DSM-V(erse)

The following is a poetic reconstruction of a conversation I had with a clinical psychologist. During my second visit, she pulled out the DSM-V (Diagnostic and Statistics Manual of Mental Disorders, 5th edition) and made me justify to her that I met the criteria for PTSD – though I’d already been diagnosed. 

The poem contains description of traumatic events (and repercussions) and may be triggering for some readers.

The descriptions can be quite graphic but please understand that this narrative spans three years. It tracks the growth and the ways in which I’ve had to evolve in correlation with this illness. You don’t need to be worried about me. This is just my story.

 

 



 

 

 

 

Shadows flicker on the wall
An optical illusion of light
transfused
through mesh curtains;
A premature Rorschach test
A trick to unveil intuitive depths
You’ve caught me;
I feel small

 

You tell me the words you speak
aren’t tainted by a trace disbelief
And yet the movement of your eyes
tells me unequivocally otherwise.
Interject carefully spun statements
by carving a line with your palm
cut space and time in half
to reach for that book.
You don’t notice that with this movement
you’ve disturbed the shadows and their sacred dance
The Light and I exchange a surreptitious glance.

 

Now I’m dancing on the precipice
of a carefully worded medical edifice
And if my foot falls through your linguistic loopholes
you’re going to tell me
“Nothing’s wrong”.
You don’t understand that
you can’t extract experience from a manual
that has never
greeted Death
this manual could
never express
the depths
of what I’ve gone through.

 

But these thoughts never materialise in words
they just spiral inwardly in concentric circles
and then disperse.
So you’re out of tune; the uninvited interlocutor.
In the exchange between the shadows and I,
you just turn the page.

 

 

Criterion A: Stressor
(one required)

 

The person was exposed to death, threatened death, actual or threatened serious injury…in the following ways:

  • Direct exposure
  • Witnessing the trauma
  • [Et cetera]…

 

What’s the difference between
exposure and a witness?
What’s the difference between
death and a near miss?

 

My eyes trace the silhouette of embodied Disbelief –
I know you think this prose
is just the manifest symptom
of a hyperbolised grief
But what do you expect me to say?

 

I don’t know if this trauma is my own
Or if my role was more akin to that of a voyeur
A superimposed statue
cast in flesh and bone
condemned to harbour eternal guilt
over a life that’s not her own.

 

He told me he was going to faint
But I walked on and I didn’t look back
Thought it was just a joke
Just some fucked up prank
Until his head hit the concrete
(I think his head hit the concrete)
And he started to gasp
(I know he started to gasp)
But it didn’t sound human;
more like a corpse reaching for breath
with century old lungs
that’ve long turned to dust
(Did he inhale all that dust?)
I shouted for someone to come.

 

What’s the difference between
exposure and a witness
I still can’t tell you whether or not this trauma is mine
The words falling out of my mouth taste like maleficent lies
I’m just a hollow shell that observed from the skies
reflecting ephemeral moments
through green and grey stained glass eyes
How could I possibly own this past?
How could I lay claim on what happened that day
when it wasn’t my lungs that filled with dirt
or my heart that wouldn’t beat?

 

I just stood there.

 

Final answer: A witness.
I think.

 

 

Criterion B: Intrusion symptoms
(one required)

 

The traumatic event is persistently re-experienced in the following way(s):

  • Unwanted upsetting memories
  • Nightmares
  • Flashbacks
  • Emotional distress after exposure to traumatic reminders
  • Physical reactivity after exposure to traumatic reminders

 

I never remembered any of my dreams
until I was around seventeen
All of a sudden reality’s subsumed by illusive dreamscapes
And I’m stuck in a TV loop with the same scenarios replayed.
Witching hour submerges me in a cauldron of bottled up burdens
I never knew sleep could
feel
this
heavy.
And I’ll wake up to a heart beating way too fast
(But at least it’s beating).
Always feel like I’m running towards something that’s way to far
(But at least I’m still breathing).
Don’t know whether they’re nightmares
or the most authentic part of my life;
Reality received through the suffocating veil of night.

 

A girl fainted at work the other week
and her friends brought her into the office
Unconscious.
And nobody else fucking knew what to do
so I’m nineteen and I’m calling the mother:
“Your daughter’s just collapsed, she’s fine, we’ve called the ambulance”
And the whole time I’m just thinking bout that same call I made to Dad
“You need to come now
B’s collapsed”
And I can’t breathe
And neither can she
And neither could he –
An earth devoid of air,
you remember living’s no guarantee.
But again I’m not the one in pain
And people are relying on me
I don’t have time to freeze.
So I meet the mother at the car
(I met my dad at the car)
And they’re hysterical
Distressed
Lost
Concerned
I’ve just got to hold their hand and take them to their child
It’s not my time to be scared
Just need to hold their hand.

