Getting to the Heart of Things: Am I Just Making It Up?

My therapist and I have recently been embarking on a long and poopy journey deep into the recesses of my brain to try to tease out some of the reasons my particular set of neuroses decided to express themselves through my body. Unsurprisingly, I find this a frustrating and unpleasant experience, as thinking at great length about the relationship between my emotions and my body makes me want to stick my tongue out and go “phooey. I just don’t like my body and that’s it.” But I am curious about what made it all circulate around my body. How did I go from needing control and perfection to needing control over food in particular and perfection in the form of an abnormally skinny body?

So we’ve been talking about blurry, early childhood memories, or tenuous connections between what I know I feel and how those feelings express themselves in behaviors, or my early family relationships and lessons. A lot of it feels like looking through darkly tinted glasses: I can make out shapes, but I’m not entirely certain what I’m looking at. I’ll be sure there’s a connection between my feelings of uncertainty early in childhood and my eventual eating disorder, but teasing out that relationship and the catalysts later in life seems impossible. Any given issue, like my need for control, has about 15 different large elements that could have been an important “cause”. We’ll spend an hour delving into a particular relationship or incident, and by the end of the time there will be something like a narrative that offers an explanation.

It’s helpful in that knowing where something comes from helps me tailor my self care and my coping mechanisms. I’m a control freak because I grew up around some volatile people? I’ve surrounded myself with very stable folks who will listen when I tell them I’m scared they’ll get angry with me if I do x action. I seek reassurance that their feelings are stable. Understanding what needs are going unfulfilled helps me to meet those needs.

But on the other hand, I feel like I’m making things up. With so many possible explanations, all of which can be turned into neat narratives, how do I know which one is right? Even more worrisome is the fact that memory is so very fallible. There are many examples of people suddenly remembering things that never happened during therapy sessions, and even if it’s nothing quite that sinister, it’s easy to reinterpret or misremember the past (especially early life) to match your current interpretations. Is it really helpful to try to delve back so far? How much accuracy can I have when I’m partially relying on secondhand information from my parents about my early life, supplemented with fuzzy, emotional memories.

Here’s something that a very literal, black and white, absolute thinker like myself has trouble with: there is no correct answer to the how of my personality. A life cannot be reduced to a couple of simple equations that can be solved if you plug in the correct self care. There is no correct narrative about my life. I do not make sense and I never will. These are not judgmental statements. Ambiguity and randomness are facts of life. We just don’t like to admit that they apply to ourselves, especially when they end up creating pain in our lives.

So is there really any point in trying to make sense of all the billions of small factors that combined to give the world my current self?

I think there is. Each narrative contains some elements of the truth. This week I may focus on some of the difficulties my parents had when I was a child and the ways that it impacted my sense of stability. Next week I may focus on my natural tendency towards order and how it expressed itself as far back as I can remember. The week after I might think about the difficult relationship I had with my brother as a kid. Each of these things contributed something to the way I am right now. When I find answers, I like to hold on tight to them. This is how it is. I don’t get to do that with these kinds of answers. Each one is just a partial, flawed answer. I have to be gentle with them, or they will fall apart. Each time I try to grab onto one too hard and say “this is who I am, this is why I am,” it stops making sense.

The multitude of narratives also helps protect against all the bits that I don’t remember quite correctly. I have to fit competing narratives together, which means parts that don’t make sense get challenged. Any time I become completely convinced that one thing explains all of me, I have to remember how easy it is to tweak my memories to fit.

Of course trusting myself to figure it out in a reasonable manner is even harder as someone with anxiety and depression: I don’t trust my abilities and my brain. This is a hard task to begin with, but for those of us in therapy who really need to undertake it, it’s even harder. It’s easy to imagine that we’re lying to ourselves to make life easier or explain our behaviors away. I once again appreciate the importance of having a therapist I trust. I once again appreciate that this long term work of building a life that balances out my difficulties is impossible when I’m in crisis. I once again appreciate that nuance is necessary even if I hate it.

Posts like this leave me unsettled because there’s no conclusion. I do think that speaking openly about what therapy is like and how it can be difficult is important. I also want to recognize that therapy changes over time. I have been in therapy for almost 5 years straight now, and while ideally therapy is not unending, I have been working on distinct and distinctly important things throughout that time. This feels like it’s close to the end, and that’s exciting, even as I realize that there’s a strong possibility I’ll never be done with the work of accepting that I will never make sense of myself. So no, I’m not just making up stories to make myself feel better. There is some element of self creation in the narratives I choose to talk about, but the overlapping narratives give me some insight into the truth, as far as it exists. That may be the best I can do.

Childhood Surgery and Mental Health

When I was about five years old, I underwent a major invasive surgery. I don’t talk about it often because it wasn’t exactly dinner table appropriate: I had problems when I was a child with UTIs because my urine would reverse along my urinary tract if I didn’t pee. Yup, refluxing urine. Sexy. It had the potential to give me serious bladder infections throughout my life, and wasn’t responding to antibiotics, so in order to keep me from being in pain often and really fucking up my urinary tract, the doctor reimplanted my ureter to a better location so my urine would stay in my fucking bladder and out of my god damn kidneys.

Lovely right?

