Flashbacks and intrusive thoughts

Content warning: self-harm and suicide mentions

I started the day with anxiety feeling like a hole in my chest, and disgusted by this body of mine and the person I am. But I had things to do and a train to catch, so I got out of bed to get on with the day.

I felt the anxiety, the self loathing and self hate, the frustration and anger of rationally knowing those feelings don’t necessarily represent reality while still feeling them, and then the fear that maybe this is all there is.

I spent an hour or so first thing in the morning afraid of myself and sobbing uncontrollably. Irrelevant detail, but this caught me while sitting on the toilet doing my business. Mental illness is anything but pretty and cinematic and I want to acknowledge that, embarrassing as it may be.

I first had flashbacks of the day I tried to kill myself. The desperation, the guilt, the anxiety, the pain… All the feelings as fresh as if I was right back there sitting on my bed on that day swallowing handful after handful of tablets. Then the other intrusive thoughts. Graphic images that I don’t want to see and urges I don’t want to act on, but they show up and even with my eyes open I just see those realistic images playing in my head. Some are things that haven’t even happened at all, or have happened but to a much lesser extent. Most involve self-harming in various ways where the result would range from needing some medical attention to straight up lethal, but no need to go into specific graphic details here.

All of this accompanied by the feeling that I’m just so unworthy of everything, that I’m a burden, that I’m not good enough or just no good at all. My brain forever dysfunctional and my body forever incomplete. Feeling ashamed of these things I have gone through and still go through, while also getting frustrated because rationally I know there’s no shame in having a mental illness and having specific difficulties or needs because of it.

It’s difficult to sit with the feelings by kindly welcoming them, reminding myself it makes sense that they would surface sometimes and that it’s ok and it doesn’t mean I’m going right back to square one. It’s difficult not to judge myself or beat myself up for having them. The dissonance between what I’m feeling and what I think I know to be real only creates more distress. I get angry at myself for still having such feelings and thoughts because I know they’re not true, and then I doubt myself and think what if I should actually listen to them? I get even angrier at myself for daring to question whether those negative thoughts are representative of reality.

And then I thought what I needed was to have a drink, or perhaps take a couple more painkillers than I need, just enough to take the edge off and numb things down. But I didn’t because I know better.

I just stayed where I was and I kept crying, hoping my mind would eventually calm down and stop the intrusive thoughts trying to get me to hurt myself and to convince me that all I am and all there is to my life is being ill. I find that with this as well as with panic attacks, it helps to just let it run its course gently guiding myself out of it rather than forcing myself. I wouldn’t say “just stop” to someone going through the same thing, so I try to be kind, understanding and patient with myself as I would with someone else.

I try to regulate my breathing slowly instead of trying to jump into a 7-11 rythm immediately (that’s 7 seconds breathing in, 11 seconds breathing out). Physical ways of grounding myself are also helpful, as the unhealthy methods I used in the past were self-harming and punching walls until my hand was all swollen. The healthy ways I then found are mainly using a weighted blanket by folding it as many times as possible to concentrate all the weight on my chest as I lie on the floor or in bed (don’t do this for too long!), or by sitting against a wall and pushing against it as hard as I can (if I have something I can push against with my legs that’s even better). I have tried other things suggested to me such as shocking myself by splashing cold water on my face or biting into a lemon, and those don’t really work for me.

What most professionals I’ve seen in my life failed to address was the importance of aftercare. You don’t just pull yourself out of it and get on with the day as if nothing happened. Sometimes I do have to carry on as soon as I can, for example if I’m at work, but it’s still important for me to make some time later in the day to at least check in with myself. Again, if this was someone else I would still keep supporting them after the worst of it is over. I’m getting used to always asking myself how would I treat someone if it was them and not me going through whatever I’m going through.

Today this meant that instead of rushing to get showered, pack my bag and run to catch a train, I rescheduled for a later one. I got ready without rushing, left early enough to not have to walk really fast, and found myself a quiet spot on the train. I allowed myself to acknowledge the sadness and frustration instead of immediately trying to distract myself with something else. Over time I’ve learned to recognise when it’s safe for me to engage with some of the thoughts and feelings that arise, and when I actually need to find a distraction before acknowleding them so as to avoid triggering myself back into the same state. Then I got to my destination where I had planned to do certain things, but instead I rested at the hotel for a bit and then went on a quiet walk.

I can’t always drop everything to do some self-care and self-soothing, and more often than not I have to carry on with what I was doing without much of a break. But it’s always possible for me to re-think what is and isn’t essential in that moment, and to re-adjust things things to the extent that I can in order to make life a bit easier for myself. I still feel selfish doing this, even when those adjustments don’t really affect anyone else.

