My 'Special Button'

I have a button, it is well hidden and I can live for years without even being aware of its existence. I call it my 'Self Destruct Default' Button. It is not driven by any suicidal impulses or self harming behaviours which are part of my Borderline Personality Disorder. It is, however, just as destructive in many ways, because it springs from the same source - my inability to value myself.

It starts to pulse - red - when things are going really well. When there are no crises in my life that require all of my emotional energy. When I am, for want of a better word, in danger of becoming 'happy' in my life. I have pressed this button many times in my life - provoking the breakdown of relationships (see I told you, it's not possible to love me), loss of jobs (See I told you I am a failure) and usually, as a result, the loss of my home (see I told you I wasn't worth helping - wasted resources).

I managed to do this every five years or so and kept repeating the pattern between the ages of 18 and 42, when I finally ground to a halt and found a GP willing to put the pieces together and see the full picture. My diagnosis, although a shock at first, opened doors of understanding for me after a lifetime of feeling that I was just 'over-sensitive' and losing a grip on reality.

I find myself in danger of reverting to my 'default' having completed the core Dialectical Behaviour Therapy course and realising that I have been 'stable' for a number of months. I know it is worth getting used to enjoying life as others do, but there is a core belief that I am not worth it. This I know, is the fundamental battle I have with my past experience of life. Everything up to the present period of my life has been designed to programme me to believe that 'self destruction' is safer than taking a risk with life as it is outside my experience.

But there is hope - if my life so far has programmed my default, it can be reprogrammed to a different default - one that says, this moment is as it is. To believe that my emotions do not have to rule my life, that at their worst they build to painful crescendos, but they do subside, if I am willing to wait for one moment more.

So I am looking at creating a new button to become my default and on it is written: 'Hope'.

Can we Afford to lose our Compassion?

I was bent nearly double as I tried to make my body fit the small opening made for me by a police colleague in the broken down door of a derelict pub. The stench of human detritus slammed into me like a wall as I inched forward into the blackness beyond. All of a sudden, a wave of nausea swept over me as I reacted to first the smells and, then the sight of the evidence of human degradation all around me.

“Breathe through your mouth” my colleague advised me and soon I became accustomed to my surroundings.

We were looking for a vulnerable young man, one of my ‘cases’. We were concerned for his welfare. He was a proficient petty thief, heroin user and someone many considered to be on the human scrapheap at the age of nineteen. We didn’t find him, in that den, one of his favourite hangouts, just soiled mattresses, empty junk food wrappers and the tell-tale signs of recent drug use.

We moved in silence wandering from one darkened room to another. Then, as my colleague and I scrambled our way back out into the winter’s gloom, the daylight hit me like the brightest noonday sun. Such darkness and filth as it would have been difficult to imagine. Yet Matt and countless others inhabit this netherworld in every one of our towns and cities. It has become all that they know and all that they think they are worth.

On the way back to the office I pondered what had been lost from his young life. He had been a promising footballer at the age of 11, and among the foul mouthed cynicism of prisons and drug dens he maintained an air of respect for others. He was devoted to his mother, who, at the age of 40, had met the ‘wrong man’ who introduced Heroin to their home. First he introduced her, then he introduced her son, to the great emotional blanket that enveloped both their lives – stole all that they had, and then left. Nice.

If I were to meet Matt in the street with his ‘chav’ uniform of joggers, hoody and battered hi-tops, what would I feel – would it be compassion or contempt? Would I be prepared to scratch beneath the surface?
He remains for me, one for whom I have a ‘soft spot’ simply because I could see his potential beyond the ravages of his drug of choice. My concern is that in the current climate where government ministers brief about ‘strivers’ and ‘skivers’ there is no room for us to invest anything of value or meaning into a life like Matt’s.

At the time I was working with him (before Cameron and Osborne began dismantling the welfare society) we offered him a place on an intensive multi-agency programme (comprising Probation Service, NHS, Police and Drug Charity staff members) whose main aim was to find ways to divert this prolific offender away from his need for drugs and to provide a pathway and the means to fulfil his potential.

