DBT Distress Tolerance: A Hail Mary Pass Before You Pass Your Threshold

Last week was the first week of the Distress Tolerance module in my DBT group. It’s a smaller group this time – about six of us. Distress tolerance is about when you are in the moment when you reach the threshold before you allow yourself to completely act from your emotions and do ineffective things – which I can maladaptive behaviors. Examples like binge-eating, self-harming, screaming at someone unnecessarily, etc. The idea is that if you can find that moment before you reach that point, there are things you can do to held subside the emotional eruption that is churning inside you before it explodes.

A lot of the modules are about understanding emotions and using tools to live effectively and not letting your emotions impact your decisions. It’s about understanding your triggers, and having tools to get in touch with yourself to pull back and think. You try them, practice them, sometimes they work; sometimes they don’t.

But this is for when you can’t “stop” and breathe it out. You are in a ruminating tornado, so far in your head that rationality has fled. A lot of the tools involve physical changes – like changing the temperature of your body, or doing something intense to ease the energy like running extremely fast, screaming into a pillow, sticking your face in ice water.

This past year, I’ve learned a lot about how to detect when the tornado is starting. I can usually sense in my body that I’m starting. My chest and stomach get tight, sometimes I get tingly in my extremities, my mind usually goes blank, or maybe it’s that the thoughts are going so fast, I feel overwhelmed. Sometimes I can get light-headed and my breathing becomes short. These are times when I usually call someone, try to take deep breaths, change my environment by just getting in the car or going for a walk, or even taking a propranolol to slow my heart rate and calm me down. After that, I can usually identify what triggered it, and try to self-soothe. (Mostly by watching tv or cleaning).

This is a simplified synopsis of DT, but I assume I got the point across. And most of us know that being able to use these skills are an ideal. Even if you have been doing it for years, it doesn’t mean it will work every time. So distress tolerance is for those times when you can’t slow it down, but before you have hurt yourself or something /one in your life. And you hope it works when you need it.

Last week we were discussing what we do when we feel our emotions taking over. While others were talking, I felt my face get flush, my chest tighten. I tried to breathe. I tried to bunch myself up as much as possible to squeeze the pain out. (That makes no sense, but whatever.) And then it was my turn to speak. My voice was shaky. I tried to breathe, but I started to feel my face scrunch up (into my ridiculous cry face), and I left the room. I ran outside and tried to breathe but I was starting to hyperventilate. I found a window that had markings on it that made little triangles and I started to do something they recommend in DBT – I started counting the triangles. It sounds so silly and so simple, but without consciously realizing it, it is refocusing your mind on something, as mundane as it is, and it allows you to step back from the thoughts. I kept counting and then tried to breathe and this time it helped. I then told myself to get my shit together, and did a “half smile” as evidently that physiologically help change your mood, and I walked back in.

Looking back, I cried because of my personal frustration and sadness. I wondered if I had heard this information just four days before if it would have helped me and I wouldn’t have harmed. I also cried because without this chemical change I would have been able to approach this as a “what if” scenario rather than a “now that you’re here.” I also cried because I’m not sure any of the distress skills would have worked, and that I suppose scared me the most.

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Raise Awareness about Veteran Suicide

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Click on this image to view the website and learn more about this initiative for understanding and preventing veteran suicide.

I posted this a few weeks ago when I learned about it, but in light of Memorial Day, I wanted to repost and encourage people to get involved with helping veterans in their communities.

I don’t know if you have all seen this in the news, but there is a new initiative to get the public educated and involved in the rampant veteran suicide that plagues our country. (According to statistics, 22 veterans commit suicide every day.)

I cannot do it justice, so I suggest going directly to the website to learn more. While the push-up challenge is a great way to get people through the front door, it’s the bigger message and larger actions we as a community need to take to be there for our veterans.

There are so many things to be angry, scared, and frustrated about in today’s world. But maybe today is the day to learn more about our veterans and the struggles they have once they come back…and get involved.

#22kill

Food for Thought: Portrayal of Disabilities in Movies

(I generally avoid posting opinions on controversial issues. However, this really seems more like an educational opportunity rather than an attempt to incite. Also, I suppose there is a spoiler here…but honestly, just watch the trailer and you’ll know it anyway.)