If I really don’t have the time for anything right away, I still find a few moments at some point to just see how I’m doing, think about what’s happened and whether anything triggered it, see how I feel about it now and leave space for those feelings, see what worked and didn’t work in the moment, and see whether there’s anything I can do for myself that would help now.

It’s a learning curve and I always remind myself that no matter how helpless I feel in the moment, it will always pass and I just have to ride it out as best as I can. But this isn’t always easy and I don’t always believe it.

And going back to the fear I mentioned at the beginning of the post that maybe this is all there is… Where does my unaltered self end and my mental illness begin? I don’t think they’re separate. My self is mentally ill. There’s no “before” where I wasn’t affected by mental illness or a weirdly wired brain in one way or another. There’s no future where I will be free of it. It makes me have a lot of gratitude for every day I get through where I’m stable and content, but deep down it also just terrifies me feeling like there’s this ticking bomb inside me and one day I won’t be able to extend the timer any longer. I’m confident in my coping skills at present and my medication is working really well, but there’s no guarantee that will never change. What if the stability of these last two years has been just a fluke? I know episodes will still happen at some point to some extent, and with medication and the right support network I will be able to get through them… But what if I can’t? That terrifies me.

Still, I remind myself that right here, right now, I am stable and doing well and getting through the tough panic attacks and moments of self-doubt. Just as impermanent as this is, so is everything else. My illness can’t be everything there is to me because I have proof that there are times when it isn’t. So just as I can’t take the stability for granted, I can’t assume that any future episode will never end. And that settles my fear a little bit.

What stability looks like so far (1 year on meds)

I started my medication in mid 2020 after my diagnosis, and I reached the full dose I’m currently on in August 2020. Thought I’d show what my mood has been like since then, and reflect a bit on the past year.

I have been tracking my mood using the Bipolar UK mood scale and my own spreadsheet (template here).

Some reflections in no particular order

Ups and downs still happen. I have relatively long periods of a consistent neutral mood, but I still have low days (and some high ones) here and there. But they became less frequent, less severe, less long-lasting (a couple days of feeling low as opposed to a couple months), and way more manageable.

Meds take time to kick in. Although I was in a much better place when I left the hospital after a few weeks titrating meds, it took me another six months or so to reach a point where my mood was stable and where I felt in control and confident in my ability to manage it.

The first few months are scary. Coming out of a mixed episode while inpatient after a suicide attempt was scary. Wanting to be alive for the first time is scary. Every slight mood change had me worried I was about to spiral out of control again.

Intrusive suicidal thoughts took a while to go away. I still have them sometimes, but rarely. They were more common at the beginning. I didn’t want to die, but after being suicidal for over a decade, it was just my brain’s go-to thought.

It took time to know myself. I didn’t instinctively know what my healthy range of emotion is. I had to re-learn what normal sadness and normal joy looks like for me, what’s a normal reaction and what’s a warning sign of oncoming depression or hypomania.

It’s not always the bipolar disorder. I have frequent migraines (not chronic, but close) and part of the prodrome for me is a depressed mood with increased anxiety. Many of the lows in my chart are migraine-related, which is something that took me a few months to identify.

It’s not just medication. I wouldn’t be alive without medication, let alone function without it. But meds alone don’t do all the work. When my mood goes up or down, it’s a lot less severe and more manageable than it would be without meds, but it’s up to me to use coping skills to get it under control and get back up (or back down) to something neutral.

My baseline leans more towards the low side. I’m more likely to have low than high moods when I deviate from neutral. This might be the nature of my bipolar, or it might just be the nature of my life circumstances (a crappy job atmosphere, migraines, some dysphoria as I sit on a long waiting list for surgery). But it’s completely manageable.

I haven’t fully come to terms with it yet. I fact-check and research most information I come across. I’ve read about migraines, about gender dysphoria, about why bright sunlight makes me sneeze, about so many things in my life big and small. I still haven’t read much about bipolar disorder besides self-management strategies because I’m not ready to fact-check how much of a progressive illness it might be, or how likely it may or may not be that my meds will stop being effective or that I will have another episode. But I don’t like living in ignorance, so I’m working on it.

I don’t take stability for granted. I know I’m not cured or fixed. I know I’ll live with this for the rest of my life, and I have a few decades of life ahead of me if nothing gets in the way. I track my mood, I’m self-aware of my thoughts and emotions, I take my meds, and I avoid any known triggers to the best of my ability. I know stability is not forever guaranteed, so I’m grateful for it and I try my best to maintain it.

It will be interesting to see how things go as the years go by. They might get worse at some point, but I’m confident in my ability to handle them better than I was able to in the past.