Identity and Anxiety: Struggles of Object Permanence

I had a realization this weekend. While I was prepping for a pub crawl with my boyfriend, I noticed that he kept wandering off to go grab things or do something else, and inevitably I would wander after him like a lost puppy. At some point he mentioned that I didn’t have to come with him everywhere, and jokingly I yelled “I don’t have any object permanence without you!”

Of course as is true with many of my jokes, there is a fair amount of truth hanging out in the middle of that statement. While it’s not true that I become worried about my own existence when I’m in a room alone, I do hang my sense of identity on other people’s validation and understanding of me far more often than is healthy. When I haven’t talked to anyone in too long, I start to wonder who I am and what I’m doing. Do I actually want to write all these things? Am I actually an empathetic person? Am I really intelligent or do I just fool people into thinking that?

My brain functions in comparisons. What does it mean to be smart? It means being able to understand more than other people, reach conclusions faster and better, speak more clearly or convincingly, or know more about more things than others. What if there are no others around? Then I would have no idea if I was smart or not. I assume that my experience of the world is the same as anyone else’s and the only times I know that there’s something good about me is when someone tells me that I’m different than others in some fashion: kinder, more compassionate, smarter. And so I crave those validations more than anything else. Without them I have no idea who or what I am.

One of the symptoms of Borderline Personality Disorder is a lack of self identity, an inability to solidly ground your sense of self without help from others. It can be one of the most difficult elements of the disorder to combat because it requires a fundamental reframing of who you are and how you exist in relation to others. When your identity is a comparison or a response to others, who you are is wholly dependent on them. In some ways, you cease to exist autonomously, because when the people around you stop talking to you or paying attention to you, you stop knowing who you are or what you should do.

In some ways, for me, this difficulty stems from a deep desire for objectivity. I am a perfectionist and I want deeply to be right about everything. That means that if I call myself intelligent, I want some sort of absolutely certain standard to which I can point. Comparisons are the only standard I’ve got. It’s my uneasy truce with the fact that in the grand scheme of the universe, “I am intelligent” is a meaningless statement. It may not be true that others with BPD crave this certainty the way I do, or that they use external validation because they’ve come to the conclusion that all meaning and knowledge is relative and self-made. But there are lots of parallels between my huge, existential temper tantrums and the concrete confusions of those who are struggling to define themselves independently.

So here are some of the conclusions I’ve come to about how to build a sense of self when all you want is for someone else to tell you who and what you are.

1. Stop asking. Seriously. It’s enabling. If you’re starting to feel uncomfortable about something (am I mean? am I stupid? am I annoying?) first try checking in with yourself and looking at some facts instead of getting someone else to give you the answer. Other people aren’t always around and other people can leave and sometimes you have to be ok on your own. So before you ask for reassurance, reassure yourself. Learn how to use facts and experiences to build up a sense of self. Am I annoying? Well, I have a lot of people who seek out my company, so probably not.*

2. Think about your values. Consciously. Constantly. Remind yourself what actually FEELS important to you. A great litmus test on this is to check in with yourself when you start feeling guilty or ashamed about something. Why are you feeling this way? Is it because someone else has told you that your behavior is horribly wrong, or do you think you’ve actually done a bad thing? If option 2, this is pointing towards one of your values that you have violated.

3. Practice uncertainty. Seek out circumstances in which you won’t have a concrete answer or label for something and just be with it. Get used to feeling like you don’t have a clear answer. It may never feel awesome, but you can start to desensitize yourself to it and get through the rough patches by knowing that there will be times that you feel confident and clear about who you are (protip: these are often times when you have just accomplished something, made a big decision, or spent time with people you’re comfortable around).

4. Labels can be really helpful. Sometimes it’s too hard to come up with a complicated self definition when you’re in a moment of uncertainty or fear or need. Having a list of go to’s can be helpful. “I’m a writer” is one that I rely on often, not only because it is so deeply true that I cannot imagine ever being anything else, but also because it gives me a path forward to start to figure out other elements of myself: writing them down. The label gives you something to rely on when you’re struggling. They don’t have to define you forever, but they can be a helpful stepping stone towards identity if you just want something simple.

