Thursday, 22 January 2015

Count on It

I work in words and pictures - it's the most familiar way for me to explain the world around me. There are times though, when the cacophony of thoughts running constantly through my head, as well as the exhaustion brought on by battling the storms of thoughts and feelings, means that I cannot find words or pictures to articulate anything. That's when I need to stop trying to make sense or find words, for my feelings. There are times when I need to stop the internal 'noise' and rest my mind and emotions.

One skill I often neglect is the use of the abstract: shapes, numbers don't need any explanation and they are so emotionally neutral that regardless of the feelings I am experiencing, they cannot make it worse. I used counting and numbers in the early days of my recovery, when my mind was too tired for words and emotions were maintaining the exhaustion because I was not in control of the thoughts fuelling them. I have mentioned mindful breathing as a skill before, when I am most in need of a break from my thoughts if I couple this with counting then I can control the flow of thoughts. Here are some ideas that I've used.

1) I Simply count my breaths. It is probably the easiest way to notice my breathing and how quick or slow it is. It also means that I can either keep going as long as I want up to any number or I can simply repeat '1', '2' instead of 'in', 'out'. By counting I don't have to fight the thoughts as much because I am focused on saying the number.

2) I Count while walking. Either, again the '1', '2' instead of 'left', 'right' or make groups of numbers eg count twenty paces, then start again. This has the benefit as well, when starting to move more, of taking the focus from how far I'm walking to focus on the rhythm of walking itself.

3) Starting at 100 deduct 7 until I reach zero. The mental arithmetic is a quick way to take me away from any battles with thoughts as I need to put my mental energy into visualising the sums in my head.

4) Sudoku. I was unable to concentrate long enough to read, but the simplicity of the Sudoku puzzles allowed me to focus my mind on a restful activity, which also meant that I could build up my ability to concentrate in short bursts.

Counting allows me to make progress in small measurable steps. It is another way to press 'pause' on the flow of emotions and thoughts. In a sense succeeding at the puzzle don't matter as much as the process of focusing on the numbers themselves. Give it a go, the next time you are caught in the feeling/thought cycle. There's a reason people say to count to ten when you're angry!

Tuesday, 20 January 2015

If I can't love myself, where do I begin with self care?

Being able to feel secure in my place in the world is vital to my ability to engage with the world around me. I cannot contribute to the communities I may want to be part of if I don't feel that I am accepted or, more accurately, acceptable to those around me. I will not be able to sustain relationships if I do not believe that I am worthy of that most basic of human needs - human contact and interaction. For most who suffer from BPD (Borderline Personality Disorder) a lack of basic self esteem underlies most self destructive behaviour. I will not care for myself, because I don't believe 'I'm worth it'.

One of the hardest things I was asked to do in DBT was to say 'I love myself so much'. It still hurts to even write that. I cannot say that I've reached a point where I'm able to say it with any level of belief. A lack of self love in the past evidenced itself in behaviours which often resulted in crisis in one or other area of my life. I would spend until my debts were so overwhelming they affected my physical and mental health. I neglected my physical health - I rarely went to the doctor, what was the point? I reasoned, it would be a waste of resources - because it's me.

No therapy in the here and now can undo the experiences and relationships in the past which have stolen any sense of self worth. Even the most loving relationship in the here and now cannot hope to permeate the depths of my sense of self loathing. A friend of mine who has gone through the adoption process told me about some of the training they received on expectations of the children's ability to absorb the effects of a loving home. During training they were told that the child is like a cup with a layer of cling film wrapped over the top. Pouring love into the child is like trying to pour liquid into the cup. It cannot get through. There is a certain acceptance of the reality of the impact of invalidating early environments.

I can relate to that image. I have been unable to understand or feel that I am loved, despite having some very high quality friendships. It is true that the hurtful, rejecting relationships have been the ones that I have gravitated towards over and over again. Again I return to the core belief that 'I am not worth' any better treatment. People wouldn't ask questions about why abused women and children don't seek help, if they truly understood the cumulative impact of experiences which reinforce again and again, that I am less than, that I am someone whose needs don't matter, that I am someone who can be used and abused at will and no one feels is worthy of rescue.

So, given that has been my experience of life, where do I begin with self compassion and self care?