The funding for such schemes – which targeted the 5% of criminals locally who committed 50% of acquisitive crime? Gone – replaced by ‘payment by results’ contracts with private companies such as Serco and G4S. Although, we had a proven record of significantly reducing re-offending rates. There was a cost, in time: average time on the programme, three years; in resources: each local team committed a full time member of staff to the core team of four (the police committed two neighbourhood police officers), we had a budget for ‘rewards’ such as interview suits, work boots and, on one occasion, Artists’ materials.

The concept of a Society in which all children regardless of birth would have the same access to Health, Education and Shelter was born out of the deprivations of World War. The politicians of the day were determined that the orphans, widows and wounded of our nation would not be neglected. There is an economic argument for cutting back on where resources are allocated. From what I can observe of the current round of ‘austerity’ this seems to be focused not on ideology with humanity at its heart, but on profit and loss as solely measured in monetary terms. The problem for the current government is that societal change relies on a desire to bring all members up to the same level of value. No one member of society is ‘worth’ any more than another.

I contribute as I am able and if that is more than my neighbour is capable of giving, then please share my over capacity with them…. Idealistic? Maybe, but the likes of Clement Attlee didn’t think so, and it did work in its very British way for so long.
Surely, there is enough inventiveness in this country to find a way to balance the books whilst maintaining a compassionate society with the ideals of education, health and welfare for all people regardless of background, upbringing or beliefs?

My Dog as Mindfulness Therapist

"I think your dog will be important in your recovery" I'm a reflector and I really took some time to absorb what my DBT (Dialectical Behaviour Therapy)Therapist was telling me about the resource right under my nose. At the time I was new to dog owning, having received a little bundle of white fluff as a Christmas present about a year before I started my DBT Therapy. Initially, I think I could be described as a 'helicopter' dog owner, I so didn't want to mess up this little creature that was so dependent on me. Dog walking was a tense affair with me guarding against her 'annoying' others and reflecting badly on me. It was only when I started to use mindfulness skills that I really began to enjoy the time I spend with her.

So let me introduce her. She is a cross between a Malamute and a Samoid - a fluffy Husky - or 'Siberian Wolf' as a number of people have characterised her! She is big, but thinks she is no bigger than a chihuahua and therefore plays with gay abandon with all sizes of dogs. She is a highly sociable animal and leads me into a lot of really positive conversations with strangers. Her name is Smilla (for those who ask I can tell you this was inspired by the novel 'Miss Smilla's Feeling for Snow'). She is my companion - I miss her when I go on holiday and she goes to her favourite 'pet hotel'. She can read my moods - which change frequently. I love it when I am lying on my sofa and suddenly a massive paw lands on my tummy to assure me that she is there for a cuddle when needed. Above all, she is dependent on me in a way that I have never allowed any human being to be for fear of letting them down. This ball of fluff relies on me for all her needs - and yet she is supremely chilled about this fact - she trusts me to look after her. That is strangely liberating.

After more than a year of DBT skills training Smilla has become an integral part of my mindfulness practice. She is a skilled coach in the following Mindfulness skills:

1) Just Notice - Smilla is nosy. She stops to smell everything of interest, including, people, small animals, birds, plants, trees etc, etc. Through her I have discovered that there is a wealth of wildlife very close to my home. One day a small vole was deposited at my feet in a macabre 'show and tell' and I noticed! I wasn't distracted by any internal ruminating in that moment.

2) Live in the moment. The benefit of being a dog is that there is no future or past there is only what is literally in front of their nose. A dog biscuit brings great joy because it is enjoyed exactly as it is in that moment - a little bit of bliss which is bestowed with unconditional love. I am capable of loving another creature without fear of abandonment and rejection, because our relationship is not full of the past or future fears and hurts.

3) Participate. Smilla engages entirely in every activity. From the tip of her nose to the very end of her fluffy tail every part of Smilla demonstrates her enjoyment of playing with her friend Farai (a Black Lab). When asked to sit the whole of her body holds itself in readiness for the expected praise and in that moment every part of her is invested in the task of sitting. How often do I do things 'mindfully' without fully engaging and therefore miss out on the benefits of the mindful experience?

