It wasn’t an easy decision, but perhaps it was an inevitable one. Yesterday, I filled my prescription for anti-anxiety medication.I cried.
At first I assumed I cried from sadness, or resignation, or my pervasive sense of brokeness. But I then realized they were tears of relief.
When I met with the psychiatrist on Tuesday, she drew a diagram very similar to this:
I don’t consider myself a fatalist. I don’t express, or believe, sediments such as, “everything happens for a reason.” I can’t accept that there was a “reason” or “plan” that subjected me to ten years of torturous abuse in the hands of a psychopath. And yet I find myself struck at how much of what has happened over the past few years has been so instrumental in me finding and utilizing the help I need. For instance, in order to teach, I took several additional biology courses that were not part of my major. Two of those – evolution and physiology – have been essential in enabling me to understand what happened to me. Being able to conceptualize the workings of my brain and body have given me a much deeper acceptance of anxiety as a natural outcome of my experiences instead of a personal failing.
But I digress. The main peak in the diagram above shows the natural course of the sympathetic and parasympathetic nervous system. The sympathetic response is a purely biological response designed to keep us alive. ”Fight or flight”, as it is often called, is a lightening fast, unconscious response to (perceived) threats. The parasympathetic response, or the “rest and digest” or “feed and breed” branch of the nervous system, is a much more gradual process, that returns the body to homeostasis and maintains “non essential” processes such as digestion, reproduction, and relaxation.
These two systems work in tandem to respond to the myriad of situations that we encounter everyday. Most people operate at the “normal” level where they experience a moderate degree of arousal everyday, punctuated by more pronounced periods of stress and relaxation.
Prior to therapy, I was operating at an frighteningly high level of sympathetic arousal. Upon waking everyday, the anxiety kicked into high gear and kept me hyper-vigiliant to a whole slew of perceived threats. I learned to do this because I grew up in an environment with very real, persistent threats. This vigilance helped me to feel prepared for the dangerous, unpredictable world I was living within.
CBT has helped me bring that level of sympathetic response down, to a place that, to me, feels reasonably relaxed. But the psychiatrist indicated that I was still living in a state of “high anxiety.” Frankly, this was news to me. I know I have periods of anxiety, but I’m learning to manage them and can often distract or calm myself down. While therapy has been enormously helpful, it’s obviously not enough. I’m feeling nearly ready stop my CBT, but it still appears that my anxiety is much, much higher than it needs to be. So the medication is suppose to help bring me down closer to a normal baseline of sympathetic arousal.
As we’ve heard numerous times, long-term stress wears on the body and the brain. The meds are suppose to help my brain calm down enough so it has more resources to repair some of the damage wrought from years of high stress. Honestly, I’m so curious I can hardly stand it. It takes 4-6 weeks for the drugs to take full effect (if these work for me). What will it be like to live at the baseline? Just writing that sentence makes the tears well up again. Relief.
One of the most challenging parts about this whole process is figuring out “normal.” When I was first diagnosed with PTSD, I kept reading statements like, “Therapy will help you return to normal.” Or, “renew your interest in the good things of life.” Or, “reestablish your sense of safety in the world.” But in my case there is no “re.” This sh*t started so early there is nothing healthy to return to. My whole life has been calibrated to the initial, pervasive experiences of fear, abandonment, hatred and abuse. Each time I find a new level of calm, I think, “Eureka. Journey over. Healing, check. I made it.” Only to realize that I still have miles to go. But when I turn around to see how far I’ve come, how I ache for that little girl who lived, so bravely and for so long, in such toxic circumstances.
The doctor also recommended finding ways to “exercise” the parasympathetic response. She rattled off a list including yoga, meditation, tai chi, mindfulness, massage, acupuncture. I immediately cringed. I like yoga – the aerobic variety. She meant the “slow, gentle” yoga, which I cannot imagine myself doing. Meditation? Ha. I’ve tried it, can’t stand it. Mindfulness? I’ve actually worked on this over the past year. It’s been a lot of work with no reward. Massage? I do it sometimes, but it’s hard for me, and it’s often not very relaxing. I said as much to the doc and she laughed, kindly, knowingly. ”Of course you don’t like these,” and she smiled. We became side-tracked, so I didn’t get to ask her why she said that. But I realized later it’s because all of these activities are designed for deep relaxation, to a depth of which is currently not possible for me. It makes me uncomfortable and anxious because it means putting my guard down, and that is so, so, so hard for me (damn PTSD).