1) Start with the simple things. I began to regulate my sleep. As I practised mindfulness I found that I was able to fall asleep and stay asleep easier. Under the DBT Emotional Regulation skills module, the PLEASE* skills give me a guide to what to do. Sleep is the S of the skill. I don't need to worry 'HOW' practising these skills affects my sense of self worth. I just have to try something different and see if that helps me feel better. P means take care of my physical ailments - so get myself to the doctor when I need to. I started by doing that, getting help with oft recurring migraines - they used to last 3-4 days, happen 1-2 times a month and resulted in me vomiting for at least 48 hours. Getting help with medication which prevents attacks as well as practising DBT skills means that I have only had 2 attacks in the last six months. It doesn't take a brain surgeon to work out that the impact on my emotional health of getting these under control has been immense.

2) Give it a go anyway. Even if I don't think I deserve it - by practising the non-judgemental aspect of mindfulness all I have to do is experience a bath, a walk in the sunshine, massaging hand cream into my hands, putting together an ace playlist for my ipod, watching a favourite TV series in the middle of the afternoon. It took me a long time to lose the guilt, but I kept 'acting' on my plans to treat myself. After nearly two years I am able to take stock of my needs and decide how to care for those needs in any given day. This of course needs to be balanced with using other times to care for others.

One of the difficulties of being introduced to DBT Skills in a group is that not every exercise or suggestion suits every member of the group. Having said that, if I am to find what works for me, I need to get over myself and give things a go. This is one aspect of DBT Willingness, which I understand better as a willingness to engage fully with the world and people around me. My therapist asked me to try saying 'I love myself so much' using Miss Piggy's voice (remember I enjoy drama - it was tailored for me as an exercise!). This made me less fearful of the emotional power of the words and has allowed me to keep trying to say it for real - as I have said earlier - still working at it.

3) Do what you can. Initially I found it difficult to look after my health by way of my diet. So much emotion was carried in my relationship with food. I have been obese for some time, but it was only when I had been out of therapy a number of months that I decided I was ready to do something about it. I needed to build up my ability in using other core skills such as mindfulness, long before I was ready to deal with my weight. Be realistic about what you can do. Care for yourself in basic ways such as sleep, enough water and regular meals before you try to tackle things you have used in the past to help you cope with your emotions, like smoking, overeating etc.

4) Accept any help on offer. Lack of self care results in avoiding asking for help from others OR it results in me becoming so ill that I have no option but to rely totally on others for my care. There is nothing more strengthening that being able to ask for help, knowing that I have made the decision and I know how such help fits in with my own plan of self care. Having decided that I needed to feel fitter I asked the GP about help with diet and exercise. I am so glad I did because I need additional support to keep going - in our area there is a Fit Squad which means that if you are suffering from Mental Health issues you can access three months individual support to improve fitness as well as a Food for Thought programme. I've lost over three stone and have ground to a halt - so I need to go back to my advisers and ask another boost of motivation to complete the transformation. Overall, by caring for myself I feel so much better physically and am able to enjoy activities a lot more. In addition because I am practising mindfulness, I am able to enjoy the changes.

The most important thing to remember when embarking on this journey of self care is not to blame yourself or mistaking self care for selfishness. It is not selfish to care for yourself and just because your parents or others have discounted you in the past, you do deserve to be able to enjoy good things. If you keep going with looking after your physical needs, then you will find your emotional needs easier to meet too.

* DBT PLEASE Skills can be remembered as follows:

"P L E A S E M A S T E R."

treat Physical illness
balance Eating
avoid mood-Altering drugs
balance Sleep
get Exercise
build M A S T E R y

I have downloaded the Loving Kindness meditation from the UCLA website ( This again is something which will feel painful if you are starting to work on self care, but over time allow yourself to keep going - non-judgement will be your friend.

I have found these tools on American website and have pinned them on my DBT Pinterest account. They are a good graphic representation giving some ideas about how to begin with self care:

Monday, 19 January 2015

Why am I not Employable?

It creeps up on me. It's a radiating paralysis. The day to day routines I have developed as part of my recovery go on, reinforcing a sense of progression, making me feel part of something... and yet. There are days when I am seized by unassailable anxiety, by a sense of foreboding, by fear that my recovery will result in having the financial rug pulled from under me. I am unable to scan job ads without triggering intensely negative thoughts and feelings about the prospects of any employer wanting to give me even the most menial of jobs.

