My Inner Child

Greetings all. For those who are new to my blog it makes best sense to read the posts in chronological order - that is start at the bottom and work your way up.

In my last blog entry I had a diagram of the different parts of me. Slowly through therapy I have worked out there are only three parts to me.

The Frontman - calm, considerate, polite. Appears in times of stress when the relationship with those around me is valued. I can be seething with anger, or have a massive adrenaline rush in stress, but the people around me cannot see this.

The real me, the state I am in most of the time.

My Inner Child - raging in pain and in anger. My Inner Child appears when I do not place any value in the relationships of those around me. After my inner child has finished my memory of the event is sanitised. I think I have been calm and reasonable in stating my needs but word has reached me on a few occasions that there are people who are terrified of me.

When I am triggered in my PTSD I sink into my Inner Child, into the pit of terror and fear. I have been working with my therapists on better ways to support my Inner Child so that the time I spend triggered is shorter. And with practice I am managing this better and better. We have tried different ways of relating to my inner child and it was only last week that I realised the best "person" to make my Inner Child feel safe, supported, acknowledged is "Dr Roy".

Yes, the skills I learnt as a doctor that enabled me to calm and gain the trust of traumatised children are the skills I need to bring to the fore when my Inner Child needs attention. This new way of relating to my Inner Child has brought me to a calmer place. The world feels less threatening now.

However, during this time I have also been monitoring my pulse and blood pressure as it has become clear that my BP is not fully controlled by my current meds. This has lead me to discover that I am running on adrenaline near to 100% of the time that I am awake and functioning. So while I feel calmer inside my threat systems are still on DEFCON 1. 

This may also explain my expansive memory. Memories are "laid down" better when there is excess adrenaline in the system. So I have been running high on adrenaline for most of my life.  

Besides the different parts of me are also the "scripts" I was taught as a child. So for any medical related appointment I am well groomed, well attired, well behaved and on time. This has led to most of my therapists perceiving me as higher functioning than I truly am. So I have begun to experiment with going off script. This caused my inner critic to get quite upset, angry, harsh. The first attempt went well. I was even unintentionally late, I parked and without self criticism I did not run or walk fast but went at a measured pace with my anxiety rising as I got closer.

That psychotherapy session and the next few after were spent exploring ways of going off script with my psychiatrists, my inner critic was quite clear that there was no way I could do that. In the end I did manage to go completely off script, with less anxiety each time.

And now Andrew along with one of my psychiatrists have thrown me a conundrum. Stay in Auckland, or move up Matakana way. We already have two properties we will be viewing at the end of this week. Whilst I have been house sitting in Matakana, both Andrew and my psychiatrist have noticed how calmer and more relaxed and even happy I am. Auckland is a never ending supply of noise stress but I am unsure about the possibility of moving.

The Power of the narrative

The Power of the Narrative

(For those new to my blog it makes best sense if you scroll down and read "The Journey" first, "The Narrative" second, and then this post)

Through luck and my good friend Joy I found Pete Walker and his book “Complex PTSD From surviving to thriving”. I had skim read it once, when in a moment of boredom I decided to open it and start part way through at a place that felt relevant to me. I was quickly upon his chapter “The power of narrative”.

It was pleasing to read in what I have blogged so far shows I am on the road to recovery, but it was frightening to read some of what I have yet to deal with. Indeed most of his book documents areas of my life, my emotions, my relationships that are in need of further work.

Frustratingly, in some ways, the book is written for survivors of parental abuse – as the writer himself is a survivor of such abuse. Whereas I was fortunate to have good parents, not perfect parents by all means. Most of my abuse was at the hands of the medical system.

So why did I become a doctor? Somewhere along the line I learnt that when “The Doctor” said – “No. Stop!” – that command was to be obeyed. There it is, plain and simple, I became a doctor to get control back over my own body. And in the last several years I have experimented with that control by having further surgeries. Having gone through those procedures and felt better for it is probably what led to the door opening on Pandora’s box.

