Monthly Archives: May 2017

Just ‘doing it for attention’

I’ve been haunted by the accusation that I am ‘just doing [whatever] for attention’ since I first heard it levelled at people who self harmed, and then my fear deepened when a friend at school accused me of it in response to my not eating.

Fear of being thought of as ‘attention seeking’ as a teenager meant I hid every element of my unhappiness.  I was petrified that someone would discover my self harm and call me an attention seeker, so I painstakingly covered.  For a decade.  And I was afraid I would be called attention seeking for not eating, so even when the school nurse cautioned I was ‘under weight’ I didn’t say a word – and publicly laughed at such an absurd assessment.

The difficult thing is, I think, that these actions are attention seeking.  But bear with me: probably not quite in the way you’re thinking.

Teenagers, in particular, are going through unparalleled emotional, bodily, and cognitive/intellectual changes. Their social relationships are radically rearranging themselves as they re-orientate themselves around peers rather than family, their bodies are changing in very obvious ways in terms of puberty and hormones, but they are also changing into the shape that will likely determine how they experience much of their rest of their lives.  More than this, they are exploring increasingly intense and sometimes romantic relationships, and learning about the pleasure their bodies can achieve in consent with others. They are coming to terms with ideas like mortality, and able for the first time to take responsibility for assessing risks and gambling their own safety.

Looking back on who I was as a deeply unhappy 14-18 year old, I still don’t know how to fully articulate that experience, or how I could have communicated the sense of being lost in my own body, baffled by my new and changing emotions, isolated from my [seemingly] entirely-heterosexual surroundings, and the fear and exhilaration I was encountering as I began taking risks with drugs and alcohol.

What I can see when I look back, is a young woman trying to ask people around her to help.  I did want attention – I wanted someone to show me how to navigate that transition in my life, I wanted someone to tell me my feelings were as significant and life-altering as they felt, I wanted someone to validate the depth of the things I felt without calling me “dramatic” (another favourite accompaniment to ‘attention-seeking’). In a sea of other teenagers, all struggling to find themselves and each other, I wanted to be seen.  I needed attention that distinguished me from the crowd (‘bloody teenagers’) and reassured me I was valuable.

My heart aches for how isolated and lost I was at this time – how desperately I wanted someone to notice the physical actions I was taking to ask for help, and how entirely unable I was to do that verbally.  Ultimately, two parents of my friends, two of my best friends, and a girlfriend, helped me in the ways I needed.

Subconsciously, I think altering your body through self-harm and disordered eating are, ultimately, actions which some part of your mind knows will draw attention.  Faced with a total lack of language for those feelings, or the skills of reflection and introspection we develop into adulthood, how else can young people communicate their need for care, for guidance, for help, for attention?

As adults, we’re expected to move away from these actions, to develop different strategies, to recognise that harming ourselves as a cry for help is ’emotionally manipulative’.  As I understand it, one criteria which is used to identify and diagnose borderline personality disorder relates to ‘manipulative’ or ‘attention seeking’ behaviour and I know a number of people with symptoms/moods similar to mine who have been diagnosed with BPD, apparently largely because of their long term self harm. I also know many of these people have repeatedly sought psychiatric help, have repeatedly asked, calmly, clearly and with specific evidence of need and defined goals, for emotional support from the appropriate health care providers; and they have been turned away.  What can you do when expressing in words, in ‘acceptable’ ways, your need for help is unsuccessful?

I  know someone who works as a NHS Psychiatrist and is called to A&Es to assess people in crisis – usually at the point they are expressing suicidal impulses or engaging in actions of self harm.  This psychiatrist can only recommend people are admitted, but cannot create the NHS beds for them to be accommodated.  These people are also, ultimately, turned away.  They might return, ever more desperate, ever less able to communicate, ever more extreme in the physical actions they take. The chronically underfunded NHS, teetering on the point of collapse, ends up labelling these people “attention seekers”.  And, implicitly, that means ‘not in need of attention’.

