Forensic Psychiatric Care

Plastic fantastic

Sitting in the back of my kitchen cupboard lurks a cup, one that I haven’t used for a number of years now but still I can’t throw it away. This cup symbolises so much for me, it’s made of melamine, a heavy type of plastic and it is practically unbreakable, it’s decorated with pretty flowers and it would happily form part of a good picnic hamper. Yet this cup has never been used on any picnic, instead it was used behind a multitude of locked doors.

This was the cup I used during my time in forensic psychiatric care, in the secure unit were for over a year I was confined. It was specifically chosen by my children as it adhered to the strict regulations about the type of non breakable cup I was allowed. The regulations about such items were very strict and if your cup didn’t conform you simply wouldn’t be allowed to keep it. On finding it the other day I thought of my time in that place and how dehumanising the whole experience was, you see it’s hard to suddenly be labelled as too unwell or perceived as too dangerous to use normal everyday objects like a china cup.

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The reality of course I now know was that I was sent there because I was depressed and self harming, but the scale and level of my harming was not in anyway as extreme as some of those I met in these places. Yes I cut myself on an almost daily basis in the hope of making the internal pain I was enduring somehow physical or more visible in some way. It was my way of protecting me, because at the time I truly believed that if I didn’t harm myself others would and this way I could control the harm done to me. I did bang my head on occasions purely out of frustration at the way in which no one seemed to understand the horror of flashbacks, of memories and of how I felt. But in all my time of harming I have never used a cup, or a knife, or a fork or any number of other items that suddenly I wasn’t allowed in this place to self injure. Nor had I ever harmed another human being, so I wasn’t dangerous in any way, yet in secure forensic services everyone is labelled and treated the same.

I look at that plastic cup and I remember how the so called professionals treated us, how they made me feel so worthless, so pathetic and so very wrong. I left an open unlocked ward and in the time it took to drive 200 miles I was viewed as a whole different person. No longer a free citizen who just happened to be ill, but a forensic detainee who could be barked orders at, denied her possessions and forced to do things whether I wanted to or not.

The forensic unit didn’t treat me as if I was ill, I never felt like a patient who was regarded an equal, no I suddenly felt like a third class citizen who they regarded as bad. In truth I feel they saw all of the women in there as criminals, yes I know many of the women I lived with in that place had criminal histories that had resulted in them being sent there, but not me. Yet these people couldn’t treat us all as individuals we were collectively dealt with in punitive ways.

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Like the cup made of unbreakable plastic, I can recall the lukewarm drinks we were served, and the mealtime chaos of cutlery counts and at times being made to eat meat and vegetables with a spoon. I was thinking back the other day to my first meal in this place and being lined up in a queue to collect my food, spaced out from the person in front with staff all around. When they handed a plastic plate, a spoon and a serving of meat, vegetables and potatoes, I was perplexed. Only that morning as I left my open ward I had sat with a china bowl and had open access to knives, forks and spoons and yet now I sat on a long bench table, surrounded by staff and other patients holding a spoon thinking how do I eat with this? I remember saying I needed a knife and fork, and being told that I wasn’t allowed such items and to shut up, sit still and eat. Yes the staff really were that blunt. My drinks in those early days came in polystyrene cups and I was told I wasn’t allowed a plastic cup until I had approval from the team.

The Team became a familiar part of my life, they ran my life for me after all they were in control, in charge and me well I was just a nobody. I soon learnt that if you challenged them over anything it didn’t get well received, but try as I might I couldn’t not challenge some of the more ridiculous rules and procedures this institution operated. They’d count the cutlery every single meal time first it was counted out then back in at the end, if they mis-counted then we would all be made to wait and wait and wait, while they hunted for the missing object which in truth there never was. Of course I never once saw anyone harm with cutlery, but pens that were freely available were used by many to self injure, as were a plethora of other objects we had access to. I learnt a million and one more ways to self harm, I learnt the weak spots in the system and I witnessed many awful incidents in there too.

It soon became clear that you could tell when certain women were more anxious and you could certainly sense who was going to harm before they did. Yet it surprised me over and over again to find the staff didn’t sense this increased anxiety and risk within a person, the team over focused on physical security and so missed clear opportunities to help women. Physical security included stupid rules about cutlery and certain other object and it also included an over reliance on locks. It focused on staff dominance and patient compliance to rigid rules that made no sense and yet the system failed.

