Little by Little .... getting our lives back

There has been a lot of discussion on the media and throughout social media about the anticipation greeting some easing of restrictions which we have all grown used to throughout the last 12 months. Having survived a stroke in September 2020 my life has change more radically than I would have thought possible this time last year. What has remained the same for me is my daily use of the same skills I have been using to live in Recovery from long term mental health issues to recover physically from my stroke and to manage the social restrictions of 'lockdown'. With that in mind I wanted to share some thoughts for managing a period of yet more change which started for us in England yesterday. 1. Take your time. As with much of our experience of developing mental health conditions such as depression and long term anxiety disorders, it has taken us some time to adjust to the radical changes to our behaviour over the past twelve months. Given the alien nature of many of the measures taken to protect not only ourselves, but also others around us, we need to reflect and ask ourselves some questions which I admit to borrowing from the day of Reflection on 23rd March. Firstly, what have we gained that we want to keep? For me, as someone who is happy with my own company I have found the lack of pressure to 'be more sociable' has been liberating whilst growing my circle of friends through meeting up online and then making arrangements as one to one walks became my main physical fitness activities. It has been noticeable over the past month that our parks and common walking spaces are again filling up with a lot of groups of people. This, for me, feels uncomfortable. Mostly I have been going into supermarkets with a confidence which has previously been elusive, both mask wearing and social distancing have made going into shops and other public spaces less daunting for me, so in a sense I have been able to venture more often into places I had avoided in the past. 'Going back to normal' is not without its challenges for me, so I need to take my time and adjust to the influx of people into public spaces.

2. Be prepared to feel exhausted. One of my early bosses, an Australian with a formidable zest for life, used to tell me, the only humans who relish change are babies with dirty nappies! Change happens all the time, but more often than not, it is usually natural, gradual and doesn't make us feel completely out of control. For a year, we have grappled with the reality of a virus which it seemed was entirely out of any human ability to control. Alongside that governmental efforts nationally and internationally have seemed to some over the top and to others (usually those with first hand experience of the effects of the virus) not enough and not for long enough. Due to the emotional impact of living with untold thousands of deaths daily, as well as the emotions involved in hoping for something to happen to stop the deaths and illness, we are emerging from lockdown feeling exhausted. Those of us who have managed mood disorders understand that emotions are exhausting. And that means that rushing headlong towards positive feelings may not be the most helpful idea. Take time to grieve what has been lost. To return to my questions: what have you lost that you would be able or want to get back? Be realistic has the past year forced change which when you reflect on it, whilst difficult to go through has been necessary and brought you to a better place? 3. Keep your Connections. Connecting is one of the #5waysofwellbeing and one of the benefits of a period of national mourning and need is that it has opened up opportunity for deeper relationships, because we have been faced with some realities about our own mortality and the limits of our power to control or influence the world around us, on our own. My recovery journeys, both mental and physical have not been done in isolation, a network of friends and professionals have helped me along my way. In the same way, maintaining our health when the crisis is over will depend on us, corporately and in community, continuing to maintain our connections through which we have managed to support one another over the past twelve months. When you can remember to take time to keep up with new friends and friendships made through this time and be grateful for kind neighbours and supportive friends. 4. Keep your awareness going. For months we have waited and watched. Perhaps, we have noticed more about the pressures and needs of our public servants: Doctors, Nurses, Police, Pharmacists, Teachers. As isolation and lockdown forced us to manage our own health and education needs, perhaps we have a greater awareness of what they face each and every day. I hope that it will make us more tolerant of the burdens many people we complain about not doing their jobs, face yet continue serving us. I recently watched a documentary about the life and death of Caroline Flack, in early 2020 before the Covid pandemic exploded. The hashtage #bekind trended all over the world. HOwever, harshness and intolerance seems to be no less prevalent and the impact of social media continues to fuel a high degree of risk of suicide, especially among certain age groups. Just because you have the ability and forum to speak, doesn't mean that you should - unless you have something that helps, rather than damages other human beings. Acknowledging that my behaviour has a direct impact on others around me, is to begin to create networks which can be safer, not only in preventing infectious diseases, but in helping to tackle the epidemic of despair. Before you post or get caught into criticising someone whose shoes you don't walk in, think, what have I learned this year about how difficult life can be for others who are different from me?

5. Be gentle. With yourself, with your family, neighbours and even with those who have had so much responsibility for having to manage an impossible situation, locally, nationally, globally. 6. Go back to basics. One of the changes I had to manage following my stroke was to think about driving again. The good thing I learned was that, having had a clot rather than a bleed, my stroke did not mean that I had to consider giving up my licence and that after four weeks I would have been free to drive again. However, even though my memory wasn't damaged to any great extent, rememberinng to drive did take some focus and effort. I went back to the fundamentals I remembered from learning to drive. I started slowly, waiting for the 'bite' on the clutch and soon, muscle memory took over. As we aim to get back to where we left off, let's look at the basics. What do you need to live a life you believe is worth living? Firstly, acknowledge what we all need to survive and I'm not talking about toilet roll...food, water, sleep, shelter. Then what gives your life meaning? Family, relationships, a faith in something bigger, being able to help others? In a sense, more than anything else 2020/21 has been an opportunity to push 'stop' on the treadmill and to reset, having reviewed what matters. Just because we might be allowed to go somewhere by a certain date, doesn't mean we should. What will rushing headlong back into holidays abroad add to my life, that time spent away from the four walls around me, doing refreshing activities in my own country wouldn't? As with any setbacks in life, we can decide to run away from it and all the lessons we have learned or, we can choose to embrace what the Pandemic has offered to us in terms of shaking us up and showing us what matters and what gives our life meaning and hope.

So, THAT happened

As I write I've reached the end of another year, 2020. I know that is has been 'challenging' in so many ways for so many people. You will have noticed that once again this is the first article in a very long time and to be honest with you the reason for that is because once again, I have been reminded of my frailty, physically and emotionally. In short, I don't remember much of September and October because on 11th September, I suffered a stroke and was rushed to hospital. I am told I was found in my bedroom with my dog lying beside me. Friends had been trying to contact for nearly 24 hours and the police had to break into my house so the ambulance crew could get in.