4)Acceptance. Smilla greets each day with enthusiasm. However, she accepts her owner and life for that day, as it is. Occasionally, she tries to change her owner by subtle (what I call) 'chunnering'. Any Malamute owner will tell you that barking is not a natural default, but a kind of have yowl, half talk is. Sometimes, morning exchanges follow this pattern:

Smilla: Yar, yar, yar (large paw banged on knee)
Me: Oh dear, I'm so tired - do you think I'm being lazy?
Smilla: Yar.
Me: Should I get up and out of bed.
Smilla: Yar, yar, yar - (while moving to stand at the door of the bedroom)
Me: Right then.... up I get.
Smilla: Yar, yar, yar, yar (as she exits the room with tail wagging).

Some days this doesn't work, the environment is too strong for her to change. So she accepts and she adapts her expectations for the day. I love her for her acceptance of me on my worst days, when she would really rather be taking me for a long, exciting walk. On those days, she accepts the quick out and in round the block that is necessary.

I have realised that my DBT Therapist was right - Smilla is an essential part of my life, but she is a reminder to live in the moment and to enjoy the moments I can enjoy without letting the past or the future rob me of that joy.

My Favourite Soothing Images and Memories....

When my mood prevents me from engaging with the world outside, it takes me a supreme effort to even venture beyond the door. I have had periods of low mood, panic attacks and just plain emotional exhaustion when I have not had contact with the world outside for up to a month. At those times when fear of contact with people prevents me from doing what I know would be helpful ie getting out and about, enjoying fresh air etc, I need to focus my mind in a way that allows me to be fed with 'good things'.

It helps for me to reawaken my senses by listening, by eating regularly, by looking and noticing familiar images. These images are positive for a number of reasons. Because some of them remind me of positive moments such as holidays and family, they allow me to reconnect with positive emotions and connect them with the world outside my own head. I use the photos as a way to engage my sense of smell, sound, taste as I imagine myself back in those moments. For the pictures of nature I again imagine that my senses are engaged with the world outside and imagine myself enjoying the feel of sun on my skin, the sense of wind tousling my hair, anything that reminds me I am not imprisoned inside, nor have I been all my life and to believe that I could enjoy such moments again.

My senses are a gift that I forget when I am struggling with emotional pain and distress, but by using these pictures I am able to remind myself that I once engaged with the world around me and I will be feeling well enough to do so again.

Does being Competent at your Job Whilst being BPD confuse your Employers?

For many years I worked successfully in a highly responsible and challenging job. Then, in 2009 I was diagnosed with Borderline Personality Disorder. My caseload included a number of clients who were classed as MDOs (Mentally Disordered Offenders). In seeking to secure psychiatric interventions, rather than imprisonment for many of my BPD cases I was disheartened to receive the repeated response, 'this condition is not treatable' and in one particular case '....is so problematic to handle that they are barred from A&E admission in the local area'. The provisions of the Mental Health Act 2007 had failed to make it to the Foundation Trust in which I worked. So, when I received confirmation that I had BPD and that my local NHS Trust were willing to offer me support and treatment I knew I was lucky. I also had a decision to make about staying in work and what I would tell my employers.

I decided that I would be open and honest with my employers about the nature of my ‘issues’. Given that I had taken time off since 2007, as I struggled with what then was an unknown problem, I believed that this would be the most productive way forward. I had had experience of trying to mask periods of emotional instability from previous employers – helped, no doubt by the fogginess of medical professionals, who seemed to believe that my ability to hold down responsible jobs meant that I couldn’t possibly be suffering from a complex mental health condition.

As I have said elsewhere in this blog, I had always been open with my Line Manager throughout the period of uncertainty about my diagnosis to the final conclusion and have found that, on an individual level both my manager and my colleagues were willing to learn and try to understand my condition and how it affected my work.

However, the sickness absence procedures themselves were applied as a ‘one size fits all’ solution to long term sickness, regardless of the intrinsic differences between physical and mental illnesses.

I don’t think a Senior Manager would ask of a Cancer sufferer, ‘A year ago you told us the 'Chemo' would work, so why have you gone off again and are now telling us that you need Radiotherapy?’ Unfortunately, having remained at work for 8 months following a difficult period, when my initial treatment failed, I was signed off again in 2011 and I was asked by the senior manager why the first treatment I had tried had not worked and was asked ‘what guarantee do we have that the new treatment they are suggesting will work and that you will not be signed off again?’