A forensic unit has a higher level of self harm incidents and serious incidents endangering life than other types of psychiatric facility. It’s not just about the clientele they serve it’s about the complex nature of people who need help, and yet are failed by the system. It would have been so easy for me to have got sucked into the cycle of punitive rules, punishments and de-humanising that took place, it would have driven me to self harm even more if I had let it. I had to fight not to succumb to this place, to not end up like many who had spent years existing in these units. Who no longer felt human or had any worth, they felt better off harming and dead than existing in this horror in which they lived. Many didn’t have visitors or leave and they were rarely empowered, encouraged or given opportunities to believe they had a future.

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I was fortunate, I had a family outside, I had children who cared and friends who stayed in touch, most of all I had years of experience surviving similar controlling environments. My abusive childhood was all about control, punitive random punishments and dehumanisation, dissociating allowed me to survive that time. Dissociating again allowed me to survive this period of my life too and parts of me would ensure I never spiralled into being a continuous long stay forensic patient.
The truth is I can’t throw away that cup now because it will forever be a permanent reminder of the fact we survived the horror of our time in forensic care.

 

copyright DID Dispatches 2015

Hidden truths -revelations of betrayal

Yesterday I realised just how much some Mental Health professionals have judged me in the past and how because of my Dissociative Identity Disorder I am at times seen as complicated and complex. You would think I’d be more able to deal with these kind of situations, but when the envelope arrived yesterday morning containing a few documents from my medical records I found myself quickly getting annoyed.

I had requested some very basic information, I wanted to know how many contacts I had had with my local community mental health team over a given period of time, and how many nights I had spent in psychiatric inpatient services. Simple you would think in this age of modern technology for any NHS trust to gather this type of data and forward it to me the patient. Well I thought it would be simple I was wrong.

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Firstly whilst modern technology exists it is only as good as the data entered into the system, my local NHS trust doesn’t keep at hand a record of such things. Instead 40 days after my original request they sent me some documents which didn’t actually give me answers to most of the questions I had asked. For instance they have no accurate record of my admissions to hospital, well they didn’t send me the data. In fact some data was withheld because despite the various documents being about me, I’m not allowed access to them if there are compiled by a third party such as the private hospitals the NHS paid for me to be held in.

But what I did receive was eye opening, in this small bundle of papers were letters written about me from various medical professionals. They contained the reasons I was sent to secure services and the reason I was kept detained in a medium secure hospital longer than the psychiatrist based there felt I needed to be. I found out how people have over time judged me in ways you just wouldn’t believe and being judged well that makes me cross. I also realised how financial issues have impacted upon my care and how little my views and wishes were taken into account previously.

In one letter it states the reasoning behind my being sent from an open mental health ward to a forensic secure service. It states that I was transferred to the forensic unit because I was struggling with depression and self harm related to remembering and subsequently disclosing childhood abuse. The primary thrust of the secure placement was to ensure that I could engage in the necessary therapy whilst being in a safe environment that I couldn’t walk out of. Of course there was no evidence I wouldn’t engage in therapy, in fact quite the opposite.

To think that my move there was because I was depressed, self harming and in need of talking therapy infuriates me. If depression and self harm really lead to me being placed in what I can only describe as a hell hole, then it’s scandalous. Talking therapies are available in the community, I really didn’t need to be incarcerated amongst murderers and other criminals. But I guess it was easier for the local team to just move me on and not have to provide any support, that and the funding came from a different pot of money so their budget remained in tact.

In another letter they talk of my being kept in that hell hole for longer than needed, it transpired that my psychiatrist at the medium secure unit felt I didn’t need to be there he felt I should be moved to a secure rehab unit and yet my local team and others over ruled him, not because it was in my best interests but for budget reasons. The local team needed time to put in place a funding request as lower secure services were financed out of a different pot of money.

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To think I suffered that trauma, that loss of liberty over a simple budgeting matter is hard, we never knew before. I took what they told me at face value, I guess I expected them to serve my best interests and my family trusted them to look after me and to ensure my needs were met in a safe way. It does feel like a betrayal, a betrayal of trust.

