'Self-care has been the biggest challenge in healing. Just when I think I’m doing so well, I catch myself taking care of others as a replacement for taking care of me. By doing so, I repeat the cycle of abandonment my abuse started. In serving others before my needs are met, I do a disservice to myself.' Christina Enevoldsen
Therapy and Self-kindness
For a long time, therapy sessions would end with a fairly typical exchange. I would express frustration at myself for not doing enough, not making progress enough, not having been present enough, not … well, just not quite being enough, ever. I would go “grr”, and gently but firmly the response from my therapist would go, “Be kind to yourself.”
To start with, it was just annoying. It felt like a saying picked up at ‘therapy school’. I didn’t realise that it actually meant anything – that it actually could mean anything. Then slowly, over time, it began to dawn on me that the reason my therapist said it was because she meant it, and that she really believed that ‘being kind to yourself’ was an actual, tangible, feasible thing to do.
I really didn’t know what it meant, and over the last five or more years of therapy, learning what it is, and learning how to do it, has been one of the biggest challenges to date.
To start with, I would fire back: “What do you mean?” and in return there would come that therapist-response (again, annoyingly, it seemed, straight out of ‘therapy school’) of, “What do you think it means?” Gradually this morphed into, “What would it mean to you?” When I eventually frustrated her enough to elicit a straight answer, on one occasion she came up with a list of suggestions of things that other people found helpful. It was supposed to aid me in self-regulation, to try to bring me down from the hyperaroused, tense-taut, fizzing frustration that always marked out therapy days.
“A candle-lit bath?”
I don’t know what kind of look was on my face in reply, but if my face (for once) was expressing what I felt, it would have contorted with disgust, to be replaced perhaps with a wave of bemusement. Why would I want to have a candle-lit bath? Could I think of anything more triggering, less relaxing, more … yuk? But at least if being kind to oneself meant doing things you didn’t like, and doing things that increased your panic and sense of shame, then maybe I was already good at it …
The reality is that for trauma survivors, especially survivors of child sexual abuse, self-care is one of the hardest things for us to do. There are many reasons that we’re so bad at it. Most obviously for me was a lack of knowledge, about what it was, and how to do it. It hadn’t been modelled to me in any significant or at least in any successful kind of a way during my upbringing. Caring for oneself, it was drummed into me (mostly subconsciously but also in frequent, barbed remarks), was selfish and wrong. You don’t tend to learn things that you don’t see anyone else doing, and that you have been told repeatedly are morally aversive. So I didn’t.
Do we have a right to self-care?
Secondly, for many of us, we don’t believe that we have any kind of ‘right’ to self-care. Growing up with a toxic, curdled sense of unworthiness and shame, it seemed counter-intuitive to want to care for a self that is (so we believe) intrinsically bad. You don’t care for bad things – you destroy them, get rid of them. The broken washing machine that is left to rust down the side of the garage isn’t being cared for, because it’s faulty and has no value. That’s how I and many others I know have viewed ourselves all our lives. And, like a washing machine, we believe that we exist to serve others. It puzzled me at first that so many other survivors that I was getting to know, especially dissociative identity disorder survivors, were caring, devoted, sacrificial people, and that many of them were or had been employed in caring professions – doctors, nurses, social workers, counsellors, support workers, teachers and the like. And then I began to realise that mostly we had all grown up in environments where we had been trained to tune in to others’ needs – frequently, into other people’s illicit and wrongfully-expressed needs – and so we had become hypervigilant to others’ wants and emotions. We were acutely aware of how we could (how we should, sometimes, just to stay out of trouble) care for others, all the time neglecting our responsibility to care for ourselves.
