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Improving Your Mental Health despite Chronic Illness, Post 1

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It’s been a while since I’ve discussed any mental health topics on the Zebra Pit, so I’m glad Mental Health Awareness Month has come around to help get me motivated. As many of you know, I have a complex PTSD diagnosis and because of this and several of my other diagnoses, I also struggle intermittently with depression and anxiety. I spent a few months in therapy recently to try to get some help to better control these issues and have picked up several new tricks that seem to be working wonders. In this two part series, I wanted to share with you some of the things that have worked well to bring me to a more stable and positive place in my mental health journey.

While I’m sort of a lifer when it comes to therapy and DIY mental health improvement, I found myself struggling when my disability became severe enough to rob me of a life and career outside the home. Between the deep sense of loss I suffered and the onset of dysautonomia and MCAS, my old bag of mental health tricks were failing. As it turns out, I needed some help to get things back in order and the changes I had to make were both related to my physical and mental health.

You don’t have to have complex PTSD to benefit from the techniques I discuss. It probably doesn’t matter how the depression and anxiety got started, either. What’s important to understand is that these conditions are NEVER “all in your head” or “imaginary” and you can’t “just get over it” when you’re suffering from actual clinical depression and anxiety. Can it heal naturally on its own? Sometimes, but healing is much faster and more thorough with active intervention. Generally speaking, these conditions take hold when there’s an imbalance of key hormones in the body such as seratonin, glutamate, and GABA.

My anxiety and depression stem from a combination of genetics and environment. I experienced long-term abuse and neglect as a child and can also experience wild hormonal fluctuations brought on by the central nervous system dysfunction. The most likely culprits are my suspected autism, POTS and MCAS, as these all can have a big impact on the erroneous release of chemical mediators in the body. While the triggers are slightly different, the results are always the same, big fluctuations in mood and even bigger guilt when those fluctuations drive me to behave badly.

What I needed to get my anxiety and depression under control was a way to control my misbehaving mast cells and POTS, some CBT techniques to get me out of negative self-talk cycles and some mindfulness training to help keep me firmly grounded in the present rather than wallowing in the pain of the past.

My Mental Health Journey

If you’ve watched my video on PTSD and Chronic Illness or my post The Toxic Shame of Being Disabled, you know that my mental health took a big hit when I became too disabled to work, after I had done years and years of hard work to improve my mental health.  You’ll also know that I already realized my original toxic shame (that heaped on me by my abusers) was somehow connected to my inability to accept my chronic illness and the recurrent PTSD cycles I was entering every time I had to face a doctor or any sort of disbelief when it came to my conditions. I was so close, but I couldn’t quite make everything fit.

It may have been in my first therapy session that my therapist simply handed me the key to the puzzle about why I was still occasionally fighting those rage demons and being so hard on myself. In essence, I was being constantly retriggered because I was being treated by doctors, family and friends the same way I was treated by my mother, my only caregiver. In some cases, even the same words or phrases were used. That’s all it took to unravel hundreds of hours of hard work.

My mother didn’t care enough to pay attention or spend time with me or learn about who I was or even ensure that she was ever home to supervise, prepare meals or anything else. I was largely abandoned at age 4 and left to care for myself the rest of my childhood, as my mother always ensured her jobs were 2nd shift so she didn’t have to be home with us. I wasn’t allowed to use the stove until I was 10 and was left hungry often. When she was there, she struck me constantly with her words and occasionally with her fists. She chose always to believe the worst of me. I was attention seeking when I was ill. I was stupid, worthless and lazy when I did poorly in school (never mind that I had no one to tutor me at home and was moved from one school district to another year after year). And when I had difficulty working under the weight of all the emotional baggage and untreated genetic conditions, I was just plain lazy and slovenly and would never amount to anything.

Having a doctor tell me they didn’t believe me or summarily discharge me or behave condescendingly, immediately transforms me into that helpless 5 year old. Without doctors, I was lost and I knew it. Abandoned, unloved and disbelieved, just as I had been as a child. After a while of dealing with this from doctor after doctor, the anxiety I began to experience before my appointments grew until I was having full blown panic attacks every time I even thought about scheduling an appointment; a very bad place for a person with chronic illness to be.