I read the book ‪#‎MeBeforeYou‬ when first came out and cried my eyes out. However, it wasn’t until the movie version recently came out that disability activists thankfully opened my eyes to the unfair messaging the movie makes in regards to quadraplegics/people with disabilities.

Not only did I realize the horrific implication in the story that living with a disability like quadraplegia makes life “not worth living,” the actor who plays him, Sam Claflin, isn’t even a quadraplegic. Then I saw the trailer for the new movie ‪#‎TheFundamentalsofCaring‬. As much as I love Paul Rudd, once again a non-disabled actor, Craig Roberts, plays a teenager with muscular distrophy.

While this movie may not include the insult that having a disability makes living meaningless, they have still chosen to use an actor who is not disabled to play this role. This is not the first time this has happened – “Artie” on ‪#‎Glee‬ was in a wheelchair, but played by an abled actor. And there are so many more examples. In fact, I can only think of one show that has respected differently-abled actors: RJ Mitte in ‪#‎BreakingBad‬. (A friend just told me that his muscular distrophy is not as extreme as what he does on television and that evidently Artie walks at one point.) I know there are more, but I would argue that the use of disabled actors to portray disabled characters is minimal in Hollywood.

It’s insulting to not understand and respect that disabilities just make you differently-abled, and that having a disability does not make your life any less meaningful or amazing.  I am not articulating this as well as well as others, so I recommend reading more from columnists and activists who are speaking out.

As someone with bipolar II, I am often angered and discouraged by how mental illness is portrayed in movies and television. While I appreciate recent attempts to bring mental illness into the fold of stories, I feel they miss the complexity of what it’s like. Movies like #SilverLiningsPlaybook piss me off. A show that I love, #You’reTheWorst, also bothered me in their attempt to demonstrate a woman in a depressive episode. I do not know if these failures are because the people that write them lack understanding of the nuance of mental health, or whether they simply use it to attempt to add depth to their work.

I guess I just felt it was important to support those in the disability community by bringing this issue into the minor spotlight I have. It’s worth thinking about. (I am also aware this happens in regards to gender and race in Hollywood as well, and that is also an issue that should continue to be addressed and should outrage and embarrass us all.)

Think about it. Read about it. Look at it in regards to other minorities in movies and television. And if so inclined, get engaged in the conversation. It’s worth having.

 

Here are a few links to some articles I found articulate the message:

https://www.buzzfeed.com/rosebuchanan/campaigners-are-pissed-about-the-representation-of-disabled

http://www.huffingtonpost.co.uk/laurenwest1/me-before-you_b_10143130.html

http://www.lifenews.com/2016/05/27/pro-euthanasia-film-me-before-you-panned-by-disability-rights-campaigners/

One Extra Pill: My Brain is Such a Drama Queen

Besides the constant tremors and occasional rapid heartbeat and dizziness, the new drug regimen I started last Tuesday seems to be working. I feel different. More steady. Anxious more than sad, which while anxiety sucks, still feels safer than sadness.

I am astounded at how incredible the mind is. Changing a medication by .25 sends it into a rapid depressive episode that last for weeks. Upping a drug by 100mg makes the person feel ready to face the day, even on the days she doesn’t want to.

Don’t misunderstand me. It doesn’t fix you. I still have dark “abnormal” thoughts about myself and my life. I worry I will, like before, suddenly spiral into destructive behavior. I’m not normal, whatever that might be. And I never will be.

But for now, at least for today, I’m pretty sure I won’t. And that is amazingly different than just a week ago.

I Fell Off the Wagon.

Disclaimer: This blog post does discuss self harm and suicidal ideation. If these are triggers, please protect yourself.

So I’ve been avoiding writing mostly because I’ve been ashamed and angry with how the past 5/6 weeks have been. I’ve spent a lot of time in my head, and perhaps writing would have been better. Maybe I didn’t want to see it written down. Maybe I didn’t want people to tell me it was going to be okay. But I’m still feeling scared and a bit weak, so I’m going to try and see if it helps. Apologies if some of this is repetitive from previous posts.

Ok, so I’ve been on Klonopin for what, 13 years. This is a controlled substance that you’re supposed to take for emergency panic attacks or maybe for a week or so to help bring you down. That’s because as a controlled substance, it’s highly addictive. Not like I crave it, but my body clearly does. Even if you’ve only been on it for a few weeks, it can take over a month to taper off – so trying to get off of it after 13 years…well it’s a very long process.

