Recently in Self-Harm Category

I have hurt myself, sometimes quite seriously, many times. It is difficult to rank serious self-harm and suicidal events because one must take into account both the physical and psychological damage. But while there is a good deal of subjectivity involved, there is no question that what I did to myself last week ranks up there as among the most serious in my lifetime.

Physical damage is what most use to rank such events because it is quantifiable. Like many others, I have taken dozens of overdoses over the years. Two of them were clearly different from all the rest. They were the ones which were especially calculated. They involved taking many times the lethal dose. And they were preceded by taking sedatives so that I would not be able to change my mind and go to anyone for help afterwards. Those were obviously serious physically and I was lucky to have survived them many years ago.

Hurting myself in the present often involves recreating the past by finding others to hurt me, either virtually or in real-life. This has gone on for years, is often an instinctive response, and is something I am ashamed of. It has been damaging because I have perpetuated the abuse done to me and has led to all sorts of problems. What makes it difficult is that most of the problems are psychological and comparatively easier to hide.

As I have healed, the more I appreciate the extent of the psychological damage of this kind of self harm. To put it into some context, long ago when parts of me were much more separated, these self harm events were more isolated. While it undoubtedly caused psychological damage, those hurt parts had little or no understanding of where their distress was coming from.

Without question, increased awareness and internal communication—whether one has dissociated identities or not—are necessary components to healing and tools to help keep us safe. But there are no guarantees of safety. When safety is breached, the increased awareness leads to a totally different perspective of the effects of this type of self abuse.

What happened last week was arguably, for me by my own scale, the most serious event of its kind ever by many measures. To call it self harm or self abuse is not even adequate. Self harm was the terminology I used a decade ago. Self abuse was the terminology I began using a few years ago. What happened last week was a psychological suicide attempt. I think it is important for me to be as precise as possible and not cloak what happened with more polite terminology.

A couple days ago, I did an analysis of both the events and feelings which has led me to label what happened in such a unambiguous way. While a lot of the actual events are lost or in flashes, I have enough information to know that what happened was in a totally different class from past events. I also have hard data. I had numerous entries in my private journal, text messages, and phone logs in the hours leading up to what happened. I have a perspective that is much clearer than any similar event before.

But the saddest piece comes not from the actual harmful events. Not from what was done to my body or done to my psyche.

The plan from the night before was to be admitted to the hospital, where I am now. I had become too unstable, too fragmented, and too much at risk. I told my therapist I needed some time to tie up some loose ends at work and do some last minute preparations. I was to be in hospital admissions by 6PM. That was the agreement I made.

It turned out that I was not grounded enough to be trusted with such an agreement or such an amount of time on my own.

I know there was internal conflict about getting hurt that day. That conflict usually is what keeps me safe. But there was very little sense of reality and no sense of ground. And, so, "safety" and "getting hurt" existed as their own isolated parallel threads. That dynamic of polar opposites existing simultaneously increased the safety risk manyfold.

At one point, I was at a tibetan arts store to get my wife, who is into yoga, a Christmas gift. Amidst all the confusion and fragmentation, at 1:45PM I wrote these words in my journal: "Healing. Went to the tibetan store for a present. Big shift now towards safety. But confusion and conflict too." That nearly led to a change of course to not get hurt. But it was not enough.

At the store, I also searched for a gift for my therapist. I thoroughly explored the shop and what I found for her was a compassion stone. It is a small stone from India with the "Om mani padme hum" mantra on compassion in Tibetan script . This is sad because it is proof that there were enormous coexisting efforts to be safe and also to be hurt.

While it certainly feels like my "gift" to my therapist is tainted, I hope we can take from this something positive.

This stone, then, obviously has critical significance. It perhaps should sit in my therapist's office, or be accessible to us. We should use it as a reminder of how the desperate effort to be safe and compassionate was destroyed—within minutes.

For me, that stone will probably be my most important icon in the world. It is something tangible from that horrible day. It will mean more to me than the medical records I have from the major overdoses. More than poems I have written from long ago about sad events and abuse. More than any art work I have made. Even more than records I have from the Catholic Church.

That stone represents the fact that I made a choice. That stone embodied all of my hope. It embodied all of my compassion. And I, and I alone, made the choice to destroy all of that.

