It was the last week in May 2014. I had packed up all my belongings in my flat, got my affairs in order, and decided that I needed ‘to be dead’. I didn’t want anyone else to have to clear my flat, so I took some stuff to the tip, packed my remaining belongings into labelled boxes, and wrote detailed instructions. The conflict, pain and despair of the last few months disappeared. I was calm, logical and rational (or so it seemed). Life was too painful, too overwhelming. It was hopeless and empty. This wasn’t a temporary blip—I had been here before. Yes, I had survived it then and yes, it had improved, but then it always got worse again. In a cycle, the pain and struggle would overwhelm me and hope would evaporate. I couldn’t see any way out. I was stuck in the now, and now was too much and too difficult to bear.
But somehow I didn’t die. I went to my appointment at the mental health centre in order not to arouse suspicion. But on this occasion, I couldn’t maintain my competent, capable front, and I watched myself telling them how I was really feeling. The on-call psychiatrist was called in and after ten minutes, despite never having met me before, she decided that I needed to be admitted. I pointed out my Advance Statement—a plan for crisis times to signpost myself and others towards the most/least helpful interventions—and it clearly said that hospital admissions were not advised as they caused greater dysregulation and triggering of past trauma. But it was Friday, it was her leaving ‘do’ that afternoon and ‘The risk needs to be managed.’ Rather than focusing on re-regulating me and soothing my distress, I was treated simply as a risk that no-one wanted to be left with. I was given the option of either going voluntarily or on a 28-day Section with a police escort, and they had already drawn up the paperwork for the Section in case I didn’t ‘co-operate’. Being terrified of the police and knowing that if sectioned my parents could be contacted as my ‘nearest relative’, I submitted to what seemed the lesser of two evils.
I was taken to the ward, led down a corridor to a bedroom and my possessions were inventoried and then mostly removed. When you’re distressed and suicidal, a stranger rifling through your knickers doesn’t help return you to your window of tolerance. As I sat there, the feelings of despair and entrapment simply increased, compounded by shame. What had I done? Why had I told them how bad it was? Why hadn’t I got on with killing myself earlier? By telling, I had simply made things infinitely worse. I was on ‘observations’, which involved someone peering through the window at me and ticking me off their list. But on one occasion the nurse opened the door, saw the tears which I could no longer contain, and said, ‘Sitting there crying isn’t going to help.’ She didn’t offer any alternative of what else might help, but feelings of desperation and fear were obviously not acceptable in this hospital-cum-prison cell, with its bare rooms, frequent alarms and the screams of the girl next door being pinned down and sedated because she had tried to escape.
Five hours later I approached the nurses’ station and asked to see a doctor. I flagged up my Advance Statement but again they didn’t want to know about it, let alone read it or implement it. When I tried to explain that hospital was not advisable, I was curtly informed, ‘You’re a voluntary patient—you chose to be here.’ I had to wait to be assessed by the consultant but it was now 5.00 pm and he had gone home for the weekend. And if I try to leave? ‘Then you’ll be sectioned.’
Being at the point of such utter desperation that you see death as the only option is a tough place to be. It’s the only thing you feel you have any control over, so being detained in the mental health system is far, far worse. It is degrading, dehumanising and disempowering and removes the last vestiges of control over yourself and your situation: it reinforces the sense of powerlessness that you’re already struggling to cope with after trauma.Over the previous ten years I had had a number of admissions to various hospitals. None of them had helped, but ‘the risk had to be contained.’ During those admissions I received no treatment and nor was I allowed to see my therapist, either because she wasn’t employed by that particular Trust or because she was Primary rather than Tertiary Care.
In 2003 I acquired the label ‘emotionally unstable personality disorder’, also known as borderline personality disorder. It had been a postscript in a doctor’s letter to my GP after a suicide attempt, when he wasn’t sure what was going on with me. This label subsequently meant that, during these admissions, no one saw or asked about my trauma or the reason behind my symptoms. Instead I was viewed and treated as having a characterological and untreatable flaw, with the presumption that I would never be ‘fixed’. It made me feel that I must be really, really bad—not mad, and certainly not traumatised. Just wrong.
In the psychiatric unit that Friday, I was eventually allowed to have my phone and uncharacteristically I reached out for help. I contacted a friend connected with PODS. Miraculously she dropped everything and came to see me. Even more miraculously, she was allowed to take me home with her—without anyone checking who she was, and without me speaking to a doctor. I suspected that they were relieved to pass responsibility for the risk, but for me it was a miracle. And yet it also terrified me: why had they agreed to her request, but not mine? And if she could just walk in here and talk them into my release, how easily could my abusers also have done so?
