Training Mindset

So, it's been over 6 months since my last post.  As some of my last posts indicated, it was a terrible year for me in a mental health way (even more frustrating in that most of my troubles were medication-driven).  I might talk about that more in a future post, I'm not sure, but I'm not going to talk about it today.  I've spent the last couple of months trying to figure out how to get back into writing and posting here, and not being able to think of what to write about, since most of what I've been doing has still been oriented around recovering from stuff over the summer, and I'm not ready to talk about that here yet.  But finally, I have something I want to talk about.  It started as a Facebook status thing, until I realised it was going to go rather long and I remembered that I have this blog thing that I've been meaning to get back to.  So, here it is.

I just participated in one of Valkyrie's on-going self-defense classes. I was asked to attend in my position of official Valkyrie role-player to ensure that there was an even number of students, so that Kaja, as instructor, was not also being practice partner/opponent. Since this was a stress-testing day, that was very important - it is a very bad idea to go from playing the bad guy to offering critiques/comforting the person you just upset. However, while it was about stress-testing, it wasn't doing full-on scenarios, where I would play the bad guy the whole time. Instead, we were working somewhere in between drills and scenarios, with Kaja increasing the intensity with each iteration.  She did this by playing with 3 dichotomies that describe different kind of violence: playful vs earnest violence, symmetrical vs asymmetrical violence, and social vs asocial violence.  In playful violence the goal to learn or score points or demonstrate skill, whereas in earnest violence the goal is to cause pain or injury.  With symmetrical violence both/all participants are working with the same tools and rule-set, whereas with asymmetrical violence someone has a distinct advantage (initial positioning, weapons, different/disregard for rules, etc).  Social violence is about status and proving dominance (most bar fights), whereas asocial violence is about either getting a thing (a mugging) or enjoying harming someone.  There's a whole lot that can be said about these dichotomies and categories, but that will have to wait for another post. For now, suffice to say that Kaja used these principles to construct set-ups and participant goals that lead us from relatively comfortable to highly stressed.

To begin with, we were given the choice of starting on from standing (working with strikes, standing grapples, and likely involve take-downs) or from the ground (more wrestling-style grappling and pins, with striking added later).  My partner and I worked from the ground, while the other pair worked from standing. It started as basically sparring, with given starting positions and goals (playful, symmetrical, social violence). Then we were keeping score ( still playful, symmetrical, social violence, but a bit more stressful with the added pressure to win). Then one person was told to cheat, and the other person had to decide how to deal with that (still playful social violence, but now asymmetrical).  Each person took a turn as the cheater.  The next set-up was a definite escalation, with a defined "bad guy" proving their dominance with the other person pinned against the wall or on the floor and hitting them (yelling at them was also encouraged) while the "good guy" just wanted to make it stop/get away (earnest, asymmetrical, social violence - the aggressor's goal still being about status and dominance).  Again, each person did one run through as the good guy and one as the bad guy.  Finally, the last construct (mini scenario?) had the bad guy in an extremely advantageous starting position and doing things that would likely cause severe, permanent damage or death because the other person was their toy and they like to break their toys, while again the good guy just wanted to make it stop/get to a safe place (earnest, asymmetrical, asocial).  I'm not sure what the set-up was exactly for the pair starting from standing, but for my partner and me, the good guy started lying on their stomach with the bad guy straddling their back and hitting their head or slamming their head into the ground.  Again, verbals/shouting was encouraged, and each person had a turn as both the good guy and the bad guy.  For the record, this was all done in ways designed to trigger high-stress response while being as safe as possible, with emphasis on keeping your partner safe, guidelines around the force of blows, indicating dangerous techniques instead of completing them (eg, eye gauges, throat strikes) and a safe word to make everything stop immediately (which could be used at any time by any person in the room).