I will never forget that.

And now I have to pick up the pieces and recreate what I have destroyed.

All of us live in a world of cycles.

Cycles, I think, are meant to be double-edged swords. They are the necessary friction of life that I have talked about before.

In the best of cases, we use these predictable cycles as a means of helping us navigate through the phases of our lives. Many of us probably recognize how these are sometimes referred: familiarity, teachable moments, evolution, wisdom, maturity.

We are probably all aware of how a new cycle can serve as a clean slate. When I was in school, every September I was fond of saying "I don't have a single poor grade!" Or, we are probably also aware of a sense of comfort in what is familiar. Every Spring is a time of renewal. Most every Christmas has been a time of magical wonder. I live in an area of the world that snows right around Christmas-time and that serves as a metaphorical punctuation mark.

But, anniversaries of traumatic events and triggers are also types of cycles. And therein lies the friction. And the dichotomy.

Speaking for myself, I know I can very easily find myself trapped in a new cycle and have little or no perspective on it. In other words, the cycle can be strictly seen from a historical point of view. In still other words, parts of me can be stuck in the past.

I so dislike admitting that. I would rather believe that I am full of awareness and am fully healed and fully safe. Period.

But that is simply not true.

For those of us who have lived many years using dissociation as a core means of coping or navigating through cycles or triggers of past trauma, this is not really difficult to fathom.

I have not written here in over a month, and during that time I have experienced many triggers and not navigated all of them well. Just ticking off some of the highlights, there was the perennial Halloween "holiday", with all its normally charged associations, plus we had a rare crippling snowstorm. Then the relentless news of the US college sports sex abuse scandals, which have rocked me to my core. It was not really much of a surprise, but I was caught unprepared by the impact of the late November "anniversaries" of major suicide attempts from the early 90s and the connections to where I was last year (in the hospital). Finally, "church abuse" news, direct or indirect, seems to always crop up.

Reflecting on the past month or two—I have lost track—I can easily say life has been more tilted towards disconnection and chaos and "living in the past" than it has been towards awareness and looking towards the future. My life has certainly not been in any sort of balance, and I have not been safe from purposely hurting myself. As a result, life has become extremely distorted and unstable, and what feels safe also does not feel safe, sometimes simultaneously. Some of you know will know what that statement really means.

I have been living precariously. There has been a thin line separating life and death, connection and disconnection, giving up and holding onto hope.

What is most scary, is that I do not even think I realized this!

But this afternoon, the seas have calmed. The compass appears to be working. The ship's wheel isn't spinning out of control anymore. The ship is moving forward. With direction. With purpose. I can see land.

Despite what our psychological "clocks" tell us, we arrive at a new cycle, but always at a place in time that is ahead of the last one. We may not appreciate that as a statement of fact in our times of struggle. But it is a fact. No matter how "in the past" parts of us may be, I strongly believe that we are destined to heal, to find balance, to learn from our past, to build a better future.

A note about the 'Expressive Arts Carnival.' I am sorry for the break in routine, but the carnival will be back with new activities next month.

I know it has been a long time since I have been writing regularly here. I have been keeping regular entries in my journal, but this has always been the place where I try to "collect my thoughts," make a bit more sense, put the pieces together, and gain some perspective for myself.

So, I am glad to be back!

I have this gut feeling that I am on a bit more stable ground. And it does not take more than a few seconds to look back here and see that my sporadic posts over the past few months of summer have been mainly about having no traction and then finding some stability.

Back and forth it has gone... Super functional when needed. Sometimes collapsing. Some great accomplishments at work that sort of spoke to me "It's okay keep going like you are!" Great alliances with my kids accompanied by huge meltdowns. The same type of alliances with my wife and also large fights.

Sounds like the stuff of normal everyday life, right?

It would be, except for the fact that there have fairly often been complete breakdowns in safety. That is not acceptable anymore, but yet I have been handling these huge lapses in very old ways, by getting up, dusting myself off and moving on to the next item on my list.

