Tell Tale Signs I'm Middle Aged #13

I've grown into my bum. I've always had one, if you know what I mean - when I was seventeen, I had a perfect hour glass figure (38, 28,38) but kept telling myself that I was fat. Looking back I really couldn't have been, I mean, I was training for four hours a day six days a week. What I was, was curvaceous. But you can't tell a teenager anything can you?

Now I know I'm middle aged because all the sand has settled in the bottom of the hourglass! The difference is that I'm ok with that, it's my bum and I've had fun growing it. It's the sign of a good half life well lived. No longer do I care if my 'bum looks big in this'. If it does? Get a size bigger - oh and under no circumstances wear: leggings, jeggings, hotpants, cut-off shorts with tights, etc etc I am embracing my middle age with gusto and soon I will be moving into twin set and pearls, and sturdy, sensible shoes and plaid skirt - classic and timeless. Need to work on my old lady beard too...

Dealing with Panic and His Friend, Anxiety

Anxiety comes over me like a cloud of indefinable darkness and confusion. My heart starts beating faster, my stomach goes into overdrive (like a washing machine) and my abdominal muscles go into spasm. Two years ago these spasms had gone on for over five days, which resulted in my suffering from vomiting reflex once or twice every hour. Eventually, I was exhausted and in total despair and so was forced to go to A&E. Anyone who has never suffered the effects of truly debilitating panic or depression may wonder at the impact on the body, but do not tell me that there is no link between my physical and mental well being.

Since beginning Dialectical Behaviour Therapy I have learned to focus on the signs from my body, including my breathing patterns, so that I recognise anxiety before it can develop into full blown panic attacks. Essentially, when under stress, I actually stop breathing for short periods of time. It doesn't take a genius to work out that if you stop breathing your body will get the signal that something is very wrong and that it is time to ignite the 'fight or flight' response. In other words, I was signalling my body to release as much adrenaline as possible - guess what? Heart rate rises and blood rushes away from where it's needed to where the body 'thinks' it's needed. The same goes for shallow, rapid breathing. Does that make sense? It did to me when my therapist pointed it out to me. So, the very first thing I do is acknowledge that my body is in panic mode which indicates that I am anxious about something.

Mindful Breathing

1. Notice your breathing, what it is doing and focus on returning it to a more measured level.
2. Just focus on the in...and...out, no need for deep breathing, just breathe normally and naturally.
3. Observe, the effect on your nose, in your lungs.
4. Watch the rise and fall of your ribcage and stomach.
5. Don't let worry thoughts distract you from this task.
6. Just focus.

But what about the trigger to the panic? First of all it helps to be able to name the emotion. Sometimes anxiety causes our thinking to become muddled as the reality is that the things we worry about don't come in one by one so we can manage them easily. Instead, they gang up on us and crowd in, bullying and badgering us for not finding immediate solutions. Having acknowledged that I am anxious, I focus on my breathing to relax my body, so I am not entering an inexorable physical and emotional spiral as I did previously. There are a number of mindful exercises that I have learned.

Thought Diffusion

The first and easiest one for me to manage is to attach my worries in my mind to the leaves of a tree and allow the leaves to drop gently towards a flowing river, which carries them away one by one. This exercise takes practice and a basic knowledge of mindful breathing, but is effective in everyday situations.

Guided Imagery (The White House)

Another one I use is called 'The White House'. (Here is the link: http://www.themindfulword.org/2012/guided-imagery-scripts-children-anxiety-stress/) This is a guided imagery exercise for children, but is so effective for anyone. I have found it very useful when I am overwhelmed by the size or number of my problems and worries. The most important thing about this exercise is that you cannot move into the part where you can relax until you have set down the large 'rucksack' of worries at the bottom of the stairs to the big White House. (obviously if you haven't read the instructions yet this won't make much sense, so please take a moment to have a look).

Problem Solving Questionnaire

I have recently found myself working through the 'Yes', 'No' questions of problem solving:

1. Are you worried about a specific Problem? If No, then don't worry. (Accept)

2. If Yes, is it a problem that can be solved? If No, then don't worry. (Accept)

3. If Yes, do you know the solution? If Yes, then don't worry. (Change)

4. If No, then don't worry because there is nothing you can do by worrying. (Accept)

Acceptance and Change
This process reveals two of the principle skills of DBT, in fact they are foundational: Acceptance and Change. The serenity prayer is so called because it holds these two truths in balance and releases us from wasting our energy on those things that are outside our control. My Anxiety can be controlled by using these skills, and by realising that if I can change the circumstances of my problems, then I don't need to worry. Also if I cannot change them but can learn to accept them as beyond my control, then there is no point in my worrying and I am losing out on the here and now.

Not one of these ways of managing my anxiety is either natural to me, or easy. As long as I have had panic attacks and suffered from anxiety I have defaulted to spirals which mean that the anxiety has controlled me. I therefore need to put in as much effort and time to developing the habit of preventing anxiety from (literally) taking me over and making it impossible for me to function to any effective degree.

Maybe you've tried some ideas like these and they've not worked immediately - stick with it. I know there are times when I still slip back, but never again has my whole body gone into spasm from an emotional response.

Again, I would say the key to me making use of these skills is, practise, practise, practise. I cannot change as and when the panic will rise, but I can change my responses to it and its little friend, anxiety.

I can see clearly now the Rain has Gone...

'Black and White Thinking' and 'a pervading sense of emptiness' are two symptoms of Borderline Personality Disorder (BPD). I like to avoid thinking about these two symptoms, simply because they are the hardest for me to manage.

Black and White thinking reduces any person or situation to a basic choice between one extreme and another. So, when I am in a relationship, you may encounter me saying 'I love you',and 'I hate you' with the same level of conviction because at the moment in time I am saying each statement it is what I believe with every fibre of my being. It's hardly a surprise then that those who are closest to people with BPD tend to feel confused a lot of the time. Most people I have ended relationships with have felt as if they have been tossed around in a tornado and then, spat out. One minute they were my universe and were my everything, the next the most despicable creature on earth and capable of inflicting incredible pain simply by being there. It is equally problematic being the person who experiences this see-sawing from the inside, shifting endlessly from one extreme view to another. There is no opportunity to feel settled in life or in relationships. Constant fear and expectation of rejection and abandonment, inevitably become self fulfilling prophecies, reinforcing the belief that I am impossible to be loved or to love another human being.

Black and White thinking also pervades my assumptions and views of everyday life. So, I believe that there can be no neutral or middle ground between liking and hating me. My way of managing almost every situation was to 'learn' the rules. It is my assumption that everyone else in the world is living by a set of rules that I know nothing of, if something goes wrong, I assume it's because I've broken a rule. So, if someone removes something from me, for example, if a medical professional is late for an appointment or cancels at short notice, my default thought was always 'they hate me'. It would never occur to me that they may have been delayed due to everyday hurdles such as traffic, or they may cancel simply because as humans they may get sick or have training etc. Nothing to do with me. So, inevitably any situation regardless of the setting or people involved becomes a catastrophe to me and another indication that my whole life is a failure.

While the see-sawing thinking described joins with the emotional see-sawing of BPD to create frequent emotional 'storms', these are not the most damaging of the underlying symptoms of BPD.