5. Talk or write about it. It’s easy to get lost in your own head, but if you have to put words to who you think you are, it can clarify what’s actually important to you and how you think of yourself. You can also start to compare versions of yourself if you have a record (whether in writing or through a friend’s memory), and figure out either how those versions fit together or whether there’s one that doesn’t fit as well as the other. It can help you prioritize the elements of yourself and keep them in balance. That might sound super woo woo but all I really mean is “how much time and energy do I want to put into this interest/value, and how much weight do I want to give those concerns?”

6. Start building identities instead of identity. When there’s only one way you define yourself, it’s easy for it to be fragile. That identity has to hold all of you, be flexible enough to explain you in different contexts, and be 100% right all the time. Multiple identities lets you account for the fact that we’re different in different circumstances and no one identity is objectively you all the time. It gives you more flexibility and space to be and do different things.

These won’t solve any serious identity crises (for which I would suggest some therapy), but they are good ways to keep up a practice of strong self-identity if you struggle with your sense of self.

*of course sometimes it’s to the benefit of a relationship to check in and make sure the other person isn’t actually trying to send you signals that mean you’re horrible and they hate you, just for clarity’s sake

Talking Over

Yesterday I posted about a personal experience that I had. I identified certain things about my identity and mental health, and mentioned some things that were helpful for me in terms of both of those things. The majority of the post was about things that pertained to me and me alone, with the suggestion that perhaps others could try as well because I had found it helpful, so maybe it would be helpful for others as well.

Now overwhelmingly, the response has been positive, but I did get one comment that summed up for me all that is wrong about talking over another person and their experiences.

“Well first off she should stop telling people she is asexual. As she isn’t. She made several references to sexual or romantic relationships she has had in the past. And never once did she say oh I hated the sex part….

Second she right love is awful painful for a borderline and most do get clingy. But this whole if I don’t have sex with you I can love you so hard thing is kinda of not really true. She just removed added simulation to her emotions. Yea borderline emotions are intense and painful.they lead to thinking crazy. But the key part she left out is.you don’t have to act on those feelings. Or thoughts. That once you start learning how to wait them out you learn how to think through them and separate the borderline b.s from what’s actually happening…

All she did was remove an emotional trigger.. and her fb experiment will bite her in the butt when all those friends don’t start giving that love back when she crashes again. But that’s just what I think.”

Normally I don’t take the time to respond to comments like this because they’re awful and just deeply unhelpful, but the problems with this comment are problems that I see over and over and so I wanted to take the time to break down why this isn’t actually constructively engaging with the ideas that I presented. This is a classic example of talking over someone.

So first and foremost, when someone identifies themselves (whether as asexual or bisexual or pansexual or whatever) you don’t get to tell them they don’t identify that way. Identity is complex and personal, and no human being is the Grand High Judge of Sexual Identity. This is one of the most common ways that sexual minorities get fucked with: by others defining what they are and why. It hurts absolutely no one for an individual to identify in the way that they find most compatible with their life experiences, but having your identity undermined or denied is quite painful (and especially for asexual individuals leads to things like corrective rape). As a corollary to this, if you are going to play Sexual Identity Police, at least understand the definitions of the identities you’re policing. Asserting that someone can’t be asexual if they don’t explicitly state they hated all the sex they’ve ever had fundamentally misses what asexuality is, and worse it demands that anyone who is asexual give personal information about their sex lives in order to legitimize their identity to randos on the internet.

Basically, the next time someone tells you how they identify and you feel the need to challenge it, remember that what you’re essentially doing is ignoring someone whose identity puts them in a vulnerable position because you Know More and don’t care about whatever thought they have put into identifying that way.

Now the rest of the comment seems like it’s less harmful because the commenter specifies that it’s just her opinion. The problem comes when she imperiously declares what will happen in my future and what I’m doing with my emotions. This is a nice bit of mind-reading and psychic abilities. I’m impressed.

When someone with a mental illness brings up something that they tried that seemed to help them out, telling them that they’re wrong and that they’ve actually just hurt themselves is incredibly invalidating. While you may have had a different experience from theirs, that doesn’t mean that you get to ignore the words that they have actually said or the experiences that they’ve actually had. If your depression didn’t get better through exercise but someone else says “I tried exercise and I’m really happy with how well it’s working. If you’re interested you could try it too”, the appropriate response is not “You don’t actually feel better! It’s all a lie! Exercise doesn’t work!”

