Tuesday, 22 April 2014

I'll Name that Feeling in One....

Trying to manage BPD symptoms is difficult for a number of reasons. The waves of emotions often come unbidden and are overwhelming so that most of my energy is invested in just surviving until the distress caused by them passes. One of the most confusing and distressing aspects of the condition is that often it is impossible to tell myself and others just what emotion is overwhelming me at any given time. The Emotion Regulation module of DBT begins with identifying emotions. There are a number of skills and tools that I've learned to use. First I try to slow the impact of the emotions down by just breathing. This seems to a) slow down the crashing waves of emotion b) gives me time to recognise thoughts attached to the emotions and then to begin to recognise what those emotions are.

In addition I have had to learn what feelings and emotions 'look' like. Learning about what feelings look like in others helps me to understand when my body reacts to the emotional storms inside. For me this has not been an automatic skill and I have had to work hard to do so. I have been pleased to come across some tools on t'internet which have helped me play around with recognising how emotions appear on my face. It also helps me to have a list of types of emotion to help me identify both happy and sad feelings. I thought I would share some of them with you. Some of the most fun and effective for me have come from counselling resources for children. But who said they have the monopoly on fun ways of looking at their problems?

I love these charts for showing facial expressions. Especially love the Muppets one - for some reason growing up I really identified with Oscar the Grouch on Sesame Street. This has helped me to stop and consider the impact of my own mood on others. I have a face which is like an open book - no emotion is hidden from others. Funny to think back on the number of times I was surprised that people could read me. Thankfully now through life experience and DBT skills training I have learned to read others the way they read me.

This is a 'big girls' feelings tool. Starting at the middle with the basic emotion, it allows me to identify the nuances and little niggles which can often grow when neglected or stoked by me.

When I am able to give the feeling a label then I am able to use skills to manage the emotion and feel more in control. I can use self soothe to lift my spirits when feeling sad, or I can use exercise to run off anger or frustration. I'm still learning and sometimes I end up breathless and panicky because of the strength of emotion sweeping over me. But more often now if I can name the feelings I can use my skills to stop them from driving my life.

Monday, 21 April 2014

Not all Memories are to be Feared

I used to fear remembering my childhood. There was too much pain. One thing I have learned in managing the symptoms of BPD is that even in one hour of time, there are different shades of light and dark that make up my experience. As I have developed skills to enable me to cope with distress and painful emotions I have tried to 'redeem' the good things from my past. I started with music. I love music too much to allow the bad things that have happened to me, stop me from listening to music that can bring me real enjoyment in the here and now. Things like places to visit, films, music don't have to attach to negative memories.

I have a tendency to ruminate and I used to 'wallow' by listening to what I call 'slit your wrist' music - but as I have started to recover I realise that feeling wasn't within the music or the experience I am remembering - it was coming from me. Different visual and musical arts express the range of emotions, that's what draws me to them. It's great to find outlets for my overflowing emotions. Or should I say, it's great to find 'safe' outlets for my overflowing emotions. That is what has been so liberating about redeeming expressive things like photos, paintings and music.

Recently, I have started to move on to redeeming my memories of favourite places. And there have been many. I come from a beautiful island - Ireland. There is so much to see and we did get out and about as kids. Today is a Bank Holiday and it is sunny the kind of day we would get in the car and drive (not far - nowhere is far in Ireland) down to the coast or into the country to visit amazing places. I love history and history was all around me growing up. For so long the enjoyment and escape I enjoyed in visiting these places was lost as I was overwhelmed by painful things from growing up. It is so vital to reclaim those things that actually fed me emotionally and kept me going, even when I didn't realise it at the time. I wanted to share two particular places that have been so special to me.

This is Portavogie Harbour. We would end days out sometimes here where we would buy 'potted herring' take them home and have them for tea. The fish here was always snap fresh.

Mount Stewart is my favourite historic place to visit. We had school trips and day trips as family to this wonderful house with amazing grounds. It is on the shore of Strangford Lough as well. Strangford is famous for having 365 islands and being a unique area of natural beauty because it is a sea inlet.

In places like this I could escape and enjoy imagining life in different worlds from my own. They provided a sense of safety for me that helped me to survive. In addition, they helped to feed my creativity - something which has stayed with me into my adulthood.

Saturday, 19 April 2014

The Robinson Crusoe Effect

When I was young I used to enjoy television on a Saturday morning and one of my favourites was an old black and white dubbed version of Robinson Crusoe. Apart from the ace title music I loved the story of a man who was on an island and was desperate to get off it. My child’s view was that, of course Robinson’s efforts were all about getting off the island and back to society. However, when I studied the original novel at University I realised that Robinson’s story was much more complex than that. After many years he had adapted to life on the island until the thought of rescue in the end became something that was bittersweet.