I have never before encountered this feeling of being disposible, of not being any earthly use to anyone. My working life consisted of thirty plus years of different roles; from my first Saturday job in the local Baker's to my final role as a Probation Officer. In total between 1990 and 2012 I applied for ten posts. I always progressed to interview and was only unsuccessful in securing a post on four occasions. That is a good record - I think. I have gained qualifications and significant experience in Education, Communications and the Criminal Justice system.

The trouble with me is that, throughout my life, I have struggled with mental illness. All but my final employer were unaware of the extent of my struggles. At no point have I ever been warned over the quality of my work. If anything, as way of coping with my emotional storms, I have been a chronic over achiever. Hence the brick wall I hit every time I try to move forward in finding meaningful employment which allows me to be fulfilled, provide for myself financially, as well as maintaining management of my mental health.

Most agencies who are in place to help those with mental health issues back into work are limited in what they are able to offer me. Not all of those who suffer from mental illness have never worked. In fact any casual scan of social media discussions among the mental health community indicates that many people not only remain in employment, but are also employed in highly skilled and highly challenging careers. Without wanting to be crass I reckon I would be better qualified than most employment advisers in these agencies, particularly in my knowledge of the careers which are suited to my qualifications and experience. I don't have a problem getting interviews or even getting a job. What I need is advice and support about roles which can take account of the ways I need to manage my condition.

Most of all, the biggest hurdle I need to overcome is the suspicion in the back of a prospective employer's mind, that by employing me they risk harm to colleagues and those they may work with. My biggest challenge is in finding and maintaining consistency and stability in my moods. Ironically, steady employment is a key factor in helping me to maintain that stability.

I cannot battle mental health stigma in all its forms and fight my own corner in a competitive jobs market. Certainly not on my own. One of the biggest learning curves for me has been to accept the reality of an environment which denigrates the vulnerable and those who are perceived as 'weak'. All I can do is try to plead the case for an employer to take me on and trusting that I am applying for work at a time when I feel I am in control of my condition. Unfortunately, there are no guarantees that this will always be the case. I would point out though, that unpredictability applies to everyone. No employer can guarantee that their most healthy, go ahead, uncomplicated employee, will not succumb to a virus, an accident or some other physical or mental illness, rendering them unable to fulfil their role within the company. At least if I start to struggle with my condition, I am now skilled in recognising warning signs and taking action to prevent myself from slipping further into dysregulation. Am I really saying that I am the devil that it is better to know? Perhaps. At least the risks of employing me are knowable and therefore can be planned for.

The conclusion I have reached is that I am probably better to take on the risk of an employer by working for myself. It is sad that I don't feel there are any agencies who could help me beyond advice about CVs and interview techniques (been there done that, actually got the jobs!). It grieves me that employers find it easier to adapt buildings and other aspects of the physical environment for the physically disabled, than to engage in an intelligent discussion about the impact of the working environment and culture on those with mental health conditions.

We are caught between a rock and hard place. On the one hand I am constantly reminded by populist TV such as Benefits Street, that I am one of the drains on the nation's coffers. On the other hand, I am reminded of the fragility of my situation by employers who frankly would rather have a mediocre employee who is able to guarantee mediocrity 100% of the time, than the highly motivated and skilled 100% employee whose life could be disrupted 25% of the time. It takes investment of effort and resources to help me with the 25% of the time I may struggle - sadly few employers are prepared to do that for those with mental illness.

I think a lot of people perceive mental illness with suspicion because no one outside can see evidence of the illness, unless I am in absolute crisis. Do we need to wonder that self harm and suicidal ideation is so prevalent - dramatic it may be, but it gets more of a response than me describing my distress.

Here I sit, continuing with voluntary work in the hope that it will help me rebuild my confidence sufficiently to begin to apply for paid work again. I fear the consequences of having to work part-time, of needing to balance the reduction in benefits against work which pays the minimum wage. Above all, I am paralysed by the question, 'am I employable at all'?

Saturday, 10 January 2015

7 Marks of a Mindful Person

This is a really helpful way of summing up the difference between Mindfulness and other 'interventions'. If it is to be effective, it has to become an integral part of the way I live my life. It only helps me manage my BPD (Borderline Personality Disorder) when it replaces the 'coping skills' I developed when merely seeking to 'survive' and becomes the way that I actually manage to 'live a life worth living'. That means that it is more than just a set of skills. If I am to be effective in using the DBT Core Mindfulness skills, they have to become a part of my daily life, more than just a habit - they have to become an essential part of how I view my life, my experiences and who I am. That means it is a profoundly life changing experience more than it is a treatment option.