The Klonopin doesn’t actually do anything for me, except ensure my body doesn’t go into withdrawal. Since I’m going to London in September and their healthcare isn’t as tip-top in terms of mental health (which is saying a lot given how shit ours is,) I figured if I could get off of it, that would help. It also is known for impacting memory – in fact recently, they were recommending no one over 50 take it. The only comforting thing about this is that it could be one of the reasons why my memory and cognitive skills have been getting worse over the years. Given I’m about to go into an incredibly rigorous academic program, I want to have as much of my brain functioning as possible.

Anyway, I was really pushing my psychiatrist since I’ve been better to start tapering. I guess I was only thinking about the physical side effects of withdrawal and figured I could handle the shakes and sweats and vomiting – whatever happens when you withdraw from Klonopin (I naively based this on movies where people detox.) So I pushed her and we went down by .25. Ok, evidently that’s a LOT. You’re supposed to go down by .125 every 3 weeks or some shit like that. Anyway, I didn’t realize there would be brain chemistry psychological effects and I became very depressed.

It’s been over a year since I have had clinical depression and all of a sudden I felt the weight and pain again. That sucked, but even more so, it scared the shite out of me. It also brought some old depressive thoughts to the surface again. Ok, so after a week, we went back up to my original dosage. But the depression didn’t pass, which I still don’t get, but whatever. So then we tried to give me some extra short release tabs of meds I am on that helped with my clinical depression and they did jack squat. But each day my depression was getting worse and my bad habits came back to town.

Still, after this past year, I knew what it was like to not be clinically depressed and I could differentiate when it was the depression guiding my thoughts and when it was me. I really tried to be compassionate to myself. I excused not going to the gym, or thinking about my future. I allowed myself to not leave the house for days. I don’t know, I suppose I thought if I resisted it, it would just make it worse. But it was like the angel and devil on my shoulders – they were fighting each other. And so the mood swings went from fine to so fucking low I wanted to die. And while in my heart I knew the depression was chemical, it still feels rational and true. And so the same things that before might have made me anxious but excited, became terrifying and pointless.

And then I fell off the wagon. It’s been over a year since I’ve self-harmed.

Looking back on that Friday, I had been in therapy earlier that day. I had been told that there was another life path that might be better than going to LSE which had kind of mind-fucked me since I was already doubting my ability to go, and decision-making is my number one anxiety-maker. And my therapist, who is still an intern, told me that she would not be able to communicate with me if I was in London, or out of the state where I currently reside.  I have known this was a possibility for a while. It was part of the reason I deferred from LSE last year. I wanted more time to work with her. Anyway, she told me and I kind of just voided it. I guess it was just too much for my mind to handle so I put it in the emotional void of overwhelming news and went home.

I was cooking dinner, watching some tv, and all of a sudden, the depression just hit me. I mean, it came from nowhere. I wasn’t ruminating about anything at the time and then all of a sudden it was like I had just been punched in the gut. I couldn’t breath and found myself bent over in absolute mental pain. Everything imperfect, all of my doubts, it all came to the surface and slapped me. I felt nauseous. I tried to cry but when I opened my mouth nothing came out. And then the craving for self-harm felt no longer like an option but like a need.

So I did. And at the time, it felt amazing. I guess what it must feel like when you slip from your recovery and go back – that first sip or hit in a year, it’s intense and satisfying and feels fucking amazing and you wonder why you ever stopped. But I quickly realized it was escalating not calming me. I wanted to do it better and I was worried I wouldn’t be able to stop. I went through the tiny rolodex in my mind of people I could reach. This person wouldn’t be available, this person couldn’t handle it, this person shouldn’t have to. I truly didn’t want to call anyone but I guess I knew I had to do it. I was at my threshold and I just didn’t want to tip over because I think there was still a part of me that knew it wasn’t real – that it had just happened too fast to be right or rational and I just had to stop it before I did something I couldn’t come back from.

