Each week I travel to Boston for Therapy. It takes 8 hours to go back and forth. It is a commitment and an expense but this woman, along with my commitment to my personal growth and self-awareness, has literally saved my life. These meetings have helped me to uncover the truth that I, like the universe, am a self-organizing system. In addition, our time together has helped me to understand that deep in my soul I have the wisdom and insight to manage the pain of PTSD while striving to live a purposeful, meaningful and peaceful life. Furthermore, I believe that for me, seeing her is a medical necessity. I need someone to assist me with organizing the disorganization that comes with an anxiety disorder so that the individual parts of my creative system (my mind, brain, body, heart and intuition) can work together to provide me with the best and most creative life possible. It has taken me 10 years of hard work to come to this place where I understand I hold the tools and relationships to manage the suffering while finding joy and peace on a daily basis. Today, I am able to manage living in a sober fashion and in the gentlest and kindest way possible. I am not willing to give up my medically necessary meetings with her to find care locally. Since this is my choice, I need to manage the distress of making a trip to Boston and being outside my home from 9:30 to 5:30. This week I struggled a great deal but was able to manage it because I had my routines to count on and the success I felt brought me great joy and peace. This article is about how my day unfolded and what I did to manage my anxiety successfully enough to accomplish the goal of having my 45 minute session with Lisa, my therapist.

I began my preparation for my trip to the city the night before by doing a schedule of the next day. Each week I take the 9:50 bus so I knew I needed to be up around 4:30 am to get my routines in so I would be able to even get on the bus. Getting up early is not usually a problem. I naturally wake up early. Like everyone else with PTSD, sleep is often an issue. However, today I have learned to see this time of day as a time when I can manage the best because I have a series of routines. It took me 55 years to figure out these routines so that I am able to see these early hours of the morning as a very beautiful, productive and peaceful time. I have learned to appreciate that I get to see a different side of the universe and its amazing beauty and complexity in the darkness. This is a real change for me because darkness is a significant trigger. Today, I have rewired some of my thinking and made adjustments to my sleeping schedule so I can experience beauty along with the pain of darkness. My thinking about darkness has changed but my physiological response stays the same. I believe in neuroplasticity. I see how much I have changed many of my thinking patterns but the physiological memories I am beginning to believe may always stay with you. I guess I just have to have hope and be patient with my evolutionary process.

Every morning I wake up with huge anxiety. On the days I travel to Boston, I wake up even more anxious. I think it is because I am so aware that I will need to contend with the heat, noise, crowds, and sunlight all day. Today, I still find it hard not to feel like a victim to these elements because they overwhelm my senses and make being a sober, embodied self more difficult. Furthermore, I know I will get little relief from these elements until I get to Lisa’s office. In addition, I am quite aware that I am bombarded by other people’s energy and emotions so I know I will experience a great deal of pain from being out in public.

On my travel day this past week my anxiety was so high that I had extreme difficulty performing my basic morning routines because my prefrontal cortex was so shut down. First, I tried getting dressed but kept buttoning my shirt wrong. I could not focus enough to button it correctly. I tried 3 times. It was completely frustrating. In this frustration, I gave up and put on a shirt that didn’t need to be buttoned. Secondly, I kept forgetting to take my morning pills. It took me several times of going to my bedroom because I could not remember what I was doing there. I knew this was part of my routine but kept forgetting why I was in the room. I had to talk myself through the process with the help of my husband. When I am having such anxiety and prefrontal cortex shut down the simplest things become a great challenge but once again, I have my routines and tools to count on so I can achieve success and peace. At one point, I found myself just wandering around the house lost in confusion and had to stop and ground myself. To do this, I walked to my husband and held him. This allowed me to energetically connect with him. This is a tool I usually use to help me to self-soothe and ground. I was well aware that I needed the assistance of my husband to continue my process of getting to the bus. In addition, I employed two other routines to manage my anxiety. One was a movement session which includes a cardio workout and chakra poses. The other tool was a 2 hour writing session. These tools are part of my morning session every day. They bring me joy, success and peace while managing the distress of my anxiety. After finishing my routines for the morning, I made my way toward the bus.

I am laughing at myself as I am writing this because I also have routines and tools I use for the bus. One example is that I leave 20 minutes early so I can be the first one on the bus. I stand in the same spot because experience has shown me that the bus stops there. I need to be the first one on because as soon as I get on the bus my panic attack starts and I get bombarded by all the energy on the bus. To manage, I sit at the front of the bus, in an aisle seat, and if I don’t get my own seat, I share with a woman. So far, I have been able to find this on every bus ride. However, it does not take away the pain of being in a group of people with all their flowing energy and emotions. Therefore, I struggle with constant dissociation and constriction.