When you have been told that you were an 'accident' of birth, a 'mistake'. When your parents tell you that your emotional response to pain is not the right way to react. When you are never praised by your parents no matter how successful you are at school or at sport. When your parents essentially focus all their emotion on their own relationship and only connect with you as a child through physical, emotional or sexual abuse, then your ability to identify your place in the world and universe becomes severely impaired.

This loss of identity and feeling of dislocation is one that pervades many explanations of distress from BPD sufferers. When I first came to the notice of Mental Health services, I repeated over and over again 'I am not made for this world', while the sense of isolation and disconnection resulted in an almost unbearable, physical sensation in my chest. I felt as if someone were reaching into my chest and was squeezing my heart to the point that my breathing was compromised, often prompting panic attacks. The trigger for these feelings, reactions and episodes?

Sometimes, something as small as a colleague or client, questioning something such as, 'when did you last make a brew for everyone?' This kind of office jokery could result in a rumination that might last three or four hours and limit my ability to associate with my colleagues for up to a week. I could be so dysregulated that I was often unable to focus on my work, after such comments. Such a level of sensitivity is highly debilitating not only in working life, but more importantly in my social life.

By the time I was diagnosed with BPD in 2010, I had misread so many situations and ruined so many relationships and friendships due to my black and white thinking that it was easier for me to isolate myself and try to survive entirely on my own. This fed the belief that I was unlovable and reinforced the sense of isolation and emptiness caused by my sense of personal invalidation. I had learned the hard way that no matter how intense the feelings in intimate relationships, no matter how close the friendships, no one person could cope with my need for validation. My intimate relationships quickly burnt out - the longest relationship I have ever had lasted three years. Eventually, rather than put myself through the pain of total engagement and almost obsessive love for one person, I learned to not even notice if anyone was interested in developing a relationship with me. I have lived in a self imposed 'purdah' for a long time now - it feels safer.

As I have worked my way through the DBT programme I have learned to accept friendships at face value. I am pleased that some new friends I have made since 2010 have not got fed up of my constant 'mind reading' and extreme mood swings and doubts about their motives. I have learned to question my assumptions about situations.

I try to help my friends understand that BPD is not just about being 'sensitive' but that some reactions to life which are second nature to them, such as the process above, have to be learned and practised by me. I am not able naturally, automatically to question my initial emotional response, but first I must manage the extreme rise in emotions such as embarrassment or panic, by self soothing, then I have to work through the rational responses to the situation one by one until I have assured myself that the thought which triggered the negative emotion is not'reasonable', using 'wise mind'.

In this way I am learning to manage those moments when emotions have clouded my thinking, but I also must learn to love myself and accept myself in order to stop the flow of negative thoughts and emotions. If I can feel fulfilled in my life, if I can find meaning and hope, a purpose, acceptance of myself as I am, then I can learn to manage and confront the invalidation which is at the heart of my lack of self. If I can treat myself with kindness and not hold to extreme views of the universe that remain entrenched. Then I can begin to see the nuances and grey areas in human relationships and in situations that I am involved in. I know that the clouds and the rain are clearing - some days, due to lack of emotion regulation, (usually my sleep patterns are disrupted) I may find myself slipping back - but more and more I am seeing clearly the positive in my life. I just need to see me as a positive too.

My DBT 'Let that Emotion Out' Playlist

Sometimes I don't want my self soothe to be an opposite emotion - sometimes I'm right to feel angry or frustrated - it is after all only a human response to some things in life. Not all these songs are obvious choices, but for me, sometimes the real power is in the lyrics and the expression of thoughts, particularly about injustices in life. Some you will naturally already guess at, just cos they let you bounce around the room and shout your feelings out - safely!

1. It's my Life - Talk Talk (beautiful expression of becoming an individual - No Doubt also did a brilliant cover).
2. Caught out There - Kelis (!)
3. My Life - Billy Joel
4. The Frog Princess - The Divine Comedy (best ever break up revenge song so clever and funny! - don't miss the guillotine)
5. I know where I've been - Hairspray soundtrack (This is righteous anger well articulated - great build up to crescendo)
6. Just a Girl - No Doubt
7. Not Ready to Make Nice - Dixie Chicks (for when you encounter assumptions and prejudices!)
8. Gives you Hell - All American Rejects (Just angry)
9. He had it coming - Chicago soundtrack
10.Road Rage - Catatonia

I guess this falls into Emotion Regulation rather than Distress Tolerance as it is a way of accepting emotions such as anger, but equally being able to express it safely is part of managing distress. Listen and move to the music until the crest of the wave of emotion has died down - it should be easier to manage and 'sit with' afterwards. HINT: Don't focus on the cause of your anger as you listen, try to focus on letting the song express your anger or frustration and let it go at the end.

Middle Class, Middle Aged, but I have no voice...

I write letters and emails. Not just any letters and emails - I write to the Prime Minister, to MPs, to newspapers. Well I think I've done things back to front. I remember a teacher telling me in the 1980s that he thought we were the 'me' generation. We were 'Thatcher's Children' content with things as long as we had good prospects and expectation of a better lifestyle than our parents. Maybe we were apathetic, maybe it was just youth, but I didn't engage with politics outside of my duty to vote - oh yes, we did that. Beyond that I'm not sure that I was very radical at all for a young person.

Now I realise that I have strongly held views about the nature of society I want to be part of. It shames me that the current crop of 'leaders' are 'my age', 'my people'...except not a one of them represents me. I'm a middle aged, middle class woman and I don't feel I have a voice in parliament - what on earth does that say about our democracy?

So, I write letters. I am continuing a family tradition as I follow in the footsteps of my great Uncle Billy - or the 'Bold Horatio' as was his name in our family. He was a GP in Durham and wrote copiously to Mrs Thatcher, Mr Kinnock, The Times, anyone with influence. He had a collection of responses to be proud of, considered responses which showed that his point of view had been registered by an individual, rather than as part of some machinery of 'managing the message'. I waited for four months for a response from the Ministry of Justice only to be fobbed off with a regurgitated press release, rather than engage with any of the evidence based points I had made regarding the privatising of Probation. In fact, as I recall the letter from the PM's office had assured me, three months previously that my letter had been sent by them to the MOJ for a considered response.

My 'roar' of protest used to be a 'tut' followed by an eye roll. Now I've got my gander up and I have nothing to lose, so speak up I shall! Like the 'bold Horatio' I shall make a nuisance of myself and ask, if someone like me feels as if I am unheard, how on earth do others in society feel? And where did real leadership go? Is it just my age that makes me feel that they don't make MPs the way they used to? Where are the characters? Where are the politicians who have convictions and ideals? There is no colour, no nuance, no intelligence in political debate and that I think is not just a sign of me being a grumpy old woman, but is a sad reflection of the current state of our democracy.

It has been with surprise that I have found my voice, realising that it feels as if I am some sort of radical. The thing is I am fighting to keep well established parts of our welfare state - the NHS, a publicly owned and accountable Criminal Justice System, with a core belief in investing in people's capacity to change. It is frustrating to find that my battle is with a morally vacuous, intellectually bankrupt ruling class that is incapable of engaging in sustained debate. Instead, for years now, we have been fobbed off by some kind of unholy alliance between government and media.

So I will continue to write my letters and emails, in the hope that there may be someone in government today who actually knows the ideals that their policies represent. I am certain of my ideals, they have formed the backbone of this country since the end of the last war - how come I'm the radical? When did a compassionate society become too expensive? How did we end up being led by a bunch of public schoolboys masquerading as politicians? What real alternatives do we have?