I didn’t want to bother him, but I called my brother. I’ve called him before. I hate doing it because he has so much on his plate and he’s just such an amazing person and I don’t want to hurt him, but I also know he’s a police officer, so out of everyone I know, he has seen it with others and can understand it without freaking out. When I called him sputtering and hyperventilating, he went into police mode – asking questions to ensure I was safe, if I needed to go to the hospital, or call 911. I was yelling out everything I thought meant I couldn’t do this anymore but he somehow got my breathing to slow, to pull me back or out of wherever I was. He was at work, helping on dispatch – the irony of others calling 911 while he talked me through my emergency was not missed.

And he just stayed on the phone with me. He told me some funny stories about ridiculous debacles of the day, he talked about the chaos of his life, mundane and big. He kept me listening, asking questions, laughing. I patched myself up while we were on the phone. He stayed on the phone with me as he finished up work, got in the car, drove home, fed the dogs and started eating his dinner. And when I knew I was okay for the night, when the exhaustion of it all hit me and I knew I was too tired to think or move, we got off the phone. Thank goodness people like him exist in the world and I am beyond lucky to have one in my life.

The next day is always the worst. Not only do you feel the ramifications of your actions, you feel stupid and ashamed. It all felt so silly – and worst of all, I had broken my streak that had become a badge of honor. But I made it through that day. And I made it through the next and got to my psychiatrist. It was easier to tell her. She has known me for a long time, since the ECT stopped working. And she’s known me when this was a regular thing. I guess that felt better because I didn’t feel like she was judging me, because both of us at that moment, knew it was clear that it wasn’t me.

I had spent the week overanalyzing if I was making things worse, fighting to not feel better, trying to exacerbate the depression. But saying it out loud, it just made no sense. It also made sense why I felt overwhelmed – I was questioning my next big move, and my therapist and I were going to have to end our relationship. I was also turning 35 in a few months and even if I wasn’t clinically depressed it was still a heavy date to approach as I had declared it, when I was 33, as the last day I would live in the pain I was in. Even if I wasn’t clinically depressed this would have overwhelmed me.

So I’ve been recovering this past week. The med change seems to be working, and I can handle the side effects, which in the past with this medication, seem to dissipate over time. The cravings aren’t gone, but the temptation is low,  especially every time I see the evidence of last Friday and realize how ridiculous it looks and the amount of work that will go into hiding and healing.

Funny enough, we are doing distress tolerance in DBT, which is meant for situations just like those. It started four days after the incident. I’m still unsure if I’ll make it to the gym today. And I’m unsure if I’ll be effective or what choices I will make. I still know deep down that the problems that arose when I was depressed are real. The way I handled it wasn’t me, but it doesn’t mean the issues don’t still exist. And I do have to deal with them. Maybe not today, but I have to apply for my visa in two weeks, so soon.

I’m hoping in another week or so, I can look at that moment with some understanding and compassion. To see it not as a failure, but as a reality check of both how far I’ve come and that it really is a disease and not the true me. So many of my scars are memories of a time and place. I used to think of them as tattoos of where I was was and what I’ve been through – and maybe these too will come to serve as mere place markers in my life. But for today, I just have to decide that no matter what I do, or how effective I am, it’s ok. Because it is what it is, and for now, that will have to do.

Help Raise Awareness about Veteran Suicide @ 22Kill.com

 

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Click on this image to view the website and learn more about this initiative for understanding and preventing veteran suicide.

 

I don’t know if you have all seen this in the news, but there is a new initiative to get the public educated and involved in the rampant veteran suicide that plagues our country. (According to statistics, 22 veterans commit suicide every day.)

I cannot do it justice, so I suggest going directly to the website to learn more. While the push-up challenge is a great way to get people through the front door, it’s the bigger message and larger actions we as a community need to take to be there for our veterans.

There are so many things to be angry, scared, and frustrated about in today’s world. But maybe today is the day to learn more about our veterans and the struggles they have once they come back…and get involved.