I have been hoping the new school year for my kids would bring some much-needed structure back into my own life and help me slow the pace down. I do not really know how it happened, but the past year has been about taking on more and more; partly because I felt like I needed to, but also because I knew I could. My schedule has been so busy that I have not been able to have any consistent time for self-care. There has been only a bit of self-care here and there, but mostly everything else in my life has come first. As a result, those little bits have not been enough to keep me safe or allow me to feel like my life is under control.

There might as well be a giant red flag flapping in front of my face. And I have to wonder, "Is this your garden variety "workaholic" mode meant to foster distraction and denial?"

I know, because I have done it many times before, that if I set limits for myself, practice more self-care, and do "less", that there are huge benefits. I can often be more productive in all facets of my life and be much happier and achieve more "wellness" as an added bonus.

We are now two weeks into the new school year, and nearly three months since the old school year ended, and only today does it truly feel like there is real settling. Real slowing.

Could it be that I have been on a three-month long roller coaster ride and it is now just coming to a halt? If so, what a waste. My hands weren't even up in the air!

Last year in Looking Back and Ahead, I tried to make sense of my long healing journey as well as identified my gains for the year. I think it is probably good practice for all of us to reflect on the past year and use it as an opportunity to celebrate the gains, validate the tribulations, and set goals for the upcoming year.

For me, this year has been filled with at least as many ups and downs as the last one. Most of what follows is based on a discussion with "My Healing Guide" a couple of days ago. Whenever I talk about short-term gains, she likes to frame them in a larger context, as being built on the accumulated efforts of the entire journey. She says it is like I have already built a foundation, and our task is to add floors and rooms. I do like that metaphor.

I do believe that the Contract of a year ago was the launching point for what I was able to accomplish this past year. The entire Contract is really based on just a few basic principles (summarized by single words): trust, acceptance, and validation. Everything flows from these. While we don't read the Contract much these days, we don't really need to; its creation came from a place of near complete common ground and all inside know its essential elements to our core. Yes, the Contract has stood up well this past year. We have all understood its significance.

While I know our therapy work this past year was a true collaboration, it was important for me to tell "My Healing Guide" that she played a huge role in helping me continue to heal. I absolutely do not take that help for granted. None of my gains would have been possible without her help, without her willingness to be there for me, to walk with me, to listen to me, to promote trust, acceptance, and validation. Likewise, I do not want to underestimate the role that the online community, through this blog as well as reading of others, has played in helping me to think more broadly and regularly about many of the issues I, and others, face.

I also have an appreciation for the fact that healing is really about living. It is not all about therapy. The work we have done has helped me live more of the life I want to live. Yes, there have been some really low lows this year. But there have also been new connections inside, with my children and, to some extent, with my wife.

The 2010 year started out horribly with the Our Family Crisis, which blew up in our faces. This family "friend" was truly distorting my relationship with my wife and driving a huge wedge between us. This situation had been ongoing for years, but I think it came to a head because the "friend" saw an opening partly because I was in the hospital so often. It is astonishing to me that I was able to solve it. I stood up for my family. I took charge. I reestablished boundaries. The result was that my wife and I became much closer and that set us up for what was to come.

In Holy Week, Church Visit, Scandal, and Miracles, I wrote about how "My Healing Guide" went with me to the church where most of my childhood abuse took place. I never imagined that would have been possible, and I still cannot believe we did it! It was initially all completely validating and healing, but it did stir things up inside which caused us to eventually question whether it was the right thing to do after all.

There were gains made, however, which helped us realize it was definitely the right decision. Those gains came at a cost, though, because of internal instability that landed me inpatient quite a bit this past year; five hospitalization for 59 total days. I knew Easter was going to be really tough. In The Word of the Lord?, I wrote about some of the issues I faced during Easter and how I tried to put into perspective the stream of news coming out of Rome.

We then addressed directly a part who was key to the self-abuse. Inside, we were all certain she was the embodiment of evil. We were all afraid of her seemingly unlimited power. In Inside, an art piece done in the hospital, she stepped forward and joined in the healing process. That was a huge leap forward for all of me.

Not all was safe, though. That huge shift led to additional instability in my system. There was a long period of continued self-abuse from other parts who were newly activated. I wrote about this, mainly from an intellectual perspective, in Sex Injury: Past and Present. I used sex to recreate situations that would lead to my own abuse and recreate feelings of worthlessness. I do think, now, that I have come out the other side. I firmly believe that kind of self-abuse is permanently behind me. I am continually being reminded of what it was about (through flashbacks) and know it cannot ever happen again.

