Tuesday, 20 March 2012

Charting stress, dissociation and fatigue to assess the links

I'm pissed off with Blogger today. Why does it think it's OK to randomly change my blog url without letting me know? And where has the fucking 'edit' button gone at the bottom of the posts so that when I've posted my ramblings I can easily go back and fix it after Blogger has decided to spontaneously delete a chunk of my writing? Love hate.

I mentioned briefly last week that New Psychologist asked me to fill in a chart of everything I was doing every hour for a week and rate on a scale of one to ten: fatigue, stress and dissociation. I think she wanted to do some kind of statistical analysis on the data to see if there's any link between the chronic fatigue syndrome and the psycho brain. I only remembered half way through the week though that she specifically said, I could edit the scale or charts but to make sure I kept the hour by hour ratings going. Oops. For the first three days I was rating the parameters by activity e.g. 1300-1530: sitting on my arse watching TV... Fatigue = 6 Stress = 3 (Home and Away can be pretty nail biting at times), Dissociation = 5 etc.

Once I'd realised that I had fucked it up I had a look through to see how difficult it would be to fix it into an hour by hour chart but it was looking like it would take someone with a fatigue of less than 'two' and I was at about a 'six' at that point so I decided it was something she could do herself if she's that bothered.

Turned out, she was bothered because she has now asked me to do the ENTIRE task again. Sigh. It's quite a consuming task and as a few of you rightly pointed out, it's sometimes very difficult to rate dissociation. I'm just doing my best though. Generally dissociation doesn't really go below a five, because I rarely feel 'real' or 'alive'. Most of the time I feel like I am an observer sitting far back on the edge of my consciousness watching a robot going about my life for me. A six would probably be once I start getting visual disturbances or floaty feelings and a seven is zoning out etc. But even then, if I'm on my own, sometimes I'll zone out without realising it and so it's impossible to rate that. There have been a few hours I haven't been able to account for.

Anyway, NP did have a look at the first weeks charts and at the session last week she proudly announced that after reviewing my charts she felt there is a strong link between stress and dissociation... get that girl a medal! Who would ever have thought that dissociation might happen when I'm stressed? OK so she's new to this maybe. I nodded and let her continue. She said it was very clear that I 'use' dissociation as an avoidance technique when I'm in stressful situations or triggers arise. I know this, but from her explanation of her views, I got the sense that she feels it's something I consciously do. I don't think to myself: "I don't like the way this man is looking at me so I might just zone out now and come back to in a few minutes". It's not conscious like that. It just happens. She says that on some level it is intentional though. I get what she means but it doesn't mean that I can stop it from happening. It just happens.

I had also decided to rate 'pain' as a parameter as I've always felt sure that the recurrant varieties of pains I get are related to stress and dissociation. NP agreed with this theory and talked about somatic symptoms which can occur with dissociative disorders. Sometimes it's easier for the body to express it's reaction to trauma than for the person to feel the emotions. She was preaching to the choir with that one, but it's good that we're singing from the same hymn sheet (huh... she must also be in the choir).

She did have some other interesting insights though: she noticed that I tend to get higher levels of dissociation as well as 'flashbacks' and intrusive thoughts around bedtime and when I'm showering/bathing. She wondered if this might be something to do with the process of undressing and being naked. It's not something I'd consciously thought about. I do struggle with showers at times. Sometimes I find myself becoming overwhelmed with anger for no apparent reason and banging my fists on the walls in the shower, which brings Adam running up to see what I need. Oops. Sometimes I've found myself curling into a ball and crying or most commonly, scrubbing my skin raw like a maniac thinking "I can't get clean! Must wash off the badness!" But bedtime... well there's the theory of getting undressed... or the whole 'bed' thing. But really I think the main reason it happens when I get into bed is because there's nothing left to distract myself with. During the day, no matter if I have the energy of a normal person or of a person with chronic fatigue syndrome, there is ALWAYS something I can do to distract myself and prevent intrusions into my consciousness. I think I just spend my whole life doing that... avoiding. Then, once I get into bed at night, it just all comes flooding back in.