I now had control over my body, and my mind was screaming out for healing. At this point (as in near enough to now in real terms, not the point at which my mind was losing the plot) my insurer asked for a second psychiatrist to review me.

The encounter was an intense and challenging one, though for the larger part of me the psychological defences I developed as a child were strongly to the fore. Meaning that the present self was divorced from the real me, I went somewhere else pleasant and devoid of pain. ”I have become comfortably numb.” A line from Pink Floyd’s “The Wall” album.

Fortunately Chris (the second psychiatrist) allowed me times to be fully present and give me some of his insight. From this stemmed more foraging into Pete Walker’s book and a second book by Suzette Boon about dissociation in the face of trauma. I am learning more and more about myself and have developed the following pictogram.

"Who am I?"

Les Miserables

The Frontman

A pleasant friendly fellow who will largely be cooperative, with a tinge of hypervigilance and the defender on hand.

The frontman appears on first meeting someone, before establishing trust, and more importantly takes over in times of STRESS.

Assisting the frontman and switched on AT ALL TIMES is

HYPERVIGILANCE, monitoring always for the preprogrammed triggers that are signs of imminent PAIN.

Also assisting the frontman and switched on at all times is

THE DEFENDER, a prickly acerbic character that will start with a "back off" warning and growing from there if needed.

Someone, as yet unknown, is carrying the PAIN.

I have found my "Incredible Hulk" though I do not know him well, when he appears I dissociate and believe that I have been pleasant and direct in stating my needs.

I have now had my first glimpses of the small boy in pain and angry that no-one is listening to him.

Lastly and without doubt not the least is the REAL ME.

I am:

Friendly

Fun

Cheeky (Monkey)

Interested

Connected

Caring

Empathetic

Knowledgeable

Perfectionist

HARSH 

Inner & Outer voice

Vulnerable

Suffice it to say I continue to make progress. The journey is ongoing, my thanks to those who walk alongside me and hold my hand.

A brief suggestion

After a delightful afternoon tea with my friends Roger and Kathy Hay I thought I should add this brief post.

If you are new to this blog it will make more sense to scroll down and read “The Journey” before reading “The Narrative”.

And as an aside Isaac Newton is quoted as saying that most people only ever use about ten percent of their brain, I think I may have been using quite a bit more.

The Narrative

I have realised that some information is missing or incomplete in my post: “The Journey”. I have travelled a long way to get here and have a team of extraordinary people helping me. So much of what I have learnt about myself through working with these people leads me to assume and not always convey enough information for others to understand my journey. Here, in “The Narrative” I will try to add a bit more of an explanation.

Additionally, in consultation with my psychiatrist, my nortriptyline is to be increased from 75mg to 100mg as there remain indicators that my pain levels are still too high.

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I was born on the 5^th of August 1968. As stated in “The Journey” I was the third son born to my parents with a cleft lip and palate. Cleft palates come in just a few varieties – mine fell into the worst category being called a bilateral cleft lip and palate. (The photo is not of me, but is an example.)

As you will have already seen in my last post my initial surgery was delayed, I cried and split my stitches and an irritated and rushed surgeon did a poor redo. This resulted in my having a total of five corrective surgeries by age six. At that time the only pain relief options were aspirin (orally) or morphine by injection. Unfortunately I also markedly suffer from one of the side effects of morphine, nausea and vomiting, thus necessitating further injections of anti-emetics.

Place yourself in a child’s mind for a moment. Are you in pain? “Yes”, rewards you with pain in the form of an injection, often multiple injections. The pain relief comes later. A child takes little time to learn that saying “no” is a more preferable option – particularly if you have learnt to suppress the pain with your brain.

The downside to my having learnt to control (or deny) the pain is that my brain was (and still is) working hard to suppress any pain inputs and thus never received the signal that the pain in my face had stopped. So for nearly fifty years my brain has been tasked with stopping the pain, being hypervigilant of signs that more pain is coming, learning my lessons at school, becoming a doctor, working and developing my skills along with managing a team of staff with their individual needs.