There were two occurrences that led to this resolution.

First, was when my wife found out about my self-abuse by my accidentally leaving my electronic journal open to a particularly sensitive entry. That she now knows about what has been my life's deepest secret (though she does not know details) is incredulous to me. Even more surprising is that while she had immense trouble with this new knowledge, I think it has made us stronger as a couple. The cards were put on the table. She finally learned that there are truly dark aspects to what I have to deal with.

Second, was that I physically got hurt from the self-abuse itself. After I wrote Taking Care When Physically Sick, I found out the illness was in fact a direct result of the self-abuse. Getting hurt in this way ushered in a whole new sense of what the consequences really are, a reality that acting out parts had no concept of before. It brought self-abuse parts together with more healthy parts and is causing yet another reordering inside.

I have the sense that this new internal reordering will be what 2011 will be about. I know it will not be painless and I do not know what the months ahead will bring. But I hope the reordering and focus on safety will allow certain aspects of my life to flourish. I expect work and my relationships with my kids and wife will be where new gains will be made.

Already, the new reordering inside is leading me to come face-to-face with how to achieve balance in my life. How can I be successful at work, for example, while practicing good self-care? Or, said more broadly: How can I participate more fully in life and still practice self-care? 2011 will be about finding and maintaining this balance. Whereas 2010 was about acceptance.

Balance partly comes from being in touch with feelings. And this is why I have been proactive lately about getting in touch with feelings as a kid and connecting the past to the present. I have watched movies and television shows and read books which are validating and asked my Mom for old pictures of me as a kid. This is one way I know of to achieve balance. It is more difficult to get lost in a single part of me if I am also reminding myself of feelings. I have to always remember that balance is key now. Yes, I know I am being very proactive. I know I am forcing myself to feel feelings. This is one major aspect of self-care. And this is the one area I know I focused on when I started this new healing path a couple of years ago.

I also know that the sex self-abuse was one way to solve internal problems, even though it was definitely harmful and dysfunctional. I talked with "My Healing Guide" about it not only being about making myself feel worthless. But also about recreating abusive events so that I could come out the other side and prove that I was "not really hurt" and could go on and be functional. I am not sure how much was which. But I do not think it needs to be my job to figure out what the relative weights were. We are all on a new course now.

If part of the self-abuse was to feel worthless, I have to challenge that now and do deeds that heal that way of thinking. If part of it was about control and recreation, I can challenge those by practicing my skills at balancing and validation.

What is important for me to keep in mind is that I know I have skills and a plan in place to help keep my life balanced and safe.

Yes, 2010 was a year of great accomplishment. And I know 2011 will be equally great if not better.

Happy New Year to all of you!

In Blending, I talked about how I navigated through Halloween and a short hospital stay which led to increasing my level of acceptance. I almost never leave the hospital so quickly. And probably for good reason. I ended up back inpatient in exactly a week.

What I believed was acceptance was more a mirage. I asked to leave based on what was really only a minute amount of internal communication. It was not enough to leave here confidently. But I did anyway.

While I did well for several days, everything collapsed in a matter of hours. The memories that surfaced on Halloween, the ones I thought were attended to, came rushing back with a force greater than I could have ever imagined.

As I wrote in the earlier posts, I had been trying to do the work I knew I needed to as an outpatient, but just today I realized why that is so hard. Being a Dad, husband, and working has to be protected on the "outside." This means simply that I am not that willing to allow myself to be vulnerable as an outpatient. While normally this is a good boundary, it can get in the way when a step forward in healing work needs to be done.

This is why I have always used the hospital to help me with these big pieces of work. My time in the hospital has been hard. This is more normal for me here. Physical pain ramps up. I get memory flooding. I lose time. I have difficulty maintaining control. I get little to no night sleep (or sleep all the time).

Stopping eating and drinking, an old coping strategy, seemed like the only way out. The only way to control things. After several days, today I made the decision to begin eating and drinking again, for I was getting rather ill. The price was just too high. And, deep inside, I knew I was just postponing facing things.

