I am not sure why I feel so inclined to write on a subject which is so intensely boring. Although actually the subject itself is interesting enough, it's the process which brings about the - well maybe boredom is the wrong word. The subject matter is insomnia, but maybe that's wrong too. Everyone knows that insomnia is not sleeping, what more is there to say? So it's about the effects of insomnia.
I am leaving that first paragraph mostly unedited because it's illustrative of what I'm talking about. At the moment most of everything I write has to be written disjointedly, slowly, considered, reread, rewritten because it makes no sense, and so on. Sending texts is taking me forever! I am aware that I've described my current writing practice in a way that's probably close to normality for many people, but for me writing is something that usually requires very little consideration. This struggle to get my words set down in order feels incredibly odd.
I'm not sure how long it's been this time. Time gets weirdly out of shape when so little sleeping is going on. I've had trouble sleeping from time to time over many years. More recently I had a period of sleeping quite well. At some point that changed and sleeping for about 1 to 4 hours each night became normal again. Such nights are interspersed every so often with a night when I sleep for perhaps 12 hours but through those hours I wake every 20 minutes to an hour.
It's boring partly because there is just so much time. Extra hours of wakefulness which I don't really want to fill with activity because I want to be asleep, and to give myself a chance of sleeping I do need to be in bed. It's also boring because, although I know there are people out there doing night shifts or awake for all sorts of other reasons, it's so dark and quiet that it's easy to believe I'm the only person awake. And I can't really go anywhere or ring anyone so to all intents and purposes I am the only one awake.
Insomnia is not just boring at night though, it also casts its shadow right over the day. I'm so zoned out from lack of sleep that most of the time I don't feel properly awake. I am frustratingly, annoyingly awake in the night but whether it's night or day it doesn't feel like real awake. Everything is dull, off-key, distorted somehow. Thoughts start then trail into nothing, organised activity becomes very confusing. It's like being permanently stoned. Except every so often there's a shaft of proper awakeness which is shockingly intense and stressful, like having a bright light shone in my eyes. I think this is probably just what it's like to be awake normally, but in my stunned sleepless state I have become unused to it and it's as excruciating as pins and needles.
I heard once that after a night of less than five hours sleep your reactions will be slowed to the same extent as someone who's once over the limit for drink driving. I found it hard to believe until I subsequently had a sustained period of sleeping well and realised what a difference it made. I certainly don't feel capable of anything that particularly requires me to have my wits about me at the moment.
I suppose I should own up and say that I had neither a warm bath nor a hot milky drink before I went to bed some hours ago. I have done those things before bed on occasions, though I much prefer to have a bath in the morning than right before bed. I don't do them because they don't actually make a difference, and also because I get so sick of everyone telling me at far too regular intervals that if I do these things all will be well. It's so simplistic and banal, and they all tell it like it's news.
It is now 4am, I haven't slept yet. I woke this morning at 5am having slept about 1 1/2 hours during which time I woke twice. I went to bed for a few hours earlier but thought I'd have a change of routine and get up for a couple of hours. Now I think it's time to make another attempt on sleep.
Thursday 29 October 2009
Monday 26 October 2009
"Assisted" self harm
I came across this article via a friend on Facebook and have a bit more to say about it than would fit in the comment box. The article, which can be found here, details approaches being used in psychiatric hospitals to try to reduce harm brought about by self injury and enable service users to self injure more safely. Many of these strategies are not new, though they're probably unheard of in most mental health establishments. I think some of those described are very helpful, others quite dubious, and it may surprise you to find out which I think are which.
Everyone who's admitted to a mental health unit has a care plan drawn up, usually with their participation. That is a standard procedure and copies should be held by both the staff and the patient. A good care plan for someone who self injures should include a section on how self injury might be managed. The general aim is to reduce the incidence of self injury, though that aim may not be shared by the patient. That's because self injury can be a life-saving coping strategy and removing a person's means of coping can put them at risk. However, self harm reduction strategies do need to be put in place because they may provide an alternative and more effective way of coping at some times. For example, being given the opportunity to talk to a trusted member of staff can be helpful in managing self harm, though staffing limitations on the ward often make this unworkable.
