Wednesday, June 3, 2015

Triggers, Mental Health, Safe Spaces and Recovery.

The study of mental health is fairly new and in its early stages right now. There is still so much we don't know. This should not come as a surprise, though, since the mind is an esoteric and complicated thing, intricate and complex in a trillion different ways. Our emotions and our thoughts are affected by a vast plethora of factors: external and internal, material and abstract. Suffice to say, we have decades to go before we begin to comprehend even half of it.

Hello, my name is Fahim Ferdous Promi and I haven't updated my blog in a few days. How is everyone?

I am very pleased to be writing here after such a long while. I wanted to bring something that I believe was important to the attention of my readers: the issue of mental health and recovery. Please do not be mistaken. This is not a guide to recovery but rather supplemental literature for those who wish to understand the resources required for it.

Recovery from mental health issues is not easy. It is a long and arduous process, to be honest, and it can take anywhere between three years to fifteen. I have sat in group therapy sessions with people who have going through the system for almost forty years. This is not a jab at them. More often than not, recovery just was not possible for them not because of their own fault but that of others around. This is something that we often overlook and ignore.

Mental health issues are often physiological but even then, factors outside this come into play. After all, most of the physiological phenomenon within our body are results of the environment our bodies are in physical interaction with. There is a dynamic at play here. For example, if there is something that our mind generalizes as a threat then at that point the body, among many others, will release the hormone adrenaline increasing our heart rates, etc. preparing for a fight or flight response. For the sake of simplicity, we won't be naming the hormones individually throughout the rest of this article but rather address them as "stress hormones," "depression hormones," or "anger hormones," et cetera.

This dynamic play between the mind and body is significant and relates directly with triggers. It is often the case for many of our base emotions to certain things such as loud noises and bad smells. All of that is evolutionary instinct. For example, our ancestors who lived in the wild feared the dark because they had no means of breaching it, there was danger there and it left them powerless. This basal fear still remains within most of us regardless of possessing the tools to explore through shadowy areas. Our minds, through the experiences of our ancestors, have generalized darkness with danger and fear. Similarly, through our own experiences, we too begin to generalize many things.

A common example could be a person from a violent and abusive household. We are assuming that the household is emotionally and mentally abusive rather than physically. In this case, there might be a certain word, a certain phrase or a certain tone/inflection of the voice that the mother or the father in the family used against the child to abuse them. The scar it leaves behind on the mind is deep and often permanent. The child will begin to generalize that word, phrase or that tone of speech as a threat and it may trigger the child to either cower away or lash out somehow. This is dangerous and no-one should be pushed to this limit. If the family and/or the parents become aware of this, they should stop or they risk pushing their child back into the danger zone of their mind making recovery difficult and often impossible. Because, despite medication and therapy putting them out of it temporarily, the scar is only stitched at this point and repeat trauma will open the wound again. This is often something many do not usually bother with.

Mental health issues are most of the time chronic. Every trauma is like a wound. Therapy and medication are ointments and bandages to close that wound and stop the bleeding. A trigger is a trauma upon that wound again with the potential to tear through the bandage and reopen the wound, causing further bleeding. Once the patient is taken to a psychiatry ward for counselling and remedy, all they are doing is re-stitching the wound and reapplying ointments on them. However, the wound area has to be kept free from damage in the future so that nothing comes in contact with it and the stitches and balms can do their job healing the mark. This requires the patient to be in a safe space.

The safe space or the recovery space is where the person is away from their triggers or has immediate resources to tend their wounds when they hit their triggers. I will try to use two different physical health issues to explain this as many find mental health issues too vague or abstract to understand this concept with the comprehension it needs.

First, we will start with diabetes. Let us say that sugar is a trigger for a diabetes patient. Now, let us the patient has consumed sugar somehow. Doctors and medical professionals, at this point, will try to lower the blood sugar in the patient's body and balance it out to ensure their survival. However, after that, once they return the patient home, it is up to the patient, their friends and their family to make sure that the patient does not come near consuming sugar again. The doctors and health workers cannot permanently get rid of the patient's vulnerability to sugar so they will advice the patient to keep away from it. This is extremely similar to many triggers for mental health patients too.

Now, let us say, similar to the diabetes patient, the mental health patient has a vulnerability to a certain word or a certain idea. They may be triggered by reading about physical or mental abuse because of their past experiences, they may be triggered by seeing a scene depicting suicide or they may be triggered by hearing a certain person's voice. When this trigger hits, the person, depending on their condition will react. This may be voluntary or involuntary.

From my personal experience, I suffer from chronic major depressive disorder and generalized anxiety disorder. The voice of my uncle will usually cause heart palpitation or shallow breathing, dizziness, nausea, etc. This is because of my past experiences with him. Hence, hearing his voice for me is similar to a diabetic person eating sugar. In order to control the reaction, my doctors have prescribed sedatives and other medication plus exercises and other activities.

However, it is only for when I'm triggered just like a high insulin dose may be administered to a diabetic person after they accidentally consumed sugar. They are not to take this 24/7. The doctor doesn't expect the diabetic person to consume sugar all the time and then get administered the medication. It is only for an emergency. Similarly, the medication and therapy after a trigger is only after the mental health patient hits the trigger but, just like a diabetes patient is supposed to stay away from sugar, a mental health patient is supposed to stay away from their trigger.

Another example would be someone with heart complication issues being asked to stay away from foods rich in cholesterol. Same as above, the person is asked not to eat them. In this scenario, the trigger is similar to the cholesterol-rich food. The basic point of these comparisons is that triggers can affect a mental health patient akin to how a sugary food would affect a diabetic patient or cholesterol-rich foods would affect people with heart disease.

However, if a person with diabetes is staying away from sugary foods then we say that they are playing it safe yet if a person with mental health issues asks to stay away from going somewhere or doing something that may trigger them then they are often judged for being lazy, weak or cowardly. They are expected to "break out of [their] comfort zone" and touch the sky. Ask yourself this, would you ask a man with a broken vertebral column to go mountain climbing with you? If he said no because he has an injured spine would then tell him to break out of his "comfort zone"?

We have to come to terms with the fact that certain conditions disallow certain people from doing certain things. Children who have gone through experiences of sexual abuse/molestation may not be able to read Greek mythology because of its graphic content. Adults with anxiety issues may not be able to sit in an environment with loud noises. And yes, we understand that it is not always possible to avoid triggers (trust me, one of my triggers happens to be email alerts and I can't avert that) but please, try to be considerate that once we are exposed to it, we will not always be in a healthy frame of mind to participate in whatever is going on around us. Our wounds have been reopened and we need some time and safe space to sit down, tend to them and constrict the bleeding before we bleed too much.

People with mental health issues do not want or need your pity. What we do, however, require and ask for is empathy, compassion and understanding. We need you to understand that there are certain things we just won't be able to do without being damaged and we would appreciate it if you would rather not force us into going through it. There are some places not safe for us. These are not non-comfort zones. These are danger zones.

Just like you would not push a feverish child into the cold rain, do not push us into our trigger areas when we do not imperatively need to be there, when we know there are alternative paths that we can take to prevent getting hurt. Don't oblige us towards harm. We only ask for safety and for the chance to heal.

This is a special address to our friends and family: those close to us, those who we need to understand.
We have been dealing with this a lot longer than you. We are personally in the fire.
Do not tell us you know what we need better than we do. Rather, listen. Listen and understand.

— Fahim Ferdous Promi

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