Techniques for Mental Health Improvement

It has helped a little to finally be diagnosed and connected with doctors with knowledge of my health conditions. Unfortunately, it didn’t help enough. Understanding that my reactions were shame based also helped and let me feel a little less guilty about it. However, it wasn’t until my therapist helped me clearly connect the dots that I could fully accept my behaviors and stop the self-defeating cycle of being triggered, sometimes behaving badly because of it and then beating myself up about it and only fueling that shame more.

I had really begun to feel bad about myself. Even if I could still list the positive attributes about myself, they were all in past tense. I couldn’t feel them or feel like they still existed. I participated in frequent negative self talk that wasn’t even true. In psychological terms, this is known as distorted thinking and many people fall prey to its trap. My therapist helped me with that, too. She assigned me exercises to help me identify when my thinking was distorted and reason out why. This has helped me significantly and I no longer need to pull out the worksheet to do it. If I need to utilize it now, it happens in my head. The true beauty however, is that I find I rarely ever need it anymore. I guess that’s why the workbook it came from is called Ten Days to Self- Esteem! It’s a great cognitive behavioral technique and I’ll probably post about it in more detail going forward, but here are some copies of the worksheets in case you want to try it.

On this sheet you describe the thought and then assign which types of distorted thinking you’re participating in. Often, there are several categories that fit.

While working with a therapist is probably my number 1 recommendation, there are a variety of ways you can work on these issues alone and buying workbooks like those these exercises came from is a great way to get started. I always learn things from these books. Here are a few that I’ve read or completed and recommend, including the two from above:

The other psychological tool that’s been invaluable to me is practicing mindfulness meditation.  Meditating can be tricky for people with chronic illness. Most of us utilize mental blocks to help regulate our pain whether we’re conscious of it or not. Because of this, when we open ourselves fully in a meditative state, we get flooded with pain.  There is a work around for this, however: practicing ACTIVE meditation of some kind. It sounds complex, but it really isn’t. You just have to choose an easy task—crafts, arts, coloring, a guided meditation, tapping, gentle exercise or simple movements—and discourage any distractions or outside thoughts. Anytime you feel your mind wandering, you just bring it back to the task at hand.

Active meditation isn’t just for spoonies, either. It probably works better overall for people in the current age where we’re always busy and constantly bombarded with information.  You can find a wide variety of apps, programs and websites to help you learn how, but I will also write about this in more detail, later. Here are a few great books on mindfulness and active meditation to get you started,now.

Another technique which sounds really simple, but often isn’t for people with anxiety and/or dysautonomia, is deep breathing. Deep breathing exercises are only helpful if you know how to utilize the technique and your central nervous system and muscles aren’t so locked that it’s physically impossible to take a good, deep breath. The 90/90 balloon exercise below will help you learn how to breathe deeply and will actually help you to build your core and helps to address several musculoskelital concerns:

Once you’ve been practicing the 90/90 for a little while taking a good, slow deep breathing exercises should no longer be a problem. When you begin to feel anxious taking several slow and measured breaths helps to switch the autonomic system and park it in rest mode. Doing this several times a day can be very helpful in maintaining peace. Be sure when practicing breathing exercises that you’re engaging your diaphragm and most importantly, going very slow and steady so you don’t hyperventilate. You can ry the breathing exercise below first to see if you need to practice the 90/90 exercises.

Pinterest image with blue sky and clouds is overlain by text. The text reads: "Breathing Exercises: 1.	Sit or lie flat in a comfortable position. 
2.	Put one hand on your belly just below your ribs and the other hand on your chest. 
3.	Take a deep breath in through your nose, and let your belly push your hand out. Your chest should not move. 
4.	Breathe out through pursed lips as if you were whistling. Feel the hand on your belly go in, and use it to push all the air out. 
5.	Do this breathing 3 to 10 times. Take your time with each breath. 
6.	Notice how you feel at the end of the exercise. The Zebra Pit"

How Exercise Can Help:

Exercise has many powerful attributes which are beneficial to spoonies, when done gently and with healthy consideration given to avoiding post-extertional malaise (PEM) and joint injury. Spoonies should exercise regularly despite pain and other problems unless your doctors tell you otherwise (for example people with NMH need to be evaluated before they take on exercise). It is important that you go slowly, pace yourself and protect your joints. For more information, visit these guides specific to POTS and EDS (the EDS one is probably good practical advice for most connective tissue disorders, but I would consult with your medical team to be sure.