That was a whole lot of description before getting to the point I wanted to make (hence why this became a blog post rather than a Facebook status update).  What I found really interesting about the whole thing was how my mindset going into the class influenced how I acted in each of these fights.  Even though I did all the same things that the other participants did, I entered the class thinking of myself as being there as a role-player rather than student.  I was there to facilitate other people's learning, rather than as a student myself.  Even while changing mindsets throughout the exercises (now I'm a sneaky cheater, now I'm psychopathic bastard, etc), I was still in role-player mode.  This was most obvious when I was the good guy in the last set-up, even though I tried to move away from it.  Essentially, I was still being (relatively) very nice to the person trying to murder me (though I still escaped to safety).  I did not get the degree of emotional buy-in and adrenaline dump that often comes with stress-testing.  With buy-in, my responses become instinctive and reactionary (at least in the past).  Today I was still thinking and actively deciding what to do next, often going with a lower level of force than could be justified by the situation.  At this point, I don't know if going into this kind of stress-testing or scenario work with a participant mindset would put me into the reactionary, adrenalized emotional space that I have experienced in the past, or if the role-player mindset has become my standard response to this sort of training - this is the first time I've done this kind of stress-testing as a (sort of) participant since I started role-playing for the VPD.  I also don't know if this role-player mindset is what would kick in if I ever find myself in a situation where I have to use violence for self-defense.  

If "role-player mode" has indeed become my default for threatening situations, there are some decidedly good things that come with it.  I definitely like the idea of maintaining my ability to think during threatening situation - being able to strategize and even consider what level of force is appropriate would be very useful.  However, there is one huge potential trap to using a role-player mindset in a real-life situation.  Most of the time as a role-player, I have to lose.  It is my job provide a challenging situation to the other person, and do my very best to make sure that they are successful in dealing with the situation.  In fight scenarios, this means that I have to let them win without making it obvious or easy.  If I go into a real-life fight with a role-player mindset, it might include that "the other person has to win" bit.  There are things that I do to try to mitigate this.  Primarily, I set myself different win conditions, or a different definition of success.  I consider it as a win or success for me if I am able to provoke emotional buy-in to the scenario (and it's easy to tell if you have it) and provide cues to lead the participant(s) to an appropriate response.  That way, I can still think of it as a win even though I come out much the worse for wear from the actual physical confrontation.  Hopefully this means that if I am faced with a violent situation in real life and I go into role-player mode, I can still be effective by essentially telling myself "in this scenario, your win condition is to get away, or to make it so that they can't hurt you anymore".  That's basically what I did today.  I'm also guessing that even in a role-player mindset that the additional stress, adrenaline and pain of a real-life, potentially lethal encounter would counteract any tendency I may have to use lower levels of force when higher levels are fully justified.  I'm sure that there are other training things that the Valkyrie instructors and I can think of to mitigate the "I'm supposed to lose" part of a role-playing.  Unfortunately, there's no way to know for sure unless I actually end up having to physically fight for my life.  Given that, I'm perfectly happy to live in uncertainty.  

Sooo . . . ADHD then?

So, I briefly mentioned in my last post that I've been getting assessed for ADHD.  It's not completely finished yet (I assume, I've only had 3 or the 5 sessions initially scheduled, and I'm assuming at least one of those is meant to talk about treatment), but it's pretty clear that what the results are.  I have ADHD, though a relatively mild case of it.  I still find it really weird that wide range of things that I'd always put down to introversion, depression, and plain old personality quirks actually all add up to this other thing.  Part of me is still in denial.  Part of me is going huh, that actually explains some things.  

Take difficulty focusing. This is such a broad concept, it's hard to really pin down.  If I look at it a different way though, through the coping mechanisms I put in place without labeling the problem, it makes a lot more sense.  For example, whenever I have writing or (non-fantasy) reading to do, I go to a coffee shop.  I know that I can never get anything done when surrounded by the distractions of my home.  While a coffee shop has more sounds and things going on, there are fewer things to pull me away from the task at hand (laundry, dishes, my cat, the bookshelves full of old friends).  I also expect to be at the coffee shop for at least half an hour before I actually focus in and start working on the writing or reading I went there to do.  It's the same reason that I always try to be at work or at class at least 15 minutes before things are supposed to start.  It takes me that long to settle in and be able to focus.  The flip side is that once I'm truly settled, engaged and interested, I can get hyper-focused, losing all track of time as I work away.