In addition to looking at reducing self harm, however, this article details ways for patients to continue to self injure but to do so more safely. The provision of dressings on wards is usual, though they are not usually directly accessible to patients, being kept in a locked room. Usually dressings will be provided as needed, and sometimes additional dressings will be provided, ostensibly for when dressings need to be changed, but effectively they can be used for new wounds too. The contraversial aspect is the provision of clean blades. The rationale is that, deprived of their usual means of self injury, people will look around for something else to use, and that something else will be more likely to cause infections than the clean blade they might have used otherwise. This is completely true. I have known people use broken glass off the pavement outside the ward, used blades discarded by others, even staples from magazines when on 1-1 supervision. None of these items are clean and some may carry serious health risks. A clean blade would certainly be preferable to any of these. There are, however problems, which I will come to shortly.
Some years ago I encountered this dilemma myself. I was in hospital for several months and self injuring frequently at the time. It was general practice for staff to remove blades from us if they found them on us, but there are many ways to hide a blade if you're determined enough. I had a friend who also self injured and she knew I had blades. I had been to the shop earlier and bought a pack of five. She asked me to give her one of them. I was unsure what to do. On one hand I felt that she had a right to self injure and shouldn't have had her means of doing so removed. I was also aware that she was trying to contain her stress and that she might do something more life-threatening if she was unable to cut. I also felt that it was somewhat hypocritical to stop her cutting when I was doing the same. On the other hand I didn't want to be responsible for her hurting herself, especially as this particular kind of blade was different, and probably sharper, than what she was used to using. I was worried that she might injure herself more severely than she intended with this unfamiliar blade. But it was clean and new and therefore preferable to what she might resort to using otherwise. I gave her the blade. I told her it was sharper, I made her promise to use it safely, and was very relieved that she did.
I do worry that hospital issue blades might escalate the severity of some people's injuries. If someone is admitted having been cutting with a penknife, and is issued a supply of razor blades they're not going to go back to using the penknife when they get home. On the other hand it was when in hospital that I started what became years of burning myself because my blades had been taken away.
It seems to me that by far the most sensible thing is for staff to supply the dressings but let people keep their own blades. If they weren't taken off us in the first place the whole issue of whether to replace unhygeinic salvaged "weapons" with hospital issue blades would go away. That measure in itself would probably reduce the level of self injury because it would reduce the build up of anxiety and the desperation it leads to.
Now onto the part of the article that really worried me; that being the practice of nurses sitting with patients while they self harm. Maybe this is some sort of covert prevention strategy because I can't imagine myself or anyone I know self injuring when anyone else is there. This is an intensely private activity, not to be seen by anyone, whoever they may be. One of the big reasons people don't seek help for injuries and learn to do their own dressings is because they don't want anyone to see the wounds, let alone the act itself. In my view the main preoccupation would be how to get rid of the nurse so I can get on with the self harm! I can't see how encouraging a patient to self harm in front of a nurse is going to help anyone, in fact I had not been prepared for the degree of horror I experience just by writing about it. Maybe sitting with the nurse before, or, even better, after self injuring, would help. But during? Ugh!
So my conclusion: let us keep our blades, help us to use them less if you can, give us the dressings we need when we need them and don't even think about sitting there while we're cutting.
Everyone who's admitted to a mental health unit has a care plan drawn up, usually with their participation. That is a standard procedure and copies should be held by both the staff and the patient. A good care plan for someone who self injures should include a section on how self injury might be managed. The general aim is to reduce the incidence of self injury, though that aim may not be shared by the patient. That's because self injury can be a life-saving coping strategy and removing a person's means of coping can put them at risk. However, self harm reduction strategies do need to be put in place because they may provide an alternative and more effective way of coping at some times. For example, being given the opportunity to talk to a trusted member of staff can be helpful in managing self harm, though staffing limitations on the ward often make this unworkable.