#22kill

a very expensive brain: how do you know if you’re getting your money’s worth

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the other day, in a depressive episode, i was thinking about how far i still have to go before i might achieve some of the life objectives i want. i’m still unsure if i am able to hold a job, if my cognitive abilities are up to par, if i will ever be comfortable being with a man, if i’ll ever make more friends and find some hobbies i enjoy. basically, will i ever be able to at least define contentment, let alone be able to have the skills and strength to work for it every day.

i was thinking about the larger problems of mental health – it must have come from an offhand conversation with someone about how expensive mental health treatment is and how much money we could save if we had more services for those on the street rather than putting them in jail and watching them self-medicate with drugs.

and i of course felt so grateful that i have had the fortune of having a family that can take care of me and ensure my needs are met. and i realized how much money has gone into my mental health. therapy, psychiatry, medication, ECT, DBT, sleep therapy, healthy foods, gym membership, and money for “things” that may help with happiness or serve as preventatives for mental breakdowns through financial subsidies.

we have spent SO much money trying to prevent me from ending my life, and attempting to find balance so i may go back out into the world stronger and stable. but it just seems like a lot of money, time, and investment for one brain for one person. and i’m not even a psychics whiz, or literary genius. in fact, my main attributes to provide are that i am very good with people, i want to make the world a better place, and i have a constant curiousity for all things.

sometimes i wonder if i should have just forced myself back to dc. taken a job, gotten an apartment, and lived with my depression. i could probably have found a better psychiatrist and a good therapist. i could have found a gym and still eaten relatively healthy when i wasn’t in an episode. and i could have paid for it myself. i would have been miserable at work but i still would have done it and done it well. this is the life i had until just five years ago.

i don’t know why that breakdown changed. i don’t know why it was that point in time when i said, “i need help. i can’t do this.” i’ve been handling this, horribly, for most of my life and i’ve gotten by. i might have continued to have an unhealthy relationship with men and alcohol and self-harm, but i would have survived.

has all this money been worth it for one person? i’m not trying to feel sorry for myself. i don’t say this with the hopes that people tell me “oh my gosh, you are so amazing and valuable. you have undefinable worth! you are worth everything and more!” i know there are people that love me unconditionally and i am so disgustingly lucky to have that support.

i just keep thinking about the future. the impact i will have made on the earth when i leave. i know that most people leave small impacts – perhaps having had children, or a fulfilling job, or volunteering to make the world better. and their impact would be great around their small sphere. when i was a child, i wanted to be an actress, then a television anchor, then a politician, then a lawyer, then a teacher, then a civil rights advocate. i kept waiting for time to help decipher where i belonged and where i could best be of service. where could my passions and my skills fuse? i’ve known for a long time i do not want children, but i have always thought it would be nice to have a companion to share life with. i used to want to travel, and to just spend as much time as i could learning through whatever facets were available to me.

when i was 30 and i decided to leave permanently, the idea was that i was young enough that there wouldn’t be the expectation that i had to make an impact. after all, i would have been so young, i was just starting, who knows what i could have become…etc. but as i get older and we continue to throw money into trying to make sure i can leave the house every day and not scar my body, i just wonder – will it have all been worth it in the end? perhaps these thoughts feel so relevant right now because i am approaching 35, the year that i told people i would plan on leaving if i wasn’t better. when i was 33 i told my mom i would do whatever treatment, try whatever i could to get better, but if i was still in pain by 35 she had to let me go.

i’m not where i was then. i’m not in the terrible pain and crushing depression i was when i was 33. in fact, having this medication work for the first time since i started medication has changed my life. but i don’t know if it’s enough.

i know all lives are worthy. i don’t want people to throw religion at me because i don’t roll with that philosophy, but yes, i understand that no matter small the impact, worth is not something you can measure. you cannot measure the love and happiness that person provides to the people in their lives. and you cannot know what their future may hold.

but you can measure the amount of money that is drained into the maintenance of one person. and sometimes, when i think about this tiny, fucked up brain and realize how much money it’s “worth,” i just wonder if it’s a sound investment.

The Disadvantages of Being a Blank Canvas

I used to write poetry, as I suppose many emotionally-wrought young adults do. I remember how intense the words felt, how little I had to try – the release of my pain, my frustrations, my truth just spewed out of me.

I decided to read my poetry today. I think most of it was from college. I remember how soothing it felt to put my emotions on the page. But my goodness, it is truly awful shit. My metaphors are painfully melodramatic. I wrote about things I only understood from movies. I was tangential – though that hasn’t changed.

Since I’ve been on medication, at least when it works, my creativity seems to evaporate. When creative opportunities arise, my mind is blank.