Thursday, 8 January 2015

Do Staff need to be Taught Compassion?

Sometimes I need time for blog posts to 'percolate'. The reasons vary, from me recognising that I need to consider the possible impact of what I am putting out there on others, to needing time to formulate my thoughts and feelings on a subject. I wanted to write about compassion in Mental Health settings since an incident before Christmas, but hesitated because my initial response was purely an emotional response to the distress of a friend. Before putting my thoughts in the public domain I needed to allow time and perspective before putting my thoughts down in black and white.

My friend is a diagnosed Schizophrenic who battles against his labels and the medicalisation of him as a person, who is more than his often disputed diagnosis. A few weeks before Christmas he suffered a major 'meltdown' - in his words. The first I knew of it was when he phoned me from the ward and asked me to visit him. This article could deal with the ongoing battles he has with his mental health team regarding his view of his auditory and other hallucinations or of his need for ongoing medication, but more than that I needed to highlight the lack of compassion he told me about on his admission to the PICU.

Over a period of some time he had been struggling with the increasing belief that he was a psychopath and therefore a major threat to those around him. He was terrified because he was convinced by these beliefs. Instead of understanding how terrifying these beliefs must be to him and the fears that they created in him about the threat he posed to those around him, some staff started to tease him, laughing about him being a 'serial killer' and even using the term 'path' when talking to him. 'Alright, path', 'harmed anyone recently, path?'.

It is a single individual incident involving one person that I know. What has concerned me most is the basic lack of human understanding and compassion for an individual clearly in distress and need. By definition, to be admitted to inpatient care in this day and age, indicates that by all clinical standards, this person is in urgent need of help. In the world outside I would expect the usual level of ignorance about mental health in general and Schizophrenia in particular, but inside a specialist Mental Health unit, surely even a modicum of professional pride and self respect dictates a better response than taunting a mentally ill man?

I try to be balanced in my consideration of such troubling incidents. I have tried to find reasons for members of staff responding in this way:

1) Stress and pressure - under-staffing, ongoing constant change and cutbacks, bring a weariness and cynicism, probably unthinkable in the early days of most of these staffs' careers?
2) Lack of adequate training about the symptoms and perceptions of Mentally Ill people who are in crisis?

Unfortunately, neither of these reasons adequately provides any acceptable rationale for the appalling lack of empathy and understanding displayed. I know in my twitter feed I can be political in my responses to the current state of the NHS, but I do believe that there is an ideological and moral battle going on for all of our public services. When patients, services users and others in need, stop being people and become units and target statistics, then the raison d'etre of our social care and health services is under severe threat.

If a person ceases to be a person, but becomes an obstacle to completing paperwork, or sitting in an office 'getting through a shift', it stands to reason that it is only a small step to not being able to see why you should 'waste' any human compassion on 'them'. And there it is: 'Them' and 'us'. There has been a rhetoric in public life which has separated us into 'camps' of rival 'tribes' of the 'deserving' and 'undeserving'. We are not in this together - or at least that has been the effect of much of the discussion in public around Benefits and other cuts to services. So the ironic comment that 'my job would be ok if it weren't for the people I work with.', ends up being a default which in turn
informs our actions towards 'those' people.

What most of the political rhetoric forgets is that for most staff in public services; NHS, Education, Criminal Justice, they did not enter a 'career path' or to seek 'progression', but most felt a vocation. Vocation cannot be conjured up, nor can its root motive, compassion, be taught or trained. I may attend any number of Mental Health Awareness training events, with input from service user perspectives, but if I fail to see the people I work with as worthy of compassion, then there is no magic bullet which will allow me to tick this off in my professional development portfolio.

Pity cries and walks away, it looks down on those in need. Compassion enters into the experience of the person in need and seeks to understand its causes and, in time, the actions which can be taken together to meet that need.

Don't get me wrong, compassion in public services costs those for whom it is the primary motivation. I would argue that the heart of compassion in many staff is why the NHS is the envy of the world. Day in and day out, committed, compassionate staff come along side the vulnerable and most hurting people in our society. This kind of response to need cannot be trained or imitated. You know it when you see it. I know when staff working with me are seeking to understand the roots of my distress. I know when staff are motivated by more than a pay packet or are just going through the motions. I know when someone, despite the limits of the system, sticks with me until, together, we find a way through to recovery.

