This Past Year’s Musings, Part II

Photo by Chunfeng FENG on Unsplash

December 2023-February 2024

Since I didn’t feel safe staying in residential treatment, a step down to PHP (Partial Hospitalization Program) was the next best thing.  Our schedule began at 9:00 in the morning, in which we had 3 1-hour sessions, broke for a 30-min lunch, and ended with 3 more 1-hour sessions.  The morning always had a smaller group since it just consisted of patients in PHP, while the afternoon sessions added the patients in IOP (Intensive Outpatient Program) and were therefore larger. We had anywhere from 2-16 patients in each session, which were all led by a therapist or a tech. 

Most of the sessions were psychoeducational.  We learned about different aspects of therapy, including dialectical behavioral therapy (DBT), acceptance and commitment therapy (ACT), narrative therapy, and art therapy.

Dialectical Behavior Therapy:

DBT taught us a lot of coping strategies to use in the moment – things that would help ground us, distract us, and divert us from going into full-on panic attacks and other anxiety-induced behaviors.  There are so many coping mechanisms out there, and while not all of them work for each person, everyone was able to find something that they could put in their wheelhouse.  I’ve touched on some of these already in earlier posts, but the ones I have found most useful were 5,4,3,2,1 (where you identify 5 things you see, 4 things you touch, 3 things you hear, 2 things you smell, and 1 thing you taste) and Leaves on a Stream (which you visualize a stream and put thoughts on leaves that are floating down the stream…when they are out of sight, you don’t let yourself think of those things anymore).

Acceptance and Commitment Therapy:

ACT encouraged us to recognize and identify our different traumas/experiences and to actively learn how to accept what had happened to us.  “Radical acceptance” is a term they threw around a lot and at first, I balked at the idea and angrily told them that I couldn’t just think that everything was ok that had happened in my life. I couldn’t ignore the evil or the injustice of some of it because wouldn’t I then be complicit in it?  We can’t just blindly accept everything and sing kumbaya afterwards.

I zealously felt self-righteous until I realized that I was the dummy, and the one who misunderstood the whole concept.  Unfortunately for me, the group therapist who introduced this concept to me was uneducated and shouldn’t have been teaching things she didn’t know well enough herself.  In reality, radical acceptance is the idea that we accept the things in our life that we cannot change by looking at them, recognizing them for what they are (bad things do happen to good people), and not judging them (or yourself).  By doing this we ease our own suffering.  I won’t lie…this is a really complicated topic, and I am still trying to wrap my mind around it.

Narrative Therapy:

Narrative therapy was right up my alley since writing was the mechanism with which we processed things.  I wrote journal-esque entries, letters to my former self, letters to my dead dad, letters to other people who had hurt me, insightful snippets to my kid self, etc.  Oooof, I cried a lot during these. They were super cathartic to do though. 

The PTSD-intensive group therapy I took back in 2022 had been life changing for me. For years, I had avoided thinking about my dad and suppressed all my emotions so that I could function.  Six years later and I had never actually grieved my dad’s passing, and the PTSD therapy finally allowed me to do that. Narrative therapy in PHP was helpful for me too to process other ways my dad had significantly affected me life besides for killing himself. Because of this, I was finally able to recognize and admit that my dad was a shitty parent.  It gave me the ability to hold him accountable in a way as well as forgive myself for all the things I had always blamed myself for but had actually come from him.

Art Therapy

Art therapy was probably my least favorite session, unless I was writing poetry.  I called it “Arts and Crafts” time because a therapist would usually facilitate some activity like making a collage of magazine pictures/phrases, coloring a mandala, creating a word jar, etc. 

Lots of paint and markers and crayons. 

I think the idea was for us to develop/increase self-esteem, to feel positive and productive, to be creative and see where that took us in regards to what we had been through.  I liked the concept, but honestly most people just liked Arts and Craft time because it was easy and it allowed them to NOT have to think for that session. For me personally, the creative stuff benefited me maybe once a month, but having a session every day drove me nuts.  I felt like I was in kindergarten again and I didn’t know about the others, but I was choosing to be there to think/process. My insurance was also paying A LOT of money for me to be working through my shit (and I was pretty sure playing with crayons would not have met whatever criteria they had for therapeutic engagement).