Borderline Personality Disorder - Diagnosis Hopeful or Hopeless?

Trigger Warning: this post mentions symptoms of suicidal feelings and self harm, if you are affected please give it a miss

Someone asked me the other day if I found my diagnosis a help or a problem? It's an interesting question to ask and answer, especially when I consider that (possibly with the exception of Sexually Transmitted Infections) no physical diagnosis carries with it the same level of judgement and/or stigma as most Mental Health conditions.

BPD is a label, which, I have discovered since my own diagnosis, carries with it a whole heap of historical issues and assumptions.

Firstly, it has suffered from going through a long period during which it was considered to be 'untreatable'. Among some professionals it seems that this situation has not moved forward, judging from ongoing issues that people with the condition still report in finding support and help from services during crisis periods. This is despite clear pathways being published by NICE and the Mental Health Act 2007 declaring that BPD should no longer be 'a diagnosis' of exclusion.

Secondly, it is problematic to pin down and explain how a diagnosis has been arrived at. This is simply because to fulfil a diagnosis of BPD a sufferer needs to show issues in five major areas, up to a maximum of nine symptom clusters - someone has estimated that this means there are a possible 256 individual symptoms which could indicate a diagnosis of BPD. This has meant that there is much scope for debate among Mental Health professionals.

Thirdly, many service users do not like the label BPD because they feel that Mental Health professionals view this patient group as exceptionally problematic to manage. I don't want someone to look at my file before they meet me and decide that I am going to cause them problems. I am a complex person, my mental health issues are complex and have long standing complex roots. My mood changes are volatile and can switch immensely in the period of time usually allocated for therapy sessions. It takes a special kind of understanding to sit with the kind of emotional distress I often express and help me to work through those emotions to a point where I can feel hopeful. I am grateful for professionals working with BPD as a specialism who have treated me with acceptance and understanding. Above all, although I may have the same label as someone else and that helps to decide upon a course of action to take to help me, my needs are my own and more than clinical processes, I need someone to listen to me, help me to sit with my emotional pain and, ultimately teach me the skills I need to manage my condition in the long term.

Most people who dislike the diagnosis of BPD dislike it because it essentially labels my whole person as being 'defective'. For me, terms like 'emotionally sensitive', or 'emotionally dysregulated' are more helpful in some ways, except they fail to capture the all pervasive nature of the emotional and psychological distress experienced by me.So I'm left with BPD as a label that works for me as a shorthand when people ask me what my 'problem' is.

I was only diagnosed in my early forties, having been treated on and off for vague ‘stress related’ breakdowns associated with Clinical Depression. Having had my first encounter with mental health services in school, aged 16, I considered myself as someone who was susceptible to depression. No one managed to ask any questions that opened up symptoms around suicidal feelings and self- harm, so I kept that ‘sort of thing’ to myself. Besides, usually after about six to nine months on an anti-depressant I would ‘recover’ and literally restart my life. Different location, different career brand new relationships(because as part of my ‘depressive episodes’ I would have burnt all my bridges).

When I was finally diagnosed with BPD in 2009 I was relieved. The patterns of collapse and recovery had quite literally left me burnt out and bereft of all sense of who I was, with no sense of being able to experience emotion of any kind. My GP increased and changed my anti-depressants on three occasions. I was referred to the Graduate Mental Health worker at the practice. To her credit she quickly discerned that six weeks of brief CBT was not going to touch the issues she had brought out as she asked strategic questions and then, listened. My GP too listened, not just to what my symptoms were, but how I felt I was being affected as a person by my emotional and mental turmoil.

Thankfully, her intervention in pushing me forward for assessment by the Community Mental Health Team, paid off when I was assessed by someone who did not take my ‘high functionality’ at face value. She has been my CPN since 2009 and this therapeutic relationship has been crucial to my engagement in treatment and the beginning of my road to recovery. Because of the chain of care I experienced my view of my diagnosis has been largely positive. I know that for many people with BPD this level of continuity and understanding has not been there and so they have experienced the diagnosis negatively. I know I have been blessed by the quality of care I have received.

Ultimately, my diagnosis is so misrepresented and misunderstood that it gives me many opportunities to explain that Mental Health conditions have numerous causes and therefore numerous responses. BPD has allowed me to speak to lots of different people about the need to talk about Mental Health issues and to provide at least one person who they can talk to openly about how it is to live with a complex long term mental health condition. A label is helpful insofar as it helps me and those treating me to decide on a direction of travel towards recovery.

I think one of the most important discoveries of my life after diagnosis was the work of Marsha Linehan. The fact someone explained the reasons for my condition that made sense to me, and not only that, but showed real empathy and then offered a means of hope through DBT, helped me to feel that I could find a path to managing my BPD. One year after reading her initial book introducing DBT, a programme was introduced in my local NHS Trust.

Someone out there actually seemed to be able to make sense of the mass of thoughts and emotions which unspooled like unwound wool in my head. She explained how it felt to be me and she also showed that she kept her promises - trust in the therapeutic relationships is critical to the success of DBT. It has been the key to my being able to manage my BPD symptoms over the past two years:

‘People with BPD are like people with 3rd degree burns ...Lacking emotional skin, they feel agony at the slightest touch or movement.’ – Marsha Linehan

“I was in hell. And I made a vow: when I get out, I’m going to come back and get others out of here.” — Marsha Linehan

Calm Reflection

I love this picture - mainly because its colours are unexpected. Normally I associate 'calm' with 'cool' colours: blues, greens, etc. The red tones bring a new dimension to what could be a cliched image. This is another image that I use for Distress Tolerance. Especially to cool the heat of anger - I can either imagine myself in the boat, or as a swimmer, in the calm, cool water.

I can imagine the ripples travel outward from my dive into the glass like surface. The thoughts that fuel my anger can be allowed to attach to each ripple and float away from me and finally disappear into infinity. I can go further and imagine the cooling water covering my head and as I resurface receding slowly and soothingly over my head and down onto my shoulders. As I do so, I imagine the anger that is held in tension in my jawline, neck and shoulders and I focus on releasing the emotion as my muscles relax one by one.

Or, if I allow myself to remain in the boat I can lie back and watch the clouds move gently across the sky. Again, any troubling thoughts or judgements can be allowed to attach to the clouds and float away. Physical relaxation can focus on noticing each part of my body, imagining it stretched out in the boat,and allowing muscles to relax as I watch negative thoughts float away above me.

That's how I would use this image - spending five or ten minutes just focusing where I am and then leaving any anger or tension behind as I 'return' to my snuggle chair and home.

Learning to Manage the Calm

I have found myself in a strange place recently. More often than not, my life has taken on the tone of routine, almost humdrum and certainly lacking in anything approaching crisis mode. Suddenly the corkscrew roller-coaster that has been my emotional life since childhood has untwisted. I no longer start my day with a spasm of gagging and/or vomiting due to overwhelming feelings of panic and anxiety. The dramatic swing of moods from one hour to the next has slowed down and I find myself better able to recognise and manage both the up and the downswing of moods to which I was once a martyr.

So far, so good. Over two years of DBT skill building and therapy have brought me to a point where I am no longer confused by the overwhelming clouds of emotion that used to swamp and overwhelm me. I find myself better able to reflect on difficult emotions, I no longer run from them, but accept them as evidence of my humanity in the face of significant trauma throughout my life. I still have moments, usually when I have tired of my new structured life. I have caught myself being tempted to familiar path of self destruction, perhaps in a different way than in the past, but nonetheless, I have found myself short circuiting good things in my life.