And this external hypervigilance, our attentiveness to the needs of others, trained our brains in ways that hindered us from tuning in to ourselves. I remember early sessions of Sensorimotor Psychotherapy – “What’s going on in your body?” asked the therapist, casually. And I would look at her as if she had landed from outer space. “What’s going on in my body?” I would echo back, trying to buy some time and figure out how on earth I was going to answer this most complex and incomprehensible of questions. And sometimes the thought that was in my head would pop out of my mouth: “I haven’t got a body …” I knew, cognitively, that this wasn’t the case. But it didn’t feel the case. I was so horrendously out of touch with what was going on with my body, what was going on with my feelings, what was going on on the inside of me, that I had no chance whatsoever of going that step further and figuring out how to care for myself. If I couldn’t establish where I was at, whether I was hot or cold or hungry or tired or happy or upset or agitated or miserable, whether I was angry or uncomfortable or queasy or excited, then how could I care for myself in any of those or a million other potential states? I played hockey once with pneumonia, because I didn’t realise that I was ill, and pushed my body beyond its capacity and into serious illness.
So there were, and there still are, many reasons why I was and to an extent still am so bad at self-care. But over time I began to realise it as a recurring theme in my therapy sessions, an annoying fly buzzing around my head, something that demanded my attention and wouldn’t leave me alone. And I began to realise that learning self-care is absolutely essential to recovery. After all, it was abuse and neglect that was responsible for the mess I was in, the mess that had led to a severe and debilitating breakdown, the mess that had led me to being in therapy, the mess that was known technically as dissociative identity disorder. So it seemed obvious (at last) that continuing to abuse and neglect myself would only prolong the pain, and sustain the mess, and that I needed to choose an opposite path if I were going to aspire to at least some level of healing and recovery.
Why is self-care so important in survival?
A few years ago I read the Stephen Covey book Seven Habits of Highly Effective People and it introduced to me the Aesops Fable about the goose and the golden egg. And the point that Covey made was that we are all geese capable of laying golden eggs. But unless we take care of ourselves, unless we feed the goose, the goose will die and there will be no more golden eggs. So all the productivity of our lives – all our relationships, our hopes and dreams, our work, our interests, our legacy and destiny – would be suffocated by a lack of self-care. I held that concept mentally but struggled to come to terms with it emotionally. Too often it contradicted my default shame setting, that I was good for nothing, and wouldn’t lay any kind of eggs, let alone golden ones. But over time, as I returned to work and began to value myself more, I began to realise that I did indeed need to start taking care of myself as the golden goose that has the potential, like everyone else, to lay many, many golden eggs.
What I came up against was those infernal, frustrating laws of nature: the fact that my body needs sleep, nutrition, rest and exercise, and that emotionally I need a whole raft of things including positive contact with others, acceptance, challenge and excitement. I resisted this knowledge because it felt one step too far – I was, after all, severely traumatised; I had dissociative identity disorder; I had over a hundred alters. Surely the laws of nature didn’t apply to me?! Surely having dissociative identity disorder was the only fact of significance, and the threat of diabetes from obesity, or the risk of cancer from lifestyle choices, wouldn’t also smite me —because enough bad things had already happened in my life? Of course, I didn’t realise that I thought like this. I didn’t realise that deep down I had a kind of sense of equal opportunities ‘justice’, where if bad things happened to you as a child, bad things wouldn’t happen to you as an adult. But eventually, too many of my dissociative identity disorder friends developed breast cancer for me to ignore the fact that, far from childhood adversity meaning that you were off the hook from adult difficulties, it did in fact increase the risk. One research study I read suggested that the incidence of breast cancer increased by 49% for people with a trauma history.
Which of course is all terribly unfair – that you should suffer as a child, and then because of that suffering, you should be at greater risk for suffering as an adult. But I began to realise that it was a fact whether I denied it or not. And I began to realise that there is an imperative need for self-care if we are to have any chance at all of obviating the increased risks for the plethora of health problems associated with adverse childhood experience.
I also began, slowly, to realise that there was an intrinsic conflict and contradiction in what I was doing in seeking therapy. On the one hand I wanted to move towards healing and recovery, in whatever form that would take, and I was investing time and money and effort and emotion into that process. And then, at the same time, I was abusing and neglecting myself in ways that directly contradicted the vectors of therapy. I couldn’t on the one hand say that I wanted to ‘get better’, and seek and enjoy the affirmation and unconditional positive regard of a therapist who occasionally even said things that didn’t seem to come straight out of ‘therapy school’, whilst on the other hand fail to do the ‘homework’ of being kind to myself. I realised it was hypocrisy, and the kind of ambivalence-based conflict that is so often central to people with DID. So I also realised that over time I would have to start ploughing the ground, putting some hard back-work into digging up the fallow ground of my self-care, if the seeds that were being sown on a weekly basis in therapy were going to grow to an abundant harvest in fertile soil. I couldn’t abdicate all responsibility for caring for me to my therapist, my husband, and my friends.