The fact is, I don't remember anything before I awoke in the Stroke Rehab Unit of my local hospital in mid October, but my friends and family unfortunately are only too aware of what they watched me go through as I survived first the ICU and then the move to Rehab, all the time wondering if I would ever a) wake up b) be able to speak c) walk again. In the end I have been unaware completely, except for some seemingly vivid dreams of having to be manhandled around the wards, or being woken and becoming agitated. I have remained oblivious of the seriousness of my condition at that time. I remember the week before the stroke feeling dizzy and unwell with a stubborn headache which refused to shift. On the day before I walked the dog for four miles and remember returning home and phoning a friend because I was worried by the headaches. I don't remember our final conversation which worried her. But I must have gone upstairs feeling ill and gone to my bed. I know I have written often about recovery in terms of mental health, but never did I expect to put my DBT skills to such direct use in addressing a life threatening condition and beginning the slow process of addressing aspects of my lifestyle which had led to a clot on the brain. However, first in coping with the trauma of a near death experience and then in beginning to acknowledge (accept) what behaviours and habits I needed to change I found that those skills I have been using since 2011 when I was first diagnosed have been so helpful in guiding me through all the competing thoughts and medical opinions. Above all, my experience has confirmed my personal faith in a God who never felt so real to me than when I was reflecting in my hospital bed on how miraculous my recoery has been. I know that I was surrounded by so much love and so many prayers for my life and recovery that I can only conclude that 'someone' answered. That is my personal conviction and I know that the character that has been built over the earlier decades of my life brings me hope for the future. Covid, naturally was a big part of the hospital experience as first on the ward, then in a Old People's Home where I went to finish my recuperation, people started to test positive and this, in reality was as close as I'd come this year to the pandemic. As a result of my experiences this year I find myself reassessing my prioritising of job hunting and the stress and pressure I've put on myself to comply with society's pressures to make my life 'worthwhile'. I now need to learn to value my worth in terms of the quality of my relationships and judging from the wonderful response of those I love the most, I am worth caring for = in the words of a mug a received this Christmas - I am loved outrageously!

Accepting Love - The hardest task of all

I think I've shared before a picture of the traumatised child which explains how hard it is for adoptive and foster parents to successfully give that child an experience of unconditional love. A friend who is an adoptive Mum shared it with me and at the time it resonated powerfully with me. When someone has been shown nothing but proof that they are worthless, when a care-giver seeks to pour love into the cup of that personality finds the love running off without even touching the inside. This is because all that has gone before, the trauma itself, the coping strategies and the fundamental frameworks of belief about themselves as worthwhile human beings serves to form an often invisible film stretching over the whole of the mouth of the cup.


I have spent the past ten years of my life slowly working to remove that film from myself. I know that in reality some who have tried to break through it have encountered, not a feather light, flimsy film, which lets in light, but steel shutters. What I have learned to accept in the past few months is that despite learning a lot about trusting others, the key to opening these shutters lies entirely in my own hands. It is not enough for me to acknowledge that love is being given to me, but for me to accept, without reservation or justification that I am loved. There are many moments on the path to recovery from childhood traumas which are paradoxically painful and healing at the same time. No human love is perfect, nor is it without risk.

Because in reality there is no human being who can love us perfectly. But when we begin to accept that we can love ourselves without feeling like frauds, then we can begin to move towards receiving love as it is intended. For me, I know I have shared before that I have a faith in a God who is bigger than me and all my problems and one of the main things that I have learned to accept is that my belief tells me, I am loved because I exist. Simple as that. One of my favourite thoughts of this year has been: 'The grace of God means something like: Here is your life. You might never have been, but YOU ARE, because the party wouldn't be complete without you.'

With healing I can now see that life is not all bad, but there are also good things in life. Some of those good things exist in me and my personality and/or abilities and gifts. And some people, not all actually think I'm worth loving. Again, this has been a long hard path to accept. As I wrote the word 'loving' I battled myself because my instinct was to find a less powerful word, such as 'like', or 'appreciate'. How many times do we stop ourselves accepting love as it is given, by changing its strength in our minds, minimising what the giver has intended? How many times have friends and loved ones tried to reinforce the positive things they see to love in us, and found themselves frustrated by our reverting to our (comfortable) old patterns, minimising what is good in us. 'Oh anyone could do that', or my favourite one 'You're just flanneling me'.

Funny how easy it is to believe in the absolute truth of critical opinions given to us or in our own minds, but how easy we find it to undermine positive praise for who we are and what we do. It's a natural consequence of not being given validation as children. Self validation because an alien concept and a skill we need to be taught later in life.

I have had to look at the negative thoughts and critical voices from my past which constantly circulated in my mind and decide if they are something that I want to listen to, or if I am willing to listen to the (admittedly) strange and novel, voices that tell there is a balance to things. Sometimes I mess things up, sometimes I do really well.

Over the past few weeks I have been wrestling with positive thoughts, because they feel odd and sometimes accepting them means something painful. I am learning that I can do things I never thought possible, that I can build webs of friends and I can cope when the ups and downs of human relationships happen. I am not shaken to my core because I disagree with someone, because receiving love means that I accept there is core of belonging within the relationships which means we can cope with 'falling out'. This is a new experience. Such little blips in reality, would in the past have meant me walking away for fear of rejection. Now they are the warp and weft of accepting that I am loved, which in turn frees me to feel love for others, without fearing the pain of having that love rejected.

So here I am saying, the steel doors are opening and I choose to receive the love that is offered to me. I know I haven't arrived and my recovery means that I continue to take one step forward when I can. As long as the movement continues forward, then I can say that my heart which has been frozen for fear of the risks involved in connecting with others, is melting. If that's sappy - so be it.

Recovery Interrupted?

One of the occupying concerns I have had since social distancing was implemented in the UK, has been for those who have been attending our weekly community group. Online I have ongoing contact with many more in terms of numbers. However, I am aware of the needs of face to face contact and encouragement particularly for those who are waiting for referrals, or for those who are in the process of recovering from mental health issues, which means our group meetings have built (or were in the process of building) relationships which serve to support our members manage mental health in their daily lives.