I know that now, rather than being plagued by capricious emotional storms completely outside of my control, I can learn to recognise the signs earlier. The storms still come, but I am better equipped to survive them.

Except, that I sometimes petulantly, deliberately choose to ignore my emotion regulation skills. In my last 1:1 DBT therapy session the admission that I am regularly staying up through the night, brought an almost exasperated response from my therapist - I mean she's right, just 'what am I playing at?' It's bothered me as I reaped the whirlwind this week and found myself tossed about on the kind of emotional storm I haven't really experienced for at least a good few months. I've realised I haven't been practising my skills when things are good, so that they are second nature when I really need them. I didn't need to go through the exhausting emotional maelstrom and the exhausted aftermath, (still feeling it three days later). Or at any rate, I could have used my new skills to limit the damage from my negative emotions quicker.

Instead, I revisited some familiar old feelings and reassured myself that I could indeed consider myself a total failure, as my internal monologue has convinced me of since my childhood. So, what does this tell me? It tells me that we are indeed products of our past. It tells me that when we have had the mirror of our minds distorted by our childhoods of invalidation then it is all but impossible to recognise a fair reflection of ourselves in it. It tells me that I am not finished healing and recovering from my BPD symptoms. Just because the untwisted mirror image of my 'good life' seems shocking to my invalidated mind, does not mean that I cannot become accustomed to it.


There is something else that this has taught me about certain emotions. Having spent so long learning to manage and 'sit with' negative emotions, I am having to learn to use the same skills to manage positive emotions. One of the reasons for my disturbed sleep has been a propensity to allow the lightness of emotion lead to 'hyper' behaviour, the energetic surges from feeling 'happy' have resulted in really productive moments, but I have not controlled these moments and channelled them, but allowed myself to be carried away into the wee small hours of the morning.

As a result it's back to the basics of distress tolerance and emotion regulation for me. Looking after myself and my lifestyle in order to provide a stable foundation to keep going on a day to day basis. In a sense I am fighting the same enemy, but at a different end of the spectrum. Positive emotions are equally difficult for me to manage, mainly because I find them uncomfortable as they are a dissonant voice challenging my self critical inner monologues. As much as I need to use my Mindfulness skills to 'sit with' my grief and sadness, I need them to 'sit with' and become comfortable with feeling good about myself and what I can achieve in life.

In a sense I am fighting a battle that is familiar to me. I am using my skills to keep me and my emotions in the here and now. Where my negative emotions tethered me to the past, my positive emotions risk catapulting me into anxiety and the future. So, when I started to feel nauseous and was throwing up at the end of last week, I maybe could have been more aware that all was not well.

What is most encouraging for me is that I am no longer unable to articulate an amorphous emotional cloud, but I am naming the emotions and how they are affecting me at the moment. I know what I have to do to regain my equilibrium, it will take more time and effort on my part. I have the skills I need I just need to use them. I don't need to beat myself up for this latest storm. As Scarlett O'Hara memorably said 'After all, tomorrow is another day.'

Taming the Wild Horse

This is one of my favourite paintings of all time. To really appreciate it you need to see it in its setting in the National Gallery in London. It is breath taking. I love it because I love horses, their strength, their grace, the power and the gentleness and delicate spirit which can so easily be broken.

It's Whistlejacket by Stubbs.

I discovered it when I visited the National Gallery in between meetings in London about twenty odd years ago. When I look at it now, it has even deeper meaning. I can see myself in the wildness of the race horse. Or rather I can see the power of my unfettered emotions in it.

It is not an accident that the horse is portrayed without constraints rearing on its hind legs - unfettered. Interesting that in looking at its flailing hooves, it can be considered either as a threat to those around it or in fear of those around it. This is a creature who has been trained to use the power of its muscles to race. But in this portrait the artist has chosen to capture the natural power of the horse.

And this is where I begin to recognise myself in his eyes. Animals have to be taught to be aggressive towards humans. A puppy or a kitten is all trust. The claws and teeth come out in earnest as they learn through bitter experience that sometimes the hand that feeds can also cause pain. It is not hard to spot the abused dog in the park when you reach your hand out to touch them - they flinch. It's not far from the behaviour seen in hurting humans.

There is nothing that we as watchers can see that is causing such fear and terror in the horse, but we know that it is real to him. For me that has been my experience of mental and emotional distress down the years. People around me may have witnessed the outworking of the extremes of emotion, but could not see the cause of such distress.

When I look long enough at the painting, the fear in his eyes fades and I am able to focus on his beauty, his strength and the portrait of this great racehorse in his entirety. My experience of BPD is not the entire story of my life, nor is my condition the entirety of me. If you observe and notice me long enough, hopefully you will see I am more than my emotions, that I am a fully rounded human being with a modicum of grace (I hope) and a spirit that has not been broken.

The Long Road to Self Compassion

When most of your life has been about trying and failing to earn parental validation then internal expectations can become exceptionally distorted. From the outside I look fairly successful, I have completed three degree courses, am fully qualified and experienced as a Teacher and a Probation Officer, from an early age I was a successful athlete, swimming for my school and regional teams of elite swimmers. I am considered to be an effective communicator and have managed to write and perform comedy sketches in a range of contexts. Yet, yet, yet...I consider my life at best to have been a triumph of mediocrity and at worst to have been a complete failure.

I am writing this post at the end of an exceptionally stormy week when I have perceived myself to have failed utterly in my attempts to manage the symptoms of my BPD. What has prompted this castigation of yourself? You ask. I lost my temper in a DBT group and (in my mind) caused a scene by storming out of the room. Suddenly, after months of managing to regulate my emotional life and remain relatively balanced in my perception of the world and people around me, I found my emotions spiralling out of control. So much so, that after the group finished I had to wait nearly an hour before my emotions were stable enough for me to feel safe enough to drive home. That was actually progress because in the past I wouldn't have been able to use wise mind about the risks of driving while dysregulated.

This in itself has not been the greatest battle I've faced this week, such escalation in emotional intensity is common for those with BPD. What I have battled with has been in 'giving myself a break'. First of all, in response to my initial reaction of ending my participation in the DBT Graduate group, my therapist pointed out to me that my outburst was neither out of proportion, nor unexpected. Secondly, most of my anger was not related to the incident in the group, but was directed entirely towards myself for 'losing it'. Again, my therapist pointed out that I was wrong to assume that my emotional outburst had 'ruined' the whole group. She also pointed out that the statements I was making were not based on fact but on judgement - primarily of myself, for being a failure.

I know the DBT skills I need to use: wise mind, mindfulness focusing on my feelings in this moment, thought diffusion and emotional regulation skills to return me to balance in my responses. I could maybe try a 'loving kindness' meditation (UCLA Website: https://itunes.apple.com/itunes-u/mindful-meditations/id434136047?mt=10#ls=1) But I have struggled with one massive obstacle - suddenly the old default to self punishment has reignited and I am finding it very difficult to find reasons to be compassionate towards myself.