Life with a mental illness has been described in many different ways and one which resonates with me was from Sylvia Plath, the American poet. In an autobiographical novel describing her lowest points in her late teens and early twenties she described her life with Mental Illness as being like life inside The Bell Jar. I have related to this on many occasions, as sometimes it feels as if I have been trapped in a vacuum sealed glass jar; others could see me, but I had no way of making them hear me. At times the best way I could find to describe this was that I was 'inside my own head, screaming'. If you have felt the isolation brought by depression and other mental illnesses you may relate to this sense of being cut off from the rest of humanity.

Like Robinson Crusoe, depending on how long you may have struggled with mental illness, you may find yourself feeling in two minds about ending the isolation. On the one hand, emotional distress is exhausting and there is little energy to cope with others. On the other hand, remaining isolated from others only confirms some of the more negative thoughts about yourself and stop you from receiving emotional energy from others.

For me life on the island of Mental Illness was painful, but ultimately, I was 'safe' from humanity. Basically most of my emotional and psychological wounds were the result of the actions of others. This along with the combination of my biological predisposition has meant that I have battled psychological maelstroms all my life. When I was diagnosed and offered 'shelter' in MH services, I was able to find some respite from the dangers of relationships. I have been quite happy not engaging to any emotional depth with anyone over the past nearly fourteen years, since the last traumatic breakdown of a relationship. Being 'in treatment' has meant that I have had a focus on managing my BPD and it was a convenient excuse to ignore the need to engage with anyone outside my therapy bubble. Except, I have reached a point where I feel strong enough to manage relationships. I don't trust everyone yet, 'In God I trust, all others have some way to go to prove themselves...' But I have let some people in and it's been ok. I know I am healing because I can say I am fond of certain people and look forward to their company. I still enjoy my times of solitude, but I am no longer in danger of going for weeks at a time with no human contact. I would say that I have learned that in order to cope positively with my relationships and friendships I know I will continue to need those times on my own to recharge my emotional batteries - people I think will continue to tire me.

I have now been given a date for my final discharge from Mental Health services. I know that it is testament to the journey I am completing (at least this stage). I am happy that there is equilibrium in my life. It's not perfect. I still react emotionally in situations that other people take in their stride. I continue to battle some of the demons from my past. I have developed new skills and rather than my BPD (Borderline Personality Disorder) controlling me, I am feeling that I can ride it's storms and maintain a level of stability which will allow me to step off my island and sail back to 'the mainland'. However, I am aware that I have been sheltered on my island, I have had safe places and people to whom I can speak to about my ongoing battles with my emotional extremes. I am at the point on my journey to recovery where I can see the docks looming into view and will face the prospect of walking the gangplank back to the life I was ripped from about five years ago. It's a scary thought.

However, I'm not going back to the same country. Anymore than Robinson Crusoe would recognise the world that awaited him back in England, following his many years on the island, the place I left behind no longer exists. Many of the friends I had then have fallen by the wayside. Some gave up on me, some have considered me 'lost at sea' and others just haven't been that interested in maintaining relationships in general. There are other friends, though who have strengthened the friendships with me because we have weathered the storms together. They have patiently waited for me to return from my desert island. These relationships rather than the therapeutic relationships are what will sustain me through my recovery.

I still face the pain of the final separation from people who have been really important to me, who have helped me, who have been privy to the most intimate details of my heart and soul. That's not an easy transition to make. In the past I have moved on too quickly, I have not allowed myself time to grieve friendships and relationships. The process of leaving services is yet another opportunity to learn a new way of doing things. Of allowing myself to feel grief and know that I can live with it. What is different about these therapeutic relationships is they have been honest, straightforward and have delivered what was promised. When we have had issues I have felt confident enough to be honest about the impact of mistakes on me - what has been refreshing is the level of self confidence in my CPN and therapist which has meant that they could own mistakes and we could work through the implications together.

My journey out of services has above all, been well planned. This ending has not taken me by surprise, and though I can acknowledge that it will be a difficult transition, I know I am ready to return to life after the island.