We are doing our best to keep connected, but with the best will in the world, connection and relationships cannot be fully healed without the ability to meet up and read mood and body language. Easier for someone to shrug off low moods when online or through distancing messaging and go back into our cocoons. Never has it been easier for people to mask their emotional and mental struggles, particularly those of us who live alone.

This has been brought home to me through the rise in statistics around domestic abuse and some cases of people dying alone at home from Covid-19. Both physical illness and domestic abuse are major contributors to poor mental health.

So let's be more alert for signs that would normally go unnoticed.

1) We are all social distancing so if someone has not been seen out and about for a while that can easily be overlooked. Do you know if your friends are using their opportunity to get outside of their house. Honestly when you are at your lowest, the thought of such activity is almost impossible to contemplate. How can you check on those who live alone and are at risk from neglecting physical care?

2) Have your friends or family disappeared from all social media? Can you check if the green dot appears next to their name? Can you message them privately?

3) When did you last have a meaningful conversation with isolated people that wasn't about the current situation?

4) Do you make times to contact your friends and family to video chat? It is easier to check in if you have made definite arrangements, it also gives both you an opportunity to have appointments again to look forward to.

5) If you are unable to make any contact via distancing means it is reasonable to go to their door and check on them. That would be allowed.

6) All the usual people are available to seek help if you need to ask for it. It may take a different form, but you can still contact the person's GP or phone 111 for advice on what next steps to take. However, if you believe there is an immediate risk to the life of anyone then 999 is your option.

7) It is important that we all monitor our own moods and recognise when we need to ask for help. Again, your GP is still there and can do video chats and if necessary arrange for a face to face appointment. Organisations like the Samaritans have not gone anywhere. They can be contacted through their usual phone number 116 123 from any phone. You can also email if you feel unable to talk: jo@samaritans.org (this takes 24 hours to receive a response)

Above all, whether you are concerned about yourself or others, tell someone and get the help you deserve. Just because we are in the middle of a health crisis caused by a virus there is no competition which says, your needs or health issues are less important. All lives matter and it is okay to not be okay with what is happening around us. That is to be human.

Isolation - surviving on the desert island

'No Man is an island' the words of John Donne have never been more starkly in focus than during the current worldwide battle against a common invisible enemy. A virus has shown up the lies that tell us that we can be divided into different groups, that there is such an entity as 'them' and 'us'. An organism designed to attack human beings is currently ravaging every nation, every race, every creed, every age group, every shape, shade and form of humanity across the world.

I have often thought on and off about ideas of loneliness, isolation and solitude and the different qualities that each can bring to our experience.

At this very moment we are following government instructions to distance ourselves and to avoid social contact outside our homes. In reality we have been forced to put physical walls around behaviours which we have fallen into and which have always forced us into a kind of social distancing before we had a name for it. We have been forced in concrete terms to live out the reality of what impact dividing ourselves from the wider community and world outside our homes can have on us as human beings.

In thinking about what isolation and loneliness can mean to us as human beings I have found that it is helpful to have before me the complete sonnet from which the famous quote comes:

No Man is an island
Entire of itself,
Every man is a piece of the continent
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were as well as if a manor
Of thy friend's or thine own were:
Any man's death diminishes me,
Because I am involved in mankind.
And therefore never send to know
For whom the bell tolls,
It tolls for thee.

Nowhere is the fragmentation and division within our communities more evident than in our collective response to death. Death and grieving has increasingly become private and individual. One of the most visible impacts of the current outbreak within Northern Ireland was a realisation that traditionally, we as a people, were out of step with much of the UK as we continue to grieve as a community. Families reported the difficulties of facing death without our cultural gathering together not only in emotional and spiritual support, but also in the very practical provision of sustenance to the bereaved. In a sense, the culture I belong to has come face to face with the isolation felt when death comes to call and it is not felt as a wider community.

This pandemic in contrast to our modern response to death has been to reinforce Donne's words, 'Any man's death diminishes me'. If anything, in the regular displays of support for the NHS and the bringing of help by neighbours and community groups is bringing us back to the idea of shared grief, for the first time since WWII. There is a natural desire to care communally which has been stifled by the way we have developed our modern way of living.

We have been living in a fractured world, separated and isolated into political, cultural and religious ghettos. Never more so than in the last five years or so. The danger in this is in believing that I or we don't need anyone else. However, community is not just a good idea but is bound up in our very nature. I am made for connection and my humanity is somehow wounded when I fail to acknowledge this.

Death in reality is the great leveller. It is the one experience that every single one of us will face, young or old, rich or poor, educated or uneducated. It is also the one life experience through which we see starkly our shared humanity. Suddenly in the face of death we are faced with a sense of something sacred about human life, something which day in, day out, in normal times we are able to ignore.

The core issue with loneliness and isolation is that both of these states result from a lack of connection. As we socially distance we are challenged by the fact that it may not be the physical proximity of others that influences how lonely we feel. We all know the moments when we experience being 'lonely in a crowd'. I live alone, so it is not an effort for me to 'socially distance', physically it is easy for me to be on my own, isolated or lonely. Yet in this period of isolation I am feeling more connected to my family and friends than usual. This crisis is enabling people to strip away the masks of social niceties and busyness which means that interactions can be deeper. It's a waste of a video call to reply 'fine' to the question 'how are you doing?' We can see it as being an opportunity to share a uniquely common experience, to share how it has affected us and our families, to share how we feel about it. In short I am finding that this situation is creating time for us to be honest with ourselves and our loved ones. And our relationships are feeling deeper and more connected as a result. Or is that just me?