I have been on both sides of public service and I know that when I meet staff who recognise our shared humanity, then there is a strong foundation on which therapy and medication can be built. Rather than mock the beliefs of someone in the throes of psychosis, humanity asks, 'What would I want someone to do if it was me?' Relationship depends on trust, therapeutic relationships begin with a compassionate assessment of another human being and their needs - some of them shared by all people, even me. If you view the people you work with as 'them' rather than 'us', maybe it's time for a change of career, or a holiday?

Thursday, 1 January 2015

A WHOLE New Year?

I have spent the last few New Year's Eves huddled inside my little cocoon with my dog, avoiding the forced socialising and build up towards midnight. This year I wanted to be with others, so spent a really fun evening with friends. The countdown to midnight comprised the final ten minutes of our night together. It was good to see the New Year in with friends and be able to reflect on how different things are from the same time last year.

A conversation on the way home about how we didn't welcome the WHOLE of 2015 in at midnight, simply the second after midnight on the 1st of January started me thinking and has led to this blog post. It's made me think again about how much pressure we put on ourselves to find a 'magic bullet' or 'magical season' or 'magic moment' that will end our misery or bring us final fulfilment. The problem with putting all of our desire to change and improve into what turns out to be one week of determined effort, or if we are really focused, perhaps a whole month of living up to our 'resolutions' is, that our NEW YEAR quickly disappoints us and we often end up feeling failures and give up on our resolutions and, often, ourselves.

Midnight on the 31st December 2014 has not suddenly meant that I have woken up with the job I so desperately need/want. My chimney and roof remain in desperate need of repair. I still have to walk my dog so that she is happy and doesn't chew or destroy my furniture. Nor was there a handsome (or any other kind of) Prince standing at my door awaiting my response so that he could whisk me away from my drudgery to contentment and bliss. Even in the original fairy tales (often really gruesome) there was no Happy EVER After. We've managed to 'Disney' out the reality that for most people who have an awareness of the world around them and their place in it, life is often painful. There are very few of the friends of my generation who do not struggle financially. People become ill, both physically and mentally. However hard I try, I cannot foresee any of these events simply because I have stayed up until midnight on a designated night of the year. I cannot prevent them from happening, nor should I be surprised if they do. Happy New Year is a blessing, a desire that 2015 will be good. It is not a statement of policy or intention.

All that happened last night at midnight, was that one moment of my life moved into another. Through the practice of mindfulness this is how I have learned to manage life. It has been important that I have learned to ACCEPT those things that are beyond my power to change. I am better able to watch the Daily Politics, as a result. I don't get overly emotionally involved anymore, because apart from using my vote and expressing my opinion, there is little else I, on my own, can do. I know, I would love to think that the universe revolved around me more than that, but difficult as it has been, I have learned I am not the solution to the world's problems!

Last year, I finally decided to stop setting myself unmanageable dieting goals. It was only in March, after I had achieved some level of progress in managing my BPD, that I felt ready to work on feeling better physically. For the first time I stopped looking ahead to an arbitrary target weight and decided to focus on my love of fruit, vegetables and home cooking. The changes I made had to be in the moment. Any progress I made was not reliant on my feelings - a lapse was not a relapse (something repeated as a mantra to drug users in recovery). I don't know when it happened, but as the weight came off pound by pound I made my way through the year shedding over three and a half stone.

Change is possible, but I can't decide how a whole day is going to go, let alone the whole of a year. So, any decision to change how I do things must be on a moment by moment basis. What matters is the ability not to judge myself for the times I miss my targets. I have had to learn to readjust my aims. To look at the target and decide if it is the right one for me, then reset my sights and try again. It is easy to become discouraged if I think I have to determine the progress of a year in advance. Or even if I actually believe that by any effort on my behalf I can influence the progress of the year, I will condemn myself to constant battles with myself about how powerless I am. Better for me if I learn to accept my life as it is right now, then choose areas that I want to change, before I set myself achievable goals. Above all, I do not have the capacity to live life in wormholes or time and space vortices, which means I can only live my life along a line of time which progresses, moment by moment. You know what? I think that's more than enough for me to handle!