Realizing that was like switching on a dizzyingly bright lightbulb. It illuminated so much that I have struggled to understand about myself. I don’t like slow music. If it’s not upbeat, I tune it out or shut it off. I always have at least two “projects” with me – reading, knitting, homework, etc so if I’m caught with any “downtime”I have something “productive” to do. I start waking about 4:30 every morning. I do not like long meals. I often do not taste my food. I always have to know what’s next. I get explosively angry about “wasted time.” I cannot really and truly relax.
Yes, I do sometimes feel relaxed. But the diagram above made me realize that there are degrees of relaxation. You see, I have always dichotomized my experience. If I didn’t feel “up tight” then I was relaxed. There was very little in between. But now I realize that my entire life experience exists on a continuum much broader than my daily experience. My current experience exists in that narrow band between the peaks of my anxiety and the “valleys” of relaxation. But that narrow band lives within a much broader range, and by working at it, I can move those valleys further down to more and more relaxed states. But it’s scary, because I have memories – both conscious and unconscious – of very bad things happening when I was caught unawares.
It’s tempting to keep living in this narrow band (it feels safer) but continuing to live in a state of “high anxiety” is damaging to both my body and my brain.
“One Little Word”, if you haven’t heard of it, is choosing one word, in lieu or in addition to New Year’s resolutions, to help focus the upcoming year. Two years ago I chose “Risk” and I really enjoyed the experience of molding my year around risks – big and small – and seeing what became of it. It was a huge year of growth for me.
Last year, I couldn’t settle on a word, so I didn’t. But I think I have a word this year. Well, a phrase. It’s “moving in.” I’ve talked a bit about this before, this idea of “moving in” to my own body. When reading up on “exercising” the parasympathetic nervous system, mindfulness of the body was a recurring theme. Again, this makes me anxious just thinking about it. Indeed, I’ve previously become aware that “I” lived in a small part of the back of my brain, but refused to really inhabit my own body. It’s a scary thing, owning a body. Bodies are vulnerable, to other people, to disease, to brokeness, to pain, to clumsiness, ugliness and humiliation. I learned these lessons very, very early. I retreated out of my body and carry it around as dead weight, refusing to invest much in it because it only leads to betrayal.
That worked, in its own way, for a long time. But that strategy is no longer congruent with how I want to live my life. It’s time to move in. How? Well, I have a few ideas.
- Pay attention, and then respond. I often become aware that I’m sitting in such a way that causes me pain, but I don’t adjust. I will sometimes get blisters or other injuries but don’t stop working. Sometimes I know I’m in pain, sometimes I don’t. I often don’t go to the bathroom when I need to, because I think I’m inconveniencing myself or someone else. I rarely listen to myself. This needs to stop.
- Count calories. I know, this seems weird. But I’ve increasingly become aware that I have no idea when I’m hungry or full. I eat when it’s convenient or when I’m afraid I will be hungry. Hunger was a persistent part of my childhood. I’m terrified of hunger. So I subvert it by eating preemptively. This needs to stop. I have no gauge of a healthy amount of food. I know I eat way more than I need (my clothes are getting increasingly less comfortable!) but when I try to “pay attention” to my body, I just feel “hungry” all the time. I think that by counting calories for a while, I can calibrate my body to healthy amounts of food. This would never have been possible for me before smartphones. I downloaded an app that I think will help me do this for a while. I’m not being down-to-the-single-calorie neurotic about it, but I need to get a handle on what is healthy. I think this is a step in the right direction.
- I’m considering halting my alcohol consumption. This is still an idea I’m just toying with, but I’d like to carve out room to think about it more throughly. I don’t feel like discussing the reasons right now, but it might be a good idea.
- Exercise. I’m actually pretty good about this, most of the time. But when I start feeling down, I stop. Considering that it helps me feel better I need to do it most when I’m having a hard time.
- Try acupuncture. That is the one thing on the list from the doc that I can imagine myself doing at this point. So I guess I’ll try it.
- Continue learning to take care of myself. I’ve drastically improved my skills on this over the past year. And I hope to keep getting better.
- Practice self-compassion. This isn’t easy, either, but I think it’s helpful in body mindfulness, which is helpful in activating the parasympathetic nervous system.
- Give medication a good, solid go. I don’t want to be on it permanently, but if it can calm my brain enough to allow for some healing and the experience of a “new normal”, hey, why not?
Well, that’s a pretty good start. So much information buzzing in my brain. Feels good to get it out on “paper.” Thanks for reading.