In offering some steps to take I think the most helpful thing I can do is share with you the gift of solitude. It is different from isolation and loneliness, in that it provides a uniquely spiritual time to reflect and be honest with myself, so that I can more effectively reconnect with those I love once I have come out of solitude:

'Solitude is the furnace of transformation, without it we remain victims of our society and continue to be entangled in the illusions of the false self. Solitude is the place of the great struggle and the great encounter, the struggle against the the compulsion of the false self, and the encounter with loving God who offers himself as the substance of the new self' (Henri Nouwen, The Way of the Heart)

This reflection from Henri Nouwen clearly focuses on a Christian perspective where solitude allows him to connect with his God. When we begin to reconnect following isolation caused sometimes by mental illness, or physical illness, periods of time when we need to regroup before engaging again with the society around us, it is important that we establish from whence our hope and meaning come. For me, as I have often said in this blog I find it in my personal faith in God. For others it may be other 'higher powers', but this is a starting point.

When we seek to connect or reconnect in a meaningful way with those around us, I have found another Rule of Living helpful to encourage me to connect honestly, it comes from the Northumbria Community and is encompassed in two words: Vulnerability and Availability.

In the coming together of communities at this time I have witnessed both vulnerability: NHS staff willing to risk their lives on the frontline, neighbours helping the elderly out in their neighbourhoods despite having to go outside their own cocoons. Availability means breaking out of our walls and making ourselves available by being authentic and offering to share our real selves with those with whom we come into contact. When you are facing an mortal enemy, the social fears and anxieties pale beside them. I can only relearn trust if I am willing to be both vulnerable to disappointment, or rejection and if I am willing to break my own sense of reticence to engage with people and make connections as much as a I can.

Ultimately, because I have a shared humanity and 'because I am involved in mankind, any man's death diminishes me'. However, when I recognise our shared humanity and join with others to address sometimes boring, practical issues together, sometimes saving actual lives, then I am most profoundly connected not only with the people around me, but with the wider world and creation of which I am an intrinsic and valuable part.

Young People's Mental Health: The Clash Between Welfare & Achievement

I have hesitated for some time before putting in writing my thoughts on the subject of Young People's Mental Health within our current education system. I have witnessed the narrowing of what education means, from a distance. I have witnessed increased concern from parents and friends who are teachers and educators about the welfare of the children and young people in their care. I have tried to help young people with the support of their parents to negotiate the emotional minefields of their most significant educational milestones.

Sometimes when discussing young people's mental health, we are satisfied with laying the blame on new technology, social media and other things that are different from our day. However, unless you are involved in trying to provide a balanced creative and social education within the current education system, it is unlikely that you will be aware of the impact of successive diktats from government about focusing on exam results, to the detriment of a truly culturally diverse curriculum. Also the focus on needing to achieve, 'outstanding' according to OFSTED criteria seems to be taking focus away from preparing young people for a rounded and successful life, which enables them to weather the inevitable storms and challenges of life as it is.

Why decide to cover this in a Mental Health blog? Because I have recently had a more sustained glimpse inside for the first time since leaving teaching in the 1990s. I am currently trying to overcome my fears and have been applying for work so that I can make the step away from having to rely on benefits. This has meant I have been attending interviews for jobs which are focused on 'Pastoral', 'Welfare' and other 'caring' roles within schools and colleges. My CV obviously gives me some encouragement that I am being invited for interview. My teaching coupled with my lived experience of mental health, along with the work I've been doing in the community would seem to be a perfect fit.

However, following my interview at a local college, which on paper was all but perfect, I have felt deeply uneasy and, at times upset about the atmosphere and attitudes towards students' welfare. Although the role was designated as 'Pastoral' none of the discussion, observation or interview questions explored the link between mental well-being and 'success'. It upset me primarily because I know that one student from this college took their own life in a very public way last year and I am aware of the emotional issues currently being managed by students within the college.

On paper there is a 'counselling department' but I wondered about how effectively this works as there was no explanation of how this department worked alongside those trusted with the general welfare of the student body. Or even, if there is any wider conversation beyond referral and tick in box. In the end the aim of the Pastoral role was to ensure that students remain within the college and 'successfully' complete their courses.

As myself and the other unsuccessful candidate were sifted halfway through the day, I realised that we were the 'quirky', more experienced, more expensive candidates. We stood out, we were big personalities - too big and too experienced maybe to just deliver a proforma welfare programme of lessons. There did not seem to be any scope to individually tailor delivery of coping and mental well-being skills to the small tutorial groups in addition to the prescribed programme of social and health education.

I now know my main mistake was in focusing on helping young people develop a safe group of people and safe place within college so that they could feel supported emotionally as well as academically. The problem, I wanted to ensure that young people enjoyed their time and were able to manage stresses around exams and the future by providing a forum to share coping skills.

This I find is not the pastoral agenda for school and colleges. It can't be. Exam results and OFSTED reports are integral and essential to funding for all activities within the establishment. There can't be additional resources for the mental health initiatives the government has now loaded onto the already overstretched education system.

There are a large number of these posts being advertised and not every school or college I have attended for interview have had such a narrow emphasis. In fact I have been encouraged by conversations with school leaders who recognise the need for a compassionate and responsive mental health strategy which is willing to consider building up resilience and crisis management skills for all of their students. While educational success is dictated by government and political ideology and narrowly assessed based on exam results, we will continue to face growing issues around young people's battles with anxiety, depression and other related issues such as substance misuse.

Unfortunately, on a wider note the pressure to maintain successful exam results, in some settings seems to resulting in a more chalk and talk form of teaching for A Level. This again, saddens me, as one of the joys of the Socratic Method is to build on students' strengths and natural interests to encourage, a questioning, inquiring, critical frame of mind, which can be the foundation to the independent learning essential to be successful at degree level. I found student areas to be quieter than expected, and classes less discursive and confident in expressing their own opinions. There are few times for reflection it seems to me, within these most formative years.

My conclusion is that there is no room for a teacher like me anymore within education. I believe too much in the individuality of life experience and the fact that each student does not come to us as an empty vessel passively waiting to be filled by the prescribed knowledge which can be measured by exams and tests and reassure those in power who wish to avoid questioning minds.