The letters that I now have talk of me having issues, being a nuisance, being complex, having flawed behaviours, having considerable contact with services and being detained. They seem at times critical of the fact I understand my condition, have insight and awareness, perhaps it’s more difficult for the Mental Health professionals to accept that.

Of course besides the letters, I still need the information that I initially requested and so I will have to pursue that over the coming weeks. It’s clear attitudes at times towards me have been misguided, professionals clearly unable to understand or consider my view point or feelings. It’s clear too that finance or rather the lack of it have played and continue to play a significant role in how mental health services are delivered. I can’t help wondering how many more people suffering depression and self harm are being sent to inappropriate placements for talking therapy when it would be far cheaper to deliver this in the community.

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The letters and documents I have received will now be filed away, I’m not going to focus on the past too much or let them upset and distress me. I know yesterday when I did get distressed and annoyed it affected my alters; the other parts of me. I had to spend time calming myself down and I did walk away from the paperwork and do other things. In fact one of my alters intervened she told me to stop, to put the file out of sight and not get upset, she was worrying about me. For once in my life I listened to advise and the file did get put down, I realised this could overwhelm my weekend. But I know now I am far better and worth much more than others silly attitudes and stupid judgements. Yes it hurts to think they misjudged me, to think they don’t understand but I can choose how I respond.

If I’m honest I feel sad for those mental health staff who have no understanding of what it’s like from a patients perspective, who feel threatened by patients who understand their condition and who have no idea of the impact of secure units on people. Most of all I worry that talking therapy for trauma and D.I.D is at times seen by medical staff as just impossible, whether that be because of funding restraints, time limits or a simple lack of awareness.

Copyright DID Dispatches 2015

The Day I Had To Say Goodbye To My Family

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 I can remember so well the day, it started like any other day in hospital I had woken after a night of poor sleep in my small clinical room. A room that contained just a bed and a wardrobe, and a crate of art things and personal possessions. I listened to my radio as usual, this had become part of my daily routine as a long term hospital patient. I was called to get my medication that morning and despite speaking to a number of staff, no one said this was to be my last day close to home.

My room was at the far end of a corridor and I recall walking up into the main ward many times that day. Talk on the ward between the patients was about Christmas, who was likely to get home and which of us would have to stay. I knew I was going nowhere, I’d be staying in hospital after all my Section 3 had only been in place a short while, but everyone including me believed I’d be close to my family.

The staff didn’t give any glue to the changes that were about to happen, in fact they talked as if I would be there over the festive period. Looking back now no one from the hospital team was honest to me, no one told me I was about to face turmoil, chaos and changes I couldn’t imagine. Perhaps they were worried about how I would react, yet in truth the surprise element only made things worse for me and my family.

I was aware that the doctors had spoken about moving me but no final decision had been taken or so I was led to believe. They had kept saying a move to a trauma centre would be a safe way to deal with trauma work and would be faster than doing it as an out patient. I had no clear understanding of the type of place they were thinking of, nor do I believe had my family. I do know we were assured of lots of things, none of which turned out to be true.

Looking back I’m not even sure that the staff making the decisions knew about secure services, nor did they really understand the nature of the place they were thinking of sending me. A private institution that supposedly could cater for people with a trauma history, that focused upon the control and restrictions it could place upon patients rather than relational security. Intensive trauma work should have meant numerous therapy sessions each week, with a raft of other groups and activities designed to aid recovery. That was the kind of care I was told I needed but it wasn’t how this place operated,  though given it was 200 plus miles away how could those tasked with making a decision really know.

That day progressed like many before it, medication, meals and some Occupational Therapy too, speaking to the staff was limited as they hid as usual behind the office door, failing to interact with the patients. In the late afternoon I recall the doctor visited briefly, I was huddled into a small room to be told the news.

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In that moment life changed the staff informed me that I was being relocated, relocated from an open unlocked NHS ward to a forensic medium secure privately run facility, not a specialist trauma centre.  I can recall it wasn’t a great conversation, it lacked much clarity or detail there were just simple facts. My family who had been informed with as limited a time as possible would visit that evening, I would leave at the crack of dawn the next day and a nurse would travel with me. I had no rights to challenge or question this decision and I certainly couldn’t say no to their plans to transfer me.