Supplying the care you need
The barriers to learning self-care were enormous. To start with, I felt that I just didn’t have the skills. A constant directive came from my therapist for me to notice what I did for others, and to start to do it for myself, and slowly I began to realise that the skills were latently present but had never been self-directed. The biggest barrier was the desire, often held within me by different parts of my personality, to punish myself. I realised that, like many of my other dissociative identity disorder friends, I was highly skilled in the art of self-criticism, whilst lacking in the ability or perhaps the willingness to extend empathy, supportiveness and compassion to myself. I could maintain a constant stream of fault-finding towards myself, exacting the highest, most unattainable standards upon myself, whilst holding a totally different set of values towards others. (It must however be said that our ability to criticise and attacks others was also at times highly developed.)
Time and again I would hit up against the numerous mental obstacles to self-care in the form of restrictive beliefs: “I’m not worthy”, “I don’t deserve it”, “It’s selfish”, “There are people worse off than me.” Often you don’t even realise you think these things until that excruciating moment, often in therapy, when the therapist looks you in the eye and says, “Why don’t you deserve it?” Perhaps the most effective metaphor I found myself using with someone else was, “Does a car deserve petrol? Do we give it a hard time for being so needy, for being so greedy and self-centered to want petrol, or do we just take it to the petrol station and fill it up?” We can so often get stuck in that circular debate around our worthiness, around whether we deserve to have some time off, whether we deserve to take it easy, or have something nice, or enjoy ourselves, or receive a compliment. And all the time the car is stuck on the station forecourt, unable to do what it was built and bought to do, and we fail to realise that we really don’t even need to be having the debate.
The argument that “There are other people worse off than me” is one that I hear frequently from other survivors, many of whom have suffered the most inhumane and horrific abuse through long periods not just of their childhood but of their adulthood too. I sometimes fail to see much veracity in the claim that there are other people worse off than them, but I myself have publicly stated on a number of occasions that I consider myself to be one of the ‘lucky unlucky ones’, mainly because the abuse I suffered, whilst atrocious, has been matched in its extremity by the levels of care, love and support that over recent years I have subsequently received. But for me, I began to make progress when instead of comparing myself to others and wondering if I deserved that care, love and support, I decided that yes, there were people worse off than me, and that was why it was so vitally important that I care for myself: so that I can help them too. I have to fill the car up with petrol so that I can get on with my journey of recovery for myself, and recovery for others. I refuse to sit around any longer on the forecourt debating what I deserve.
Learning to tune in to myself to assess and respond to my needs, and develop some level of care for myself, was and still is hard. Many of us are not very good at it at all. Our medial prefrontal cortex, the ‘front middle bit’ of the brain which helps us reflect and zone in on our internal experience, has in many cases failed to develop sufficiently as a result of neglect. I like to see this part of my brain as a muscle that is puny and atrophied, but which I am now regularly working out at the ‘gym’. As I do, I’m beginning to see progress, and I’m less liable to want to respond, “But I don’t have a body” or “I don’t know how I’m feeling.” Use it or lose it, the slogan goes, and I’m learning, slowly and sometimes still too reluctantly, to use it.
But there is a huge fear that many of us have when we first start to tune in to ourselves – that we have within us such a huge reservoir of need that attending to it will burst the dam, and we will drown. It is a very tangible fear, full of a sense of overwhelm and risk. What if, instead of turning the tap on slowly in the safety of the confines of therapy, what if, instead of just having a little cry and then being able to pull ourselves together again, what if … what if … what if the whole thing comes gushing through? All those years of hurt and heartache and trauma and terror? All the hugeness of all the loss and all the abandonment and all the abuse that was so overwhelming that we could only dissociate in order to cope with it, and which resulted in us being the way we are now?