Participating in a regular exercise program can improve overall mood, help balance hormones and raise endorphin levels, providing an overall feeling of wellbeing and happiness. It can improve sleep, something else which is essential for positive mental and physical health.  Exercise can also help to loosen tight muscles and help us relax and feel less anxious. It can also help get things off of your mind, especially if you work to stay present and focused on the tasks at hand instead of letting your mind wander to less pleasant ideas.

The activity doesn’t necessarily have to be “exercise” in the traditional sense. Anything physical that gets your heart rate up a little, blood circulating through your body and good deep breaths into your lungs is a great way to combat anxiety and depression. If you prefer to take walks, hike, garden, bowl, canoe or rent paddle boats, go for it! So long as it’s safe for you to perform that activity (see the articles above for some tips).

Spending time doing anything you enjoy is always a great way to turn around poor mental health, at least temporarily. Whether you consider spending time with friends and family, reading a book, taking in the fresh air and flowers at a nature preserve or going shopping to be great fun doesn’t matter, so long as you choose the right activity for you.

There are some great techniques here and I hope you find them helpful, but for most spoonies with some form of dysautonomia and/or mast cell disorder, you’re going to need some help from mother nature’s pharmacy. In part two of this series, I cover a number of over-the-counter natural medications, vitamins and minerals you can take to help with both depression and anxiety. I also discuss how medications can impact mental health and what to do about it when you realize something you’re taking is causing a problem:

References and Further Reading:


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The Toxic Shame of Being Disabled

5191gfd1hql-_sx322_bo1204203200_There’s an understanding in our society, both spoken and unspoken that places the worth of an individual on what they can accomplish. When your health deteriorates to the point that you can no longer take care of yourself, let alone hold a job or take care of your kids and your house, you may find that you’ve internalized that belief to your very core. You quickly begin to wonder what value you have left if you can’t continue to lead the productive life you’ve always had and this can lead to toxic shame.

In many ways, this is doubled for spoonies who spend years going to doctors who do not believe them, misdiagnose them, and spend years searching for answers about their mysterious symptoms and conditions. It can take an average of ten years to get a proper diagnosis. Some patients are outright accused of faking, are shipped off to psychiatrists in the false belief that their problems are psychological and lose the faith of friends and family who do not believe that their illness, or the extent of their illness, is real.

All of these things were true for me for over 15 years and I was filled with guilt and anger with myself over circumstances I couldn’t control. I felt like a complete failure and believed that everyone around me thought I was a failure and a lazy good-for-nothing fake. I became intensely angry every time I had to ask for help, or felt I wasn’t being understood, or asked to do too much. I became enraged every time I felt embarrassed by my cognitive decline and memory loss, the fact that I couldn’t write anymore and that my peers were being unforgiving and callous about it. Eventually, I became intensely angry about everything.

I became so shame-bound about my illness that I began pursuing a diagnosis not to get help, but to prove to everyone just how sick I really was.

I knew logically that it wasn’t my fault, but I couldn’t escape the feeling that I was doing something wrong and that I should be terribly ashamed of my circumstances: Because anger was a much easier emotion for me to deal with, any situation that invoked shame, I quickly replaced that shame with anger. I also utilized my anger as a way to push people away. That way I didn’t have to deal with them or my feelings of shame.

I’ve written about my struggles with these emotions a few times and my attempts to repair the problem, but I was missing a key element. I didn’t understand how this shame seemed to wipe out all the headway I made in my early adult years to heal from an early life of abuse and neglect, and this understanding was key.

Then I came across a wonderful book by John Bradshaw called Healing the Shame that Binds You. As I read the book, I began to understand that the shame I was suffering about my disability was the same kind of toxic shame I inherited from my abuse and neglect. As Bradshaw explains, shame is usually a healthy thing, but when shame becomes internalized and we begin to define ourselves by our shame, it becomes toxic.

“To be shame-bound means that whenever you feel any feeling, need or drive, you immediately feel ashamed. The dynamic core of your human life is grounded in your feelings, needs and drives. When these are bound by shame, you are shamed to the core.” John Bradshaw

In a person who is disabled in a society that shuns and sneers at the disabled and those who are less than fully productive, it’s easy to internalize this shame and let it define us, even if we’ve never had a problem with toxic shame in the first place, which is pretty doggone hard to escape in present day America with familial abuse, childhood and internet bullying, and the pervasive number of unhealthy people around to help pass around heaping helpings of shame at every turn.