I felt bewildered, frightened and confused beyond words, I had so many questions so much fear and yet they told me it was the best place for me. I recall feeling as if the hospital managers just wanted to rid themselves of me, that they really didn’t care about what was best for me or my family. Looking back my views haven’t changed, the move was based purely on financial reasons this certainly wasn’t a clinical decision, not was it based upon risk. I had no criminal history, had only absconded; whilst detained under the Mental Health Act, once and was willing to work at trauma therapy.

When I ask my family about their recollections, the one issue that they recall is the limited amount of notice they were given. My daughter who was my nearest relative was informed late afternoon too, she and her Dad then tasked with trying to organise a visit that included my two sons. My ex spoke with me on the phone, he was concerned with what was happening and he was frustrated at the lack of understanding by hospital staff. He had wanted to take me out for tea, one last family meal before the move and yet the hospital managers wouldn’t allow it. I was being observed and monitored perhaps they thought things wouldn’t be too stable in my last few hours on their ward.

That family meal didn’t happen in the way he or the children had hoped, but defying hospital rules he and the children arrived laden with McDonalds take out. We would have a family meal even if it was different, we would have time as a family one last time, they would say goodbye properly.

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Food wasn’t allowed on the ward, so the staff ushered us into a side room, squashed in this tiny room we had our meal. We enjoyed hugs and a few tears, my sons and daughter gave me something to remind me of them. A photo was one memento I had to have, alongside a number of small hastily grabbed trinkets from home that the children felt signified them. One son gave me a toy model of a dragon, he was really interested in them at the time and there was also a soft cute little monkey that really summed my youngest. Each gift was treasured as I knew that the children had thought carefully about them and they didn’t want me to forget them.

They also brought a small case for me to pack some things in and they took home all my art things as I had been advised these wouldn’t be allowed in my new hospital.  My daughter was allowed into my hospital room for a few minutes to help me pack, it gave us time to briefly talk away from her brothers. As the oldest I needed her to lookout for them and more than ever act as a surrogate mum, I knew I wouldn’t be able to do that for a while.

There was lots of reassurance on both sides, the children promising to visit and write and call. I promised to keep in touch and think of them every day and I really wanted them to know that I would miss them. By the time it came to say goodbye there were tears, lots of them, because despite my mental health issues, despite my past, despite me at times wanting to die, we are a really close family. This move would impact all of us for many years to come, I wonder if the hospital managers realised how much grief and pain, how much stress and worry their decision to relocate me caused. I very much doubt it.

Looking back at that time in my life still hurts, I will forever remember the nightmare journey of those years, the nightmare of secure services. The nightmare of being uprooted and taken from my family, and the anguish I felt not just then but in the years that followed.

Seven years on despite it still hurting, I need to focus not on the past but on the future and to remember the positives that came from that time, for out of the darkest of times came hope. My family and I realised if we ever needed to the value of family, the bond we all share and the separation well it strengthened us all to cherish one another. We have grown together not apart because of that time, and I know my children truly love me despite everything and they know I love them more than words could ever say. I guess facing what we did means today we can be assured that no matter what we will always be there for each other.

Copyright DID Dispatches 2014

The Life Sentence of Being Sectioned

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The other day I read a comment on social media which asked approved mental health professionals to think before they section someone in order to get them a hospital bed. It was stated that being detained under the Mental Health Act remains on a persons file for life, and suddenly it got me thinking about the impact of my time in mental health services.

You see I had assumed that having not been detained under the Mental Health Act for over 5 years, I was free of that part of my life. Indeed I haven’t been in secure services since that time either, so again I had assumed it was behind me. Yet if the comments are true and these things stay on file for life, I am in many ways doomed.

Doomed because no matter how long I keep myself out of a mental health bed when people look at my medical file, my past will jump out and hit them in the face. The professionals will see that I have been sectioned for more than a year and that I have spent time locked in a forensic medium secure unit. Will they then assume that I have a criminal record, because most people think you only get sent to these units if you have committed some type of heinous crime. Furthermore will they wrongly assume I must be dangerous, because believe me that’s what some misguided people think.

When I was studying for my degree I had to challenge the course lecturer on the issue of forensic services, it was stated in course material that these units were for criminals with serious Mental Health issues. It also stated that they had to have demonstrated a high degree of risk to others to be sent to these places. I knew of course this wasn’t always the case, I was living proof of that and yet it took a lot of determination and challenges to prove to them their views, their facts were both flawed and inaccurate.