Process Group

In addition to the psychoeducation and artsy time, we had a session every day in the afternoon in which the manager (who was also a Licensed Professional Counselor) would lead an hour of us just talking.  Literally.  He would introduce himself and then tell us this was a time for us to open up and share with the group about things that were bothering us/reasons we were there. While Arts and Crafts time annoyed me, Process Group made my anxiety go through the roof. Sometimes people would share about really terrible things that had happened to them, which triggered me and sent me into multiple dissociative seizures while I was there.  I am very very sensitive, which in some ways is a gift, but in others, really made it difficult for me to function.  Not only was I trying to deal with my stuff, I was also feeling what these other people were going through and I honestly could not handle both. 

So, that made Process Group hard. 

But most of the time, people just complained about every day stuff.  Unfortunately for me, the groups were overpopulated with young adults.  There was an 18-year-old kid there because their parents made them go and who literally complained about how soggy burgers made them feel angry.  One 19-year-old kid whined about how hard his life was because his parents still made him have a curfew at midnight.  He had also tried to kill himself because he hadn’t made the swim team. 

Overall, the conversations tended to be very immature and shallow.  I know that these were things that were really terrible in their minds, but I honestly just wanted to strangle them most of the time.  I tried to listen to them and take them seriously, but I felt like I had lived 20 more lives than they had.  I was more mature when I was 11 than these guys were.  While they harped on their parents or their curfew or their next vape, I had real problems that I was dealing with.  I seldom shared in Process Group because I felt like my issues were so utterly foreign to these kids and it was hard to take their trite solutions that they inevitably always offered. 

Practically speaking, it was also hard for me to share in Process Group because it was always our largest group.  The fewer people there were in a group, the more I tended to talk. I am embarrassed now looking back.  In my mind, I was so judgmental and harsh towards these people, but I really shouldn’t have been judging them about what they thought was therapy worthy.  Regardless of what they were suffering with, they needed help too. 

During these months though, I was angry. 

• Angry at everything in my life that was unfair and hard and wrong.
• Angry at the people in my life who should have protected me but hurt me instead. 
• Angry at my body which acted as my biggest nemesis.
• Angry at medical professionals who have gaslit me, dismissed me, given me wrong medications, misdiagnosed me, blamed me, yelled at me, gave me wrong information, made everything so much more difficult than it had to be, etc.
• Angry at the therapist who led Process Group because he didn’t lead.  I wanted answers, I wanted help, but he just sat there while we flailed along.  He never answered any of my questions.

The Result of All That Therapy

It took a while, but I began to see improvements. 

When I first started PHP, I didn’t even realize how bad my self-esteem was.  I loathed myself.  My thoughts, every day, all day, were thoughts about how ugly I was, how stupid, how useless, how worthless, how wrong, how broken, how I deserved what I got (a body that didn’t work, a husband who didn’t understand, etc.).  It was appalling.  The therapy and activities we did didn’t necessarily make me feel great about myself, but they helped me to stop shitting on myself so badly.  I got to where I could go whole days without thinking one bad thought about myself and wow, that definitely made a positive difference. 

As I went along, I became less harsh, more internally accepting of the young kids in there.  I still believed that the program should have two groups of people: the young adults aged 18-25 and then the rest of us real adults.  But the more I listened and the more I shared the more I realized that people are just people.  Everyone needs therapy honestly.  I was 18 once too (granted, I was never entitled like these guys and I still had heavier things to deal with than these people did).  Mental illness does not cherry pick only certain individuals… it affects anyone and everyone. Regardless of your age, race, ethnicity, gender, sexual orientation, education, intelligence, geographical location, personality, sensitivity, religious beliefs, socioeconomic status, etc., mental illness grabs hold of people and swallows them whole. 

Some people seek help while others don’t. 

Some are affected deeply and chronically, while others just struggle seasonally or during times of high stress.

Some people take medication, others refuse.

Some people become defined by their mental illness and allow it to shape their decisions and behavior, while others fight, fight, fight the effects of what mental illness is doing to them. 