Toxic shame effects every part of your life, from how you treat yourself and others, to how well you can cope with the outside world. It bullies us into making bad decisions, hurting ourselves and participating in unhealthy cycles. Toxic shame can create narcissistic or multiple personality disorders, bipolar disorder, obsessive compulsive disorder, addiction issues and more.  I’m with Bradshaw when he says “Hell, in my opinion, is never finding your true self and never living your own life or knowing who you are.” Without resolving issues of toxic shame, it’s impossible to achieve fully knowing one’s self, or finding the contentment or satisfaction you see in others.

Healing the Shame that Binds You isn’t a new book and toxic shame is probably a fairly well known concept for people familiar with twelve step work, but I feel it’s something that could benefit a much wider audience and I recommend reading the book if any of what I’ve said rings true for you. Toxic shame can exacerbate our already fragile health and further complicate issues with dysautonomia, as it often causes anxiety. We already have enough challenges in our lives without allowing toxic shame to complicate things further.

Healing the Shame that Binds You will not only help you understand the nature of healthy and toxic shame, but it will also help you on your way to doing something about it offering tried and true methods of healing the shame that binds you. It isn’t always easy work, but once you feel the uncoiling of those complex emotions and a new level of calm begin to build inside you from this important work, you will understand it’s true healing powers. You may even find improvements in your overall health and a new will to fight.

Right now, Healing the Shame that Binds You is available in audiobook format for free on Hoopla with your library membership. You’ll find hoopla in your app store on Android or iPhone.

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Changing Perspective 

This fantastic article from Joel Minden at Psychology Today makes an excellent point about positive thinking and the limits of its usefulness in making real long-term change in your perspective. The problem? Often we choose things that are too positive, outside the realm of our own experience and therefore unrealistic. To combat this, he suggests:

replacing negative beliefs with ideas that are more accurate and useful.

For example, when you catch yourself thinking in unreasonable ways, begin to assess accuracy. Some questions to ask yourself:

  • What’s the evidence to support this belief?
  • Is there any evidence to reject it?
  • Is there a more accurate way to think about this situation?

Next, consider the usefulness of the belief and whether it would benefit you to change it. Some questions to ask yourself:

  • What’s the likely effect of thinking this way?
  • How does it affect my emotions? My behavior?
  • What would happen if I changed my belief?

Using exercises like these to move toward more accurate and useful beliefs can have a huge impact on the intensity of unpleasant emotions.

Being a pragmatist that relies heavily on the extensive critical thinking skills my social science background gave me, I realized this is how I have approached my self examination and attempts at change without ever realizing it. The affirmations I created all have some basis in reality even if they didn’t feel emotionally true to me at the time because of my depression and flagging self-esteem; they are things I have known and felt before, or can see objectively, when I’m not in the mood to punish myself for some of my less desirable qualities.

Though I hadn’t really worked this out in my head, reading Dr. Minden’s article helped me see and understand my process clearly and why it’s successful for me now when it wasn’t in my teen years and why it works for some and not others, so I wanted to share this important insight with my readers as well.

That’s why reading these kinds of things really are helpful, as they can help us understand both what we’re doing right and where we may need to make adjustments to attain the desired effect.

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Affirmations and Effective Journaling

Editor’s Note: This post was last updated 8/20/19. Thank you.

The last two days have been incredibly productive. It’s amazing what one can accomplish once you’re willing to let go of the electronic babysitters and face your problems. It all seems so silly now, but I won’t allow myself to get mired down in why it took me so long to take this step. I can only say that for whatever reason, I am finally ready to begin dealing with the emotional consequences of my disability and I am very grateful for it.

I will say that I do not believe for even a second that this spiritual and emotional awakening arriving at the same time that I’ve made such strides in tackling my dysautonomia is in any way a coincidence. Being at the mercy of dysautonomia is every bit as much the psychological roller coaster that bipolar disorder seems to be (I have a good deal of experience dealing with people with this disorder, so I in no way make this comparison lightly).