 

Final answer: nightmares (?), emotional distress and physical reactions after exposure to traumatic reminders.

 

 

Criterion C: avoidance
(one required)

 

Avoidance of trauma-related stimuli after the trauma, in the following way(s):

  • Trauma-related thoughts or feelings
  • Trauma-related external reminders

 

I sigh and my Self escapes through the exhalation
I see her float out the fourth storey window
She knows the following lines are a
Journey to the Interior
and she’s not prepared to traverse
the shifting landscape within her.

 

“(Have I been walking in circles again?)”
Lost/found/lost/found ouroboros has no end.

 

It’s year 11 and I’m reading Atwood in a free
And I start to cry once my eyes gaze over the last few lines
because I can sense the presence of something else inside;
a shell of my own creation, it forces all emotion to hide.

 

You weren’t interested in this story
cause you wanted something more recent.
I serve up my suffering on a silver platter:
Here;
have your pick…

 

You select the tale of earlier this semester
Nineteen, sitting in the back of a CCP lecture
The professor plays a clip of a girl getting beaten by police
(It wasn’t even that similar to what happened with B)
Until he tackled her to the floor
and oh god now she’s unconscious
and I’ve lost my subconscious
and I’m running to the bathroom stalls
and everything is spinning
(It wasn’t even that similar to what happened with B)
But she was on the floor
Could she breathe
I can’t breathe
I can’t breathe
Take a pill
Take a breath
Vacant eyes
Thoughts are still.

 
Tectonic plates shuffle the Earth’s surface
I’m too numb to notice
the tremors rearrange manila folders
containing my carefully labelled burdens
Miscellaneous papers
translucent with water vapours
Ink bleeding down tiles.
I see a list of triggers flash before my eyes
And the largest of all files titled
‘THINGS YOU ARE NOT ALLOWED TO FEEL”.

Final answer:
Pangaea has disappeared
And with it, all my tears.

 

Criterion D: negative alterations in cognitions and mood
(Two required)

 

Negative thoughts or feelings that began or worsened after the trauma, in the following way(s):

  • Inability to recall key features of the trauma
  • Overly negative thoughts and assumptions about oneself or the world
  • Exaggerated blame of self or others for causing the trauma
  • Negative affect
  • Decreased interest in activities
  • Feeling isolated
  • Difficulty experiencing positive affect

 

A list of people I’ve described the incident to:

  • Mum, after I raced to the car and told her B collapsed
  • My boss, after he ran out to help
  • Dad, on the phone, telling him to come quick
  • The stranger who started performing CPR
  • The paramedics
  • Nan, telling her to meet us at the hospital
  • The ambulance driver, The NETS, The cardiologist, The psychologist(s), The psychiatrist, The GP, The principal, The deputy
  • My best friend.

 

I’ve told this story so many times
I don’t know whether my memories have their roots in that May
or in the vines that climb my psyche with their suffocating tendrils
I’ve grown tired of trying to retrace what happened that day.
So I just can’t tell you whether this version
is a manuscript of universal truths
or universal lies. But either way;
you’ll make up your own mind.

 

I think he had a seizure.
I’m not sure, his head hit the floor
He started to gasp, I rolled him over
But did he start to shake?
I think he started to shake
I’m not sure, my hands are shaking.
The paramedics asked me at the time
and I think I said yes
But right now I couldn’t do better than a detached guess.

 

You look incredulous when I tell you that I blame myself for what happened
“It was a cardiac arrest you had nothing to do with it”

 

But I did.

 

I rolled him onto his back.
And I shouldn’t have.
He should’ve been in recovery position
cause now there’s dirt in his lungs and he can’t breathe in
So now they’ve got to keep him
in a coma
in the ICU
because he couldn’t breathe
because I didn’t know what to do.

 

How could the blame possibly be mine?
I was only sixteen
didn’t know CPR at the time
And maybe if I did
it wouldn’t’ve taken 25-fucking-minutes
to resuscitate him.

 

Final answer: …

 

 

Criterion E: alterations in arousal and reactivity

 

Trauma-related arousal and reactivity that began or worsened after the trauma, in the following way(s):

  • Irritability or aggression
  • Risky or destructive behaviour
  • Hypervigilance
  • Heightened startle reaction
  • Difficulty concentrating
  • Difficulty sleeping

 

How do you stop seeing Death
as a figure that lurks behind every corner
(I thought he was dead)
Now we’re walking to school together
and I can’t let him linger behind me
Because my gaze is the only preventative cause,
that heartbeat-inciting, repetitive force
and if I stop watching he’s going to fall
(I keep thinking he’s dead I can’t take this anymore).

 

Now let’s take it back to that year 12 excursion
Eighteen, on a train
we all pull up to the station.

 

But there’s someone on the ground.

 

And there are people all around.