Now correct me if I’m wrong, but even the most highly regarded medical training does not include crystal ball reading, I believe that’s only on offer at Hogwarts! However such questions betray an underlying suspicion, or even prejudice, about mental illness, and that is: it’s all in my head! If you don’t fit neatly into the procedures, which again and again, I was told were there to support me to remain in work, then employers seem to waver between wanting to help, and threatening me with capability procedures. In the end it became impossible for me to remain in work, even on a part-time basis and engage in the intensive DBT programme I was offered a place on. I took voluntary redundancy in 2012 - the first wave of redundancies which have marked the dismantling of the Probation Service as a public service agency serving the community. I will therefore not be able to return to any role which would make direct use of my skills and experience, but that's another day and another story.

So can such Sickness Absence procecures deal with the paradox of the worker with mental illness whose work is characterised as ‘excellent’?. In the present climate the pressure not to disclose mental health issues will grow, but how can we educate employers to view those with mental health problems in the same way that they view physical health problems? With the same level of compassion and support?

How much Emotional Resilience do you have?

I used to think of myself as a rubber ball. Throw me down and up I'd pop. Problem is, after nearly 25 years of cycles of breakdown and rebuilding all my 'bounce back' was spent.

Among other things I have learned that one of my main ways of coping with past traumas had been to throw myself (heart and soul) into challenging work with extremely challenging people - satisfying but emotionally draining. I have learned too that I was not equipped to restore my emotional batteries to remain effective in this role in the long term. I survived 10 years.

At the point I stopped 'functioning' I raised my eyes from the emotional grindstone to find that not only had I run dry, but any chance of building myself up emotionally was impossible due to me becoming isolated socially and emotionally from every significant relationship.

I have observed a number of factors which are important in building emotional resilience:

1) Find your Hope and Meaning. Whatever your beliefs, it seems to be that people who have a firm faith in something tend to be able to find meaning for their own suffering and pain. For some, this may be in an external God who bestows meaning, for others, they find meaning in the human relationships around them and, ultimately in their own relationship with themselves. Wherever people tend to find it, meaning provides a framework in which to work towards wholeness. I personally believe there is a God and therefore there is meaning in all of life.For me there is a need for an ongoing dialogue which seeks to balance the pain of life with the value of life. There have been times when I did not want to continue living - at these times I have learned to adjust my perception of God. For me faith must be dynamic and responsive to all of life.

For some, it is easier to assume no God or superior being and to focus on finding meaning in human relationships or in the universe around.

Whatever our beliefs, it is important that our faith is in something that is robust enough to make sense of our own suffering and offers a way to create meaning for our life and experience, through engaging with the world around us. Finding this meaning is important as an anchor when our emotions and/or perceptions of the world around become unstable. They provide a foundation on which to build key life changes.

2) Have compassion for Yourself. How often are we prepared to give support, help and hope to others, that we wouldn't consider ourselves worthy of? Be kind to yourself: make time to restore yourself emotionally. When you are exhausted, it may feel good to listen to someone else's problems, but where can you find the emotional strength to keep you going and to help them? It isn't selfish to take a long bath, if that helps you relax and begin to remember how to enjoy things. No matter how compassionate other are towards you, if you are incapable of loving yourself, then you can't find a way to let that love and compassion in. Learning to love yourself, especially if your life has told you that you are not worth it, takes time and effort. It is worth because it not only feeds you from within, but enables you to absorb emotional energy from others.

3) Take Care of the bodywork... I have an old car and when it breaks down I call either the RAC or my mechanic. They are necessary in a crisis. I would be an idiot if I tried to run my car on a day to day basis, without providing the basics of petrol, water, oil, check tyre pressures and make sure the brakes are working. I have a responsibility to maintain it as well as I can it also reduces some of the regular bills from the mechanic. So, how do we care for our body? It is clear that there is a link between physical stamina and emotional or psychological well being. Physical well being is not just being a perfect figure or being able to run a marathon, it includes being regularly aware of the signals from our body that it needs rest, food or water, and doing something to meet those needs. When I am physically fit, I know I can cope better with my relationships and tend to be in a position to give as well as receive.