In addition to looking at reducing self harm, however, this article details ways for patients to continue to self injure but to do so more safely. The provision of dressings on wards is usual, though they are not usually directly accessible to patients, being kept in a locked room. Usually dressings will be provided as needed, and sometimes additional dressings will be provided, ostensibly for when dressings need to be changed, but effectively they can be used for new wounds too. The contraversial aspect is the provision of clean blades. The rationale is that, deprived of their usual means of self injury, people will look around for something else to use, and that something else will be more likely to cause infections than the clean blade they might have used otherwise. This is completely true. I have known people use broken glass off the pavement outside the ward, used blades discarded by others, even staples from magazines when on 1-1 supervision. None of these items are clean and some may carry serious health risks. A clean blade would certainly be preferable to any of these. There are, however problems, which I will come to shortly.
Some years ago I encountered this dilemma myself. I was in hospital for several months and self injuring frequently at the time. It was general practice for staff to remove blades from us if they found them on us, but there are many ways to hide a blade if you're determined enough. I had a friend who also self injured and she knew I had blades. I had been to the shop earlier and bought a pack of five. She asked me to give her one of them. I was unsure what to do. On one hand I felt that she had a right to self injure and shouldn't have had her means of doing so removed. I was also aware that she was trying to contain her stress and that she might do something more life-threatening if she was unable to cut. I also felt that it was somewhat hypocritical to stop her cutting when I was doing the same. On the other hand I didn't want to be responsible for her hurting herself, especially as this particular kind of blade was different, and probably sharper, than what she was used to using. I was worried that she might injure herself more severely than she intended with this unfamiliar blade. But it was clean and new and therefore preferable to what she might resort to using otherwise. I gave her the blade. I told her it was sharper, I made her promise to use it safely, and was very relieved that she did.
I do worry that hospital issue blades might escalate the severity of some people's injuries. If someone is admitted having been cutting with a penknife, and is issued a supply of razor blades they're not going to go back to using the penknife when they get home. On the other hand it was when in hospital that I started what became years of burning myself because my blades had been taken away.
It seems to me that by far the most sensible thing is for staff to supply the dressings but let people keep their own blades. If they weren't taken off us in the first place the whole issue of whether to replace unhygeinic salvaged "weapons" with hospital issue blades would go away. That measure in itself would probably reduce the level of self injury because it would reduce the build up of anxiety and the desperation it leads to.
Now onto the part of the article that really worried me; that being the practice of nurses sitting with patients while they self harm. Maybe this is some sort of covert prevention strategy because I can't imagine myself or anyone I know self injuring when anyone else is there. This is an intensely private activity, not to be seen by anyone, whoever they may be. One of the big reasons people don't seek help for injuries and learn to do their own dressings is because they don't want anyone to see the wounds, let alone the act itself. In my view the main preoccupation would be how to get rid of the nurse so I can get on with the self harm! I can't see how encouraging a patient to self harm in front of a nurse is going to help anyone, in fact I had not been prepared for the degree of horror I experience just by writing about it. Maybe sitting with the nurse before, or, even better, after self injuring, would help. But during? Ugh!
So my conclusion: let us keep our blades, help us to use them less if you can, give us the dressings we need when we need them and don't even think about sitting there while we're cutting.
Sunday 4 October 2009
Finding the right pace
This is an issue that I return to again and again, and I know I'm not alone in this. Throughout our lives we all need to adjust our pace of living from time to time, and mostly it's something we can do without too much thought. We find ourselves doing less when we have flu, more when we have children to look after, we make adjustments for holidays, visits from friends and families, deadlines. Sometimes life circumstances bring about less welcome changes - we have too much to do and get stressed and exhausted, or find ourselves with too little to do and become dissatisfied and unfulfilled. Then we have to think a bit more about finding our way back to a pace of life that feels more natural.
For those of us with conditions which fluctuate, where our energy levels vary more frequently and extremely, the art of pacing ourselves becomes an issue that we have to give a lot more attention. For example, I have a number of friends with fibromyalgia whose energy and pain levels vary unpredictably and dictate that their pace of life has to slow down, and then speed up a little when symptoms recede - not too much though, or those symptoms are back again. In my case, with bipolar, my activity levels can vary hugely. When I'm low I do little more than lie in bed most of the time. When I'm high I do very little staying still. When I'm somewhere in between I find it very difficult to find a balanced pace.