Over the weekend, I did a good deal of art. I made 10 important pieces (one of them is shown above). Today with "My Healing Guide," I tried to make sense of them and put them into context. As I did, everything kind of started to fall into place. I saw the 10 art pieces as telling a story. A story I could never tell with words alone. And a story I could never tell outpatient.

We went through the images quickly because we were short on time. And she clearly tried to help me move towards a place of acceptance. This was truly hard for me. It has not been at all easy to accept that some of the abuse was at the hands of multiple abusers (or "organized torture" to use my doctor's words that sent me over the edge on Friday). While, I have always known bits and pieces of these memories since the early 90s, it was always much easier for me to think they were false memories. That I make them up. To deny.

But one of the biggest lessons I have learned over the past couple years of healing is that to deny sets up a conflict with specific parts, and leads to self-abuse that recreates it all. So, really the only path to healing is to accept the truths we hold inside. Today I was telling myself that I would not be going through so much internal struggle and pain and self-abuse if there was not truth to the memories which have haunted me for years.

This afternoon, I did not go to any groups. Instead, I stayed in a sort of sleep-awake state, processing. I was getting titrated memories and there was some kind of communication going on internally. Most of it was about acceptance. It was interesting that I was not flooded with memories. I cannot even say for sure what the images were. But I am certain I was trying to put everything in its place.

Normally, when I make this kind of progress like today, I say I have done enough in the hospital and start to advocate to leave. But I do not have the sense I am over any hump. As soon as I moved towards acceptance, and started taking in liquids again, the physical pain came back. I will give myself more time here. And I am not certain where this stay will take me. So much has happened already in such a short time.

What I will work on now is to be gentle with myself. To continue to try to eat and drink enough. To accept as much as I can. To not push the memories away, but to contain them safely. I will continue to express myself through art and writing in my journals.

I also know I need to find a way to talk about the overwhelming material outside of the hospital. I know how to do a lot of things. But this is one skill I have not quite mastered. The question for me is: How do I handle the responsibilities of life while at the same time make progress on what is held in parts of me and needs to be addressed and healed?

In the last couple of posts, here and here, I wrote about awareness and using specific skills that have helped me (and hopefully you too).

It was interesting that I also paid careful attention in those posts to say that the skills do not always work. Not working probably means many things to each of us at different times. For me, I am very specific. For me, it means that I have not been safe; that I have self-harmed. That is the case today.

I have to tell myself that it does not mean all that work I do means nothing. I have to tell myself that the skills really do help and it is expected that there will be setbacks. I have to tell myself that I will recover from today. I have to tell myself that I need to keep faith in myself that I will keep healing.

I will pick myself up and try again. I will try to be more aware. I will try to do more of what I know helps.

But this is not an easy time period for me. And I know for many others it is difficult too. In the US, Halloween is a major holiday. Well over a month ago, decorations were in the stores. We are surrounded by images and sounds. Images that never "seemed" to bother me in the past, now send me over the edge and reverberate all throughout my system. For the past several years, Halloween has been very hard.

It has always been a time of extreme activation of certain parts of me; the parts who deal with issues of living and dying, good and evil, and other scary things. And, each year, very specific scary memories always rush to the surface. My reactions seem off scale, but comparable to those I experience around Easter.

As I have healed, I have become aware of this unrest inside during this time. I have realized how sensitive I have become. How easily triggered I am. So, navigating through these weeks around Halloween is not ever easy.

I cannot even ride it out in peace because my wife has a huge Halloween party every year for all the neighbors and kids. It does not at all make sense to me. For several years, I have huddled in my bedroom, medicating myself to get through. I do not want to do that this year. I thought I could be involved in the party and have it be okay. I had a sense that things were going to be okay this year.

Until today.

11/2 Update: I just noticed that on Halloween, Dr. Kathleen Young put up an excellent article on the subject as it relates to child abuse survivors. It's worth taking a look at. See: Trauma Survivors and Halloween.

In my last post, Healing from a Place of Strength, I talked about many of the positive strengths I have available to me now, much of them attributed to a new sense of awareness.

Not to belittle that positive approach, but there is the reality that healing is not a positive linear progression. I failed to mention what is perhaps obvious to most, that there are many times when a positive outlook is simply not possible. There are many times when awareness falls by the wayside. There are many times when my mind is seriously fragmented and I am completely dysfunctional. Perhaps the most harmful outcome of this "other side" is when we resort to self-harm.