4) Avoid Emotional Blackholes I guess no one would like to called a 'hole' of any description, but we have all come across those people who we can never help no matter how much time or emotion we spend on them. As someone with BPD I have been an emotional 'Black Hole'(BH) - it took some very honest friends to help me to see that no 'one' person could provide the emotional healing that I have needed. It also helped to know that my emotional needs were understandable given what has happened in my life. I have learned from my own experience as a BH that boundaries which protect both people, also help to build healthier friendships and relationships. If you are open and honest about what your limits are, then it is possible to limit the emotional impact of draining people.

Above all try and care for every aspect of your life as you begin to feel better. Remember, no part of us exists in isolation from the other parts.

Who to Tell? What to Tell?

I believe firmly in the importance of the 'Time to Change', 'Time to Talk' campaigns run by Mind, Sane and other mental health charities. I know that the best challenge to Mental Health stigma is for people like me to be open about my diagnosis. But there is a caveat -

sometimes discretion and self preservation are needed

simply because even those closest to us, just don't get it.

I have found it easier to tell those who are distanced from me - the 'strangers' in my life, if you like, that I have Borderline Personality Disorder. a) Because I was not invested emotionally in their reactions to me and b) because they were not invested in keeping me in roles that didn't help me.

I have encountered a number of reactions:

1) The first person I told was my Line Manager immediately following the second or third assessment when Mental Health staff started to discuss my BPD symptoms. Despite her lack of knowledge (and, indeed my own!) she was consistently supportive and was keen to listen and learn with me about what my condition would mean for my remaining in post as a Probation Officer. In the end I took voluntary redundancy due to the realisation that my challenging caseload was not helpful to me in seeking manage my emotion dysregulation. She even supported me when a Senior Manager insisted on expensive assessments by privately funded Psychiatrists whose sole aim was to assess my risk of physical harm to my cases - the vast majority of whom were violent and dangerous male offenders! Three times the response came back 'no, the highest risk of BPD is of suicide and self harm'!! and still Senior Management sought to prove that I was suddenly a risk to others, having worked successfully in that office for seven years! However, my own instability meant that I knew it was best for me and my cases if I moved on. On leaving my career behind my Manager left me with a positive professional regard which I am slowly able to take on board and use to move into a future career - just don't know what it is yet.

2) Telling my family is problematic - I can never tell my parents. Growing up even physical illness was dismissed - certainly no room for compassion for mental illness. Ask my brother who suffers from chronic severe Asthma and who was told that his attacks were just due to him being 'highly strung'. Instead of opening myself up to reinforcing negative statements and parental rejection, I have been living a lie with my parents since I was diagnosed. They know I have a condition which requires me to have given up my job and to attend therapy twice a week for the past year (Dialectical Behaviour Therapy - DBT), but beyond that I cannot share with them. Sometimes accepting that I will never change them or their views stops me from suffering further at their hands.

3) The rest of my family - I have received nothing but support and love from my brother and his wife. They have read up on the websites and books I have recommended and have recently supported me in speaking publicly about my experiences to small groups. Their children have now grown up with me as their auntie who gets very down at times but will always be the person they have known and loved since they were little.

4) Speaking in public about my experiences has shown me that there are so many people hungry to hear that they are not alone.

I hope that as I articulate my own experiences they will resonate with others - I know I really appreciate the Twitter community of those who have BPD and who have been helped by DBT - it reminds me every day that they have come through and are leading stable rewarding lives. (esp @HealingFromBPD and @DBTPath - thanks guys)

My Self Soothe Kit... What's in yours??

#Selfsoothe Box

As part of my DBT Distress Tolerance skills I have developed a range of ways of self soothing. In my box are:

1) a photo of my dog Smilla - she wouldn't fit but she gives me lots of cuddles and I enjoy walking (in all weathers) with her - DBT skills self soothe, opposite to emotion action and Exercise (PLEASE Skills).
2) Bag of chewy or fruity sweets - yum
3) Lovely fragrant shower gel/bath bubbles for long soaks
4) Ipod - lots of playlists including very cheesy pop for opposite to emotion and mindful listening - leads to dancing at times!
5) DVD box sets - Downton for escape, Homeland for distraction, others because they absorb me and give me a break from feeling.
6) Beads - feeling them helps to ground me when I am feeling anxious

God be in my Head

I grew up in Northern Ireland which meant that I was familiar from an early age with the writings and prayers of Saint Patrick. Patrick’s Breastplate intrigued me. How could God be before me, behind me, above me etc? In particular I was bothered when Patrick prayed that God be in his head. How could all of God, my child’s brain reasoned, be inside my head?