Then there's the procrastination/motivation thing.  I'd always put this one down to a personality quirk made worse (way worse) by depression.  While depression has certainly been a factor, it's compounded by ADHD.  Clearly, the whole trouble focusing also comes into play here.  There's always something more interesting things to do than that school reading/work project/household chore, and starting things is extremely difficult.  The good news one this one is that I sometimes do the previously avoided household chore as part of procrastinating on doing the school reading.  

One sign/symptom that initially confused me was losing things.  I don't lose things, at least not often.  The usual example is losing your keys, and my keys have never been misplaced for more than 30 seconds.  Ask me where something is in the house and I can almost always tell you - and if it's not where I said, that usually because someone else moved it.  Add one word and make slight perspective change though - losing track of things.  I may not lost physical items, but I definitely lose track of things that need to be done.  Physical day-planners and calendar apps are very much my friends, and even when I'm using them religiously things still get missed.  Usually everyday things that I assumed I didn't need to bother writing down, like doing laundry or scooping the cat litter, and I only realize that I lost track of it when I have no more underwear or the cat starts pooping everywhere.

Then there's the whole listening thing, also connected to focus.  I'm often not very good at it.  I can think I'm paying attention, and next thing I know my eyes have glazed over and I'm staring vaguely over the shoulder of the person I'm supposed to be listening to.  In lecture classes I compensated by taking very thorough notes in order to stay focused and just put it down to not being a auditory learner.  It's not considered socially acceptable though to take notes on a casual conversation.  Even more frustrating is when I'm sure that I'm really listening and paying attention - for example, during a conversation with my partner about something that's been really bugging them.  I hear them, I promise to work on it . . . and somehow I completely forget about the entire conversation until the problem comes up again.  

There's a whole bunch of other signs/symptoms, most of which I have trouble with to a certain extent.  Impulsivity, bad time management, difficulty making decisions, restlessness, hypersensitivity (both emotionally and to physical environments), etc.  

When life is going well, I manage all of these things reasonably well - I might come off as a little scattered, but nothing out of the ordinary.  I have coping mechanisms that work.  But add a whole other level of complication when other parts of life aren't going well.  It isn't unusual for depression and ADHD to go hand-in-hand, and they tend to amplify each other.   On top of that, undiagnosed and untreated ADHD limits the effectiveness anti-depressants. Until the ADHD is being treated, the anti-depressants can only ever be partially effective.  No wonder I've been at least moderately depressed for most of the last 15 years.  The only stretch that I was in no way depressed was when I was basically self-treating the ADHD through enormous amounts of physical activity.  The good news is that now that the diagnosis had been made, we know that adding a stimulant (to treat the ADHD) to my anti-depressant is likely to make a big difference.  There are a number of stimulants that can safely be taken with SSRIs, the most common kind of anti-depressant.  Because nothing in my life can be straightforward though, the anti-depressant that I'm currently on is an MAOI, which apparently can't be taken at the same time as a stimulant.   Not sure yet how that one is going to be resolved, but I'm trying to think of the whole things as two steps forward and one step back, rather than one forward and two back.  Yet another medication change might be on the horizon for me.

Anyway, back to the ADHD.  Apparently I have it, even though I never had trouble staying in my seat in school.  Stupid stereotypes, focusing on one aspect that not everyone experiences.  It's much more about the "attention deficit", only some people get the "hyperactive" part.  And there are many ways that people experience the attention deficit/difficulty/difference part.  At least I know now that I'm not just lazy, flaky and inconsiderate, there's (multiple) neurological things at play.  Next steps: emotionally accept that, and wait for my psychiatrist to figure out how to treat the depression and the ADHD together . . .

 

Still here (potential trigger warning)

So, if there's any of you who had started following this blog more regularly, you've probably been wondering where I've been for the past few weeks.  I do still want to make weekly posts, I just was unable to do so for a little while.  Here's why.

The medication changes that I've been trying since January (and spoke about here in April, in the post called Medication) were not only not helping, they were making things worse.  One of them, called Lamotrigine, did something very strange; it made my emotions feel like they were off in the distance where I couldn't tell what I was feeling, while I still had the physiological reactions that went with the emotion.  I'd go through the physical stages of feeling upset or anxious or angry, but not be able to access the thoughts and feelings that should have gone with them until they hit overwhelming levels.  Even then, it was like hearing someone from 5 blocks away - you know something is really strong/off, but can't make out very much.  Needless to say, it was extremely strange and confusing.  I didn't realize how bad I had gotten until almost too late.  I'd hit the planning stage of suicidal thinking.