The heart of the problem is the problem of my heart towards myself. Suddenly, my assumptions about myself are challenged by the time I've spent in treatment, by the stable relationships and friendships I have been learning to accept. Where do I begin to find validation? I am no longer capable of returning to the old failed ways of coping with extreme emotion and am on a long road towards new ways. Trouble is I'm not there yet, so I am having to take slow, baby steps that focus my mind on what compassion in general feels like and then, in turn, seeking to get used to what compassion for myself feels like. I am a work in progress:

1) Peeling off the 'protective skin': I am now aware of the protective covering which has prevented me from truly feeling the warmth and acceptance of true friends. It is for me to practice accepting their love, without anticipating rejection or abandonment - in a sense I am unlearning 'mind reading' which, in reality, I was never particularly good at. I am learning a new skill and that is taking people at face value - if someone is kind, it doesn't mean that there has to be a sting in the tail. The people in the here and now are not the same people who have hurt me in the past and they should not be punished for the wrongs of others. The song Innocent Man by Billy Joel comes to mind. If I can learn to risk myself in friendships in small steps and learn that now is not then, maybe I can allow the protective 'skin' to be removed.

2) The Child inside Me deserves some Compassion:I need to learn that the child who was so hurt and whose fears and pain still surface from time to time, doesn't deserve punishment, but actually requires some compassion from me. I am the adult who gives voice to the pain of that child and therefore, I need to be able to acknowledge that we are one and the same. If it were any other child, I would weep. If it were any other adult I would understand the struggles and seek to help. That's my challenge.

3) The Adult Survivor deserves some Credit: At some point I have to give myself credit for getting this far in life. Despite the pain of my childhood, in spite of my BPD, I have achieved a lot. Most of all, I have lived through real suffering and trauma. Too often I am looking at myself through the critical eyes of the abusive parent and I owe it to myself to accept that I am one strong woman simply by virtue of the fact that I am still here. Anything else is a bonus and credit to the skills and character that drive me on to be the voice of the child I was and to become the person who has taken every twist and turn of my life and used it as a stepping stone to a better quality of life, than I have known previously.

4) Healing and Recovery take Time: Time is not a luxury but a necessary gift to myself as I move towards healing. It took me well over thirty years of breakdown and rebuilding to get to where I am. Healing will take time and I won't always get it right - skills can be learned quickly but take a lifetime to master. DBT skills can help me to manage my BPD, but they will have to become an intrinsic part of my life if I am to manage my condition effectively, long term. In addition, sometimes I will still need to find time and space in which to recover - and that's ok, because surely taking 'time out' has got to be better than self destructing as a response to difficult days.

If you are like me, someone who is a perfectionist, someone who has exceptionally high expectations of yourself, try to open your heart to yourself, in the same way as you open your heart to others. You know how to be compassionate, just try turning it on to yourself.

Is there such a thing as the 'right victim'?

Trigger Warning: this blog deals with difficult issues raised in the media recently and talks about the impact of rape and sexual abuse on victims. Do not read if you would find this subject distressing.

In the past couple of weeks there have been a lot of stories about victims of sexual assault, rape and abuse. Most commentaries on these stories seem to have included a lot of what I think are 'excuses' for the perpetrators of what are, rightly considered devastating crimes.

I'm wondering when the public perception of rapists and abusers changed? I mean does it depend on whether a victim is successful in the court process, whether they come from a 'nice, good family' (direct quote from Australian police about a 14 year old victim of a gang rape by 5 men!). Whether they are perceived as being 'unstable', or 'one of those women'. Does it really matter if a woman was drunk, when her rapist took advantage? Does that mitigate the crime, as has been suggested in some court proceedings? Really, what kind of man is satisfied with a sexual act with a semi comatose woman?

Surely, these kind of crimes say more about the perpetrators' distorted views of human relationships, than the failings of the victims. I don't normally use this blog to speak about victim issues, sometimes its too close to home for me and I need to know my own boundaries, but recent portrayals of victims of crimes ranging from sexual harassment to child rape have prompted me to respond with one or two thoughts.

1) Look at the Emotional Impact. It has beggared belief that in some recent high profile court cases, victims who have sought to bear witness to their experiences have been castigated for 'gaps in memory' or 'being emotionally or mentally unstable'. Now anyone who has any knowledge of surviving traumatic experiences will tell you that emotional distress, especially when it is extreme, is indicative of highly damaging life experiences. Often, depersonalisation and detachment are essential tools for survival. Nowhere in the court process is there room to ask, what part do 'gaps in memory' serve in helping someone survive? No one in the process seems to have given the victim any opportunity to answer the question, 'what has happened to you to make you so distressed?' It seems that in an effort to present 'the facts' our court processes discount the emotional impact, when often that is the most powerful evidence of a crime having taken place.

2) Visible Scars are easier to accept. When someone has recovered from a serious physical assault and appears in court, there are often graphic images taken from all sorts of angles, of the wounds inflicted. For the victims of sexual crimes, often the wounds are so deep and so hidden, that it is hard to see the real impact on the victim. Especially, in the cases of historical abuse when adult survivors seek to give voice to child victims, the long term effects of abuse cause prosecutors to view their key witnesses with suspicion. I mean, who wants to take the risk of putting a witness in the dock who's going to 'go to pieces'. My question is, what training is there for police, prosecutors and others in talking to victims of abuse? In my ten year experience of working in the criminal justice system, victim issues and particularly the more problematic area of victims of sexual and domestic abuse, receives scant attention in training for those involved in bringing perpetrators to justice.

3) Scapegoating the Victim lets the Perpetrator off the hook. I have extensive experience of working on rehabilitation programmes for perpetrators of domestic abuse and sexual abuse. No one wants to consider themselves the 'monster' that the papers portray, so victim blaming or total denial of the offences is the default for most of those who have been convicted of offences of this nature. If they are encouraged by media images of victims as being even partially to blame for their crime, then this allows an 'escape' route for them to avoid facing up to the impact of their own behaviour on their victims.

One the first hurdles to overcome is a strong sense of self pity and if we, as the public, give perpetrators 'an out' such as there being such a thing as a 'deserving victim' then, the hope of challenging deviant and criminal behaviour becomes so much harder. I have had conversations with men convicted of extensive sexual abuse of minors state to me that 'She (aged 7) was so provocative... she led me on...' It is horrifying enough to encounter this as men seek to avoid the inevitable realisation of the life long damage they have inflicted on their victims. What horrifies me even more is that on no fewer than two occasions this week I have read of court decisions and statements by Judges which have included 'mitigation' such as 'the (11 year old) victim gave consent to her (20 year old)' rapist. Am I alone in feeling that there is something significantly wrong with our society if the very system designed to punish and rehabilitate offenders is repeating the same justifications as convicted sex offenders?

4) Sex without consent is Rape. I don't care if it is a stranger on a street, someone that you have just met, or within the context of a marriage, if a person tells you that they do not want to engage in sexual activity, then to proceed against their wishes (even if they are unconscious - especially if they are unconscious) is to commit a serious sexual assault, no matter the nature of the sexual activity engaged in. Rape is rape is rape is rape. It seems simple, if you meet resistance of any kind, STOP. Ask. Check it out with your partner. If your 'partner' is so drunk they can make no sense, then to proceed is to make you a rapist and to inflict real emotional and physical damage on your victim. Be honest with yourself, if you wouldn't treat your sister or mother, or aunt in the way you are treating (and often talking about) the woman in front of you, then why do you think it is ok to carry on? I also don't know when the concept of 'playing hard to get' stopped being about avoiding dates, or saying no to a relationship and became 'saying no to sex' but meaning 'yes'.