Tuesday, 15 April 2014

Saving the Starfish

There was once a little boy who loved splashing about and foraging in rock pools. For hours on end he would carefully lift rocks and stones to reveal the miracles of nature beneath. Each little pool was a mini world and he saw himself as some sort of benevolent super being 'freeing' each creature from their 'prisons' under the rocks and boulders along the shoreline. He didn't stop to think about the worlds and lives he was upending. Yet, somewhere at the back of his mind was the knowledge that the destiny of the crabs, shrimp, cockles, mussels and other creatures were entirely in his hands. Slowly he began to become more select in the creatures he chose to help. He realised that not every crab under a rock needed to be freed from their hiding place. He began to recognise the 'safe places' for them and changed his focus from changing each creature's lot in life, to making sure there were plenty of safe places in 'his' rock pools for those he wanted to protect.

One night there was an almighty storm tossing angry waves around the familiar bays of his holiday home. With great excitement and anticipation he ran down to his favourite rock pools. A scene of devastation met his eyes. Snotgreen party streamers of seaweed, with assorted pieces of human detritus, plastic bottles, flip flops, string and tins, were intertwined with clusters of discarded fish egg sacks, jellyfish and, seemingly strewn across the whole shoreline, were hundreds, upon hundreds of starfish. The boy sank to his knees and began to sob. He had no way of saving all of the starfish. He didn't even have the ability to save any of the creatures in one of his little rock pools. The raging of the storm had cleaned most of them out, stripped of all hiding places. The storm had proved to him how useless his efforts were.

As his tears flowed he started to look around him. He began to count. Slowly an idea formed. He could reach about 10 starfish immediately next to him as he kneeled in the sand. He picked one up and threw it back into the ocean. 'Saved you.' He said as he threw it. He picked another one up, 'Saved another one.' As he walked along picking up starfish one by one, he stopped looking at the hundreds he couldn't reach, or who were beyond any help, and started focusing on each one as it lay in his hand, before he returned it to the sea. He learned a good lesson. 'I may not be able to save all the starfish, but I can save as many as I am able, one at a time.'

Sometimes we have huge mountains to climb, trying to bring justice where there is none, trying to fight against governments who seem impervious to pain, compassion, or even reasoned debates. Sometimes, we battle our own demons. We have lifetimes of trauma and pain to overcome. If we focus on the whole of the mountain, we will feel very small and very helpless.

I remember taking some 13 year olds to the Lake District to learn about climbing and abseiling. Standing at the bottom of the cliff face looking up I was so overwhelmed by the task ahead, that I chickened out. I learned something as I watched the kids make their way up where I didn't dare to go. They didn't look up or down, when encouraged by the instructor they looked at their feet planted on the cliff wall and they made progress as they moved each step upwards. Even the most frightened child managed to make it to the top and back down again. Because I let my fears overwhelm me by focusing on the whole of the task ahead of me, I was beaten by the cliff face.

There are times when it is tempting to give up trying to right wrongs and seek justice in this world. I am learning that even though I can't change the world, I can try and change the world for one person. I come across needs around me every day. I cannot meet them all on my own, but I am learning to help those immediately within my reach. I love the concept of 'pay it forward'.

As the boy walked through the carpet of dead and dying starfish he was making a pathway of hope across the shoreline. Perhaps, if more of us tried to make a difference to just one person in a small way: speaking up, educating the ignorant, supporting others who share our values and beliefs, then we will be making a start on changing the world. Don't be overcome by the mountain ahead of you, just focus on the one next step you need to take to move forward. Focus on what you can do immediately around you and you can save the starfish, one at a time.

(Credit to my friend Rachel, who keeps reminding me I don't need to take over the world, just save one starfish!)

Saturday, 12 April 2014

Kindness, Please!!

I have been musing on kindness this week. It's not been about a nebulous benevolence to all 'mankind', but rather in regard to the way that people debate with one another online. I am new to tweeting and blogging. I keep telling my friends who are sceptical about all the good that can be achieved when communities of likeminded individuals come together to support and encourage one another. Never is this more important than when publicly highlighting issues around Mental Illness.

Since I was diagnosed with Borderline Personality Disorder (BPD) over four years ago, I have faced stigma and ignorance from employers, erstwhile friends, family members and through the media. Over and over again I have had to find the strength to 'explain' my symptoms and why people can't identify me as struggling with psychological and emotional distress from some kind of 'red letter' brand on my forehead. It has been a relief therefore, to have found online a community of people who have or are going through similar experiences as me and to know, ultimately that I am not some kind of alien stranded on a planet far from my home, that there is a community I can belong to and know that when I have had a difficult distressful day, I can come online and find understanding and support. Who knows maybe the online MH community is a colony of aliens on earth! Which is why it is so important that we are good to one another.