I spent the weekend with this friend. We talked but mostly we walked. We did normal things like visiting a museum, reading in Waterstones, going out for lunch. I felt like a fraud: if I had really wanted so badly to be dead, would I be sat here now, curled up, reading The Hunger Games? But the normality, routine, movement and left brain activities had calmed my amygdala and helped me to get back in my window of tolerance. Once regulated, we talked about what had led to this point: my belief that I made no difference to anyone or anything by being alive, other than to cause trouble and problems. The symptoms of trauma—agitation, hypervigilance, insomnia, body memories, emotional flooding—plagued me day and night. The dissociative parts of my personality were all pulling in different directions in a frantic bid to survive. I was fighting a losing battle to avoid and block out the memories. Sitting here in 2016 I now know that the same part of the brain that deals with memory also handles imagination. I was fervently doing everything I could to not remember, but perhaps that was also making it so much harder to imagine a life beyond all of this.
My second belief was that I didn’t have a life, let alone a life worth living. As well as battling the dissociation and denial, life was a merry-go-round of appointments talking about my ‘care’, or rather talking about how to manage my ‘symptoms’. I had no interests, I did nothing, I went nowhere. Not surprisingly, many friends found me hard work because I had nothing to contribute to a conversation. ‘How was your week?’ they would ask. But I didn’t want to relay the minutiae of the latest traumatic memory, nor discuss how many appointments I had attended that week. Instead of enjoying the company of friends, I was engulfed by shame and so I started to avoid them.
So that weekend in May 2014, I cried, ‘But what’s the point in doing all this painful and heart-rending work in therapy, when I have no life worth doing it for?!’ My friend calmly and brutally replied, ‘So what are you going do about it then?’ She acknowledged how painful it was, but she also refused to believe that this was all it would be or could be. She understood that I couldn’t see a way out, but she asked me to believe—to choose to believe—that she could. Would I borrow her belief and imagination until mine grew?
It was a weekend that changed the direction of my life. That act of generosity gave me a first experience of someone standing up for me and protecting me. But also because I used our discussions during that weekend as a springboard. I started to understand that powerlessness is the core essence of trauma, and the entrapment, despair and helplessness i was feeling were actually emotional memories—feeling flashbacks. To change things, I had to move out of being powerless and find my agency and autonomy. I had always read voraciously and attended training days, believing knowledge to be power and a major pathway towards recovery, but I now had to enact this knowledge. I had to apply it. I had to live it.
As therapists so often say, ‘It’s not happening now.’ And I knew cognitively that the abuse was over, but I wasn’t living as if it were over. I had survived the most unimaginable things. I had escaped—moved away, cut off contact with my abusers. I had surrounded myself with mostly safe people. And yet I still lived in a terrified way. A child uses a secure base to develop the confidence to explore and investigate new things. Living terrified, I had to do it the other way around—I had to start exploring and investigating, in order to demonstrate to myself that I was safe and secure. So I started to take little, seemingly insignificant, steps. I bought and tried one new food each week. I signed up for a free month’s trial of Spotify and listened to lots of new music until I discovered what I liked. I bought a subscription for National Geographic magazine with my Clubcard vouchers, so that I could remind myself just how incredible and vast our planet is. I took train trips to the beach and found a literal safe space which I’ve returned to time and time again. All of these inconsequential, ‘normal’ things that other people did, and which I had stopped doing or had never even started doing, became the focus of my life rather than just surviving my symptoms. And as I did them my confidence and sense of adventure grew.
I felt undeserving and unworthy, and yet I started to realise that this was how I was treating myself. I had always felt guilty about spending money, having nice things or doing anything pleasurable, because I was on benefits and the message I had from the entire welfare system was, ‘Taxpayers are stumping up for you and you should be ashamed of your scrounging.’ Whilst remaining financially wise, I started to give myself a few good things. I bought a Café Nero gift card and went there on Saturdays with the newspaper or a good book. My therapist cancelled two sessions due to sickness and so I used the money for a subscription to National Trust. I couldn’t afford a holiday so I went to housesit for a friend, and went walking, took a boat trip and explored new places. Two months after my non-stay in hospital, I moved house. I’d realised how much I hated living in a grotty little flat in the middle of a big city, and that I needed fresh air and vista. I’d kept myself locked into the misery of that flat, because I hadn’t felt that I deserved anything better, especially because I was on benefits, but also because of my trauma history. Although I only stayed in the new house for 9 months, it was a massive stepping stone for me in terms of my future, believing that I could have some good things in my life and that there was a point in building a future.