I expressed this view to NP and she must have thought of that herself because she whipped out a pre-copied diagram and gave it to me to look at. It showed a flow chart of a dissociative brain which suggested that there is avoidance, where the individual (so to speak) doesn't allow consciousness of traumatic material, then there is the other extreme, where they become overwhelmed and too immersed in it and then this either leads to dissociation or switching to an alter personality. Sigh... I'll look for it and give you a better explanation. She suggested that we need to learn to be able to tolerate thinking about the difficult things without dissociating, so she wondered if perhaps we might start with thinking about something more current that causes emotions and try to talk about that. She felt this could help me 'learn' how to be present with less painful things and so I could build up a tolerance so that I might get to the stage of being able to think and talk about the really bad stuff.

Something about how she explained that freaked me out and I ended up zoning out and getting dissociated right there in the session. I think in my head, it felt like she meant that this would happen very quickly and I was scared that I'd be asked to talk about things I'm not ready to even think about. She can be quite astute. She reassured me that this was not going to happen any time soon and that she didn't expect that work would be done with her (meaning, T is still due to return after six months) and that I should be reassured that I won't be rushed into anything. It didn't mean a lot to me at the time but I have found those words comforting this week. She's not so bad. She is trying.

I sense that she's anxious about working with me. I wonder if it's the 'label' of dissociative identity disorder. Maybe she feels ill equipped to deal with the condition and so is relying heavily on text book advice and research papers. I do think that those are important, however, I can't help but think if she relaxed a bit and got to know me she'd learn a whole lot more about the condition.

To finish with a final Blogger complaint: the spell checker is not working today (either that or I haven't made any mistakes, which would be a frickin first) so I apologise for any mistakes in this.


Justine said...

Hi Candycan,
She is trying isn't she? In both senses of the word! It feels like she is gaining an understanding of DID (which is to her credit) but then presents it to you as if it's all new to you too - very frustrating for you.

I really agree with your last comments - that if she just tried to get to know you it would all be easier. Her approach is very behavoiural isn't? there's space for that in therapy I guess,e specially in short term work, but I always respond better when someone comes alongside me then listens, waits until I'm ready and then trusts that I am doing the best i can do for myself. Which you are - at least I think so :)
P.s Have exactly those probs with showering.

Candycan said...

lol, she IS trying, yes. I like the way you word it: that she's gaining an understanding of DID then presenting it to me as if it's new to me too. That's exactly how it is. It doesn't bother me excessively, because as you say, at least she is trying. But you're right, her behavioural approach is good in some ways but she'd get further in her understanding if she took a step back and relaxed a little and just got to know me without trying to apply diagrams to everything I say.
But I'll take diagrams over interrupting any day! Thanks for reading. Sorry to hear that you have the same problems with showering. It's reassuring when other people are similar, not that I'd wish bad things on you, but I hope you know what I mean.

TattooedMultiple said...

Another brilliant blog, you make me feel normal reading it. Could you share a blank one sounds like a good helpful thing to do and show our therapist

Ellen said...

She does seem very focused on 'tools' and methods, and that could be a sign of her insecurity. I went to a psychologist once and she also had lots of charts, hand-outs and specific methods, so maybe that is the training.

Sounds like a good plan to start being accustomed to smaller uncomfortable feelings.

Pretty funny, her linking dissociation to stress...and avoidance! wow. no kidding. :-)

Candycan said...

Hi TM, I will see if I can add the template for the charts. My laptop is playing up at the moment but I will get onto it asap! Glad my blog strikes a chord with you. It's always good to meet others with similar issues.

Hi Ellen, I think you're right about it being to do with insecurity. I think she feels inexperienced with DID and makes up for it in research and background reading. It has its advantages too.