We may experience things somewhat differently and the chemistry behind what’s going on may be somewhat different, but it is organic in both cases and entirely beyond a person’s control. No, they can’t just “calm down” and behave themselves like everyone else. Believe me, if they could, they would. They want to just as much as you want them to. No one wants to feel that way.

Dysautonomia and the depression, anxiety and anger that accompanies it is a big part of why I’ve come to feel such negative feelings about myself again. The slow changes I’m experiencing with these issues as my body heals are also how I’ve come to have a little pity for and patience with myself these past few weeks and have helped me to begin forming these new ideas and conclusions about myself. Improving my dysautonomia may have been the only way I could have begun this work in the first place, though I share it here in the hopes that others who also struggle with these issues may see their problem for what it is without having to go through it firsthand.

Need help improving your symptoms of dysautonomia? Check out my post: See Ya Tremors! Bye Bye Brain Fog!

Mind, body and spirit are inextricably linked and it is essential to heal each part to achieve wholeness; something we all desire in whatever modified definition we can come to accept. Like it or not, this is the life we have, the body we have, the mind and spirit we have. We get no other. We must do our best to care, love, nurture and cherish it for if we do not, certainly no one else will.

Journaling

Normally, I consider a journal to be a deeply private thing, but for the purposes of example, I wanted to share the first three pages (give or take) of mine. I set them up to guide my process and they include those things I seek to change about my thinking and my actions, or what I call my “core issues” along with statements I need to keep in mind, or my daily “reminders.” I follow these up with some daily “affirmations” that I am trying to memorize without much success and will more than likely have to print off and laminate instead to place beside my mirror. All three pages will be part of my daily regimen of self-care. Page one is my Reminders:

Remember

I like to start off with my reminders because it’s a mixture of both positive and negative and a good place to start. It isn’t all hard stuff to swallow, nor is it all sunshine and kittens. It’s realistic and things I need to keep in mind everyday no matter how I feel or whether or not I’m stuck in dysautonomic hell.

Each day as I review my reminders and core issues, I will take notes about my progress and record any thoughts I have had about them. I might add a new issue that has come to my attention or examine a problem I had or the way I reacted to something and why I think things happened as they did. Being highly emotive, I tend to work things out by talking them out, so I will incorporate ideas from conversations I have had with my husband or friends. I don’t ever take away issues, but I may explain that I feel they are taken care of for now. I don’t remove them, because most of them are lifelong problems, so I know somewhere down the line they are likely to rare their ugly heads again.

CoreIssues

Take a look at my chosen issues for some examples. You may have some similar ones and some different. It may take some time and honest soul searching for you to come up with your own. That’s OK. A journal is always a work in progress and should be private so you feel completely comfortable with being totally honest. Hopefully if you don’t have a therapist, you do have a friend you can be open and honest with that can help with some gentle suggestions. Don’t be surprised if you feel they are wrong or if you get really upset about it. Try not to comment if it does. Instead think really long and hard about it and ask yourself why you had the reaction you did. That’s where you’re going to find the answers you’re really seeking.

For me, this kind of work is the easy part. I’m a well trained monkey on the therapy wheel and once I’m prepared I have no difficulty with a level of emotional honesty that shocks most people, because not only am I aware of my flaws, I don’t really feel the need to hide them. What I do have difficulty with, still, is taking a compliment. Especially since my self-esteem is lingering in the s portion of the toilet right now, so sitting in front of a mirror telling myself I am beautiful inside and out and that people like me and want to be around me when I do not believe it is incredibly difficult for me. To be honest, I have yet to do it in a mirror, or above a whisper because it just feels like such a big fucking lie and I have a great deal of difficulty occupying that space.

Affirmations

I also find this to be the hardest document to share. In part because it shows how bad my self-esteem really is and makes me feel a bit vulnerable for it, but also because I have come to suspect as an adult that people take my quiet shyness as egotism and I have always found narcissism such an ugly quality, so I hate to publish a list of I statements about how fantastic I am when they are things that I actually feel the complete opposite about myself. This list could have been so much longer, but I caution you to pick only the biggest of your issues to begin with. You can always choose others later, once you’ve got a good hangle on these.