We all are on a journey, but we are each on different parts of the journey, different places on the spectrum of life, different paths of seeking happiness as human beings.

I also learned how to have more control over my dissociative seizures.  One of the therapists there would sit with me while I had them. Sometimes she was just silent, but she let her presence be known. Other times, she would encourage me that I was doing really well, remind me to breathe, tell me it was ok that I was in this space. Somehow, she knew when to say that everything would be ok, that we weren’t going to the ER, and that I could take however long I needed.  My dissociative episodes started getting shorter and I was able to get my body to calm down and stop shaking.  The fear and the panic associated with them diminished as my ability to affect and control them increased. 

This alone would have been reason enough to go to PHP for 3 months.

Most impressive during my time in the PHP in Maryland was how it forced me to identify the trauma that had gotten me to this place to begin with.  Some of my trauma, I already knew.  But there were other things that had affected me that I didn’t even realize until I was there facing it.  For the first time, I felt like I was able to really look at things, dissect them, classify them as things I needed to accept or things that I needed to continue working on.  I worked through (some more than others)

• childhood experiences with my dad, including his leaving when I was 12 and me growing up as a mini adult
• religious trauma of growing up in a strict, conservative Christian church
• medical trauma of being sick for most of my life but not being diagnosed with Ehlers-Danlos Syndrome until I was 30 (and all that entailed)
• being engaged to an (emotionally, verbally, sexually) abusive person in my mid-20s
• losing my faith
• losing my cat, my dad, my grandmother, and my dream of working as a PT in 2016
• losing my ability to dance because of my EDS, which was a huge part of my identity and one of the few things that truly gave me joy and allowed me to be me
• losing my mind in 2021
• losing my ability to hold on to a job, to contribute, to be enough for my husband
• having an incurable, degenerative disease that causes me to be in pain most days and prevents me from being “normal”

I realized that I had a lot of grief and loss that I had never really processed and recognizing it was both validating and intimidating.  Despite my improvements, I still felt irrevocably broken.

Adam’s Part

The more I learned and the more I improved, the less my husband seemed to understand.  After a month of PHP, he began pressuring me to find a job again.  When I told him I couldn’t find a job during full-time therapy, he would then pressure me into finishing up therapy.  When are you going to be done?  Are you ever going to be done? Why aren’t you fixed yet? He asked these questions over and over again.  Most of the time, I didn’t know how to answer, but every time he asked them, the more broken I felt, the more I felt like he was resenting me.  Even though we had already reached our deductible with health insurance, he didn’t want to continue paying for treatment and when I stepped down to IOP (which was pretty much the exact same thing as PHP, just for half a day instead of a whole day) he made it very clear that I should not need more therapy.  So, I stopped.  Instead of the month that my individual professional therapist recommended, I attended IOP for a week and then quit.

During these months I tried other things to make Adam happy.  I started the disability process with an attorney in January, the idea being that if I couldn’t hold down a full-time job, then at least I would be bringing in some money to help with expenses. I created this website with the intention of reviewing things I have learned in therapy and sharing resources with others who may not have the opportunity/ability to go to therapy. This enabled me to feel like I was contributing something positive to the world too. I also worked on publishing my book, hoping that I would eventually be able to make some money from that and give it to Adam for our expenses. I invited Adam to attend some of my individual therapy sessions so that he could hear from someone else what I was going through and what I needed. We started marital counseling.  I tried talking to him and giving him more details about my days spent in therapy (which he wanted), though it was hard for me to explain my progress in a way that made sense to him. I shared things that I learned, like triggers and coping strategies and insights into myself. I missed a lot of days of therapy because of pain, and I tried talking about that more to him too since in the past I had always done my best to hide it so I wouldn’t make him uncomfortable or upset.

Despite how hard I was working to get better, Adam dismissed how important therapy was.  He wanted me to be better, to be the Rachel he originally married.  He behaved like if we just didn’t feed the ideas of EDS (and what it was doing to my body) and trauma (which I had suppressed so long and was literally causing me to lose my fucking mind), then we could be normal and we could do normal things.  I felt like Adam was living in a fantasy world and the more I shared with him the more I felt isolated, alone, abandoned, bereft.  I cried often, asking him to support me, telling him I needed to feel like he was with me and not against me with all of this.  I apologized again and again that I was too sick to hold a job, that I wasn’t contributing, that I needed all this therapy to begin with. 