I still think, though, that awareness is the antidote. It is also a skill that we can cultivate over time. In much the same way that dissociation has been an automatic response for many of us for so long, we can learn to use practical skills regularly to help keep us safe. Having and using a safety plan, imagining safe internal places, relaxation, grounding, journaling, listening to music, taking a PRN, and more, are all things we can do to push the odds in our favor. It does not assure that we will stay safe. It does not assure that we will not "break down." It just increases our chances of getting through safely.

Like all skills, we must practice them if we want to get better at them and increase their chances of working when we need them. Unfortunately, when we are feeling "well" or "together", those are the times when we usually do not practice. I have often thought that because so much of our life is consumed with difficulty, when we are in a good spell we want nothing more than to enjoy that time. There is nothing wrong with that.

This is why I have tried, and I know I am not always super good at it, to incorporate skills into my daily routine no matter how well or un-well I am. One of my greatest skills since I started working with my "Healing Guide" has been to keep a drawing journal. For the first year or more, I went through a Canson 120 page Field Drawing Book almost every month. I filled it with drawings, but also hand writing. The attention to feelings that I talked about in the last post could not have been done just in therapy. The drawing book turned out to be absolutely essential.

Another skill I have cultivated over time, was to build up my electronic journal. At first, it was just a single file that I edited when I was on a specific computer, and eventually I programmed a rather elaborate system—thank you programming skills—whereby I can write to the journal securely through a Web interface from anywhere or even from my iPhone-formatted page. This journal tends to be much more focused on words, but I also use it to attach art or photography I make.

I use the journal mainly to make sense of what is going on in almost real time. That is the key. If I find myself in a tough situation, I can immediately take out the iPhone (if only that is available) and make an entry about what is going on. Often, I can make an entry before I dissociate. In the past, there was no systematic way to keep track of things. Back then, this is just a couple years ago, if a trigger would generate a dissociative response, it would often just sit until I went to therapy. If that was several days later, my access to the experience was probably gone. That meant that my ability to learn from what happened was also gone.

One does not need a complicated system like I have to do what I do. You can easily keep a computer file on your home computer. If you want, you can even take it to and from work via a thumb drive. For the times when you are away from your computer, I used to keep what my therapist called a "feelings journal" in my pocket. These were pocket sized journals where you can jot down thoughts and feelings or pictures that you can come back to later.

I think the nitty gritty of cultivating awareness (and indeed healing from dissociation) is actually pretty straight forward. There is nothing complicated about journaling. It may take some time to stick and become standard practice. I know for me, I struggled for many years before I was able to keep a journal. I had notebooks all over the place, and I never was able to make it a regular healthy habit. I just did not want to spend the time. I did not really think I needed to. I was wrong.

For me, I see daily journaling for someone who is dissociative as absolutely critical. You are shortchanging yourself if you do not journal regularly. I once had a doctor tell me that my journaling was akin to how a cystic fibrosis patient has to hook themselves up to a machine to clean their lungs twice a day. She maybe went a bit too far in making her point, but looking at it objectively, she really did have a valid point.

One area I am really not that reliable in doing is DBT-like diary card check-ins. I have set up an iPhone App called LifeLog to do the recording for me. I have two cards, one is basically an acknowledgement of parts, listed by name. I go down the list in a mindful manner and acknowledge each. I do not do it to necessarily engage in discussion with each part; it is more like that I am taking a breath and saying "Yes, this is who I am and how I am made up."

The other card, is a more standard mood monitoring. I have adapted it for me by highlighting the areas I feel I need to pay attention to. On a 1-10 scale I rate the following: Acceptance, Happiness, Anger, Fear/Anxiety, Fatigue, Physical Pain, Dissociation Level, and Overall Safety.

Of course, like I said, doing these things does not guarantee anything. It does, however, give us a better chance. And even though many of these are "in the moment" techniques, it is important to appreciate that if done over time, the scale at which they work becomes greater and greater.

It is not a magical "awareness" that helps make us better. It is awareness generated from very specific skills, applied regularly like medicine, over time.

