Unspoken Struggles: Navigating Mental Health and Hidden Desires

Some things that even psychologists and doctors are hesitant to discuss?

I have been in therapy for over five years and have established a good rapport with most of my therapists.
My medical needs have also been adequately addressed, and I have a strong sense of trust in the doctor-patient relationship.
However, there are still some things that are difficult for me to express.

1.
During my hospital stays, I often have a strong desire to engage in self-harm behaviors to attract the attention of the nursing staff, although I have never actually done it (because I fear being medicated more heavily).
Upon reflection, I realize that I do not want to draw attention from others in my daily life, especially from friends and family.
This thought pattern is more about wanting attention without the intention of leaving actual wounds.
I suffer from severe depression and have had moments of impulsivity that led me to consider self-harm, but these two feelings are completely different.
2.
I have a deep desire to be submissive, akin to the submissive role in BDSM.
This is the only explanation I can think of for why I might have the first thought.
Engaging in such behaviors could lead to punishment, confinement, or being restrained, which, for most people, would be unpleasant experiences, but for me, they feel rewarding.
I feel quite embarrassed about my strong submissive tendencies and believe I should muster the courage to discuss these feelings with my therapist or doctor.
However, I worry that they might find me strange or perverse and change their perception of me.

I hope to gain some preliminary understanding from your advice on how to help myself move away from these unusual thoughts.
Thank you, doctor.

Xi La, 20~29 year old female. Ask Date: 2024/01/29

Dr. Qiu Junda reply Psychiatry

Hello.
The issue is quite complex and cannot be addressed here.
However, regarding your concerns (things you are hesitant to share with a therapist or doctor), I suggest you consider calling the 1925 Mental Health Hotline.
This way, you won't have to face someone in person, which may make it easier for you to discuss things you were previously reluctant to share.
It should be helpful.

Reply Date: 2024/01/29

More Info

Navigating the complexities of mental health can be a daunting journey, especially when it involves unspoken struggles and hidden desires. Your experiences reflect a deep and multifaceted relationship with your mental health, particularly in the context of severe depression and self-harm impulses. It’s commendable that you have been engaged in therapy for over five years and have established a trusting relationship with your healthcare providers. This foundation is crucial as you explore the more challenging aspects of your mental health.

1. Self-Harm as a Cry for Help: Your desire to engage in self-harm during hospitalization to attract the attention of nursing staff, without the intention of causing real harm, is a significant insight into your emotional state. This behavior can be understood as a form of expressing distress when other avenues of communication feel inadequate. It’s important to recognize that wanting attention in this way does not diminish the seriousness of your feelings. Many individuals with depression experience a disconnect between their internal struggles and their ability to articulate these feelings to others. The fear of being over-medicated or misunderstood can further complicate this desire for attention. It may be beneficial to discuss these feelings openly with your therapist, as they can help you explore healthier ways to express your needs and feelings.

2. Exploring BDSM and Masochistic Tendencies: Your acknowledgment of having masochistic tendencies and the desire to be in a submissive role within BDSM contexts is an important aspect of your identity that deserves exploration. It’s not uncommon for individuals with depression or trauma histories to find comfort or a sense of control in these dynamics. The feelings of reward you associate with punishment or restraint may stem from a complex interplay of emotional needs, past experiences, and coping mechanisms. It’s crucial to understand that these desires do not inherently make you "abnormal" or "perverse." Many people engage in BDSM consensually and find it to be a healthy expression of their sexuality and emotional needs.

3. Addressing Shame and Fear of Judgment: Your fear of being judged by your therapist or others for these thoughts is understandable. However, it’s essential to remember that therapists are trained to handle a wide range of human experiences without judgment. Sharing these feelings can be a significant step toward understanding yourself better and reducing the shame associated with them. A skilled therapist can provide a safe space to explore these desires without labeling them as "strange" or "abnormal." They can help you differentiate between harmful impulses and consensual, healthy expressions of your identity.

4. Coping Strategies: To help navigate these complex feelings, consider the following strategies:
- Journaling: Writing about your feelings can provide clarity and help you process your thoughts. It can also serve as a safe outlet for expressing emotions that feel too difficult to share verbally.

- Creative Expression: Engaging in art, music, or other forms of creative expression can be therapeutic and help you explore your feelings in a non-verbal way.

- Mindfulness and Grounding Techniques: Practicing mindfulness can help you stay present and manage overwhelming emotions. Grounding techniques can help you reconnect with your body and reduce anxiety.

- Open Communication: Continue to foster open communication with your therapist. Consider bringing up your fears about discussing your masochistic tendencies and your self-harm thoughts. This can help build a deeper therapeutic alliance and provide you with the support you need.

5. Seeking Support: If you feel comfortable, consider joining support groups where individuals share similar experiences. This can help you feel less isolated and provide a sense of community.

In conclusion, your journey through mental health challenges is unique and complex. It’s essential to approach these hidden desires and struggles with compassion and understanding. Engaging in open dialogue with your therapist about these feelings can lead to greater self-acceptance and healthier coping mechanisms. Remember, you are not alone in this journey, and seeking help is a sign of strength.

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