn’t end there for us – accepting and using any help we get is also a struggle.  How many times I simply turned away from help because I couldn’t let anyone help me – because I believed I was worthless and that the world would be a better place without me.  ED screamed at me abuse for daring to ask for something I didn’t deserve and wasn’t ‘sick’ enough for.

These patients not only have to fight for what is a right – basic care – but fight their ED to allow them to fight for their own lives, too.

Valuable time is lost, and people with an eating disorder can deteriorate so quickly. Ella has been in emergency, her life in danger – but she still isn’t deemed ‘sick enough’ for a bed. One of only two beds for people with eating disorders in the entire state of New South Wales.

The situation is similar in my own state – where there are only four beds for a state that covers nearly 2 million square kilometres, and has a population of 4,580,700 people. (Source) That is simply crazy, and dangerous. We don’t have other services to back up this deficit either – no day patient or outpatient programs, for example. If you are a public health patient – and many are – that’s IT for you if you have an eating disorder, and if you are ‘sick enough’ to be in one of those four beds, (even if you ARE, there is a wait list longer than Santa’s) this ED unit is really just basic care – refeeding. Not therapy. It’s the ED unit I myself have spent years at. And as you can see – I’m far from better.

Back to asking for help – far deeper than the ED runs the complex PTSD, past traumas torment me day in, day out. For years, I’ve just borne this. I’ve seen it as my lot to live with – and had no hope at all of ever living any kind of peace and safety in my own mind. I feel like I’m constantly surrounded by ghosts – of my past, of myself. I’m haunted.

I’ve seen so many psychiatrists and had a few psychologist and counsellor sessions – never have I really done more than told them how my week has been, or how I’m going with the ED symptoms. A few of them in more recent years talked about my past with me – but then it was just talking. I am very much able to separate myself emotionally from my story and just tell it.

But talking about it is NOT processing it.

Trauma therapy does not only consist of telling your story or focusing on traumatic memories, though of course that is a crucial part of the work. Bringing trauma memories to mind, talking about them in a trusting relationship, and developing the capacities for managing them while staying present in the moment are all crucial parts of the healing process. A premature emphasis on traumatic material can in fact do more harm than good. Many trauma survivors may first need to learn and practice a variety of self-care skills that you can then employ during the memory work phase of therapy.

In the past, trauma survivors were encouraged to speak about their abuse in the belief that this catharsis would be healing. Sometimes this instead led to re-traumatization rather than mastery of the material or healing. In fact, some trauma survivors are able to tell their stories easily, but in a dissociated manner. Because of the risks involved, this healing work is best done with the help of an experienced trauma specialist who can help you learn techniques to cope with memories effectively. One goal of trauma therapy is to help you connect to the past while staying in the present. – Dr Kathleen Young (Emphasis mine)

Yesterday I had my second session with the psychologist who specialises in trauma. And this is the main reason I’m shaking my head about waiting so long to insist on seeing someone like her. Only two sessions in, I know without a doubt that this woman can help me in ways that nobody before has even touched on.

I have hope, because for once it really does feel like I am not going to spend the rest of my life haunted.

We have started with some psychoeducation. My psych wants me to understand why the trauma affects me the way it does – a better understanding of an illness leads to being able to better manage it.

Objectives of psychoeducation for PTSD:

• Develop vocabulary to describe PTSD feelings
• Identify cues and symptoms that he is experiencing PTSD (and similar symptoms of anxiety)
• Link those feelings to specific triggers and areas of vulnerability
• Develop a short-term action plan for dealing with PTSD
• Accept that his PTSD is causing him problems
• Link cues and symptoms of PTSD with triggers and with harmful coping behaviors (Source)

She also stressed that there has been exciting research in recent times about how creating new neural pathways in the brain helps people who have been through trauma - you can learn how a trigger makes you feel, then learn a new way to respond to that trigger. By practising the new response, you are creating a new pathway, and the more you do it, the stronger that pathway becomes and the old one dies off. (This is a very simplified explanation from my understanding) It means that you don’t have to spend the rest of your life feeling fear, danger, panic, anxiety, etc when something triggers you. You can teach yourself not to.

At the end of the session, I admitted to her that I wasn’t sure that cognitively I was doing very well, because I’m still struggling with my eating – and that was an issue for my case manager about me seeing her, along with the worry that digging up the past was causing me to relapse. She said that being cognitively impaired will not at all stop me from getting a lot out of therapy – and was shocked when I told her how all these years the most constant refrain I have had from everyone who has ever been a treating professional in some way has been “You cannot work in therapy until you are weight-restored and cognitively well.” It has been a catch-22 for me – the traumas fuel the eating disorder, but I can’t work on the traumas because the eating disorder makes me too cognitively off-the-planet.

Here I am, shaking my head yet again. All those years, I bought into that myth that it was pointless for me to engage in therapy while I was cognitively impaired. That I would have to simply live with being haunted by my past and all that it caused me to go through until such time as I’d been sufficiently able to fight my eating disorder to gain and maintain adequate weight. I truly thought that I was a lost cause because what I needed to gain weight to have therapy for, has always been one of the biggest causes of my eating disorder in the first place.

So round and round I went. No more!

I’m going to get the most I can out of this opportunity.

And I’m not wasting any more time. My psychiatrist – Headshrinker –  is fired. I don’t have the rest of my life to tell him how my week was while he fidgets, watches the clock and surreptitiously picks his nose. (I wish I was joking about the nose picking.)

I always have so much fun finding the pics for these posts! I am in love with a lolcat-filled Internet

Anyway – never let anyone tell you that you can’t do therapy until you have gained weight. Never give up asking for help when you need it. If you think you need help, you need help. Remember that being able to access the help you need means you are less of a ‘burden’ to society than if you don’t get that help and end up much sicker for much longer.

I hate even writing that ‘burden’ bit – that’s the sort of thing a few ignorant and nasty people have loved to say/write about me. Many of us believe it. But it’s not true. ALL of us are worthy of the help, care and support we need. Every single one of us. Nobody should have to fight to get just basic care, and nobody should be made to feel guilty for being sick and needing help – something none of us chose to be in the first place.

We didn’t choose to be sick, but we can choose to fight to get better. And so, it’s even more important that we be able to get help when needed – and low of those who guilt us for being ‘burdens’ for attempting to take away our choice to fight, too.

Keep fighting, everyone. Because there is always hope! There’s a whole world out there to discover! 

Have you struggled to ask for help? Have you struggled to access help? How has this affected you? 

Have you ever had therapy, and do you think it’s helped you? 

What improvements would you make to the public mental health system in your country? 

Image Sources 1, 2, 3, 4, 5, 6