When doing daily affirmations, you really need to work your way up to doing them in the mirror (and not only coiffed and in makeup, ladies). Get used to looking at yourself and smiling and saying the words over and over again, every single day. Record them and listen to them. Over and over again until you truly believe them. The reason we do this is to replace old bad tapes we have all set up in our minds about ourselves. We may not even know they are there, but they are. They come up every time the subject comes up. We have to change that thinking one way or another and repetition is the best, most proven way to do it. I’ve done it before and it worked. I can do it again. So can you.

Finally, I wanted to provide a few useful guidelines for journaling:

  1. Pick a quiet, comfortable place where you can be alone with your thoughts.
  2. Choose the right implements. If you write faster than you type, write. If your hands hurt from writing, type. If you like to doodle while you think and then start writing, use an art pad and make it as creative as you want or use a regular journal and create all the marginalia art your heart desires. Whatever works best for you.
  3. If you need devices to assist you in writing or typing, get them. There are sheaths you can buy to go over pens and pencils, you can buy big fat pens, you can speak to type. If you do better talking out loud, try recording yourself instead so you don’t have to worry about editing for clarity. You can pick up a cheap recorder or use one on your laptop or cellphone.
  4. If you have busybodies in your life, protect your journal. Lock it up, password protect or fingerprint protect it. Put it in a hidden folder. Do whatever you have to do to ensure your privacy. It doesn’t matter how close you are to your spouse/best friend/roomie, there will always come a time when you want to write about something you don’t want to share and that’s your right!
  5. Free-writing is great some of the time and works great for some, but others need structure. If you find yourself going in circles or just getting more upset, look into journaling guides and workbooks, like those I selected for another post, here. There are a lot of them out there. You can also find exercise examples on many blogs on a variety of subjects.
  6. Take advantage of inspiration when it hits. Just finished watching a movie that had some parallels to your life? Wonderful! Journal about it to help unlock the full potential of that experience!
  7. Don’t use your journal to rehash every wrong that’s ever been done to you. Sometimes you need to use it to examine a particular experience, especially if it just occurred, but try to keep it rooted in understanding your own reactions and motivations and NOT THE OTHER PERSON’S. Also try to avoid perpetuating bad feelings. Look instead for resolutions and take aways: Why did I react like that? How could I have done things differently? How might I approach or possibly avoid a similar situation next time?
  8. Review your journal regularly to look for patterns of behavior and opportunities for improvement. After all, the whole point is to make your life better, happier and more workable for you! What’s the point of writing these things down if you’re only going to ignore them later?
  9. Never use your journal to berate, belittle or chastise yourself. Remember, we are all inherently flawed and that’s OK. We’re going to make mistakes. We’re going to slip up. That doesn’t define who we are. It’s how we deal with those errors that really counts and being hard on yourself about it only makes your life harder and your shame about it grow. Learn from the experience, change from it. It’s the best thing you can do for yourself and all anyone can ever ask of themselves.

Resources and Related Materials

This post discusses my mental health journaling strategy and includes a number of tips on pitfalls to avoid along with some ideas of how to accommodate disability and still enjoy its benefits.
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Healing the Spirit

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I realized recently that I have some hard truths to face and that those of the medical variety are kind of the least of it. After all, I’ve been living with my illness for a long time now, whether I’ve known what to correctly call it or not. Yes, it’s been a bit of a mind-fuck to contemplate changing the name of my disease and how I care for and protect myself (yet again). Yes, it’s been very difficult realizing that many of my behaviors over the last 20 years has caused permanent damage to my body and I have lost mobility I can never get back because I listened to idiots (many of which who have medical degrees) who assured me that being active would not come back to haunt me in my later years. Yes, I am afraid that this is probably the best I can ever expect my mobility to be ever again. I mean, fuck. Who wouldn’t be upset by all this? There is a whole truckload of upset on each subject alone. Still, the atrophy of the physical self hasn’t caused the dragging-me-down-so-I-can’t-sustain-that-fake-ass-smile-for-longer-than-10-seconds-without-toothpicks-propping-up-the-corners-of-my-mouth kind of miserable; it’s the severely stunted emotional growth that somehow came along with it.