Assessing risks and understanding fear
Sometimes it’s hard to assess risk accurately, to perceive if the fear is founded or exaggerated. All feelings seem overwhelming and terror-bound at first. The merest sense of anger rising in us, the anger not at the huge injustice of criminal atrocity visited upon us as children, but perhaps just someone pushing into the queue ahead of us, or not listening properly, or not giving us due respect … the merest whiff of that can send us into a tumult of rage and lava-like extremity, so we pull away from it instantly, as quickly as from a flame or the hob. In reality, I’ve found that tuning in to my needs internally has not demolished the dam and everything has not come flooding out. If anything, it has reduced that incessant pressure and made me feel more secure in the strength of the dam walls and their capacity to appropriately hold the big feelings within.
I had to work hard to overcome a sense that I existed to serve and care for others, and that I shouldn’t or mustn’t care for myself. This core belief, buried beneath rock-hard layers of bitter experiences, had been reinforced by my own treatment of myself during adulthood: working too hard, caring for others too much, being over-committed and over-involved in everything I did. It was a seismic shift to believe that I existed for more than to serve and to care for others – that I existed in my own right, just to be, not just for what I could do. But poor boundaries, that creeping, sleeping inability to say ‘no’ and erect fences around myself and my stuff, made it hard for me to create the space that is essential for self-care. Busyness, after all, is fulfilling – it gives us feelings of potency, of being ‘good’; it keeps our feelings at bay; it gives us a sense of purpose and a sense of value. We have something to show for our time – a list of achievements and lots of ticks on the to do list – and we perhaps feel that our productivity justifies our existence and compensates for the negatives of us existing and ‘stealing’ others’ resources.
Too often we don’t create the space necessary for self-care because we don’t want to: we don’t want to pay the price of less productivity, and the discomfort we might feel at the accusations that invariably missile towards us from kids, or friends, or family that we are being selfish to want some space for ourselves. It’s an easy button for abusive, immature or self-centered people to press in us, and more often than not they keep pressing it in order to get us to meet theirneeds so that they don’t have to take the responsibility of meeting those needs themselves. We thus can be trapped in a cycle of abusive relationships where we fail to invoke any edges in our life, any tensa-barrier beyond which we say, “No! I need to meet my own needs now because I matter too.”
Is there shame in self-care?
Shame, of course, precludes self-care. It is most commonly expressed instead in self-harm: either the blade-bleeding variety or its more subtle variants such as food abuse, or alcohol, or drugs. Or, of course, its silent, passive accomplice in the form of self-sabotage, which trips us up when we are metres from the finishing line and we can start to hear the plaudits for running the race well. Shame has played a major part in my life, demanding perfection of me, withdrawing my rewards for work well done, increasing pressure, insisting that unless everything is done, then nothing counts. And as I have battled and engaged with my relationship with shame over the last few years, I have more recently begun to realise that for too long shame has been a welcome member of my household: because shame keeps out anger. What I mean is that if I were to acknowledge that the shame isn’t mine, that I am not bad, but it’s other people who should feel ashamed for the bad things they have done to me, then the irresistible next step is to flare up with anger – anger at the wrongness, anger at the injustice, anger at the people who have trashed my life and gotten away with it while I have paid the price. That anger is like a volcano waiting to erupt, and it scares me. So, too often, it is safer instead to sit with shame, with its passive-aggressive depression, rather than handle the outflux of this hot, fiery, unpredictable and perhaps uncontrollable rage.
And a lot of that anger, when released, was directed against the self, in volatile eruptions of self-harm. How would it be, my therapist asked me one day, if I could redirect that anger towards self-care rather than towards self-harm? The concept was so startling that I had to ask her to repeat what she had said, because it sounded on first hearing unnervingly like a line from The Jabberwocky. What if I could grab a hold of the handlebars of that anger, that roaring motorbike of pulsing, throbbing energy, and I could steer it towards a path of self-care rather than self-harm? To use its energy positively, not negatively? I am still processing that, turning it over in my mind, but it has its parallel in what I have said for a long time about anger: it’s the energy I need to get out of bed on a morning, and to try to change the world. Now, perhaps, it’s time to start trying to change the world by laying more and more golden eggs, and for that it needs a fit and healthy and sane golden goose.