Why assume that women who are feeling out of control because of alcohol or drugs, must be bound to 'enjoy' the experience of sex in those circumstances? Is it me, or is this similar to the justifications of the prisoners I worked with who were convicted of raping children? 'oh she was playing games', 'she led me on', 'she wanted it'. What part of 'no' or even just the inability to speak don't you get? Again, I ask what kind of man gets satisfaction from completing the sexual act with a woman, who to all intents and purposes is not present at all? Worst of all when did the courts buy into this farago as mitigation for rape?

5) Not Guilty doesn't mean that the victims have lied When alleged abusers have been found 'not guilty' it does not mean that the victims who have acted as witnesses have lied. Rather, the constraints of the criminal justice system are such that there needs to be burden of proof that often is missing in historical abuse cases to allow juries to find, 'beyond reasonable doubt'. Unfortunately, for the victims of rape and abuse who have gone through this process recently there has not been enough support in place to help them survive the verdicts. In one tragic case, one victim was so distraught by the verdict that she took her own life.

Finally, when a victim of abuse or rape takes the steps to report the offence to police and then goes through the lengthy process of putting themselves in front of a court room, they do not do so lightly. There will be no balance in justice until victims of these offences are offered understanding and support through the trial and then in the aftermath, regardless of the verdict of the court. Certainly, the courts should not be forums where rapists and abusers can extend their abuse of individual victims, which unfortunately, due to the propensity of such offenders to plead not guilty often happens. Granted those who are innocent deserve their day in court, but it is rare and refreshing to find out that someone accused of such offences has 'pleaded guilty to prevent further injury to their victims'.

The Joy of Feeling Small

I love images that remind me of how big and wonderful nature is. This Turner painting is one of my favourites, as it captures the awesome power of wind and waves.

Having experienced sailing, it is always easier to be in the boat as it rides the waves and uses the wind to power it forward. My focus at the helm is to be on the fixed points which show me reliably the safe direction to head. What I have learned from sailing is that the winds and waves come and go unpredictably, I only have control over myself and the ropes and rudder in my hands. What helps me be effective in surfing the waves and using the wind, is my ability to calm myself and observe the wind direction, strength and sense it's rises and falls.

In other words, there is no better example of being truly mindful of your environment than when you are sailing. It is a powerful lesson, in accepting life and circumstances as they are, and making the most of them to propel myself forward in life.

When I look into this painting I don't see a ship in danger, I see a ship that is surviving and managing despite its brokeness to ride the stormy waves.

My DBT House

This morning I have been preparing a session for my DBT Graduate Group which is due to meet on Tuesday. I found it on a website for counselling for children. I thought it would help our group as we try to set ourselves medium and long term goals. You see, for a group of people for whom identity is an issue which is central to our disorder, even being certain about who we are at any time is a struggle. So, we have been struggling as a group and as individuals to set any definite goals.

When I came across the DBT house, it didn't matter that it had been designed for children. As a former teacher and communicator I understand the effort which goes into engaging children in learning. Why do we inflict static learning on adults so often, powerpoint, anyone? Who said learning couldn't be fun for adults too?

First draw a house. It can be any style, but must have: a floor, a door, a roof, a chimney, 4 floors or levels and above the house a Billboard.

Now on your drawing write or draw the following:
1. On the floor (foundation) list the values you hold dear.
2. Along the walls write anything or anyone that supports you.
3. On the roof name the things or people that protect you.
4. On the chimney list ways that you ‘blow off steam’.
5. On the Billboard list the things you are most proud of.
6. On the door write the things you keep hidden from others.

Now draw the following on the levels of the house:
1. Level One: Behaviours you are trying to control or areas of your life you want to change.
2. Level Two: List or draw the emotions you want to express more, or more effectively.
3. Level Three: List all the things you are happy about or want to feel happy about.
4. List or draw what a life worth living would look like for you

It's a simple idea. One that actually builds on what has already been achieved. Despite what the storms and instability inherent in our experience of BPD tell us, we can only have survived if some basic essentials of identity have remained in place. Once again we are reminded that relying on our emotions and the thoughts driven by them are not reliable foundations on which to build our sense of self.

Instead, as I have worked my way through this exercise I have recognised that I do have some very strongly held values: kindness, compassion, a belief in justice. I have also learned that rather than being abandoned by every friend I have ever made, I have maintained some key relationships that have survived the ups and downs of my life. I am essentially likeable - that is what a fact based assessment of my relationships tells me. My feelings no longer drive my life, I am free to set myself small goals to help me achieve a more balanced way of living. More than anything, this exercise encourages me to see my recovery as a work in progress, one which is positively building a 'life worth living'.

Treat the Past as a passing Visitor, not a Permanent House Guest

When the past comes knocking, I have some choices to make. I can ignore the knock on the door, or I can open the door and face it, or I can open the door, invite the past in and ask it to live with me. Each response will have its own consequences good and bad.

Too often I have lived with the past as a permanent house guest. It has lived in my mind with memories and waking dreams that keep the pain of past traumas alive. In a way, I helped it feel at home in my head, by engaging it in conversation, I thought I would be able to 'understand' my past and find reasons why and why not. Instead, it became comfortable and made itself at home. So much so, that I missed a lot of my present, simply because looking after my 'house guest' left me emotionally exhausted and unable to engage with the here and now.

As I have worked through the Dialectical Behaviour Therapy programme, the importance of the Core Mindfulness Module has become central to my letting go of the past and its hold on my life. It doesn't mean, that suddenly I don't have to deal with flashbacks or disturbing dreams, but it does mean that I don't have to let the memories and emotions from the past spoil my present.

When I get the inevitable knock at the door and I know it's the past lurking outside, I open the door, I acknowledge that the familiar visitor is there again. No longer, do I have to invite the past in, to make itself comfortable in my head. 'You shall not pass'! Having acknowledged that it's visited again, I close the door on it and return to my life as it is - in the present.

Here is a simple explanation of the What and How skills of basic Mindfulness:

Learning to keep your mind in the moment….

Stop Your Mind Racing… (WHAT skills you use…)

Observe

* Just NOTICE the experience – Don’t react, don’t analyse
* Have a TEFLON MIND – let thoughts, feelings and experiences just pass through your mind – don’t focus on them or hold on to them, let them SLIP AWAY
* Keep your FOCUS – don’t get distracted by thoughts or sounds or sights that take your attention away from what you are doing right now.
* Be ALERT and aware of every thought, feeling and action that come to your mind.
* WATCH your thoughts coming and going. Notice each feeling – as they come and go like waves. Notice exactly what you are doing.
* Use your SENSES – when your focus slips use one of them to bring you back to the here and now – ‘Stop and Smell the Roses’'Wake up and smell the Coffee!'.

Describe

o When you notice something – Put WORDS to the EXPERIENCE eg in your mind say ‘I’m feeling sad’…. Or ‘my stomach muscles are tightening’… or ‘I’m thinking I can’t do this…or ‘I’m walking one step at a time…’
o PUT YOUR EXPERIENCE INTO WORDS – as if you were commentating on what is going on. Don’t analyse or criticise.