Somewhat miraculously, I told my therapist.  She helped me talk to my partner, and we started putting safeguards in place - getting the numbers for crisis lines, arranging to meet twice a week, seeing if I could get in to see my psychiatrist sooner, etc.  At my next session with her, we discussed how to tell when you should go to the hospital.  I felt like I was right on the edge, but wasn't sure if I needed to go that far.  As we spoke though, I realized (stopped avoiding) that I didn't trust myself to be home alone while my partner was at work; so far I hadn't acted on anything, but I was more exhausted from fighting the impulse everyday.  By the end of our session, I'd decided it would be best to check myself to the hospital.  Again, my therapist helped me talk to my partner.  We made arrangements for him to pick up of my things from home  and meet on the way to the hospital (I was afraid that if I went home than I would lose my nerve).  

I spent a week in the hospital psych ward.  It probably would have been longer if my mother hadn't been able to come stay for a couple of weeks - I still didn't trust myself to be home alone for hours at a time.  I was taken off all of the medications that I had been on.  I'm now in the stage of waiting for the old medications to get completely out of my system before I can start a new one.  Having my mother here has made a big difference; she keeps me company and encourages me to go out and do things without pushing too hard and overwhelming me.  For the week or so I've mostly just been tired (sometimes exhausted), without the hopelessness that went with the exhaustion before I went in to the hospital.  While the new medication comes with some significant dietary restrictions (including very little cheese and chocolate, and no bacon), I'm told that it often works well for people with the kind of persistent, treatment-resistant depression that I have.  I am back to feeling like my depression is a life-long illness that can be managed and minimized, rather than a terminal illness practically guaranteed to end in an untimely death.  

So there you have it - that is why I've missed a couple of weeks of posting.  It's been a difficult time, and a time that is difficult to write about.  It's still very fresh - I don't even start the new medication until next week.  I hope though that writing about my experiences helps the movement to improve understanding of mental health struggles and decrease the stigma associated with them.  It was stigma that almost kept me from going to the hospital, and yet it was the best place for me to be at the time, and may be again.  Always remember that mental illness is just as legitimate as physical illness, and never hesitate to claim the care that you need.  

An ExA Session

So, this week I thought I'd take you through the general structure of an Expressive Arts Therapy session - the architecture of a session, as our theory calls it.

First comes the filling in.  This part is pretty self-explanatory; the client talks about what's been happening in their life and if there's a specific thing that they want to work on.  Occasionally, this may be all that happens, particularly if it's the first session.  Other times, it may take only a minute or two.  

Next comes the decentering.  We put the things discussed in the filling in to one side, and move into the arts.  The options here are endless, using whatever is available to do something that engages the imagination.  It can involve visual art, music/sound, movement/dance, theatre, writing (poetry or prose), or any combination of the above.  In my thesis, I am arguing that it could also involve the martial arts.  It can be extremely simple or extremely complex - from playing with rocks to a full theatrical production that is worked on through many sessions.  Often, we will move between multiple art forms during one session - for example, start with a gesture/movement, use the movement to start a drawing, then tell a story about the drawing.  Sometimes what happens stays close to what is discussed in the filling in, theme-near; say, writing a poem about the client's fight with their spouse that morning.  Sometimes the art-exploration is theme-far, with no perceivable link to the filling in; say, a slow, graceful, meditative dance inspired by the movement of whales, after the same filling in about a fight with a spouse.  The therapist might work on the art piece with the client, work on their own art piece next to the client, or simply observe.  

After the art-making comes period of aesthetic analysis, talking about making the art.  At this point, we try not to go into making guesses about underlying meanings.  Instead, we talk look at the creative process itself - what it felt like, if there were moments of particular challenge or particular enjoyment, if the client is satisfied with the result, if it feels done.  The therapist might mention things that they noticed, how they felt while the art was being made, or ask the client to give the final result a title.  ExA jargon refers to this as "staying on the surface" - looking at just the artwork as its own entity, separate from its creator(s), rather than as a reflection of the client's subconscious (a much more psychology-based approach).