The secret (not so secret) about experiences is that they’re personal. Different things work differently for different people. It’s easy within the mental illness community to get defensive or catty when someone else copes differently from the way you do. It sucks to see someone else doing well if you yourself can’t find good coping mechanisms. But despite how easy it is, it’s a horrible plan. If someone isn’t asking for advice, don’t give advice. If someone did something differently than you would have, you can just move the fuck along. The more we perpetuate the idea that there’s a “right” way to recover, the worse off everyone will be. It’s simply not true that her way of dealing with BPD is the same as my way of dealing with BPD, but that doesn’t have to come with a judgment.

I don’t really care if this person fundamentally misunderstands why I did what I did or how my asexuality is interacting with my BPD or doesn’t get that the point of my experiment wasn’t to just take sex out of love but rather to see what it was like to be open with love and love more people more fully. What I do care about is the implications of her comment that I’m doing something Wrong because I didn’t do what she’d do. I care about the implication that she gets to decide what identities and treatments are better for random people she’s never met. I care that this is considered appropriate dialogue on the internet.

It’s not dialogue. It’s talking over.

 

Mistaking Romance for Sex: Intersections of Mental Health and Sexuality

Yesterday I discovered a new blog about asexuality and spent some time diving into the archives. As someone who is still trying to sort out their identity I spend a lot of time asking myself if the experiences of other aces resonate with me, and as I read a theme started to pop up: an inability for ace individuals to understand or empathize with sexuality or sexual desire, and because of this difficulty with understanding flirting or innuendos.

At first glance this sounded nothing like me, but when I wasn’t paying much attention something hit me: I am deeply incapable of telling when people are hitting on me or flirting with me. I can tell when other people are flirting with each other, and I understand the types of things that one is supposed to do to be considered “sexy”, but I’ve never had any clue how to do them myself and when others try to flirt with me it often goes flying right over my head. For most of my life I’ve assumed this is because I have cripplingly low self-esteem, and I was one of those people who could never imagine someone flirting with me. But now another possibility had presented itself: what if I never noticed or could flirt because I have always tended towards asexuality?

This was the first of a series of realizations that perhaps having a sexual orientation/identity other than straight, allosexual, monogamous, CIS etc. and having a mental illness might lead one to misinterpret one’s emotions and attractions, or may mean that one’s presentation of their identity looks significantly different from others’. It may make it a little harder to parse what exactly your identity is.

Here’s the thing that’s been bothering me for a while: how is it that I suddenly can identify as asexual when I happily identified as allosexual without even a thought that I might be chasing the wrong things for almost 10 years of active dating? I certainly don’t think I was repressing any feelings of asexuality. I actively pursued relationships because I felt attracted to people. I have been actively sexual and enjoyed the experience at times. How can I be asexual if I never felt any confusion about what sexual attraction was, if I never felt as if I was missing out on a feeling that everybody else had, if I never felt that something wasn’t working about my allosexual identity?

But then I read one person’s musings on the fact that it makes sense for them to be aromantic and asexual becuase they rarely feel the feelings that are supposed to be “romance” or “sexual attraction” (e.g. nervous, excited, obsessive, racing thoughts). They say:

“I’m a pretty chill person. I don’t get excited, overjoyed, scared, or stressed out much. Most of the time, I just feel calm, comfortable, and slightly positive about life. My emotional reactions are quieter, shorter, and fainter than most people’s (except for laughter – I laugh a lot). It’s not that I suppress my emotions, I just don’t feel them very strongly in the first place. I’ve been like this ever since I was a child.”

And it hit me: I am the exact opposite. I have all the feelings of being romantically attracted to someone ALL THE TIME. I am always nervous and obsessive and excitable and have huge swings of emotions. I am hyper-romantic.  When I fall for someone I fall HARD. And because I have this overwhelming attraction to someone on a romantic level, I think that I’ve always just assumed that I was also attracted physically: I mistook my hyper romantic attraction for sexual attraction (just another minor consequence of compulsory sexuality and the tendency of our society to conflate romance and sex).