Participate

o COMPLETELY LOSE YOURSELF IN THE MOMENT – get involved in the here and now. For example, Don't just listen to the music, really enjoy it and when the urge comes over you, dance - madly, badly and with your whole body committed to the experience.
o GO WITH THE FLOW – dance to the music, sing along, whatever is needed in the here and now.
o Actively PRACTICE your new skills
(see previous post: http://bpdlifeinthemoment.blogspot.co.uk/2014/02/you-mean-i-have-to-keep-going-with-all.html)

‘Taking every thought captive….’ (HOW you use your skills….)

NON-JUDGEMENTALLY
• See but DON’T EVALUATE. Stick to the facts. Don’t think about ‘good’ and ‘bad’, or ‘should’ or ‘shouldn’t’
• UNGLUE YOUR OPINIONS FROM THE FACTS
• ACCEPT each moment as it is
• ACKNOWLEDGE both the helpful/wholesome around you and also acknowledge what is negative/harmful.
• DON’T JUDGE YOURSELF

ONE-MINDFULLY
• DO ONE THING AT A TIME – When you are eating: eat. When you are walking: walk.
• LET GO OF DISTRACTIONS – if your thoughts or feelings distract you from what you are doing, let them go and go back to what you were doing – and keep doing it again and again.
• CONCENTRATE YOUR MIND – don’t multi-task, if you find you are trying to do two things at once, stop and go back focus on doing one thing at a time.

EFFECTIVELY
• FOCUS ON WHAT WORKS – do what needs to be done in each situation.
• PLAY BY THE RULES – don’t cut your nose off to spite your face.
• BE AS SKILLFUL AS YOU CAN – in the situation you are actually in.
• BE AWARE OF WHAT YOUR OBJECTIVE IS – do what is necessary to achieve them
• LET GO OF ALL THE NEGATIVES THAT HURT YOU AND DON’T WORK IN THE SITUATION AS IT IS. 

Tell the past where to go and remember:

The Past is History
The Future is a Mystery
Right now is a gift, which is why it's called the Present.

Self Soothe Image...

I find it comforting to be among nature that feels so gigantic compared to me. I've always loved standing on the shore with wild, windswept waves lashing the sand. I enjoy the sense of dizziness from being surrounded by the sheer enormity of large mountains as I pass through and I have learned to love the solidity of trees - none more amazing than Redwoods - so reassuring to walk among living things that have been there thousands of years - and when I can't be there in person I love using great photos to imagine myself right in the middle of these wonderful forests....

Time to Talk

I sat in my car, dumbstruck, wondering whether to just continue on to work, or if there was suddenly some seismic shift in me since I set out for my assessment appointment that morning. I had been struggling with Mental Health issues which I thought were related to the stress of my job for the past year. My Manager was aware that I might be suffering from bouts of depression. This, though felt really different, somehow I didn't feel as free to talk about 'Complex Mental Health Issues' with my employer. Instinctively, I knew that a label was going to change everything. And this one had a lot of baggage attached - Borderline Personality Disorder (BPD).

Being a creature of habit, I continued on to work and debriefed my Manager, deciding that both she and I were the same people we were the day before. I also decided to trust in the good sense I respected in her as a colleague working with challenging people. I was right. Together we wondered about the label and what it actually meant in practical terms for my job and me as a person. It is hard to find a good Manager, but when you do, really appreciate them. So hurdle one was over, I had told my employer that not only did I have a Mental Health problem, but it was one that I really was only beginning to learn about.

Unfortunately, the procedures in place and the attitude of the Senior Managers in charge of my area were not as compassionate about my diagnosis as the person most responsible for my day to day work. Suddenly, from being supportive the shift in sickness procedures became a focus on whether or not I was a risk to my cases. This shows a shocking lack of understanding of mental illness in general and BPD in particular. Again and again, I was referred to Occupational Health with the same questions, was I safe to be left alone with violent offenders? What impact was I likely to have on my colleagues? Sounds ridiculous seeing it in black and white, given that I had worked happily and effectively for the same team for over five years. Amazing that suddenly, I was the risk to be assessed, rather be the assessor of risk which was one of my roles at the time. Finally, they decided that they needed to pay for a private Psychiatrist (somehow all the assessments and support being given to me by the NHS had become suspect as they were all emphasising that my risk to others was minimal!!) who fudged the issue by asking me my opinion!

In the end, a combination of this ongoing process every time I took a dip in mood and the worsening of my symptoms forced me to consider an offer of voluntary redundancy. I think this kind of treatment by employers goes on without challenge simply because the cost of standing up for yourself, along with dealing with your mental illness, is just too difficult to contemplate.

A diagnosis of mental illness is isolating. Suddenly, you're not sure who and what to tell. Every conversation becomes a risk. For me it has been painful at times to realise that some friendships which have lasted a long time, foundered when my problems had a definition and a way forward. Although there are problems with the diagnosis and the label, it opened up hope that I could overcome it with effective therapies. I've had various responses from 'Rubbish, you're just depressed'... (the fact that they can say, 'just' depressed alone, gives an idea of the misunderstanding out there of the impact of mental illness),to 'don't be ridiculous, you've got your own house, car, job'.... to 'but you're so normal!'. These responses show out and out ignorance of what mental illness is and who suffers from it.

More subtle were the responses which initially seemed supportive, but as time went on and they realised that not only was I seeing a CPN, monthly, seeing my GP monthly, but I was also expected to attend twice a week for treatment at my local Mental Health unit, they started to tell me that it was silly the amount of time being taken to 'help' me. After all I had managed for over thirty years without this level of intervention. I guess these reactions demonstrate how far I had managed to mask the worst of my symptoms from those around me. By the time I was diagnosed - no one in my life at the time was aware that I frequently self harmed and that on a daily basis, I thought about suicide. Frequently, I was so overwhelmed by negative emotion that I could not function outside a work situation. When that environment was removed from me, some of my symptoms were suddenly more evident to my friends.

There is a perception of Mental Health problems as being something to be afraid of. I have begun to speak in public recently about mental health stigma and have been shocked that prejudice is found in all sorts of people from all walks of life. One of the responses is, 'but you can't have a complex mental health problem, you are not a violent person', which shows the need for real education about real people with real mental health issues. The fact is that you are more likely to be the victim of violent crime when you have a mental illness, than you are to be a perpetrator. As with many taboo subjects, headlines and media mask the truth and facts are neglected in exchange for selling more advertising, papers and programmes. I have found that this 'them' and 'us' gulf is best closed by speaking openly to people - when I'm well enough. I have also developed an upfront attitude to explaining why and where I can't cope with certain situations - 'I'm sorry being around people today is just too painful for me.' I no longer do things out of deference to other people, I am learning that when I am struggling with my emotions I need to care for myself, in the same way that I would care for myself if I had 'flu. And instead of making something up I let them know that I am unwell, just as I would with 'flu. After all both my BPD and the times when I have 'flu just tell me that I am a human being.

It is amazing that Mental Health is a subject that seems to be shrouded in mystery, something that is only discussed in hushed tones in corners. We may laugh at the older generations like my parents who refer to mental health problems as 'having trouble with your nerves'. But I'm not sure that modern attitudes are actually any more enlightened. They may have terms like depression and anxiety, but understanding has not developed any further than, 'why don't you get out and about, some fresh air and try to feel better!' Unless people actually HEAR what those of us with Mental Health issues say about how we are affected, then their understanding cannot develop any further. And if we are not engaging them in the conversation, then certainly no one is going to feel comfortable bringing up the subject.