Finally we come to the harvesting, connecting the art work back to everyday life and the challenge(s) discussed during the filling in.  The therapist might ask if the art work hold a message for the client, and what that message might be.  This is also where we identify resources, and reflect on how they may be applicable to a life challenge.  For example, the person who danced like a whale likely has a pool of calm/serenity than they could work on tapping into during future conflicts with their spouse.  Sometimes art itself is a valuable resource - doing something simple (composing a haiku, doing a quick doodle, imagining a dance move) can give a bit of distance and perspective when you're feeling anxious or angry.  Watching someone make art, or making art with them, can teach you a lot about a person and what traits and resources they have - if they are patient, persistent, experimental, detail-oriented or big-picture, careful or a risk-taker, if they prefer solo work or collaboration, preferred methods of communication, etc.  All these things can be considered resources, and can be applied to many of life's challenges.  It is also easy for someone to forget these sorts of things about themselves, or that how to apply such a trait to a particular problem.  Sometimes the artwork and the resources that come to light during the making aren't applicable to the specific challenge brought up during the filling in, but the insight can be valuable in other parts of life.  While largely about harvesting the creative process for resources and learning, this last part of the session must also bring the client back from the imaginal realm where art work happens, and bring them back into the everyday world.  By the end, the client must be ready to go back into their usual life, hopefully with a new perspective or approach for dealing with challenges.

Obviously, real life is messy - often, a session won't follow this exact format.  Usually, we move in and out between different stages - filling in can continue while we're working on an art piece, some aesthetic analysis and harvesting can begin while still working on the art work.  Sometimes entire sections will be skipped, or covered in only a sentence or or two.  While we allow for a lot of flexibility and adaptation to each client and each situation, this is the basic framework we start with and work from. 

Thesis Writing

I started writing my thesis in October 2015, and if all had gone as planned, I would have completed in by May 2016.  Needless to say, all did not go as planned.  When I began spiraling back down into the depths of depression in January 2016, work on my thesis was put on hold along with everything else.  It was almost a full year before life and medication changes made it possible for me to start working on it again.

I'm writing my thesis on serious play, and using that concept to bring martial arts into Expressive Arts Therapy (ExA) practice.  For me, serious play is about bringing a playful approach to a serious experience or endeavor.  A playful attitude opens us up to creativity and options that would not have occurred to us otherwise, while maintaining an underlying awareness of the seriousness of the issue helps to keep us from pushing too far.  It allows for both cooperation and competition, and disrupting the status quo.  It was through experiencing this training attitude at Valkyrie that I realized its therapeutic power, leading me to expand on a term already used in ExA to describe it.  Through the use of a serious play approach, I am opening the door to using martial arts in therapy, particularly as an option for working with issues around violence, anger, fear and trust.

At this point, I am beginning to write the most interesting part of my thesis, the results section.  I have finished the first drafts of the introduction, the literature review and the methodology section.  As my primary methodology is a heuristic approach, the results section is largely based on my own experience and exploration.  I plan on also including the results of some arts-based research conducted with some of my fellow Valkyries.  However, I'm currently stalled.  With the returned depression problems I've been having over the last couple of months, I haven't made it Valkyrie in ages in order to ask people to participate.  I've also been lacking the motivation to write on my own experience, as well as the ability to think of what to write about.  With yet another medication change last week and feeling some improvement (evidenced by writing this), I'm hoping that the necessary shift has begun, and I'll be able to get back into again soon.

While the stretches of being unable to work on my thesis have been extremely frustrating (and guilt-inducing), I think that in the long run it will actually make for a better final product.  Faced with the first strict deadline, I probably wouldn't have tried doing the extra arts-based research with other Valkyries.  Now that I know my next chance to take my exams won't be until June 2018 (since I won't be ready this summer), I can afford to take the extra time.  I also have an extra 2 years of experience to draw on for the heuristic-based sections.  I look forward to being able to dive back in and, given how I've been feeling the past few days, I'm hopeful that it will be soon.

My Walk

It's been a rough week, and while today has been going better, I don't really feel like writing.  Instead, here are some of the flowers that I get to see on my walk to the coffee shop where I usually write.