Where that leaves our need to support young people so that they can be resilient enough to cope with all that life throws at them, I don't know. I do know that educators need expertise from outside as well as resources which can help them feel more confident in speaking to young people about issues around self injury and suicide in particular. It requires investment in pastoral staffing which is separate from the academic staff and curriculum, where young people can have confidence that there is a safe place and safe people with whom they can be open. The school nurse service maybe a model which can offer one pathway, or designated mental Health leads, which I believe is in the pipeline. I would say that given the current pressures on management, such a role does need to be seen as not linked to a student's academic progress.

Small short term projects are a good start. However, I do believe there needs to be a completely different approach to school pastoral structures, particularly in the post 16 world.

These are simply my personal views.

Both....And....Life's Balancing Act

In the wee small hours of the morning, when I have tossed and turned all night, with anxious thoughts, all is darkness. Although the opposite point of view - the rose tinted glasses view that life is a bowl of cherries, seems less problematic, it is no less damaging, if it causes us to be unable to engage with life as it is.

The Dialectical part of DBT (Dialectical Behaviour Therapy) recognises that life is not all black or white, darkness or light, it can be both at the same time. For those of us who experience rapidly seesawing emotions acknowledging the reality of competing truths, can be difficult to negotiate, particularly when our emotions are informing our thinking that the 'truth' is either all black or all white. The sweet spot lies between accepting competing realities and fighting against one or other truth to the point of exhaustion.

In DBT, the decision sweet spot is called Wise Mind, a balance between being all rational or all emotion. This helps us to balance our purely rational, impassive, view of life with our instinctive, emotion driven knee jerk reaction to our life experience in making decisions which are ultimately helpful.

I understand Dialectics as the balance beam along which my view of life in all its light and shade can lead to me accepting the ups and downs of my life. It is an essential part of the Radical Acceptance which helps me to accept my past, build on my present and move forward into the future.

Dictionary definition: 'Dialectical thinking refers to the ability to view issues from multiple perspectives and to arrive at the most economical and reasonable reconciliation of seemingly contradictory information and postures.'

In applying it to my recovery and use of DBT skills, it is an extension of Wise Mind and moves us from the wilfulness of persisting with long discredited ways of coping with the contradictions of life to an acceptance of life as it is. It helps me to stop being a captive to my instinctive, emotional responses to life, which can be out of kilter with the reality I am experiencing.

Looking back on 2019, following the General Election, just before Christmas which rounded off an awful year, all seemed dark. Then I looked for other perspectives. I am grateful for the blogs of @sarah.styles.bessey who often reflects on the difficult experiences of life. She sums up for me the practical application of thinking dialectically about what we are going through:

'This was the year I learned all over again to reconcile that many things can be true at the same time:

...we miss who we used to be and we love the person we are becoming;...

love and grief;

hope and lament;

there are miracles and there are not;

there are funerals and there are baptisms;

this world is devastatingly broken, filled with weeping and suffering and this world is so freaking beautiful and good you could cry at the sight of a baby’s thigh or catch your breath at the sight of pine trees against a rose coloured sky or turn up the music to sing in the car with the windows down.

All of it: true.'

Life is not all darkness, nor is it all happiness and light. The difference between joy and happiness is that happiness is mostly dependent on what is happening to me. Nobody can be happy all the time.

Joy goes deeper and can exist at the same time as some of the most difficult of times. We can be grieving a major loss, or be struggling with the most difficult of circumstances, but in the midst of those times I can also experience the joy of a good cup of coffee, shared laughter, the warmth of my dog cuddling next to me.

Research shows that feelings last approximately 90 seconds and are fleeting - if we do not constantly fuel them with underlying triggering thoughts. This means that the most negative of emotions is survivable and passing. It also means that there is an opportunity to enjoy moments of positive emotions and allow them the same space to breathe as we give our negative feelings. When your life has been dominated by believing that your darkest moments far outweigh the times that were good, reflect and give space to those moments of light and hope which have sustained you. If we can give the times of light more weight than our negative feelings allow, we will be able to recognise that our lives are both light and shade and our challenge is to keep our focus on balancing these truths about life.

Where do I go from Here?

This year: my mother died, my Dad was critically ill for a long period, as siblings we had to travel back and forward throughout the time he was in hospital, there were times we were told he might not make it, but he has and now needs ongoing care. I continue to struggle to find a place of security financially, my benefits review has resulted in another 1/3 cut to my income (still waiting for final outcome, but could become another battle right down to a Tribunal), I was taken ill and spent a week in hospital and am still undergoing tests to find out what exactly is going on, I've had disappointment after disappointment when seemingly earning from my voluntary work has ended due to....I know not what? Stigma? Risk aversion? Fear that I'm overqualified? Too old? Too honest? Making use of my 'Lived Experience' is fine when I do work for free, but apply for a 'proper' job and suddenly all the skills and abilities, which have prompted well intentioned people to encourage me to apply for jobs, seems to count for nothing. I've been battling a particularly persistent viral cold/'flu and know I am physically exhausted. Finally, when there was some hope that the wider society attitudes towards people in need, poverty, illness, relationship breakdown, homelessness, hunger (in the UK, in 2019!) were changing. Bang. An uncaring, self-centred government has been returned with the power to pursue a kamikaze direction which will continue to drag us all down with them. I now hope that all the prevailing wealth of evidence I've read is wrong for the sake of all those who are already suffering from this national preoccupation.

Today, I know I have reached the end of my resources. It's understandable. It's human. It's okay to be not okay about all of this. Tomorrow I have a choice. Where do I go from here? The song from Evita has been running through my mind today and I recall that from this point in her story, such a low point, she begins her climb to superstardom. I totally have reservations about her path and indeed the trajectory she finally followed, but I look at it as a lesson in picking yourself up and starting again.

So, what is my own answer to the question, where do I go from here?

1) Accept that this is painful. Allow myself to grieve. Name the feelings. Disappointment, hopelessness, sadness, fear. Don't judge myself when I cry. Life is hard.

2) Life needs purpose and meaning. I have written before about where I anchor myself when looking at finding meaning in both good and hard times in life. Because I have invested my belief in someone who is bigger than me and my feelings, I use my prayer times to take a step back and look at the bigger picture. Within this space I find hope and perspective, both personal and for the wider world.