The thing is, I can’t imagine anyone who didn’t have extremely strong emotions doing this. Strong and sudden and whole body feelings of “want”. I can’t imagine anyone who didn’t get taken away by their emotions would ever find themselves so romantically attracted to someone that they’re convinced the want is actually a want for sex.

But that desire, that feeling of “need” is the same kind of feeling I might get towards my fluffy cat, or a beautiful picture, or a philosopher I find particularly fascinating (often with some added element of “I just want to hang out with you all the time” that indicates romance). Genitals don’t come into the picture. It’s simply the strength of the emotion that got to me.

And here’s where we come to mental health. Because that tendency to get utterly overwhelmed by emotions is one of the borderline personality disorder traits that I have. The tendency towards obsession and anxiety is part of my generalized anxiety disorder and eating disorder. The particular intersection of this intense emotion and a society that says “if you love someone you want them in your pants” may have fooled me into thinking that what I wanted was sexuality when in reality I wanted deep connection, a special relationship with someone, care, romance.

It’s fairly obvious to me that as a society we don’t spend a whole lot of time being careful about the ways we speak of attraction: you LIKE someone or you don’t. And if you do then you want to date them. And if you want to date them then you want to have sex with them unless you’re not “ready” or you’re repressed or you’re too self-conscious, then you’ll want to have sex with them at some unspecified point in the future. This means that if someone feels any sort of strong emotion towards another person, they feel pressured to identify as “attracted”. Additionally, the identity that goes with attraction is not supposed to be fluid: if you feel any attraction towards the same sex, you’re gay. Any attraction towards the opposite sex, you’re straight. Any attraction to both, you’re bi. Similarly, if you have any desire towards one overarching relationship, you’re monogamous and if you have any desire for more than one partner you’re poly. End of story.

If you combine this with any sort of mental illness, it seems like a recipe for confusion and frustration, because often mental illness means emotions and desires express themselves in all sorts of new and interesting ways. Example: for those with BPD, deep amounts of care for someone often mean that you spend a lot of time “testing” them (for fear they’ll leave you) by doing odd things like not calling or talking until they do so first. I would imagine that for someone with OCD it would be difficult to distinguish feeling obsessed from feeling attracted. For those on the Autism spectrum, sensory stimulation can be overwhelming. How to tell if you’re sex-repulsed or simply experiencing a sensory overload?

When you perceive the world differently from others, or experience emotions differently (more or less heightened) than others, how can you tell what category you fit into? How do you see the parallels between your own desire (or lack thereof) and the desires of others? Especially because mental illness can make it difficult to understand and effectively manage your emotions, the “all or nothing” approach to dating and romance seems to be perfectly suited to further confuse the issue and lead to misunderstandings of identity. Almost everyone feels some amount of attraction to all kinds of people. Almost everyone feels some element of desire for stability and some for freedom and new experiences.

How do you interpret these feelings if a. you’re not stellar at identifying your feelings in the first place b. your feelings tend to be significantly stronger or weaker than other people’s c. you tend towards all or nothing thinking d. you’re not very good at coping with emotions or making healthy decisions when in the grips of emotions? How do you incorporate the feelings you have into a sense of identity when your feelings might change rapidly or you don’t want the things that are supposed to be a part of “attraction” (or you want more, e.g. kink)? And if you’re already struggling with relationships, boundary setting, expressing needs, or simply being effective at communicating, how do you learn to create your own kind of relationship rather than using the template that’s already available?

Now none of the elements of understanding identity are unique to those with mental illness, but what mental illness can do is obscure things and simply make life a whole lot more complicated. It can also amplify certain emotions or diminish others, so that the attraction or repulsion you feel might be HUGE or barely noticeable.  And all that makes it a lot harder to parse out what kinds of relationships are good for you and what kinds of relationships you want.

 

Tolerating Distress

One of the things that has been very difficult for me in DBT is the idea of “distress tolerance”. For the most part, American society does not promote the idea that there are times that things will suck and you’ll just have to let that be and you can’t do anything to fix it. We’re a society of fixers. There’s always a solution if you try hard enough right?