Since I am trying to stay more embodied and less constricted, a second tool I have learned to use on the bus is to always take decaf coffee with me. It is the only way I can stay embodied and be on the bus. I never remember to use breathing techniques to ground because, for me, it requires too much prefrontal cortex involvement. I have learned that, for me, I need to experience things through the senses. The warmth and the taste of the decaf coffee usually does the trick. However, this particular morning I had finished my decaf coffee before I even got on the bus, that is how distressing this morning experience was for me. Because I did not have the decaf coffee, I resorted to the next tool I use to manage my anxiety – journaling.

As soon as I found the appropriate seat, I opened up my journal and wrote whatever thoughts were running through my mind. When my anxiety is high, my thoughts race at a rapid pace. It is one of the reasons for my daily mental/physical pain, fatigue and disorganization. However, I have learned from experience that when I write in my journal in a free-flowing manner I am able to be more present at least mentally. I still go in and out of dissociation and constriction because my creative system wants to naturally protect me from the pain being too much to bear. In my attempt to stay more embodied, I try to remember to drink my water to come back into my body. Using dissociation is my last resort but I would not have been able to stay on the bus if I didn’t use every technique I have at my disposal. I need to see Lisa. She is a key person in my medical treatment. I say medical treatment because there is urgency to my care. Having a good therapist is just as important to my well being as it would be for a diabetic to have insulin shots.

After 1 hour and 30 minutes on the bus I was able to bring my mind to a place where my thoughts were racing to a manageable level. I still went in and out of dissociation but on that day I was okay with it. I see this ability to dissociate safely is a gift of my wise mind, my self-organizing system. When I was 10 minutes from Boston I started having difficulty breathing because I knew I had the difficult task of managing the noise, crowds, heat, sunlight and public transportation in front of me. But once again, I have my routines for managing the panic and the trip to and from her office.

I have places where I need to stand or sit in order to be able to care for myself gently and kindly while trying to manage the anxiety from being in the city and getting myself safely to her office. Experience over the last 5 years has taught me where to stand to get on the subway train and trolley and where to stand or sit once inside the train or trolley. My positioning helps me to have a better chance of getting a seat where I don’t have people sitting on both sides of me and allows me to be the first one off the train so I do not get caught in the crowd when I change from the train to the trolley in the busiest station in Boston. Today being summer crowds, the trolley was full. I was not able to find a seat alone. So my body and brain self organized and I naturally ended up separating from sections of my body. It is safe to separate on the trolley and train. I had no shame or anger at myself for the dissociation. I was thrilled to see how my body and brain naturally self-organize. It is really a creative tool I use to fill a greater medical need which is to see Lisa. Furthermore, the trolley drops me off at a spot where I can get a vegetarian salad for lunch and bring it to the Lisa’s office. (Generally, I wait in her office suite for an hour or so before an appointment because of her schedule and the bus schedule.) When I entered the store, I became overwhelmed and just stuck to my routines – pick water up in aisle 4, salad in aisle 1. Again, I laugh as I write this. I really do see some similarities between me and Sheldon Cooper on the Big Bang Theory. I depend on my routines. They work with my natural, evolving, creative self-organizing system. They bring me success, joy and peace. They are also the gentlest and kindest thing I can do for myself. After 10 years of hard work I finally believe I deserve gentleness and kindness. In fact, I believe it is my responsibility to create it. My tools and routines are how I manage in a world and life that has overwhelmed me my whole life.

Once inside Lisa’s office suite I find great relief, it does serve as my cave experience that I need each day to heal my hyperaroused Central Nervous System. I sit in the same chair every time which is a seat away from the most lights and people. It is a relief to be out of the bustle of the city and in the quiet of her suite. This is where I usually sit and have my lunch. Eventually I had my session. It is always a burden when she says “time is up” and not because I want to process more but because I am just so aware of the challenges I face once I leave her office and begin my journey back home (to my sanctuary with my husband). However, I have routines for this as well. Luckily I get on early enough on the trolley that seating is never a problem. I can usually find either a single seat or a seat with only a person sitting on one side of me. Again, people on both sides are too much to bear. That day, I spent time observing what my brain and body did naturally to self-organize. For example, for a time I was fine and fully embodied when I was in a single seat. Then one woman came and stood by my chair. I naturally separated from the side of my body that was closest to her energy. I was grateful once again that this technique is available to me. However, every day I try not to stay in a dissociated state and physically constricted position but it is naturally what I do. Once again to stay embodied as much as possible, I use my senses. I have learned over the years to carry with me a piece of fruit, some vegetables or nuts as well as water and decaf coffee. These are my tools for managing in the city and really anytime I journey out of my house. It is how I help my self-organizing system.

The greatest gift over the last 10 years is that I have learned to trust my nature and appreciate the beauty of my self-organizing system. I am just like the universe. I am a creative, powerful and self-organizing system always in a process of evolving itself.