A pivotal change for me was in my relationship with mental health services. I know I wasn’t always easy to work with, and some staff patiently gave me hours of their time, for which I am grateful. I can recognise now how frustrating it must have been for them, when I began to speak of my struggles, or articulate my true feelings, and then suddenly I shut down and withdrew. After attending a scheduled appointment and appearing fine, just hours later I would make a serious suicide attempt or dangerously self-harm. I know now that this was the outworking of disorganised attachment and dissociation. My Trust didn’t have a code for dissociative disorders, let alone an understanding of how they present, and so at times my behaviours were interpreted as problematic and resistant, or that I was wilfully refusing to engage and be co-operative.
The label of ‘emotionally unstable personality disorder’ is strongly associated with attention-seeking behaviour and excessive cries for help, and yet I was often told that I was a ‘dangerous patient’ because I didn’t communicate my distress or disclose my self-harming or suicidal ideation. ‘If only you would tell us how bad you feel,’ they would say. ‘We can’t help you if we don’t know what’s going on.’ But I couldn’t. Back then I didn’t dare mention the flashbacks I was having of ritual abuse. I didn’t have words for the body memories I was experiencing, of being raped at age 5. I couldn’t even hint at pregnancies, babies, and death. The deeply ingrained injunction ‘Do not tell’ still ruled me.
I was stuck in a vicious cycle of trying to avoid and run from my memories and the cause of my pain, but also wanting someone big and strong and parental to make it all better. I hated that unspoken need, but couldn’t relinquish it. I subconsciously wanted someone to see and notice my distress without me having to verbalise it; I wanted someone to soothe and care. And in the mental health system, it is so easy to fall into the child position. After all, it is called the ‘care’ system; you are assigned a ‘care’ coordinator; you have a ‘care’ team which meets to review your ‘care’ needs, and make a ‘care’ plan. And yet the care just wasn’t there, and I was replaying the dynamics of original family patterns of neglect and abuse. Often I wasn’t seen or heard, and I couldn’t tell. When I was most distressed and most in need of regulating and soothing, I was locked away from the normal world to be ‘cared for’ by strangers. They gave me medication, left me alone for hours, or instructed me to go to sleep while a man sat watch at the end of the bed.
At times, however, I did experience moments of care. There was a wonderful Nigerian nurse called Isaac who would take me to play table tennis. When interrupted by other staff, he would loudly respond, ‘I’m giving Karen her meds!’ A junior doctor on her first rotation, perhaps too fresh to become jaded or narrow-minded, would check in with me for ten minutes each day. She wrote on a piece of paper and stuck it on my wall: ‘You’re doing okay. You will be okay. You can do this.’ I still have that piece of paper.
I was stuck trying to elicit care to relieve the pain, believing that I needed it from this parental ‘care system’. If only I could explain better, then they would understand me better, and it would all be okay. If I could just be good, do what they wanted me to do, then maybe it would all be okay. But no service, no nurse and no psychiatrist can make it all better: they simply aren’t that powerful. Over the months that followed that weekend in May 2014, I began to realise that I had to stop giving them that power. I began to understand that there was no cure or treatment that someone else could administer to me, to magic me better, and that I had to stop defining myself by the boxes and codes and labels they used (or were forced to use). I had to stop trying to get them to understand me or believe me, but I had to focus instead on understanding, believing and knowing myself.
I also realised that I’d come to believe that I was dealing with stuff simply because I was ‘in the system’. In reality it was doing nothing to address the underlying trauma or to calm my oversensitised neurobiology. I was just spending my whole time getting worked up about my next appointment, wondering what to say and how to say it, wondering how I could make myself heard. I was caught up in a battle to be understood, rather than a battle to recover.
I knew that I couldn’t recover entirely alone—in the same way that I would have remained in the psychiatric unit that Friday if I had had no one to help. But I shifted more towards using the system and its staff as tools. I plied my social worker for practical advice about where to get my car fixed, or clubs to join. I even discussed recipe ideas for Christmas lunch with my psychiatrist. I used my CPN as a kind of auxiliary imagination, and together we came up with flashcards full of ideas of things to do when life was tricky—but also when life was good. When I saw my GP, I excitedly told her about the new things that I’d tried that week. When things were tough, I thanked her for her patience, rather than apologising for being a time waster. I started the painful and risky journey of being more real and vulnerable with selected friends. But we also planned activities that we could do together, like the cinema, a good walk, baking gingerbread—things that didn’t revolve around trauma and struggle.