My brain said – “Enough, I cannot do all this”. So I have stopped and am taking time to address the things my brain no longer needs to do. I am addressing the pain. I am addressing the hypervigilance. But this will take time.

Along the way I also needed grommets inserted. A complication occurred that meant I lost 80% of the hearing in my right ear along with disrupting the canals that convey information on which way your head is currently tilted. Fortunately you have a second one on the other ear. If such a complication occurs to an adult they usually end up suffering disabling attacks of dizziness at unpredictable times, often resulting in their loss of employment.

Yet again, as a child I learned to compensate and control the good versus bad inputs my brain was responding to. So along with controlling the pain my brain learnt how to compensate for the loss of balance signals from one side of my head along with suppressing attacks of dizziness. I do remember most nights of my falling asleep at this time were accompanied with a sense that I was spinning backwards continuously.

There is much else that has happened to me, I am uncertain what to tell you all and I don’t wish to wallow in the muck. There was the bullying at school. Coming out as a gay man. Having senior lecturers in medical school pull me aside in stairwells and other out of the way places to tell me to go back in the closet or I will have no career.

I have fought against so much to survive. But I am a survivor and I can find my way out of this current hell hole. The thoughts and wishes shared by my friends, many of whom are my ex-patients, are helping bolster me up at this time and I thank you all.

The Journey

As I am slowly reaching out and reconnecting with my former patients and old friends I am needing to explain repeatedly how I am, how I got here, what's happening now and where is this all going? All very reasonable but the retelling is painful in itself and as pain is the central theme of my journey I wish to lessen it by recording here the essential questions so that we can skip most of "that" and talk about things less painful and more joyful.

Pain.

Pain is a brain event. We know what "turns it on" in most cases, but we do not understand how it turns off. We do know some people are born without the neurons that transmit pain messages to the brain, and they never experience pain. We also know in some people pain (particularly back pain) gets turned on by a physical event, and that the pain never turns off for a prolonged period.

My Pain Journey.

I was born with a cleft lip and palate. I was the third son to my parents with a cleft palate, so they knew the drill pretty well by then. At that time the plastic surgeons were delaying the first repair until the baby was 6-9 months  old so that the baby's mouth was bigger and a bit easier for the surgeon to work in. The plastic surgical unit also had a policy that the parents were to be separated from their child until 1-2 days past the surgery so that they were not upset at how their child looked.

Mum knew what was going to happen. She knew that I would know she wasn't there and that I would cry - risking tearing apart the sutures that had been carefully placed to achieve a good cosmetic and functional child's mouth. She had nursed two children through this procedure previously, she wasn't going to be upset by my appearance. However Ward Sisters rules were not to be over-ridden no matter what.

So it happened. I cried. I cried in pain and my mother was not there to console me. I tore my sutures. I was then taken back to theatre where the frustrated surgeon did a rush job resulting in a poor cosmetic outcome. Thus I had two further trips to theatre whilst I was still a toddler in an attempt to achieve a better cosmetic outcome.

The period of ages 2-3 years is a critical period in which the child forms the idea that they are a separate being to the world around them, and that there are other beings who may come and go. They learn that they can influence the behaviour of others around them. Unfortunately during this period I suffered painful surgeries, and learnt to use my brain to suppress the pain messages so that I could get on with my life.

One of my earliest memories was of a nurse threatening to smack me if I did not stop crying. So the message was clear - don't verbalise your pain or you will be punished. There were many other such messages. When it came time to have the sutures removed (a painful process) I was told to be still and stop wriggling as that was only making things worse - the message being if you are good and still this will hurt less.

I learnt my lessons well. By the time I was 14 I endured a 75 minute procedure under local anaesthetic in which the surgeon removed a tooth, cut a trench hole into my palate to locate the adult tooth that was in the wrong place then try to put it in the place now vacated by the removed baby tooth. Hmmm, hole too small. Chisel bone out. Place tooth and suture everything up. At the end of this procedure the doctor and nurse both complimented me on how well I had handled what they had done to me.