The main thing I've found as I've spoken to different groups locally is that there are so many people out there who think they are the only ones who are struggling with mental health problems. The more we can talk to one another about the facts and reality of our illnesses and conditions, the more people will feel less isolated. Also hopefully the more people get to know individuals behind the diagnosis, the more they can see, that actually it's not 'them' and 'us', but it's any one of us who can be affected by Mental Health issues.

Acceptance is not Approval

Trigger warning: this blog deals with my personal journey through childhood trauma to forgiveness and may bring up some difficult issues - if this is likely to affect you please give this one a miss

"You know what your problem is? You've never learned to forgive."

For a start, when someone's opening gambit is to tell what your own problem is, you know the conversation is not going to be going anywhere positive. Secondly, the person speaking had never actually talked to me in sufficient depth to know if I had anything to forgive at all, let alone the real story. The reality is that I am learning to accept that I suffered physical, sexual, emotional and psychological abuse from a number of people in my childhood. Because it has been my journey, it has taken me a long time to accept that what I took to be a 'difficult childhood' actually was full of traumatic events. When you are the one living through and surviving trauma, then 'normality' very quickly becomes a distortion of other people's reality.

Forgiveness is a huge subject, for me it is central to my overcoming my past. However, no matter how I have found the process of forgiveness I don't believe that I can prescribe the 'how to' for anyone else, no matter how closely our stories may resemble one another. That is because I have learned that just as my experience of emotional and mental instability is unique to me, so my journey to forgiveness is equally unique.

I would say, though, that forgiveness is a crucial process on the road to recovery from trauma caused by other people's abuses. I do not believe forgiveness to be a single act (or determination) of the will, but it is a long and, often painful, process.

First, I have to acknowledge that I have been the victim of a wrong done to me by someone else. For me, that meant allowing that at the age of 4 or 5 I was not the author of my own physical and emotional scars. I have had to learn to view myself with compassion, often the same compassion I usually reserve for the pain of others. For some traumas this has taken me my whole lifetime, due to the depth and extent of the scarring.

It does not help to compare my wounds with those of others. I do not know what someone else has had to endure or is able to tolerate compared to me. I am not able to feel the physical pain of another person. In the same way with emotional scars and pain, I can never truly say 'I know exactly how you feel'. I may be able to say 'I think I can understand where you've been....' No one has lived my life, or survived what I have survived, so no one can know what I feel I need to forgive. It is only I who can decide who and what to forgive. And only I know when is the right time for me to forgive and 'let go'.

Second no one can decide what Justice means for me. For some, there is a need for retribution, for the validation of going through the full formal justice process. I am not able to tell another victim or survivor of abuse what Justice is for them, I only know what my need for justice is and whether I feel I need to go through a formal court process for me to feel I have achieved it.

A number of years ago I decided that I would not pursue any formal charges against those who had hurt me, because I did not have a need to protect any others at the time from abuse, and because to do so would have caused enormous hurt to others who mattered to me. I believe that there is a natural justice which has meant that I have been able - in time to leave Justice in other hands than my own. This sense of letting go has not been easy, there has been an ongoing process of recognising the wrong, acknowledging I have the power to choose which path to justice I follow and being prepared to leave the wrong doers to God/fate or natural justice, call it what you will.

I have not been able to confront any of my abusers directly and therefore, there has been no restorative process of them asking and then me choosing to forgive them. Rarely, are victims offered this opportunity, simply because of the complexities involved in the relationships between perpetrator and victim. Forgiveness, then becomes an important part of my healing process, which allows me take control and without any reference to the perpetrator, to be able to choose to forgive. This has been necessary in some instances as I have decided to maintain some kind of relationship with some who have abused me. In this process, there has had to be a radical acceptance of the fact that often those who are closest to us, may never be able to acknowledge the wrong they have done to us. Therefore, for me to move forward I have to recognise that I am the one who is capable of recognising the situation as it is and either accept it or change it. Ironically, I have found that in accepting that I can forgive without seeking retribution or justice, I have also changed my attitude to the relationships involved and therefore I have allowed myself to move forward in my own emotional healing.

The most important thing for me to say is that acceptance is not approval. Just because I accept that I was a victim, and that my abusers will never acknowledge the wrong they did to me, does not mean that my forgiveness is some form of tacit approval of the actions which caused the wounds.

Rather, I have accepted that I cannot change the past, I have accepted that there is an inner strength which has been a result of surviving my past and finally, and most importantly I have accepted that those who have hurt me, as well as the wounds from the past do not have to keep me chained up for the rest of my life. Ultimately, forgiveness and acceptance of the past frees me to enjoy the strength of character my life's journey has created in me and to stop those from the past from continuing to hurt me in the present. I am free to be myself, with all my colourful complexity, in the here and now.

Ten Tips for a Mindful Home

10 Tips for a Mindful Home

1. Wake with the sun – there is no purer light than what we see when we open our eyes first thing in the morning

2. Sit – Just be Mindful of you, your surroundings, forget the distractions of intrusive thoughts

3. Make your Bed – The state of your bed is the state of your head. Take care of your surroundings.

4. Empty the Laundry Basket – Do the laundry without resentment or commentary – focus on what you are doing, be aware as you deal with different fabrics. Use your sense of touch and smell.

5. Wash your bowl – Rinse away self-importance and clean up your own mess. If you leave it undone , it will get STICKY and longer than 24 hours will be CRUSTY!

6. Set a Timer – If you’re distracted by the weight of what’s undone, set a kitchen timer and, like a monk in a monastery, devote yourself wholeheartedly to the task at hand until the bell rings.

7. Rake the Leaves (vacuum the dog hair) – Rake, weed, sweep. You’ll never finish for good, but there is satisfaction in the job itself.

8. Eat when Hungry – Be aware of how full you feel as you eat. When you feel full, stop.

9. Let the Darkness Come – Set a curfew on the internet and TV. Discover the balance between daylight and darkness, work and rest.

10. Sleep when tired

You mean, I have to keep going with all this Mindfulness business?

When I finished my main DBT skills group it took me some time to realise that all the benefits I had gained wouldn't magically remain without some effort on my part. It's a shocker, but no treatment for long term mental health problems will help without considerable effort from me. It's not as if I wasn't warned - we had 'homework' every week and we had one to one sessions every week to help us make the skills relevant to our real lives. So why did I think that magically, the symptoms I had suffered for over thirty years would just disappear, without some significant effort on my side?

And yet, I have found myself surprised when my negative soundtrack reawakens inside my head and I lose the balance of 'wise mind' as 'emotion mind' rears its ugly head. With a start I realise, hey 'you haven't been using your mindfulness to keep on track.' Now if I weren't being mindful, that statement would be accompanied by a hefty dose of judgement. However, just because I have lapsed a bit, doesn't mean I haven't made progress or that I should even consider giving up. Life is full of ups and downs, trial and error, failure and success. The most important thing is that I have NOTICED that I'm slipping back. Falling down is not the end of the story, I can get up again and get back on the DBT horse. It would be a waste of all the effort, all the learning to live with difficult emotions, all the pleasure I have learned to find again in life, if I just give up on the things which have helped me recover so far.

So, yes, I do have to keep going with all the DBT skills. They do help me, I know this because it is obvious when I'm not using them to manage my BPD symptoms. Full recovery will take time and effort, and practice, practice, practice. After all, I had over 30 years to hone those unhelpful emotional and cognitive habits.