I doubt that I could change or remove these medical facts about my section from my file, they are truthful and accurate statements, the difficulties lie of course in people’s interpretation of those facts. I have always wondered what people would think of me having being detained, would professionals treat me differently.

I know in the early days post discharge I feared being re-sectioned, I worried that at the sign of any small crisis I’d be locked up and send miles away. I was certain if I needed hospital I would be send back to secure services and yet my then CPN told me I was being silly, no one would judge me. But that fear remained and I think that fear has led me to fight steadfastly to never need a mental hospital bed again. That’s why I find it hard to call for help when I’m struggling, I have self harmed before because I was so desperate and yet I wouldn’t, I couldn’t call crisis services.

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Now it seems that these facts will stay on my file for life and I can’t help wondering if that’s already led to changes in how people deal with me. Do professionals already treat me with more caution, do they pre-judge me when they see my history. Will they pre-determined who they think I am, instead of coming and seeing me as blank canvas and judging me on my merits.

What about if I seek employment will these facts be available to prospective employers and if so how will that impact me, I doubt it’s going to help. What if I want to volunteer and need a DBS check (police check), will these things come up in that. There are so many unanswered questions that I have, so many fears that my past will taint my future. The powers that be need to allow this data to be removed from a persons health file after a certain number of years.

To those Approved Mental Health professionals (AMHP) who now hold the power to take away a persons liberty, I’d ask them to consider their actions. I feel I was sectioned initially to off load cost implications of a specialist bed from one team to another. I know my later sections were done by the very people whose living depended upon me filling their beds, operating in the private sector that was funded by the NHS.

The fact AMHP’s today are placing people on a section because that’s the only way to find a bed is deeply worrying. Do they realise the impact they make on that persons life, not just at that moment of taking away someone’s liberty but the longer term implications. It seems now those implications last a lifetime, and my records are duly marked. As I said before it feels a bit like I’m doomed, this life sentence is hanging over my head forever and there little I can do to change that.

The sad thing is I was sectioned because I was unwell, I didn’t ask to be unwell it wasn’t even of my doing. Yet it seems being unwell is punishable in this country and probably many others too with a life sentence of being labelled, pre-judged, disadvantaged and treated differently.

copyright DID Dispatches 2014

Making my journey with D.I.D bear-able

Making my journey with D.I.D bear-able

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My Little parts are keen for us to introduce our special friend

Ever since my melt down point a decade ago I have had the company of a cuddly creature to keep me feeling safe. Initially this was a rather large creature who filled my arms and to be fair wasn’t so easy to carry. After 2 years my children and I chose a new creature whose size made it easier for me to carry and to discretely transport around.

Now my cuddly creatures are not live animals, no there are teddy bears called Cuddles and Ted, between the they have been with me throughout my journey through the mental health system. Now cuddles was rather cumbersome due to her size, it made it difficult to carry her around and so she is now retired to safe storage but Ted she has been with me for 8 years now and is a daily part of my life.

I’m not afraid to admit I have her, in fact until a couple of years ago I couldn’t leave her at any point in the day. Ted was carried in my arms daily, at home and when we went out she has been a source of comfort and in many ways has given my little alters a sense of grounding and security which has been significantly helpful.

Ted has been with me in all bar two of my acute hospitalisations, she’s been locked in a forensic secure unit and a non-forensic one too, she’s endured being detained by the police when we were repatriated to hospital in the cage of a police van. She’s been with me when I have tried to end my suffering and when I have self harmed, in fact Ted has been through every step of the journey since 2006. She has spent some 130 plus weeks in hospital, her predecessor cuddles spent approximately 65 weeks in hospital.

I guess when I carried her everywhere I stood out, she and I were a partnership and yes she was my security blanket if you like and some patients and certainly some staff found it difficult to deal with this women and her bear. I was unable to cope with life, with the memories and the flashbacks which filled me with dread and fear, with the confusion and anxiety I felt I just wanted the ground to swallow me whole to stop my anguish and my pain.