Those with bipolar I often say that medications drain them of their creativity. And many of them refuse to take medication because they fear losing that integral component of themselves. The mania, for many, has helped define their selves, their passions, their art. I have bipolar II so it’s not the same thing in terms of hypomania. However, I do believe my medications dull my mind.

I kinda miss it: the intensity of it all. I think it was indicative of my resolve to find a way to still get what I wanted. I was yelling then – in my behavior and actions: “Someone listen. I am in pain and it is killing me. I want things like love and laughter and all I feel is rot. And I fucking deserve those things. My gentle, loving soul is slowly vanishing and I don’t know how to stop it. This is bullshit and it’s not fair!” I was angry at this disease and how it punished and controlled me. I just wanted it to go away. I’m still angry I suppose. Frustrated by the damage, the uncertainty, the lack of control.

But there is a sad acceptance nowadays. Maybe after medications, ECT, countless attempts at different therapies, efforts in life changes (in diet, exercise, sleep,) I’ve come to a melancholy understanding of the possibilities in my life and the restraints that come with the mental illness that will always be a part of me. Funnily enough, I think I know less about myself now than I did then. Back then, even with all the self-hate and self-harm, I still felt like I knew who I was underneath the depression. But maybe, living so long with the depression, it had come to define me, mold me, make me. But now the depression has lifted and I am, much like my brains’ creative canvas: blank.

 

Fighting Depression: A Sword Duel With a Wooden Spoon

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Wooden, Silver…You get the idea.

Well, it’s been a few weeks since the tapering debacle. Since about Thursday, I was feeling like I was coming back to “normal.” I will say this past episode really did a number on me…

and it reminded me of a few things:

  • medications are not cures.
  • in terms of mental illness, healthy sustainability, consistency, or complete “repair” are never viable realities.
  • patience is necessary for managing mental illness. and i am shit at it. too bad they don’t have a drug for that.
  • medication is a delicate dance with brain chemistry, and you can only take one step at a time. each time we try to change a med by lowering or upping, i can only do one, and have to wait weeks to see if it works, or if side effects pass or stay. if the med is not working, that means i have two to four weeks of feeling like shit, hoping that maybe it will work. and if it doesn’t, i try a different one and wait.
  • memories may fade, but the feelings of pain you feel from depression never leave you and you never really feel safe.
  • bad habits never truly die, and they feel so comfortable, right, and easy. even when you know it’s wrong, it still seems, at some place in your brain, so very right.
  • and so, every minute of every hour of every day is a fucking testament to will power, resistance, and opposite action, and it’s exhausting.

the scariest part about this past month was how low i got. the thoughts i had. the close calls. being ripped from my path of self-healing was brutal.

i wonder if it’s because my brain has gone to a very deep, dark place in the past. and so when i get depressed, it goes back there. like, if i had never gone that low, then my brain wouldn’t get there right away. but i think of it like a neuro “path” has been burned to that area of thinking in my brain, and so now, when i get sad, instead of just going to point A like a typical sad person reaction, my brain goes all the way past to point B.

and point B is a volatile, dangerous place.

i will say the fact that i know it’s my brain and not “me” really shows the progress i have made and what a lifesaver having this past year has made. because i now know what normal is, and so i know when my brain isn’t at its’ right chemistry. i think it’s what allowed me to reach out and ask for help when in the past i would have spiraled alone.

still, it didn’t matter because as we all know, when your brain tells you stuff it feels real and right and makes sense so it’s really difficult to fight it. it also makes the bad decisions even worse since you know you can do better. it’s a fucking temptress. (what is the male version of that word – tempter?)

i’m just a jumble. i feel great for 12 hours and then i panic and want to drop everything and disconnect. i use my dbt skills and get myself to do something i’m afraid of, and then 5 hours later, i’m sitting there and i just can’t use them. they seem moronic, useless, and dumb.

yesterday, i sat across from my psychiatrist and i talked. i gabbed, really. it might have been the caffeine, but at the end i said to her, “so it sounds like i’m back.” she agreed. and then i got in the car and started to drive. five minutes later i was crying. i got home and didn’t leave the apartment, answer any phone calls, clean, or doing anything positive for myself.

i’m either having mood swings right now as i recover, or i get excited that i’m doing better and am self-sabotaging to protect myself. or both.

either way, i don’t know what to do. or maybe i do, but i can’t. or maybe i can, but i don’t want to.