I know others with a more articulate plea have tackled this issue, but I felt I needed to add my own voice to the requests for us not to bring one another down. As a community, we have so much to overcome, either we need one another's support or we are not a community. I have not been on the receiving end of much abuse online, most debates I have had with people have been considered and helpful in the main. I have observed a number of negative interactions with people who have achieved so much good for the MH debate and community and mourn over the distraction, as well as the distress which is added to people who have been brave enough to become a public face of Mental Health issues.

I have experienced the lashing out of fellow sufferers in real situations which have caused me real distress. I know that I have done the same when feeling out of sorts and distressed. In real situations, however, my regrets mean that I am able to seek out the injured party and repair the relationship. Online victims of abusive interactions only have one remedy and that is to block the person being abusive to them. There is no chance to repair relationships. Added to this is the fact that online arguments and debates are word limited by the applications themselves, therefore, are open to significant misinterpretation.

A long time ago, before Facebook or Twitter, I was on a weekend residential with a group of Sixth Form girls. At 2.00 a.m. on Sunday I was forced to confiscate a mobile phone from the quivering hands of a sobbing, drunken (yeah we didn't search their bags on entering the hostel!) 17 year old girl who was in the middle of a text row with her (equally) drunken boyfriend. Immature and laughable, huh? Let's look at the key factors, emotional instability, substance related fogginess and word limited communication. The next morning, I returned the phone - after the epic hangover wore off she and her boyf actually spoke to one another on the same phones - with no word limit. They broke up completely a couple of weeks later...

But you get my point. Sometimes when someone from the MH online community expresses their distress or an opinion about their treatment etc, consider one or two factors before you press 'Tweet':

1) Have you earned the right to comment on someone else's experiences? If you have not followed someone for long enough to know the context in which their comments are made, maybe you will not have the full picture - remember 140 characters when you are emotionally distressed is not a lot of space in which to adequately provide a medical or psychological history.

2) When you read your comments back, do they offer something to the original tweeter that is positive? Sometimes if I am emotionally distressed I can easily misread someone else's tweet and respond to my own pain rather than the content of their comment.

3) Are you emotionally stable? If not, should you take a break from twitter or facebook? Often, when I am feeling vulnerable and raw I tend to avoid going online, because I know I have misread emails from friends in the past and ended up feeling hurt with no reason. Take care of yourself and don't get involved in unnecessary arguments with someone online.

4) Is what you are saying helpful or kind? Think about what you would feel like if you had posted about feeling highly distressed and then received your tweet? Would it cause you emotional damage? If the answer to any of these questions is 'yes', you have no right sending that to someone else especially if you do not know them outside of the 'twittersphere'.

5) Given the character limit, is your comment open to misinterpretation? If yes, then, think twice before hitting 'tweet'.

6) Above all, ask yourself, the purpose of the original tweet - was it just an expression of someone's experience or were they really asking for you to solve things for them? Very often when people tweet their distress, all they need is understanding and the knowledge they are not alone. You don't have to solve their distress, just show you care.

7) Ask yourself, are you this person's CPN or therapist? If not, then maybe offering solutions or advice on medication is not appropriate. Again, if you don't know someone's medical history then you may be offering dangerous or misleading advice.

8) My experience of BPD is different from everyone else's experience of it. There may be similarities particularly in regard to symptoms, but I need to respect your right to tell me that things that might have worked for me, may not be right for you. If someone tells you that a treatment or medication is not right for them, please respect their right to know themselves and what works for them.

Don't forget behind those 140 characters is a three dimensional, hurting, person. If you would be kind and considerate towards that sort of person in real life, then please apply the same principles to your interactions online. After all, we have so many other battles to fight against MH stigma and ignorance. Let's direct our energy into the right battles.

Saturday, 5 April 2014

I'm Still Standing - But I'm Not Standing Still

by Dom Helder Camara

when your ship,
long moored in harbour, gives the illusion
of being a house;
when your ship
begins to put down roots
in the stagnant water by the quay: put out to sea!
save your boat's journeying soul and your own pilgrim soul,
cost what it may.

I had my final DBT therapy session nearly a month ago now. Contrary to my fears about it, my world didn't end, I didn't suddenly forget everything I have learned and practised over the past year or more and I didn't suddenly revert to the worst self-destructive crises of my BPD. Suddenly, I realise I am still standing - more than that I have not stopped making progress. I know from cycling and other 'balancing acts' that if you stop moving forward, you fall off. Choice: keep going forward, go back or fall off. Seems simple when I put it like that. Having decided to keep going forward, I am noticing that my BPD and the emotional storms that accompany it no longer control my decision making and day to day experiences of life.