Unfortunately that’s not the case. There will be times when we simply have to wait out unpleasant feelings. In general those unpleasant feelings will dissipate or be relieved with time, or after some time we will be able to change something to improve our situation. Sometimes we also just have to accept things that are shitty: certain people will not change their behavior, your health may not improve, politics might always suck. These are things that you might just have to let be. And for these things, you have to learn that your feelings may stick around and there’s not a whole lot you can do about it. This is where distress tolerance comes in.

Distress tolerance is hard. It’s not about making yourself feel better, it’s rather about making it to the end of the bad feeling without doing anything to make your situation worse. This is one of the hardest things to remember while trying to tolerate nasty feelings, and it also makes it a lot harder to be successful because it’s hard to feel like it’s working. However it’s not a bad thing to feel like crap for a while. This is hard to understand for many people. It is normal, acceptable, and in fact healthy to feel like crap sometimes.

So what is distress tolerance? There are a number of elements to it and I’m not going to touch on all of them here, but I do want to talk about how many people give tips for distress tolerance and how we can really improve on those tips. I see lots of lists floating around about what to do if you’re tempted to self-harm, or how to resist purging. These lists are GREAT. They include things like holding a piece of ice, drawing on yourself with red marker, ripping something up, all great suggestions. Unfortunately not all of these things work for everyone, and it can be extremely frustrating when you look at the list and can’t find anything that speaks to you.

It seems to me that there might be a better way to approach distress tolerance that is more individualized. Of course sharing ideas and letting others know what’s helped you is great, but not everyone likes or responds to the same things. One of the things that we’ve been discussing in DBT are larger categories that can help you: things like using your senses, imagery, taking a mini-vacation, or relaxation. Each of these categories is then open to all of your personal ideas. Let’s look at a couple of examples:

Senses. I’ve heard a lot of people give examples of this without quite realizing it: finding something soft, holding ice, listening to music. However I’ve often found the examples unhelpful until I heard the larger idea that you should think about your senses and try to pinpoint what sensory experiences really ground you. What makes you feel like you’re really in your body? I’ve heard people suggest scented candles, but those make me sneeze a lot and I don’t much like them, so I basically just discounted nice smelling things. When I heard that scent was something I could think about, I immediately thought about my dad’s spaghetti sauce. It makes me think of home, of youth. It grounds me. I got some from my parents to put in my freezer and now I can pull it out on a bad day and heat it up, letting that smell permeate my whole apartment. This personalization is far more effective for me than the generic suggestions were.

You can do this same sort of thing with any of the skills: what kinds of images calm me down? What would be a “safe place” I could picture? What has calmed me down in the past? What kinds of things do I find relaxing? What places feel “away” for me in my daily life? What’s out of the ordinary that I could use as a small vacation?

It’s a good idea to take some time when you’re NOT distressed to think about these things so that you have a small stockpile. For an explanation of each distress tolerance skill you can go here. I don’t think we spend enough time personalizing our coping skills, but it is important to think about what works for YOU.

Falling Through the Cracks: When the DSM Can’t Find You

This week in my DBT group, we were talking about what Borderline Personality Disorder is and how it’s diagnosed (DBT was originally formulated for BPD). Essentially, there are nine traits that are used to diagnose BPD. If your diagnosing therapist sees five or more of them in you, then you are diagnosed with BPD. If you have less than five, but still have some, you are diagnosed with what’s called BPD Traits. I had never heard of BPD Traits before, and I don’t think most people have. Insurance is far less likely to cover something that sounds subclinical like that, and it’s far less likely to be understood by the general public. It simply sounds less severe, right?

 

Unfortunately, this system has a few major flaws, and it seems to me that these flaws are indicative of many of the problems with the DSM as a diagnostic manual. The main problem with this system of diagnosis is that many of the traits of BPD are things that everyone has to some extent or another (things like anger issue, or efforts to keep people from leaving you), and so they only become diagnosable when they seem to be excessive or problematic. This leaves a great deal up to the discretion of the diagnosing therapist. It also means that that therapist has to draw a hard line about what counts as problematic and what doesn’t, when in reality these traits exist on a spectrum. So you could be just over the line and counted as having the trait, or you could be so far over the line you can barely function on a day to day basis, and in the eyes of the diagnosis, you have the same trait.