In April 2015, after 13 years of involvement with mental health services, I requested to be discharged from the service, and they agreed to it. It felt incredible!
There have been many bumps in the road since that weekend in May 2014. I had worked with a private therapist since 2012, a decision I made when my therapy with an amazing NHS psychotherapist ended due to service closures. Further appropriate treatment wasn’t available on the NHS and so I made the choice to go privately and self-funded this despite being on benefits. However after three years she informed me that she could no longer work with me, with immediate effect. It was devastating news, but I was faced with a moment of choice: I could descend into a pit of despair and mistrust, reaffirming my beliefs from the past that I was bad, too much for people and would always be abandoned; or I could choose to put into practice all these things I had been learning. Thankfully I chose the latter and found another therapist to work with. It was awful and difficult and terrifying, but I did it anyway. And so I learnt another important lesson—I can’t always choose what happens but I can choose how I respond to it.
The most life-changing challenge I took next was returning to work. A lifetime ago I had gained a first class degree, set up and coordinated various children’s projects, travelled overseas on missions trips and held down several jobs at a time. But that was in my ‘pre-trauma-awareness’ days when I would do everything at speed to keep the craziness at bay. I would go flat out and then crash and burn. I wanted it to be different this time.
So I began with voluntary work, which made a huge difference. For one thing I was contributing to something bigger than me, and bigger than my suffering. Secondly, I was engaged with other people, focused together on a task, rather than stuck in my aloneness and purposelessness. I learnt to build in routine to my days and week. I worked hard on ways to manage my window of tolerance because other people depended on me being okay. I rediscovered the talents and gifts I had lost sight of under the trauma symptoms. I learned new skills, overcame some phobias and acquired daily ‘acts of triumph’. Many things still scared and triggered me—but would I let them dominate or would I overcome them in order to be able to do the job I wanted to do? Few people who have spoken to me on the PODS office phone would realise that only last year I couldn’t and wouldn’t speak on the phone. But I was asked to cover the office during staff holiday and I was presented with a choice: would the trigger win, or would I be able to overcome it, remembering that it is just a trigger? It is just an association, where two things have been coupled, and I could decouple them and associate the phone with competency rather than terror. And I did, and now I love answering the phone! Likewise, having ‘to do’ lists and project plans, rather than overwhelming me as they might have done in the past, gave me a sense of future—I had to stay alive beyond tomorrow and next week and even next month because I was committed to events and things happening which were reliant on me.
A year after my trip to the psychiatric hospital, I started working full-time for PODS, and moved to Cambridgeshire to take up my post. What a difference a year makes! I had built up to it gradually over the previous few months, moving from volunteering to some part time hours, proving myself not just to my employers but mainly to myself. They didn’t treat me with kid gloves but expected just as much of me as anyone else. But that has only added to my sense of achievement and pride. Coming off benefits fully after nearly ten years was a milestone for me and a huge relief. For the first time, I had that sense that I had worked hard to earn my money, and that it was my money which I could choose how to spend or save. I could pay money into my current account without worrying how the £20 I got from someone for a second hand bed would look on my statement to the Benefits Agency.
It is still a tricky balance for me, and I still struggle. I’m not magically all better, and I’m very far from some nebulous concept of being ‘recovered’. It can be very hard when I have a session in therapy dealing with trauma, and an hour later I’m back in the office. The trauma is still as painful and as awful. But alongside that I have a new, good life that I have chiselled out for myself. My daily new challenges at work—how to work as part of a team, how to manage my time, how to manage others, how to deal with stress—are growing my front brain and giving me a sense of mastery of life.
After years and years in the mental health system and struggling with a life just full of trauma symptoms, I struggled with feeling inadequate, incompetent and ‘damaged’. But I am learning to stand tall within myself and refuse to believe that I am fundamentally flawed as a person. I have to choose to believe that I have worth and value and deserve good things. But perhaps most importantly I have had to stop seeing myself as a powerless victim who is dependent on external services for my recovery. I had to do some big things and a thousand small things to make these changes. And I still have to do these things every day. But I’m so glad I did, because life is so different for me now. As I sit here at my desk in the PODS office, less than two years on from last trying to kill myself, there is still a journey ahead, but I can honestly and wholeheartedly say that I have a purpose and a place in the world, I am glad to be alive, and I have a life that is worth living.