3) Engaging in life means that we need to be able to engage with other people. People often hurt other people, either from intent or carelessness. However, there are acts of human kindness and there are good things in the world around us, when we take a step back. I can be encouraged at the willingness of the younger generations to carefully consider what is going on around them and, rather than shrug at the enormity of the work need to bring change, they have been prepared to act. We are made for relationship.

One of the greatest sadnesses for me during the political upheavals has been the breakdown of our society into camps/tribes who cannot articulate or even engage with opinions which differ from their/our own. Relationship means we need to listen to others, sometimes we need to hear things that may be painful for us to hear. One of my personal values is honesty and integrity. If I have wronged someone it is my job to repair that wrong. If I can learn about myself, myself in relation to others, or the world around me, then no experience will be wasted. That doesn't mean that it's easy to say, 'lesson learned', often I need to work through pain and cry tears and wait until I am in a place that is distant enough for me to make some sense of what has happened. And sometimes, there is no sense to be made; it is what it is. Life is not logical.

4) I have a choice to make. I can choose to revert to my favoured coping mechanism and retreat from engaging with life. At this point in my recovery, however, I am no longer satisfied by this as a way of managing the worst of times. It does not help me to remain paralysed by fear or anticipation that nothing can change. If I can't change the environment around me, then I need to accept that it is my task to adapt to that environment. So I can't indulge myself in pursuing the unknowable, 'Wny?' or 'Why me?' or 'Why not them?'. I have wasted too much time in the past feeling aggrieved by real injustices, but asking 'Why me?' when no one can give me an answer. Anger in response to injustice is not wasted if it drives us to challenge the general causes of those injustices.

So, where do I go from here? What now? I do what I can do, when I can do it. I accept what I cannot change (on my own) and build on what is certain in my life. Simple everyday successes can be essential building blocks to climb our way back up. Getting up, feeding myself, looking after my hygiene, making sure I am doing all I can to stay physically well is a good start. Do what is effective for you having acknowledged where you are emotionally and physically.

Most of all, look for glimpses of hope. The small green shoots of new life.

The Waiting Game

I'm not a patient person. As I have learned to manage my emotional storms, I'm realising I am an ultimate optimist. If I believe something needs to be said or done to change a situation I want to immediately act to do that. Since 2010, following my diagnosis and entering the wonderful world of mental health services, so much of my life suddenly spun out of my control. I could try to give my perspective on why so much of my experience of waiting has been linked to going on a list to be assessed for suitability for 'treatment' but I don't think or believe that it helps to identify factors that are beyond my control.

Recently I've experienced the same frustrations while waiting for assessment of a physical problem. It has given me pause to consider the things that I do which make that waiting time either painful or bearable for me. There is something in the power of my thinking to either make time seem like eternity or go quicker than I expected. I've realised that rather than being powerless during these times, I can control those things which I have control of. I've recognised a number of ways that I have been able to manage these times better than in the past.

1. EXPECTATIONS. There is nothing worse than time on my hands to make my mind increase or decrease the importance of small things to the final outcome when whatever I am waiting for arrives. If I have waited for two years for 'treatment' the importance I place on that longed for appointment becomes enormous in comparison to the what the human being behind the date is able to deliver. I think this is the most important element to manage so that long waiting times do not become a matter of gambling with how quickly my initial presentation at assessment may deteriorate. Too often waiting periods end up being shortened due to lapse into crisis. Sometimes my self harming behaviour is a way of short-circuiting the process because I feel that if I go on feeling this way much longer, I will literally die. I need some help to get through the heights of emotional pain, so that each of those moments is not necessarily going to end up with an inpatient admission. I need help to create in my own environment a safe place to wait. I wonder if equipping me again becomes part of the triage and assessment stage? This could mean that I don't have an assessment appointment followed by between six months and two years of nothing. THAT feels like I'm in limbo, abandoned, in no mans' land, helpless and more importantly as waiting magnifies my negative thoughts and feelings: not worthy of help.

I wonder if, while waiting for specialist service appointments, there is scope for equipping people with self management and distress management skills. Mindfulness which was core to my DBT therapy has been so helpful in so many waiting times for me. Could it be useful as a tool, among others, to help people manage the time spent waiting (given that the prevailing economic and political realities prevent these times from shortening in the short term.)?

I have noticed that when I break a leg or an arm, while I am waiting for the orthopaedic specialists the emergency staff have measures to support the broken bones, and alleviate the physical pain. Of course no one can remove from me the emotional pain and distress I am experiencing, even when I end up before the professional I have been referred to. No one can fix me. No one can undo my past traumas. No one can stop me feeling this lousy. BUT I can be helped to learn to manage such pain and distress in less self-destructive ways. Can I be offered some first aid for my emotions which can hold me while I wait?

2. PERSPECTIVES. My feelings and their imbalance within me cause my perspectives on the world around me to become skewed. Given the extent of my distress small things had huge impacts on my mental health. I tried two different interventions and waited 18 months before I started my DBT journey. During the time between diagnosis and about six months in the DBT programme I was still trying to remain in my demanding job. My perspective on waiting for treatment and starting treatment was heavily influenced by the sickness procedures which seemed to place some kind of magical aura on the idea that I had started being 'treated' for my 'condition'. The expectation became that because I had two days off a week to attend my group skills and individual therapy, then there should be no further issues from my mental health that would affect my work. In other words, having supported me during the waiting time, my employers then expected me to be magically 'fixed', ignoring the fact that my long term mental health struggles would require long term management, including re-learning how to adapt myself to any work environments, without ending up emotionally exhausted.

If we see our struggles with mental health as tackling pathogens, then we will end up having major conflicts between the needs of people using services and, particularly the medically trained professionals who determine pathways. I WILL blame you if you do not 'cure' me, you WILL blame me if your medications or treatments are not as effective as you had hoped. So many times during my experiences of different interventions I was told I had not made the most of the help on offer. DBT was the first time I was told that if I was not making progress then we needed to review how suitable the intervention was for me.