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Medication

I had originally planned to write about self defense and how it is taught at Valkyrie, as something of a follow-up post from last week's.  It seems that will have to wait for another week though, as I can't really focus on it at the moment.  Instead, I want to talk more about depression and medication.

I'm on a new medication again, the 4th or 5th in the  past year.  I can't remember anymore how many I've been on since I was first prescribed an anti-depressant when I was 15.  I've been on medication more than I've been off them since then, and there have still been times when I should have been taking something and wasn't.  Some haven't worked at all, some have worked for a year or two before losing effectiveness.  I don't think they have ever had me feeling good in a stable way by themselves, but they have still helped a lot - when working.  Each time they stop working is even more frustrating than the last.

Unless you've taken them yourself or are close to someone who has, you probably don't know that most anti-depressants take 6 weeks to fully come into effect.  That means that when trying to find a new one, you have to wait at least that long before you can be sure it isn't working and try something else.  Often you have to wean off your previous medication over 2 to 4 weeks before starting a new one.  That means that you can spend at least 2 months feeling depressed, have the doctor reach the decision that the new medication isn't working, and start the whole process over again.  If the medication is helping but not enough, then the dose might be increased - with another 6 weeks waiting for full effects before possibly another dose increase.  There is also the option of supplementing one anti-depressant with another, or with another kind of drug - this is where I'm at now.  I've been on the same anti-depressant for at least 6 months now, and am now trying a second supplement - the first one was technically an anti-psychotic and the new one is usually used to prevent seizures, but both have been found to help with depression as well.  Now I'm back in the waiting game, waiting to see if this new thing will reverse my current downward spiral, or if I'll be starting something new in the next month or so.  

I'm lucky in one way - I don't tend to get much in the way of side-effects.  That said, last supplement almost sent me into a manic state - I went from an ok mood with low energy to a great mood with incredible energy within about a week, almost uncontrollable.  Fortunately, the amount of energy slowly decreased to a reasonable level.  Unfortunately, the decrease in energy continued, bringing my mood with it - hence now trying something new.  The other time I've responded badly to a medication was much worse, and due to increasing the dose too quickly.  That time (several years ago), my energy increased dramatically while my mood stayed low.  To me, this is the most dangerous combination - highly depressed and highly agitated.  It was made worse by the fact that it happened to coincide with my doctor going on paternity leave and my psychiatrist going on vacation, leaving only a nurse practitioner who was unwilling to make changes to my medication, so I had to spend an additional 2 weeks in that stated.  If it weren't for the incredible support of my partner and friends, I probably wouldn't have survived.

The lack of resources for mental health issues in our health care systems makes all of this more difficult.  Many family doctors don't have a very good grasp on psychiatric care.  This is made even more difficult if, like me, you don't have a family doctor and instead rely on drop-in clinics.  While I always go to the same clinic so they have a record of all my history, the levels of comfort in treating depression vary greatly.  It is also extremely difficult to get an appointment to see a psychiatrist.  I first requested a referral to see one when things were going downhill fast last March, and was told to expect a wait of 3 or 4 months.  The referral was renewed in June, and made again in October.  It wasn't until December than I got in to see a psychiatrist for a one-off appointment, after which he sent some recommendations to the clinic that I go to and having been told that I could get an appointment to see him again within 6 months if things were still going badly.  After some confusion involving making several phone calls, appointments made, then cancelled and then made again, I saw him again yesterday.  To my great relief, he seems to have decided to see me more consistently now until we find some combination of medication that works - I have another appointment for a few weeks from now.

Needless to say, my relationship with anti-depressant medication is complex.  As I said, each time one stops working is more frustrating than the last, and the process of finding a new one is long and complicated.  When they do work however, medications make my life much better.  Even if they don't get me all the way to happy, they get me better enough to do the things that get me the rest of the way, like making art and going to classes at Valkyrie.  Medication, when it's working, gets me from unable to do much of anything to at least functional.  

I want to leave this on a positive note, but I'm not quite sure how.  I'm still in the downward spiral, hoping like hell that the steps I've been able to take will turn it around.  I guess the positive for today is that I was able to leave the house, sit in a coffee shop, and write this.  It's more than I could have done yesterday.  Here's hoping those tiny steps forward keep going.