I know this is not the first time I have talked about these skills. I discussed the iPhone Apps I use in Survivor's iPhone Essentials, Part I (July 2010). I have discussed journaling in many posts, but specifically focused on it in Journaling (May 2010).

Last week when I wrote Vacation, Changes, and Derailment, I had high hopes that I would be able to settle things down internally and find some balance. And, rightly so. Over the past few years, I have made great strides at self-awareness and acceptance. My ability to navigate the murky waters of dissociation is much better now.

However, today, my hopes are quickly waning.

I think I need help. More help than I am getting. I think I am in trouble.

When I write about out of control dissociation, I often talk about contradictions. Good, safe experiences often exist alongside scary, unsafe experiences. So, I can be tending to my gardens and playing piano one moment. And find myself getting horribly hurt in another moment. Since both types of experiences are not separated by much real-life time, I am left utterly confused, shattered, and broken.

Yes, I hurt myself. I know for sure I hurt myself last night and I have some small memory of the day before that and almost no memory of therapy on Tuesday.

I have talked before about how common it is for survivors of child sexual abuse to recreate the abuse in the present. I struggle in my understanding of that. In some way, I see it as an attempt at control. In another way, I see it as confirming perception of self-worth. In still another, I see it simply as not being grounded enough in the present so that old coping is more apt to be called upon. It is difficult to put the pieces together, because all can be true. I do know that last night was very dangerous and not compatible with the life I lead and the ideals I aspire to.

I also know that over the last few days I have been very erratic. I have been losing lots of time. My emotions have been all over the place. I have been picking fights one minute and being incredibly patient and kind the next. I have not seen the red flags, or saw them and simply blew past them and did nothing.

I am well aware that getting hurt does not solve anything in 2010. And my new awareness makes recovery from self-harm difficult. In the past, self-harm events (or self-harm coping) would easily be forgotten because there was not much permeability between parts of myself. Now, this is not the case. Today, I am besieged by flashbacks, pain, panic, and a sense of being totally broken.

Denial adds another layer of difficulty. Even though there has been a lot of lost time, there is a good deal of permeability between dissociated parts of my mind. That leads me to a place of not accepting parts. Of thinking it is all made up. That it is simply a convenient excuse to explain erratic behavior. I say I am a fraud. This leaves me even more confused. Because while I can understand the logic, I know it is some kind of internal ruse.

So, I am left holding the pieces and do not know how to put them back together. I am left knowing that I brought this on myself. How do I accept that? Everything is out of control.

In Trauma and Sexuality, I wrote about sexual healing being a taboo subject in both the literature and in therapy. Nobody wants to talk about it. Yet it is one of the main areas where childhood sex abuse victims were damaged. It is my contention that since the problem is not addressed directly in the literature and in therapy, we discuss the issues tied to sex in an unconsciously masked kind of way. We can talk about being hurt sexually and what was done to us (and think we are talking about sex directly). About being suicidal. Depressed. Triggered. Switchy. And on and on.

But, while all important, these are symptoms of what is a core issue in the present. What is our relationship right now to sex? How is sex in the present dysfunctional? How is sex in the present hurting us? Helping us? Recreating? Overcoming? And how do all these questions about the present relate to the past?

I understand, I think, the essential barriers to talking about sex, even in the "safe" confines of the therapy office. For those of us sexually abused as children, our lives were generally focused on hiding the fact that we were being hurt in that specific a way. It should not be hard to appreciate that this is fertile ground for creating shame and guilt; stains on our soul which stay with us through adulthood and whose purpose seems to be only to deny us from seeking healing (or even thinking we are worthy enough to heal).

Not to mention those of us who were sexually abused were generally taught (we call them "rules") to behave a certain way in dealing with sex, through a number of manipulative means. As with any kind of learning, neuronal circuits are formed. Sex abuse ties in with reward, pleasure and fear circuits in the brain moderated by powerful neurotransmitters like dopamine. Literally, there is an imprint on our brains. These imprints are terribly difficult to heal from. But we can heal from them if we deal with them directly instead of dancing around the perimeter.

I contend that the first step in sexual healing is acknowledging the original sexual injury. The second step is being able to break down some of the guilt and shame barriers to talking about the subject. But there is more.