Another aspect, particularly when waiting and expecting the magic bullet of 'help' is time itself. I had experienced significant trauma from early childhood right up to leaving home at 18. Then again as an adult I experienced rape and sexual assault on two other occasions (as a woman there were other lesser assaults which were just part and parcel of life in the 80s and 90s), last being when I was 40. I was diagnosed with BPD (Borderline PD) at the age of 42 although I had been through many experiences with Psychiatrists, Psychologists, Counsellors of various shades and theories from the age of 15. It is now ten years since my diagnosis. Only five of those years involved regular contact with Mental Health Practitioners. In pure terms of number of hours spent with those practitioners compared to the number of years of turbulence and unhelpful coping methods, including self harm and self destructive behaviours. Given this, it would truly be miraculous if any Mental Health Practitioner was able to 'fix' the impact of so much trauma in my life. If during the time I have to wait for a first appointment I can be prepared to recognise these realities and to accept that, at best, I will have the support and expertise of someone to walk alongside me for a time as I begin to learn new ways of coping.

3. TIME. There is something in our culture at the moment which seems to encourage us all to wish our lives away. How many of us set our sights on our next break from work, be that the weekend or our next holiday. When I am struggling most, I find it easiest to live one day at a time. I have to. I don't have the emotional capacity to imagine or hope for more than one day at a time. When I have been at that stage, I have taught myself to look at moments as more significant than something to be endured while I wait for something in the distant future. If I can focus on each moment as a span of time which I can experience fully, either to be enjoyed or endured, then I know I can survive. And as things improve, those moments begin to lengthen until I can imagine myself engaging in life more than a day at a time.

4. RUNNING AHEAD OF MYSELF. One of the hardest things I face during recovery is my impatience to get to some goal or other. At the moment I am tired of not being able to negotiate the complexities of returning to paid employment. I am managing my condition, but I don't know yet if I am ready for increased hours and pressure yet. Most of all I find the temporary nature of so much of the voluntary work I'm involved in difficult to manage, apart from the uncertainty thrown in every 18 months of having my benefits reviewed. I find the system itself is a major hurdle to negotiate to try to build up paid work. Most of all I face tremendous stigma based simply on the diagnosis I received, having worked successfully in some challenging areas. I have found with small projects and part time work, once I have reached interview or even people have seen me in action, there is usually no problem with my suitability. Sadly for the first time in my life I find that the thing which gives me added experience and expertise in working with people with complex needs, something I previously had paper qualifications and work experience for, means that my application is likely to end up in the bin, without me even being considered a serious contender. This puts a pressure on to prove myself to people who have a skewed view of Mental illness and PD in particular. So, I find myself wanting to change the universe in order to push deadlines which I know are immovable. I cannot make Christmas Day move forward from 25th December if I simply put my tree and lights up. I cannot make Colleges and Universities or potential employers change their admission/application times or procedures. Ultimately, I cannot know if I am ready for more hours of work, until someone gives me a chance. Until then I need to accept that there is a lot about the world of work and attitudes of employers to mental health that I cannot change.

Ultimately, time spent waiting can either be painful and feel like time wasted, or I can try to redeem the time:

- by not focusing on the event, appointment or occasions I am waiting for.
- It helps to go back to basics and try to live one day at a time.
- To admit when the environment is too difficult for me to change.
- To accept that moaning and allowing myself to stoke feelings of anticipation and anxiety will only make the passage of time feel as if it is slowing.
- To notice the positive things about having this time to work on things I rarely have time to work on...such as my yard, my dog, my fitness.

Finding the Words

'Shall I compare thee to a summer's day?' (W Shakespeare, Sonnet 18) or how on earth do I describe you? Finding the right words is an essential skill in trying to identify for ourselves and articulate to others, the deepest hidden feelings, experiences and thoughts. Too often when it is a problem, we find ourselves inside the 'belljar'. Locked away. One of my often repeated phrases when I was most in distress and struggling to get help, was 'I am inside my own head, screaming. No one can hear'.

That is why I found the Emotion Regulation module of DBT (Dialectical Behaviour Therapy) so helpful. I started to learn how to first identify the individual feelings from the morass of turbulent, violent waves of panic, anger, fear and self-hatred that used to tumble incessantly through my head. This step was the crucial first one towards learning how to manage the power and frequency of such self destructive and exhausting experiences. That's where having the time and safety to find and express what is going on inside is so important to begin to manage the fast cycling moods I so often experienced.

There has been a constant debate since I was first diagnosed - given the label 'Borderline Personality Disorder' (BPD) - in 2011 about what to call the clusters of symptoms and behaviour patterns which I exhibit. In one sense I don't care, my bigger battle is to find a sense of who I am among the shifting sands of invalidating parenting, my own confused sense of the world and the relationship difficulties this led to. However there are times when I am jealous of other sufferers who have a vernacular with an agreed understanding of their diagnoses: Chronic Fatigue Syndrome, Generalised Anxiety Disorder, Depression. There are always disagreements caused by stereotypes/stigma. Getting passed the minimising attitudes which get in the way of educating people about the real impact of Mental Illness is an ongoing struggle to get beyond the surface meaning of the diagnosis.

For those of us who have the complex roots both biologically and socially of emotional dysregulation, our diagnosis rarely, if at all offers any real language of understanding our experiences. We have gone through a number of versions: Emotionally Sensitive PD, Emotionally Unstable PD. Today I read of the World Health Organisation latest attempt to give us a workable diagnosis: Mild, Moderate, Severe Personality Disorder, with sub classes related to things such as experience of complex trauma, obsessive compulsivity, detachment, dissociation and disinhibition. This to me is a more positive move forward in giving a shared language between sufferer and professional to help explain the main areas where I have problems in life.

However, as with all diagnoses there is the problem of individualised responses to words and language: where I impose on them judgements and assumptions based on my personal experience and history. So, for some people being told that their condition is 'mild' may create some problems which makes them feel 'less than'. Whether we like it or not, there is a reality born of experience which tells me that words, like 'severe', 'acute', 'urgent' bring with them the resources I may feel I am in desperate need of.