 

Next to me a boy says oh I think he’s broken a hand – but there’s blood everywhere?
And everyone inside the carriage stares.
But my body gets left on that train
and the rest of me
(whatever’s left of me)
is on that platform –
Oh god someone call for help is he okay turn him on his side we’ve called an ambulance you’re going to be alright

 

My friends are shaking me
because my body has started crying.
And as though the tears that fall are an individuated reminder
of an identity I possessed long before the self-immolatory fires,
I’m snapped back into my body
(It was only a split second)
Now the teacher whispers across the carriage
“Is she alright?” – don’t worry about me I’m fine
(It was only a split second)
Death waves off the train and the engines start again
It was only a split second
but that’s all it takes
in the end

 

Final answer: hypervigilence and heightened startle reaction.

 

 

Criterion F: duration
(required)

 

Symptoms last for more than 1 month.

 

Final answer: it’s been three years.

 

 

Criterion G: functional significance
(required)

 

Symptoms create distress or functional impairment (e.g., social, occupational).

 

How do you build an identity on an illusory foundation?
The scaffolds fall down as soon as I place them
All that’s left is a pile of rotting timber and broken mirrors
Sit for hours on end playing chicken with the reflection.

 

People ask me what high school was like
I don’t remember
I turned into a robot just to cope with the passage of time.
My friends stopped talking to me.
They didn’t know who I was and neither did I
but it’s alright
I forgave them long ago

 

Now it’s the end of 2017
And I’m with friends at the beach
and things are fine, there’s no need to stress
But no matter how much I protest
I just can’t trust that voice in my head
It says “everything’s okay” but it’s been wrong before
and the risks are too great.
So it constructs grandiose scenarios of illness and death
and tries to convince me this paranoia
is so much better
than complacency
“Remember life’s not guaranteed”
Death always stands adjacently.

 

Don’t let your guard down.

 

Waves lap at the shore
The sun dips behind the clouds
Try to jump into the ocean
But you’re nowhere to be found.
It’s been hours
I’m sitting under a tree
All my friends are at the beach
But I just can’t fucking move

 

Final answer: Instead of waves
Paralysis washes over me.

 

 

Criterion H: exclusion
(required)

 

Symptoms are not due to medication, substance use, or other illness.

 

I never wanted to be put on medication.
This whole illness stems from
an inability to digest
what lies at the core of the problem
And meds always seemed like just another way
to avoid them

But I’m nineteen
And I’m moving out of home
And how am I supposed to function all on my own?
It’s been three years and countless shrinks
And every time I think I’ve finally processed it

Something comes back up

It’s never done

There’s no respite

 

Final answer: No, I wasn’t on meds
(At the time)

 

 

Two specifications:

 

Dissociative Specification: In addition to meeting criteria for diagnosis, an individual experiences high levels of either of the following in reaction to trauma-related stimuli:

  • Depersonalization. Experience of being an outside observer of or detached from oneself (e.g., feeling as if “this is not happening to me” or one were in a dream).

 

Here I am
In the realm of the possible
With quietly interspersed bursts
of nostalgia
Now I’m verging on the improbable
Spilling down the sides
of an illusory life
A concept of an identity
woven with delicate lies

This is all there is for tonight.

 

I stop eating because these bones
start to feel less and less
like a tangible home
Marrow of concrete
Stomach of tar
It’s hard to eat when you don’t believe you’re real
I don’t remember the last time sensation felt near
instead of muted and far.
Existence just isn’t here.

 

The face in the mirror reveals nothing but vacancy
And the days on the calendar all blur together hazily
Life’s morphed into a hallucination with absolutely no trace of “Me”

 

I can’t imagine another way life could possibly be.

 

  • Derealization. Experience of unreality, distance, or distortion (e.g., “things are not real”).

 

I remain stuck in non-being for most of the year
But some days instead of floating
through the limbo of supposed existence
I‘m pulled by invisible hands
down the sides of the earth
I’m not sure where I am now
And I can’t explain to you why or how
But
Something’s
Clicked

 

I’m sitting in art class
And a boy stands to grab a paint brush
And I just can’t convince myself that this is real life
I could’ve sworn people had an essence before this
Now every movement is underlied by the subtle distrust
that there’s something crucial I’ve missed
What did I do to deserve this?

 

 

Delayed Specification. Full diagnostic criteria are not met until at least six months after the trauma(s), although onset of symptoms may occur immediately.

 

The shadows have grown weary
of this loaded silence
A suspended violence
You continually misinterpret
As empty compliance
And I’m too tired to correct you.

 

Golden hour paints an aura of unreality upon this room
As though trying desperately to inform you of my dissociative mood
But you’re the uninvited interlocutor; you’ve got no clue
And I don’t know what else to do
I hear the girl opposite you whisper “thank you”

 

But I’ve already left the room.

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