Now at the time it seemed like it was just an unpleasant experience. It happened and it hurt and I was utterly miserable for about four days of my life. I remember not really eating or sleeping at all. I remember puking a lot the first day because they couldn’t get my pain meds right. I remember peeing a lot of blood. That’s about it. I moved on. I continued my life and I didn’t think about it very often except that every time I drove past the Children’s Hospital in my city I shuddered and told my parents to get me away from the “Dreaded Hospital”.

Until a few months ago when my therapist asked if there was any trauma in my past. I shook my head, sure that my childhood was normal and safe. She pushed a bit, asking about violence or loss or surgery. Surgery? Surgery counts as trauma? Yes, apparently it does, and often leads to PTSD in children (particularly invasive surgeries such as the one I had and surgeries that require multi-day stays at the hospital).

I’ve spent some time poking around the interwebs looking for more information about surgery and trauma, about what sorts of effects surgery can have, about why surgery is considered a trauma, and I’ve been having a really hard time finding much qualitative information that might shed some light on the connections between my severe dissocciative tendencies, my depression, my anxiety, and my surgery.

As someone whose natural impulse about things is to learn about them, to get information, to explore them from every angle, having an event in my past that I cannot research is unsettling to say the least. But more than that, I find it worrisome that the only resources I can find for parents of kids who are going to be going through surgery seem to be geared either at sudden and extreme accidents or towards cancer.

It seems to me that once again mental health concerns are being ignored, even in a situation where someone is already receiving medical care and should be under close supervision of doctors. Why is there not a mental health professional involved every time someone goes under the knife? It’s a scary proposition, even if you’re prepped and feel fairly comfortable. In addition, based upon my own experiences, I would hazard a guess that even if a child does not show immediate signs of PTSD after a surgery, there is a possibility that it could affect their mental health in years to come. Having someone around to teach them strong coping skills and help them process the experience could save the medical industry lots of money in the future (imagine if they hadn’t had to provide me 3 years of eating disorder treatment. Huzzah!) and potentially lessen a great deal of emotional pain for people who have internalized lots of fear and anxiety without realizing it.

It’s becoming more and more clear with research into neuroscience and neuropsychology that the experiences that we have as children deeply affect our brains. Even a limited amount of isolation can affect a brain for years into the future. Surgery can be isolating, it can be painful, it can force a child to deal with mortality, it can be overwhelming, and it can be confusing. These things can change the brain.

Typically a kid is coddled a bit after something like surgery, so you might not see the effects right away: they would be supported, they would have their needs taken care of, they’d have mom and dad around. This means they’re not going to be in a high stress environment where they might need coping skills. It’s only when they’re put into a situation that requires coping skills, or even a situation that feels remotely like their surgery experience that those effects might begin to pop up.

This is pure conjecture on my part, because as I said before I couldn’t find much by way of information, but I suspect that having something like this in one’s past would significantly increase one’s susceptibility to mental illness in the future, as well as potentially create some intense anxieties or fears that aren’t totally rational. Imagine that I’ve been seeing mental health professionals for over five years talking about anxieties and depression, and never once did they think to ask me whether I’d undergone any sort of serious medical experience. It took until this year for someone to even consider that having that trauma in my past might be related or might help me understand. 3

Why are mental health and physical health so bifurcated? Especially given the research that we’re finding that suggests that our brain is deeply connected with all sorts of other body systems, and that we rely on the same chemicals and hormones for all sorts of things, why on earth aren’t we integrating our treatment of mental and physical health? Why aren’t we sharing medical records between our mental health care providers and our physical health care providers?

It’s hard to express how frustrated I am about this, as it feels like an important element of my own health has been hidden from me, as if a doctor had found a gene that put me at a severe risk for cancer and neglected to mention it to me (I do recognize that when I was 5 the research on neuropsychology was nowhere what it is today, so it’s not as if I’m holding a grudge, but rather just feeling confused and hurt that with more information I perhaps could have avoided some of the shit that has been in my life in the past three years). I never thought that this could be an important element of my mental health, but the moment it was mentioned it clicked into place.

The feeling I feel when I am bored, when I feel useless, when I feel alone, is the same feeling I get when I think of my surgery. It’s hard to explain the sense that comes over me when I remember those days because it’s so visceral as to be nonverbal. That says something to me about its importance in grounding many of my other emotions and experiences of emotions. I feel as if I’m wavering away from myself when I think about it, but I can see my body stilling, the panic bubbling through my chest. My teeth clench. I lose the sense of my whole body. I remember the dark, the night, lying in bed unable to sleep with no one there, no one to speak to, nothing to do. It feels like it won’t ever end, it goes on forever because I can’t do anything. It hurts. I remember how much it hurt. I remember trying desperately to stay awake when they were putting me under, a bit confused about what was happening, but knowing that I wanted to keep talking to the people around me. I don’t want to go to sleep, I don’t want to go to sleep, but now hurts and I just have to sit in it because there’s no way out.

When I think about that, it’s hard not to see just how badly that experience hurt me, how it told me that my body was probably broken, how it told me that there was something wrong with me and that the only way to be safe was to always keep my mind safe and perfect.

I just wish I had known that I could think about it or talk about it or process it earlier. I wish I hadn’t kept it tucked away for 17 years. I wish someone had helped me. I don’t know that there’s a taboo around surgery, but I certainly think there’s a silence around it. I wish there were more people talking about their experiences, more ways I could find some sense of community or solidarity.

If anyone has more resources about these connections I’d love to see them, but until then I simply want to say that if anyone else wants to talk or needs support I’d love to hear from them.