 

This also means that the difference between BPD and BPD traits isn’t as clear cut as it might seem in the first place. For example, someone with BPD might be just over the line on five traits, but someone with BPD traits might be way, way over the line in four. Who’s to say which is more severe, or that one should receive a full diagnosis that allows them access to treatment, while the other receives a diagnosis that gets them almost nothing?

 

Overall, this illustrates something that is definitely wrong with the DSM: mental illness and mental traits all exist on spectrums. There is no on or off switch to depression, anxiety, paranoia, or any other problem that may be diagnosed as a mental illness (with the possible exception of hallucinations). However in order to diagnose someone (and particularly for that individual to gain coverage of treatment), symptoms are treated as present or not present. Occasionally we use modifiers like “severe” or “mild”, but more often than not it’s either there or it’s not.

 

This seems to be a recipe for disaster for people whose symptoms either don’t present as traditionally understood, who are barely subclinical, or who have an odd constellation of symptoms. I find that I often have this problem: I have lots of issues (oh LOTS and lots). I have bits of OCD, OCPD, ADD, BPD, depression, anxiety, bulimia, anorexia, and really probably a whole host of other things. But because many of them are subclinical, or I don’t have the right pairings to fit into a particular diagnosis, I have been left without any sort of personality disorder diagnosis, or larger diagnosis to fit it all together. Despite how severe my eating disorder was, I was lumped in the EDNOS category, which is far less often covered, and is often treated with less respect and as less severe than other eating disorders.

 

This is a serious problem if we want to provide proper services for those people suffering from mental health issues. We shouldn’t have to wait until a symptom is truly interfering with someone’s basic functions before we give them help. There are many problems with the DSM, and trying to posit a replacement for it is extremely difficult, but one element that really could use replacement is this all or nothing thinking. There is no “partially depressed” or “sort of ADD”. You either have it or you don’t. One improvement could be seeing mental health on a spectrum. We all have different traits, and many of those traits are spectrum style traits. Understanding that moving towards the extremes is always a problem is one great way to view mental health in a more understanding and helpful way, because it allows us to try to help everyone move towards a more balanced place, and could allow us to provide treatment for those who have not yet reached the critical zone.

 

Another issue with this system is the amount of discretion that it allows for the diagnosing clinician. Let’s look at a particular example. One of the criteria for diagnosing BPD is “inappropriate, intense anger or difficulty controlling anger”. This is fairly vague. What counts as inappropriate anger? How might things like race and gender fit into this (hint: black women will always be viewed as having inappropriate anger)? Shouldn’t there be specific examples of things that might constitute inappropriate anger, or the consequences in someone’s life for “difficulty controlling anger” or the number on an emotional scale of what constitutes “intense” anger? How often does one need to be intensely angry to get this trait? All of these things are left up to the discretion of the diagnosing clinician, and unfortunately this allows for a lot of bias.

 

There is a difficult balance here, because having that kind of specificity means that you could be very close to a diagnosis, but not quite reach the correct number of episodes, or the right “level” of anger to reach diagnosis. It seems to me that having these specific levels combined with a spectrum view of disorder would allow clinicians to have less individual discretion that can lead to variability in diagnosis, but would also allow more people to get the treatment that they need. It is widely recognized that we need some changes in the DSM, but these particular issues are ones that I have seen in action in myself and in people around me, and that seem as if they could be fixed without great difficulty. Get on that DSM.

Dissociation: What Is It, How To Help

Dissociation is a major factor in a number of psychological diagnoses. One of them is Borderline Personality Disorder, something I have at a subclinical level. Dissociation is often overlooked as an element of mental illness though. People rarely discuss it, and unlike “triggers”, it’s not thrown around as an explanation for behaviors. However dissociation is very real and has some serious consequences. It’s also something that many people experience without knowing what to call it or how to deal with it, and it can be debilitating and terrifying. For these reasons, I’d like to give an overview of some of the ways I’ve experienced dissociation, and how I’ve fought back against it.

To read the rest of this post, please visit Aut of Spoons.