I can recall being verbally attacked by a stranger who took offence to me and my bear, he said ‘people like you should be locked away’ and I guess that was easy for him to say but I wasn’t always this wreck. I am a mum and I was once a wife, I worked hard and contributed to society I never expected to find myself in a mental hospital nor carrying a bear and yet it happened. I knew I had a tough start in life but I hoped I’d managed to leave it all behind, I thought I had, but then the reality was that it was just hidden away. You see in truth much pain and anguish from my past was hidden deep inside of me waiting to reveal itself when I was least expecting it. I didn’t need a random stranger attacking me for carrying a bear I felt bad enough about myself who I was and the fact I couldn’t cope.

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Ted has been a comfort that I needed through the darkest of days she has been there and I am not ashamed that I needed her. She has kept me grounded at times especially when I have suffered flashbacks and memories. I could keep telling myself & all my alters, all the parts of me that when bad happened we didn’t have Ted and yet now we did and that meant we were safe.

As a child I only recall one teddy bear he came from a bad person as a reward for being ‘a good girl’ for not telling when the person hurt me and yet I loved that bear. I remember coming home from school and my bear being gone, my mother had decided I had to be punished for something and taking that bear away was my punishment. I didn’t have another bear, unlike most children for me toys were rare and they came and they went as a form of control.

When my children bought me Cuddles I was elated and so grateful and yes she served me well when I first hit melt down, but her size made her harder to carry. But like Ted she took so many of my tears as I could hold her and let out the pain that ripped deep into me at that time, I find emotions so hard that it’s impossible for me to explain them to others easily, to express them and yet I needed to.

My cuddly friends have been a part of each day now for a decade and I doubt I could have managed without them, it felt like they were attached to me, it probably looked like that to the world. We were this person who went everywhere with her bear and people became used to that, some became so accustomed to her they no longer saw her.

About two years ago I made the decision to put Ted inside my bag when I went out, she was still with me 24/7 but she was no longer a visual constant in my day to day life. I remember the first time I placed her in my bag I felt bereft, but I knew it was the right time to stop carrying her in my arms all the time. Part of my decision was based upon the fact that my constantly carrying this bear had caused me significant muscular issues which required physiotherapy treatment. For years I had held her in my arm so had held my arm in a bent position this had caused muscle weakness and tension and when I realised that all this pain and discomfort was a result of my needing Ted I knew I had to take action.

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For a further year Ted was still a constant, she was carried around everywhere I went, the doctors, the shops, even for a McDonalds. Then one day I forgot her she was left sat at home on my bed and I ventured off to an appointment, by the time I realised we didn’t have time to return to get her. I had to face the fact that we would have to survive without her for these few hours and of course we did, we managed and it led to more and more organised opportunities where Ted stayed home. I had some control over this so if I was struggling or facing a difficult time Ted came along, but if I felt we could manage well then she stayed home.

Now Ted lives on my bed and there are times she comes with us, so every time we attend psychology she comes along too. When I face Care plan meetings Ted comes too, holidays and other times away from home involving overnight stays she is part of my luggage. But I can now manage without her when I am shopping, or attending the GP’s, visiting friends or going for a coffee. Ted probably spends 50% of her time on my bed and 50% of her time in my bag or on the sofa, it’s a far cry from my carrying her 24/7.

This week I’m attending an event which means I’m away from home, so Ted comes too she will stay part of her time on my hotel bed but I know she’ll be with me when I need her. There will be times when I do need her, times when I feel vulnerable or I am switching more and I need to try and ground myself.

Now it maybe hard for people to understand why I a grown women need a bear but of course parts of me are little and need the comfort a bear gives. She also allows me to know that the past is over and that is so important to me. I am fortunate that my family accept her as a necessary part of my life currently, they don’t nor have they ever judged us. In fact my children who are adults themselves will often say hello to her and they occasionally buy a new outfit for her. It’s as if they understand the role she has and continues to play in our life.

I never expected this small bear Ted would become so important to me and obviously carrying her everywhere day in and day out she has weathered quite a lot, but I can’t imagine replacing her she will just age and become more loved as time progresses. She may not come out with me as often and one day she may just live on my bed, but for now Ted will keep playing whatever role I and all my parts need her too. Be that grounder, comforter or as a sign of reassurance Ted is a significant part of my healing journey and I’m glad she is part of our life.

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Copyright: DID Dispatches 2014