What does self-care mean for a survivor?
I have had to figure out what self-care means for me by a toddler-like process of trial and error, of watching and learning, or experimenting and risk-taking. Candle-lit baths might be a no-no for me at the moment but I can at last see beneath the activity in isolation to the principle beneath it, and I am beginning to find things that suit my temperament and my experiences, and respect my trigger-laden vetos. I can relax in the jacuzzi after a work-out at the gym now. I can carve time out in my week, even ring-fencing chunks of time in the calendar months in advance, to make sure I watch the football I love, and the documentaries I enjoy, and the films that inspire me. I have had to tune in to a whole panoply of selves, all the different parts that make up the whole of me, to figure out what they each need and want – and that takes time, and communication, and effort, especially when there is seeming conflict and the contradictions of polarised beliefs. I have had to reframe some of my avoidance of self-care as attempts at survival and self-protection, attempts for which I can now convey my gratitude and appreciation, but which have been superseded as my here-and-now environment has changed, and is positive, and safe, and nourishing. I no longer need to defend against perpetrators who would deny me self-care. It’s ok for me to say “I need”.
I have had to look not just at the range of needs and wishes from all the parts of my system, but all the different elements that comprise the totality of my being. It’s too easy with the label of DID to think that everything is just about ‘parts’, but we’re human beings too. We have ‘normal’ needs like everyone else. What do I need physically, emotionally, psychologically, mentally, spiritually and socially? I am having to battle with those entrenched beliefs that self-care is wrong, and cascade my new understanding of its importance and validity down through developmental layers of my selves, to each and every part of my personality, so that all of me can begin to understand that self-care is good, and safe, and appropriate. That takes time, and co-operation, and a strong will, and I am having to take responsibility for leading on that as the adult, the core, the ‘host’: I don’t care so much for these labels of what constitutes me as a dissociative me, as I am determined to ensure that I move forwards with healing, and that I keep moving forwards.
I have tapped into my developmentally younger parts and found resources that they made use of in childhood – the interests and hobbies that they had, however stunted and prohibited they were at the time, which I now as an adult, with some imagination and determination, can bring to reality in the freedom of a grown-up life: I may not have had much freedom or security to explore the cosmos as a child, but it is within my grasp now as an adult, slowly and within the confines of mortgage payments and grocery shopping and toilet-cleaning, to develop and nurture that interest. It is often easy to re-enact the helplessness and victimisation of childhood and say “I can’t!” (replete with whiny voice) but I’m beginning to see just how significant a part of our healing is that attitude of “I can!”, despite the hurdles and continual knock-backs that are a reality for everyone in life, not just trauma survivors.
And in developing self-care, I’m learning to look with a sense of temporal perspective, not just to tune into “What do I need right now?”, important though a first step that was. I’m learning to start to plan, to anticipate, to negotiate upcoming events with foresight of what I will need in the future, what I will need at difficult times, at key dates, at busy times, when I’m premenstrual. I’m sure this will continue to be a challenge, and my boundaries are a work in progress as I learn to value my self and give myself what I need: I slip constantly into old patterns and belief-frames and I forget to check in with my selves about what I need and will need. Those patterns were laid down over decades – neural pathways wired into my brain through repeated experience. And that is why it is a battle to do things differently now, to rewire my brain to expect and campaign for self-care now. But I think it’s a battle that I’m beginning to win.
In the end, self-care is...
Self-care is hard, but self-care is essential. We often don’t know how to do it, but we can learn. Often we instinctively know how to care for others, and so we have ‘transferable skills’ that we can orient towards ourselves. But it requires a commitment to recovery, a commitment to changing our faulty belief systems, and learning to live in a new world of opportunity and possibility rather than in the bomb-shelters of our past. If we can start to accept self-care as a vital part of our life, rather than resisting it, we may find that we have many golden eggs to lay. And after all, what better way to free ourselves from an abusive and neglectful past than to refuse to continue to abuse and neglect ourselves in the present?
© PODS 2011