Obviously, each of us were affected in different ways sexually. Some of us become hyposexual and just run away from sex. Some of us become hypersexual. Neither of these extremes is necessarily bad as long as you are comfortable in them. But many are not comfortable with who they are sexually and simply do not know who they are sexually.

To further complicate matters, some of us use sex to recreate abuses, whether it be through fantasy or in real-life, though I do believe there is a marked difference between the two. In the literature, re-enactment (generally referred to as real-life) is a more commonly discussed sexual outcome. In these situations, we are continuing the cycle of abuse by placing ourselves in harmful psychological or physical situations (and, yes, even if in fantasy).

It can be understood in terms of neuronal imprints and in terms of being a way to manage overwhelming feelings. I believe it is probably likely that the degree of sexual re-enactment is correlated with degree of dissociation. With dissociative identities, parts were created for specific purposes and roles which are harder to move out of. Further, it is easier to realize how sex re-enactment solves certain problems (like being able to tolerate overwhelming feelings of "parts" of us) while isolating other parts of us (who are traumatized by the present-day behavior).

Those are explanations and not excuses. Since, in most cases, the original abuse is not happening anymore, we are responsible for our behavior. In this case, I think it is most aptly labeled as self-abuse behavior.

When one is able to label one's own re-enacting sex as self-abuse, then the third, perhaps the most important, step in beginning to achieve sexual healing is reached. We can achieve this only when we realize that the "positive" effects of recreating sex are dwarfed by the negative effects. And this takes a good deal of self-awareness and brutal internal honesty.

If we keep these three steps in mind—acknowledging original injury, overcoming guilt and shame, and labeling re-enactment as self-abuse—then we are making a great effort to heal. The prognosis, I think, is good.

While sexual healing may seem daunting, the good news is that once you have achieved all three steps, there is no going back. Yes, there are "setbacks", but once you gain awareness, you cannot lose it, you can only temporarily misplace it.

A huge disclaimer here goes without saying: I am not an expert. This post is based on my personal experiences and interactions with other survivors over the past 20 years. It is not meant to be a comprehensive, or even necessarily scalable view on the sexual effects of abuse. I think there is a good chance it may be quite scalable. But I do not pretend to assert that as fact.

In Is This a Vacation or Allowing?, I see I painted a certain picture which was not totally accurate.

In my defense, I believed what I wrote last week to be entirely true at the time. But, just a couple days later I seriously self-harmed.

I saw the warning signs. I knew I was not engaged enough or paying attention enough on the inside. But, I convinced myself I was doing things differently, that I was achieving the always sought after internal balance. I said I was being a hands-off CEO, but still "driving," to use a favorite term of "My Healing Guide".

I do believe that there is a lot of truth in what I wrote. Not micromanaging my entire system is unquestionably a good thing. Allowing myself to engage in soothing activities, like my landscaping project, and rekindle past interests, like playing the trumpet, are also positives. But I allowed what was going right to overshadow what was going wrong.

I am going to use what has happened as a learning opportunity. One solution, a natural and familiar one, would be to swing the pendulum and assert full control. I think I learned, though, and this is new for me, that such a solution does not allow adequate expression of parts of me. If I assert full control, I will achieve the same negative outcome as if I am completely disengaged. To be disengaged leads to parts utilizing dysfunctional coping. To be controlling leads to my being an enemy of many inside. Self-harm is the typical result for both solutions.

This is all about balance. I am convinced it is the key to everything, but I have almost come to think of it as a four letter word.

The concept of a really great CEO, in the truest sense, is all about balance. I am determined to do it better this time. I do not have to go back to the drawing board or give up. Instead, what I am going to do is just make some small adjustments. I should continue to do many of the same positive things I was doing last week.

But the adjustments must come by increasing my level of engagement. I have to be more mindful and pay more attention. I need to document feelings. I need to keep my eye on the ball and be a little more hands-on.

In short, I think it means I am not able to have a vacation. Maybe next time I will just call it a short break.

I will publish the first Expressive Arts Carnival this Thursday. This means if you have been meaning to submit, but have not yet, there is still time. I will need your submission by Thursday 9AM EST. So far I have 6 wonderful entries. Send submissions to paul@mindparts.org.