Don't get me wrong. I still experience moments of panic, anxiety, sadness and anger, but no longer are they extremes of these emotions which take me over and leave me empty and desolated. More than anything I have noticed that I am no longer overwhelmed by formless clouds of nameless emotions. Instead, I am able to slow my mind down enough to recognise what the emotion I am feeling is. I can name them. In the past they felt like formless ghosts haunting me and attacking me seemingly at random.

I have had to work hard to get to this point. On a daily basis I need to practice good self care - eating, sleeping, drinking, exercising, not letting my emotions control my routines, but allowing my routines to help me manage my emotions. Primarily, rather than me relying on medication or on 'experts' who appear to know more about my BPD than me to help me, I have learned skills that can help me without having to phone an anonymous voice, or wait on someone else's diary for consultations or treatment. I have the ability to 'manage' what used to control me. It does not mean that I no longer suffer moments of panic or crisis, instead it means I no longer have to risk rejection by asking again for help.

More than that, I am beginning to build a life that is less turbulent and prone to significant 'meltdowns'. It has taken me some time to adjust to life without the battles. Almost like taking time to unwind on holiday - we never manage to be able to relax from day one, because it takes time to let our minds and bodies 'know' it's okay not to be on high alert. In the past I expected to be betrayed in all relationships, I anticipated moments when suddenly my ability to cope with everyday life would end and my life as I was living it at any given time would grind to a halt. These patterns had repeated for me so often, that I even managed, on occasions, to self destruct and pre-empt rejection, abandonment and failure. By doing this I was reinforcing destructive patterns throughout a period of 40 plus years. Then, I realised that it was possible to stop anxiety from distracting me from enjoying 'the moment' about 9 months into practicing mindfulness. What I wasn't so certain of was, whether I could continue to be able to do this outside of the structures of group skills and the regular one to one sessions of therapy.

It is frightening when you have battled to ask for the help that you need for most of your life, finally be offered it, then accept it and find that you are able to move forward, to then realise, that, because of that progress the help will come to an end. However, just as it is sad when adult children are unable to move away from the family 'nest' and establish lives and 'families' of their own, so any therapy which creates dependence rather than helping me to achieve the management of my condition, is not helpful to me in the long term. I continue to require anti-depressants and anti-anxiety medication as part of my stabilisation. I have learned to accept that, for the moment, that is okay. I am so much better than I was, but I still have a complex mental health condition to manage. I welcome the help and contact that is offered, but one day this support will be withdrawn. If it is managed well, as with the ending of DBT, then I will be more than ready for it. If not, then as so many have found it can be traumatic and detrimental to the progress made.

I have only started on my journey to overcome BPD. I am beginning to test myself and my new skills out in different settings. I am pleased to have sustained some honest relationships where I can begin to trust myself to 'feel' close to other human beings. Only in the past couple of weeks have I begun to be able to express affection towards my friends. I know this process started when I realised I was 'fond' of my dog and learned to speak to her with affection. Now, difficult people don't distress me in the way they did in the past. They have not changed, I have learned to recognise the emotional responses in me, to name the emotions and manage those emotions appropriately.

In the past it was easier to not even try to have any significant human interaction. In return my close friends are supportive and encouraging. I have surrounded myself with positive people who aren't dependent on funding or resources to stick by me. They accept me in the real world and what is best of all, I am able to sustain my relationships in the real world. So, there is no fear of what happens when 'reality' steps in. This is the main difference between coping in the therapeutic setting and coping in 'live' situations. One is 'safe' and allowed me to explore and practice skills to manage my triggers appropriately. My transition from therapy has helped me to see that I can use those same skills in everyday life and though I can't control the outcomes, I can accept that I am doing my best to manage my own life. And that brings a real sense of achievement. I was so encouraged the other day when a friend said to me 'Look at you, you are doing so well and it is shining out from you.' I hadn't sought validation, it was a natural part of our interaction together and an indication that we have a positive relationship. Now I can recognise people who are good (and bad) for me and stop wasting time on those who will bring me down. What is crucial to recognise in this process is that from day one my therapy was preparing me for the ending. However, because I was offered nearly two years of therapy (which included tapering and 'proper' exit strategy) I have been given time to move from intensive to 'light touch' therapy seamlessly. 'Ciff Face' endings particularly for BPD only create distress and ongoing need and dependence - in my humble opinion.

At the heart of DBT is the twin concept of 'Acceptance' and 'Change'. I accept my life as it is today, but I continue to work towards changing those things that I want to change, to continue to make my life better. I'm still standing, but I don't stand still I keep moving on and actively pursuing 'a life worth living' (Marsha Linehan).