My first clue? I can’t stand to be alone in a room with myself and will make any and every excuse not to be, for oh—the last 8 years, give or take. I fill my time and my mind with anything and everything I can to not have to think about my life, my fragile mental state, the constant inner turmoil, the tears I’m constantly holding back or the deep well of loneliness and terrible abandonment issues I’m refusing to address. I read, I listen to books, I research, I chat, spend hours in support groups on other people’s problems, shop on the internet at the level of obsessive pro, watch hours of stupid television shows I care nothing about, watch makeup and nail polish tutorials and experiment with the gobs of crap I have shipped to my home. I spend countless hours perusing stupid memes on Facebook which I like and share and comment on and tweet and blog and on it goes until there is no more I.

I do these things so I don’t have to think about the family and friends that pushed me away and I pushed away in this maniacal game of reverse tug of war, how much I loved them and how much that love hurt. I do these things so I don’t have to think about the kids I could never have and weren’t allowed to adopt. I do these things so I don’t have to think about how my self-esteem wasn’t quite as strong as I thought it was when everyone walked away and the accolades in my professional and academic life dried up.  I do these things so I don’t have to think about how every community of which I was ever a part slowly turned its collective backs from me in silent agreement that because I am homebound and disabled I no longer count. I do these things so I don’t have to try to figure out how to make peace with being a people person forever without a people.

My avoidance of these things is only perpetuating my inability to let go of them. I know this from my extensive experience with therapy, interpersonal growth and overcoming a childhood filled with neglect and abuse. Knowing this doesn’t always make it easier to get to work, though. If anything, all those childhood problems have co-mixed and intermingled with the emotions brought up by my disability,muddying the waters and making it very difficult to tell where one problem ends and the others begin. Am I rehashing old issues or are they new? Are they rooted in old bad habits and I just need a tune up (a few reminders) or do I need to start from scratch? These are questions I ask myself from time to time, feeling like I’m getting somewhere, even reaching understanding, but sometimes this knowledge seems obtrusive and even unhelpful because yes, I know the theories, but it doesn’t always help me get them into practice.

Another big problem with making any strides in my emotional health since I’ve become disabled comes from the nature of my illness and dysautonomia. Some of what I deal with is organic. How do I know when what I am feeling comes from life circumstances or is being heavily influenced by my dysautonomia? Sometimes I do, sometimes I don’t. Panic is clearly felt. Anxiety is sometimes clearly felt. Depression has layers. Sometimes I need objective help to see it clearly and it’s really not conducive to work on my emotional health when I’m in the grips of an organic episode.

Certainly it would help to have professional help figuring some of this out, but I live in an area where there is a massive shortage of qualified counselors. It takes months to years to see a counselor. Every time I get on a list by the time I get an appointment, either my insurance has changed or the provider no longer takes it. I can’t win. It’s truly ridiculous and impossible to get help unless you are ready to do harm.

Waiting for an appointment with a practitioner here has just become another stall tactic. I have to take things in my own hands and I know I have the tools I need to do it. I’m beginning by clearing away the distractions. No more Facebook or twitter except for blog interactions. Therapeutic art projects only. No more shopping (my budget will thank me) or unnecessary TV viewing. No more endless hours of meaningless chats or help sessions for other people.

In place of these old bad habits, I am once again taking up my regular meditation practice which I know is good for both my emotional and physical health. In addition to this, I have been seriously considering my spiritual health and the many stupid reasons I allowed it to lapse and the ways I want to embrace the natural and spiritual world again.

One tool that has always been key to my emotional health is journaling. It’s how I came to writing in the first place and it’s how I originally found positive emotional and spiritual health and wellbeing. I will write everyday on a topic that I’ve been struggling with, dissecting it and trying to understand what it is that I’m getting hung up on about it and how to move forward in my thinking about it. What ideas can I replace it with? How can I shape my life differently or what things might I look forward to or find rewarding instead? Those kinds of things.

Another thing I can do is look for information about these subjects from other people who have struggled with the same issues. Maybe they have a unique perspective that I’ve been missing or some insight that will help me, too. I may not have access to a professional, but there are plenty of resources to be had out there, including some workbooks and other options that might help me on my journey.

At this point, I am dedicating myself to spending some time every day on meditating, journaling, or doing some sort of therapeutic art. Anything that will provide me with the head space to think about my life and put it fully in perspective, learn to be alone with myself again and actually enjoy it. To learn to like myself again, because I just realized that I really don’t and that tells me just how dire I’ve really let the situation become.