Yes, be good and deny the fear and the pain and people will be happy and say positive things to me. Unfortunately they lied. The better you are at denying the fear and pain the more terrible (painful) things they do to you! 

So I have for a very long time been using my brain to suppress pain. It is still doing it today. It has never received the message that things have healed and that the pain has stopped. For as far back as I can remember if I cut myself whilst preparing food I only notice when there are smears and spots of blood  - here, there and everywhere. Sometimes there has been so much blood I have had to wash my hands in running water in order to find where the cut is. There was no immediate pain signal, or rather there was but my brain is already suppressing pain signals so one small slice is nothing compared to the rest of the pain it is working on.

Post Traumatic Stress Disorder.

I have taken this definition of PTSD from the American National Institute of Health:

PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.

It is natural to feel afraid during and after a traumatic event. Fear triggers many split second changes in the body to help defend against danger or avoid it. This "fight or flight" response is a typical reaction meant to protect a person from harm. Nearly everyone will experience a range of reactions after trauma, yet most people recover from initial symptoms naturally. Those who continue to experience problems may be diagnosed with PTSD. People who have PTSD may feel stressed or frightened even when they are not in danger.

My PTSD Journey.

I'm sure many of you can already see where I am going. I talked above about fear. I have early memories of listening to the footsteps of the nurse coming down the corridor. "Are they coming for me, what painful things are about to happen?" I learned to suppress my "fight or flight" response that the definition above talks about.

There is also one very unfortunate event. I was eleven and we were at Middlemore Hospital seeing the orthodontist who was beginning planning for the braces he would fit to my teeth. A mould was going to be made so that he could continue to study it in his planning, and also provide a marker from start to finish. The nurse mixed the mould material with too much water, so that when she placed the mould tray into my mouth it began oozing down my throat and choking me.

I tried to get her attention and was rewarded with a stern "Be quiet! Lie still!" Finally, as my airway was about to be overwhelmed by the oozing mould mixture and I would die of asphyxiation, I forcefully vomited it out. Where upon I was told off for making a mess! I protested. The orthodontist intervened and shooed the nurse away. He helped clean me up and explained the error that had occurred. He reassured me that he would do it right and asked me to lie back in the chair whilst he did a new mould mixture. Fight or flight? I had no choice, I could do neither.

So slowly over the last several years as my brain has finally reached saturation point I have been having moments of meltdown - total fear of what painful thing is going to happen. There isn't any actual painful thing about to happen. My brain is using triggers it learnt during my childhood and applying them to events that are totally disconnected. There is no threat of danger but my brain has lost track of present day reality and is applying past learned experiences.

Fortunately I had the good experience of meeting an amazing man who has been a cardiologist, a GP and now a psychotherapist. We have been working together and it has been because of his help that I have held it all together and put on a brave face and carried on working for as long as I did. And now, given where I am in my life, I am looking forward to gathering up some energy to confront some of my demons and vanquish them rather than letting them rule my life. This will take some time, but I do now have the time to address them.

Where Am I Now?

I am currently taking 17 pills a day. Most of those are aimed at trying to calm the pain nerves down, and they are definitely helping. My psychiatrist has treated people like me, traumatised from multiple surgeries at a young age. He has gently guided me to discover for myself what is important and what is needed. He has agreed with my decision to consider myself retired. Whilst he expects improvement he agrees that this will take years. 

So I am back to being a patient again. I am fortunate that I have income protection insurance so that money is not a worry for me. I am also blessed in having a loving and supportive partner in Andrew. 

We are planning to get married this year on the 25th anniversary of our first date. This will be a very small event with less than ten people invited as I simply could not cope with more. Not even family members of Andrews and my family have been invited. My apologies to them and you. Perhaps we may find a way to have a few small gatherings in the months following our wedding so that some of you can celebrate this milestone with us.

The Future.

The future is unknown. I am taking my time to slowly heal and perhaps one day become a more useful and functioning member of society. I have overcome an awful lot to have achieved what I have already done and am relaxed in knowing that I can continue my journey, take the time to heal, and then discover what comes next.