For the Christian who struggles with mental illness this fact of faith presents challenges which need to be worked out on a daily basis. I became a Christian as a child, yet for most of my life I have suffered from chronic mental illness. This has been challenged by well meaning Christian leaders who have sought to explain my ongoing struggles in light of one of three options 1) I never fully committed my life to Christ and therefore remain outside his Grace, or 2) I have shown insufficient faith in God’s ability to heal me from my affliction or 3) I have never learned the true meaning of being forgiven by God and therefore, by extension I am unable to forgive anyone around me, which, they reason must be at the root of my emotional and mental struggles.
I am thankful that God has shown me over and over again that He has walked with me every step of my journey. I am also grateful to the many saints who appear in the Bible, both New and Old Testaments, who are shown to struggle with the blackest of moods, with real emotional anguish.

Is it inconceivable that Elijah was suffering from emotional and mental exhaustion in 1 Kings 19? And how did God respond to those needs? Did He condemn him for not triumphing in the victory over the Priests of Baal? Did He admonish him from not trusting his Lord enough? Did He see Elijah’s anguish as a sign of breaking the relationship with himself? No, God brought Elijah to the brook Cherith and there he commanded nature, in the form of Ravens, to feed him. He drank from the brook and he slept.
‘Sleep is the season of the soul.’ As Shakespeare reminded us in Hamlet. It is not by accident that his most famous speech links the ultimate anguish of the soul with lack of sleep and the loss of reason and balance in mood and mind, as portrayed through Hamlet’s descent towards suicidal thoughts following his father’s death. For Elijah, God provided physical and emotional needs in order to restore him to his right thinking. Often, depression or other mental illnesses are exacerbated by basic lack of sleep or food, or other daily needs.

We are told in the New Testament that Jesus himself suffered intense emotional anguish in the Garden of Gethsemane, as he faced the road to the Cross. As a Man he was crushed by the burden of facing the greatest Spiritual battle of all time and eternity, as God He knew there was no option if God’s plan of Salvation was to be fulfilled ‘Not my Will, but yours be done.’ The Bible tells us that He was tempted and tried in every way as a man. As God, we know, He overcame every frailty, including mental anguish and the darkest of nights, when he was separated from his Father in Heaven as God poured his wrath on Him on the Cross. This was so he ‘who knew no sin, became sin for us’ (me).

I thank God that I don’t have to carry the burden of being a ‘failed’ Christian in addition to battling my own thoughts and moods. Instead I can learn to see my own mental illness as God telling me that he has not finished with me yet, that I still have much to learn of his Grace and love towards me and through me. One of my childhood heroes, Corrie Ten Boom was reminded by her frail and dying sister, when they were imprisoned in a Nazi Concentration Camp, that ‘There is no pit so deep that He is not deeper still.’ My soul is secure because of Christ’s sacrifice and promise. In every dark night he has promised ‘I will never leave you nor forsake you.’ If even the ‘winds and the waves obey him’ how much more will he be able to not only comfort us through the storms of our mind and emotions, but he is more than capable to calm them completely, if that is His will. My question to God needs to stop being ‘Why me?’ or ‘Why not me?’ and become ‘What now, Lord?’

When your Christian friend tells you they are struggling with mental or emotional anguish, please do not add to their distress by condemning them for being ‘less than’ as Christians, but help them to listen and wait for God to reveal his purposes through this time. Above all, help them to remember that they cannot do anything to change his love for them, ‘There is nothing I can do to make him love me more, there is nothing I can do to make Him love me less.’ And remind them to be kind to themselves. Would you allow your friend with a heart condition or cancer to constantly berate themselves for failing as a human being, or, as a Christian? No, all suffering is a symptom of our world as it is. For the Christian there is the promise that one day ‘he will wipe away every tear’ from our eyes.’