When I'm low I know I need to try to do a bit more than feels comfortable. Sometimes this is because of something very basic, such as having been thirsty for hours and needing to get myself down to the kitchen to get a drink. It doesn't sound much but that can be quite a big change in pace. Sometimes it means making the effort to leave the house most days, see friends regularly, put washing in the machine. It's tricky because too little activity exacerbates the depression but too much is overwhelming and that can exacerbate it too. It's very hard to form opinions about how much activity is right because what's right on one day might be wrong the next.
When I'm high the opposite applies. They say when you're low do more, when you're high do less, but doing less is very hard. 3am seems about the right time to get up and start the day - if I've gone to bed yet - and doing several things at once seems the best way to go about it. At these times I think it's a good thing that I smoke because it means that I do actually sit down for 5 minutes every couple of hours. It's difficult to focus on finding the right pace when high because pacing yourself is sensible and sensible things are boring. Boring things are beneath my notice because I am doing much more important and exciting things with my time!
When my mood is more stable there is more scope and motivation for finding the right pace, not least because it's one of the main ways to try to prevent relapse. But how is it done? This week, for example, I started to feel a bit better on Wednesday. It was quite a novelty to want to do things and have energy to carry them out. For 3 days I kept myself quite busy, relative to what I've been doing of late. By Friday evening I was crying with exhaustion and had to admit that although the will was there, the stamina was not. 10 weeks in bed really does for your fitness levels and I hadn't taken that into account. So, back to bed for most of the weekend. Clearly I need to take a more gradual approach, but I'm not sure what that involves and how long it will be the case. Sometimes I attempt this by making structured plans, other times I play it by ear. Sometimes I don't trust my judgement, and sometimes I have good cause not to. Sometimes I rebel because I don't want to have to think about it. Very occasionally, I get close to getting it right - for awhile.
For those of us with conditions which fluctuate, where our energy levels vary more frequently and extremely, the art of pacing ourselves becomes an issue that we have to give a lot more attention. For example, I have a number of friends with fibromyalgia whose energy and pain levels vary unpredictably and dictate that their pace of life has to slow down, and then speed up a little when symptoms recede - not too much though, or those symptoms are back again. In my case, with bipolar, my activity levels can vary hugely. When I'm low I do little more than lie in bed most of the time. When I'm high I do very little staying still. When I'm somewhere in between I find it very difficult to find a balanced pace.
When I'm low I know I need to try to do a bit more than feels comfortable. Sometimes this is because of something very basic, such as having been thirsty for hours and needing to get myself down to the kitchen to get a drink. It doesn't sound much but that can be quite a big change in pace. Sometimes it means making the effort to leave the house most days, see friends regularly, put washing in the machine. It's tricky because too little activity exacerbates the depression but too much is overwhelming and that can exacerbate it too. It's very hard to form opinions about how much activity is right because what's right on one day might be wrong the next.
When I'm high the opposite applies. They say when you're low do more, when you're high do less, but doing less is very hard. 3am seems about the right time to get up and start the day - if I've gone to bed yet - and doing several things at once seems the best way to go about it. At these times I think it's a good thing that I smoke because it means that I do actually sit down for 5 minutes every couple of hours. It's difficult to focus on finding the right pace when high because pacing yourself is sensible and sensible things are boring. Boring things are beneath my notice because I am doing much more important and exciting things with my time!
When my mood is more stable there is more scope and motivation for finding the right pace, not least because it's one of the main ways to try to prevent relapse. But how is it done? This week, for example, I started to feel a bit better on Wednesday. It was quite a novelty to want to do things and have energy to carry them out. For 3 days I kept myself quite busy, relative to what I've been doing of late. By Friday evening I was crying with exhaustion and had to admit that although the will was there, the stamina was not. 10 weeks in bed really does for your fitness levels and I hadn't taken that into account. So, back to bed for most of the weekend. Clearly I need to take a more gradual approach, but I'm not sure what that involves and how long it will be the case. Sometimes I attempt this by making structured plans, other times I play it by ear. Sometimes I don't trust my judgement, and sometimes I have good cause not to. Sometimes I rebel because I don't want to have to think about it. Very occasionally, I get close to getting it right - for awhile.
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