Attention seekers, in an age of YouTube and Facebook and make-your-own-celebrity, who instead chose to endanger their lives and permanently alter their bodies rather than start a blog (hey-oh!) or a YouTube channel or an Instagram account? Something doesn’t add up there, does it? If this was about seeking ‘attention’ there are a hundred easier routes to it.  Self harm, suicidal gestures, and disordered eating, and a hundred other self-injurious actions are about seeking attention, but not any kind of attention.  Attention – help – for chronic, overwhelming, unmanageable experiences of fear, pain, anxiety, loss or some other catastrophic emotional state.  They are the last refuge of people who either cannot discover the words to convey their emotional state and their need for support, or who have communicated their desperate need for help and not been heard.

Why else seek attention through actions, unless because nobody is listening?

My conclusion is two-fold.

On a personal note, I remind myself of all of this as I wrangle self-harm impulses.  I don’t want to self harm, what I want right now is help with these unmanageable emotions of stress, anxiety, and fear.

More generally; that attention-seeking is not bad, or wrong, or evidence that there is not a mental health condition, an emotional need underlying it.  That we must care for, and be patient with teenagers in particular and be cautious not to dismiss their actions as dramatic or (most hated of words) ‘angst’.

People ask for help in many ways – often it is not with words because those words are either not available, or not heard.

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Travelling whilst Cyclothymic

I had a disappearing comment on the blog today asking for advice or thoughts on long-term travelling/backpacking whilst cyclothymic™. I think it’s something I can offer some comments on, as I do have some experience.

I try and travel regularly: living in Europe (although I don’t get to be a proper European for much longer *weep*) gives me a huge number of cheap options for getting out there and seeing the world.  My two most recent trips were one trip for 12 days backpacking through 4 cities and 2 countries, and a 3 day trip to one city. 10 years ago, before I was diagnosed, I did a massive backpacking trip around the world for a little over 6 months. It’s this experience I’m mostly drawing on here.

In my 6 months of backpacking, there were exquisite moments, but there were also truly awful times.

I vividly remember sitting on a bed in some anonymous budget hotel in Montevideo. It was early afternoon and I’d been sleeping for about 14 hours. I was looking at the window and, for the first time, I had just the most visceral understanding of why they put locks on hotel windows/don’t let you open them. I sat and I wept. Then the phone rang, I stared at it for ages, trying to imagine who could be phoning me. I eventually decided to answer, in my halting Spanish. It was a friend I’d met a few days earlier and who I was travelling through the country with. She wanted to know if I’d like to go to McDonalds. I agreed, and met her in the hotel lobby 15 minutes later.

McDonalds didn’t cure me, of course, I was depressed for a lot longer than one lonely hour sitting on a bed. But it was a reprieve from myself, and that was all I needed to get through the rest of that day.

I hate Uruguay now – and it has nothing to do with the country or the people – only my truly terrible emotional state while I was there.

That isn’t really advice.  But it is an introduction to the possibilities of travelling.  You’re away from your support networks, you might be disconnected from online support too – although that’s less common now, but when I was travelling 10 years ago Wi-Fi was not really A Thing, and I didn’t take a mobile phone with me. You’re also less accountable – how long could you fall of the face of the planet for before someone noticed, compared to when you are at home?

Here are a few things to consider if you are considering travelling and have cyclothymia:

  1. Travelling is tiring and will disrupt your sleep patterns. For any flight more than 6 hours long, you need to schedule a day off immediately following landing/arriving to dedicate to sleep/sitting around/having a very low energy day.
  2. For long term travel you need to build routines into your stops. Can you get a part time job at a place which you plan to stay at for longer? Do you want to enrol on a language course for an hour or two each morning for a month? Is there a place you can go everywhere to give you a sense of familiarity (personally, and slightly shamefully, I’ve been to either Starbucks or McDonalds in every country I’ve been to – and I’ve been to a lot of countries). When I’m starting to get hypomanic, or depressed, that carbon-copy familiarity can help ground me a bit.
  3. What are your strategies for dealing with dangerously low mood (think me, on a bed, looking longingly at a window, in a shit hotel in Uruguay)? Will you be travelling with a friend or partner; do you have an international calling bundle on your mobile; is there someone who will accept a collect call at any time of day (time zones!) and can talk you down? Have you got travel insurance with an affordable excess, on which you fully disclosed your bipolar/cyclothymia? You’ll need that to access a consultation with a GP/short term medication/review of existing medication if you are already taking it. Similarly, if you are taking psychiatric medication, you’ll probably have to get repeat scripts whilst you travel – so you may need a psychiatrist’s letter, and to confirm your particular medication is available in the countries you are travelling to.
  4. Sleep! Sleep is so important to maintaining my mental health and sleeping in hostel dorms is pretty much the opposite of achieving good, quality sleep [case in point; my experience in Singapore is number 4 on this Buzzfeed list of strange-shit-that-happens-in-hostels]. It can be a good idea to both budget for and schedule time in private rooms or hotels. 2-3 nights uninterrupted sleep, especially if you have an en-suite and a TV so you can just hole up for a few days and reset, is about the best thing you can do to take care of yourself. I did this a few times whilst travelling and it was money well spent every single time. My more recent short-term travel is something I still plan around having one to two days recovery time when I get home.
  5. What are the hardest things for you about being either hypomanic or depressed? For me, it’s the nervous/anxious habits and fixations. I cannot cope with ‘dirt’ – real or imagined. Hygiene standards whilst backpacking can be pretty variable. Your fellow backpackers may have some fairly singular ideas about what constitutes appropriate bathroom etiquette, and don’t even get me started on kitchens. What strategies are you going to have to deal with that? If you don’t have funds to decamp to a mid to high range hotel at the first sign of trouble, you’re going to need to be more creative. I carried a thin blanket, and a few items of cutlery which I resorted to when I stopped trusting the cleanliness of bedding and self-catering facilities (I’m in a low mood period right now, and just thinking about using unfamiliar cutlery is making that dragon of anxiety rear up in my chest). I also, on my long trip, travelled with my-then-partner and she did sometimes take up the job of scoping out the cleanest bathroom or pre-washing cooking material. It helped that she tended toward obsessive cleaning in this respect and appreciated terror at ‘dirty’ things.
  6. Travel can be lonely. Don’t think for a minute that taking a laptop or tablet and staying up to date on social media is going to be a substitute for hanging out all evening with your oldest friend and putting the world to rights. There can also be a real pressure to be seen to be having a good time whilst travelling. I found it really hard to update friends (with whom I would normally discuss my mood) that I was experiencing depression whilst I was travelling. Because who could be unhappy whilst on a picture-perfect Brazilian beach, right? A good old fashioned paper journal where you honestly record how you’re feeling can help ‘get it out’ (I still have mine – it records the highs and the lows from my trip and I’m glad I have the honest account of it, as well as the edited snapshots of me smiling on beaches and in rainforests) You might also try and schedule regular Skype dates with close friends where you give yourself enough time, and privacy, to actually talk properly about your feelings. Finally, you might want to travel with a friend, or arrange to travel with other backpackers you meet for short (or long!) periods.

I can’t stress enough that making the decision to travel is not all about planning against the worst. From a cyclothymia point of view, I think there are a lot of positives to long-term travel.

Travel is good.  Personally, when cyclothymia gets oppressive or I start cycling too fast, a change of immediate surroundings helps ease that sense of crushing weight or inescapable thoughts. Travelling – especially backpacking – is about doing just that; being able to pick up and run.

I also find it really hard to be mad around people – when I’m feeling particularly mentalist and maybe having ‘strange’ reactions where I talk too much, or get distressed by certain noises, smells, or just get caught talking to myself – I’m mortified to have to see the people who witnessed it, again. The advantage of travelling is that when you’ve made a ‘bad’ [read: they’ve all clocked me as a mentalist] impression, you can just move on to your next stop and never see those people again. Problem solved!

Someone said to me, before I travelled, that your worst day travelling is still better than your best day at home.  I don’t know if I’d make quite such an extreme claim, but I do think it’s easier to keep your mood moving on when you are in the midst of a lot more activities, a lot more options, and a lot less rigid routines. Yes, you need to make choices and maybe put in place a few more protections/insurances than your ‘standard’ backpacker, but if you’re doing that in your daily life anyway, it’s not a particularly onerous task and has much bigger rewards.

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