At one point, Adam bought tickets for a play in Annapolis, which we attended with his mom.  It was a unique theatre in that the audience sat in a circle surrounding the players and we sat in the front closest to them.  I had no idea what the play was about, but I knew Adam had researched it a lot, because he always does that before he buys something.  What was supposed to be a nice evening turned into a terrible struggle for me. 

The play ended up being about a woman in the not-too-distant future who struggles with Alzheimer’s (trigger #1 since it reminded me of my Nana who had died from Alzheimer’s on my birthday).  She had a robot who looked like her dead husband and whose function was to try to jog her memory every day.  It is not clear in the play whether her Alzheimer’s makes her forget things or if some of the things in her life are too terrible to remember, such as her son shooting her dog and then himself when he was a kid (trigger #2 just because it was so emotionally jarring).  When the woman was alive, her daughter did not have a good relationship with her mother, but once the mom dies, the daughter has a crisis of faith and questions how life can truly be worth living if we are all destined to just forget it as we age (trigger #3 because I struggled with some of the same thoughts as she did).  The story ends with the daughter hanging herself in a tree (trigger #4 because this is how my dad died and trigger #5 because this seemed proof that if a fictional character can’t even pull herself together and succumbs to suicide, where does that leave me?) 

I couldn’t leave the theatre early because of the way it was set up. I would have disrupted the whole thing.  So, I sat there getting closer and closer to a panic attack or dissociative seizure and I was in tears when we finally left.  The whole way walking to the car and driving home, I kept on using my coping mechanisms I had learned at therapy to ground me and to calm me down.  Adam asked me why I was so upset.  I deflated, because Adam not only knew about these triggers, he had lived most of them with me! I was able to hold onto myself, but once we got home, I went straight to bed and cried and cried myself to sleep. I could hear him in the kitchen asking his mom if she knew what my problem was.  In the morning, I told him everything I felt and why it had affected me so much, and he looked at me blankly.  “Those things happened a long time ago now, Rachel.” And then he dismissed my concerns by ending the conversation and not bringing it up again.  No apology (that I remember).

Please understand I am not trying to bash Adam.  Adam loved me very much and he showed it by all the hours he worked, the income he provided, the house we bought (mainly for me), the travels we took (he had also allowed me to plan a trip to Morocco with his mom and my mom for September 2024), the nice things we had, the medical and mental treatment that I had.  I bring this play up because it was one of the big things in my mind that proved that Adam was just unable to be sympathetic or empathetic with me.  I truly don’t even think it was his fault.  I don’t think he meant to be mean.  I did know that Adam loved me.  All those things I said above proved it, as well as when he did make an effort to comfort me, when he did hug me, and when he told me he loved me.

The problem was not that Adam didn’t love me.  The problem was that I didn’t love myself.  That I didn’t feel loved.

March 2024

By this point I was just tired and defeated trying to fight for my need for help. PHP had been so good for me, but despite all that I had learned, Adam didn’t believe I had gotten better at all. All that hard work seemed to be for nothing since it didn’t help our relationship.

The suicidal ideation returned (it had been blessedly silent for the first two months of PHP).  The thoughts about death and dying and ways to die became an every day occurrence again and I just tried my best to ignore them.  I didn’t know what else to do.  I changed psychiatrists and they changed my meds a few times in the hope of finding something else to help the depression that was creeping back in with a vengeance.

I decided to go down south to visit my family, hoping they would cheer me up.  They did, and it was a relief to be away from Adam’s criticism for a couple weeks.  The friends and family I saw on this trip all expressed worry and concern over me and I finally admitted that something had to change at home.  I didn’t want to leave Adam, but I also recognized that he was not good for me.  That no matter how much I loved him (and he me), he was hurting me. That I literally might not make it if I stayed with him and didn’t change something.

To be continued in Part III…