I don't care in my moment of crisis where I sit in terms of others who may be more 'severe' than me. My fear becomes, if you give me the label 'mild' or 'moderate' then it follows that will not be given the help I feel I need until I prove to you I am 'severe'. In many ways this has always been an issue with perceived PD 'problem behaviour'. In reality if every team working with people like me is adequately and appropriately trained and resourced to provide the right level of intervention for me, then I can be reassured and given the right level of intervention for my needs - in theory.

It is good to work towards clarity of diagnosis, but, for me, the priority must be the reassurance that if I am given this diagnosis then it follows that I will then receive the appropriate level of help I need to learn to manage my condition.

"Personality disorders will no longer be classified categorically, but rather using dimensions of severity—mild, moderate, or severe.1 An additional category of personality difficulty will be demarcated not as a disorder, but as the equivalent of a z-code in ICD-10—ie, a non-disease factor that affects health status and encounters with health services. Following assessment of severity, clinicians will then have the option of specifying one or more of five domain trait qualifiers: negative affectivity, anankastia, detachment, dissociality, and disinhibition. ICD-11 will include new guidance for personality disorders to be diagnosed during childhood, albeit with caution, as they had previously been “inappropriately set at late adolescence or early life adult life”.1 Additionally, the revision will include a borderline pattern qualifier that is not dissimilar to the symptom profiles outlined in ICD-10 and the Diagnostic and Statistical Manual of Mental Disorder, 5th edition." (From the Lancet - Problems with the ICD-11 classification of Personality Disorders - Jay Watts - June 2019)

The Art of Connecting

I am preparing a talk to a group of Psychological Professionals talking about my story in the context of my journey through Mental Health Services. In considering the factors which have helped me most in my journey I have been reflecting on the central relationships along the way and the need to break out of the isolation of mental ill health and connecting with the world around me.

When the core building blocks of human relationships have been shattered by early experience of trauma where do we begin to rebuild trust, particularly within the restrictions of the realities of accessing Mental Health interventions? That is a message I want to communicate. Where to begin? People familiar with this Blog know that I have used the acronym CLANG for the five ways of well-being (Connect, Learn, Active, Notice, Give). That way I can truly call myself a 'Clanger'! I like this order as it begins with the C - Connect.

Connecting in relationship is at the core of our identities as humans. The truth about Trauma and its impact, is that while we survive it alone, there are few who can overcome it, effectively, alone. Healing requires relationship and, more importantly, relearning healthy relationship. ‘Most of us cannot carry these moments alone; and yet there are so few among us who will make peace with our despair.’ (Sarah Bessey – Out of Sorts) We cannot admit to our need of others if we do not admit to ourselves the extent of the burden we are carrying. When we remove judgement of ourselves for struggling with the effects of trauma and accept that the pain of despair is 'understandable' and 'human', we stop isolating ourselves from the rest of humanity and give ourselves permission to reconnect.

There is a complexity inherent in the destruction of relationship and connection caused by my early experiences of trauma. It follows then, that there needs to be complexity in the therapeutic approaches through which I make my way to healing. I wonder why group therapy is so often the central medium for some therapeutic approaches. I know within the NHS the answer is 'resources'. However, the argument can be made that those of us with experience of complex traumatic experiences 'cost' the NHS when time and resources are not appropriately allocated to helping us with this central issue of connection.

Healing takes time and commitment in relationship. Brene Brown says that we should only share with people who have earned the right to hear our story (The Gifts of Imperfection: Let go of Who You Think You're Supposed to be and Embrace Who You Are (2010)). Within the therapeutic relationship of many interventions, where is the time to earn that right?

The truth is that all of us relate to one another on a one to one basis. Groups are problematic to me, there are so many barriers to my engagement based on my experiences of relationships in the past. Social Media is a particularly difficult arena for connecting.
I believe this is because it is about quantity, rather than quality. How many mental health problems are related to or exacerbated by this medium for connection? The reality is that I have capacity for a few in-depth relationships and after that there are circles of intimacy emanating outwards from me at the centre of my social networks. Right on the outside are those I relate to only in groups, clubs, teams, churches, workplaces. There can be overlap between concentric circles of connection, naturally. On the whole I build trust in you when we spend time sharing moments that matter to both.

I have asked myself what it is about the DBT structure which helped most. The answer I think is that it offers a layered, complex approach which allows me to engage from my own experience with each element of the therapy. DBT groups work by introducing skills which then are taken up by me and applied to me to fit the life I want to live.

Our deepest relationships are those which are built, slowly over time. There are shared moments of trust. I need to learn the discipline of staying put, building or rebuilding friendships over time. In the past the fear of rejection, or even my anticipation of it, meant I would up sticks and run as fast and as far as I could the moment I felt myself beginning to rely on and (whisper it) trust in any relationship.

In the past I've written about rebuilding trust through animals. When every human relationship is laden with risk and reminds me of the pain of rejection and trauma from childhood, where do you begin rebuilding trust. I think that along with self-care for those of us suffering from PD diagnoses, connection provides the biggest challenge to recovery. Animals are wholly dependent, but they are entirely and completely non-judgemental and offer unconditional love. At a very basic level I can begin to connect with a living being who trusts me. At some point every year, within our group we discuss the fears about 'letting down' a pet. So we take it a step back and start by growing and caring for seeds. This may seem simplistic and reductionist, but if we truly do not believe 'we're worth it' we can begin to illustrate to ourselves the daily care of watering, feeding and spending time looking after a living thing. It becomes a reminder to do the same most fundamental things for ourselves in order to simply exist.

We are made for relationship and when we have our basic needs met through nourishment, sleep and hydration, we can start towards building a purpose for living. Here connection moves from a horizontal focus on those around us, to the bigger 360 degree, looking up and beyond our earthbound lives to finding a connection to something that is bigger than us and bigger than our struggles in life. For some of us, this is found in a faith in God, for others, in serving the needs of others, be it our families, or communities or even the wider world.

Connecting, ultimately says to the isolated 'you belong'.

Letting Go....

At the risk of triggering an earworm from 2013 I've been focusing on 'letting it go' this week. I am currently taking my turn at caring for an elderly very ill parent. 2019 has been quite a year with my Mum dying in April and my father a couple of months later for radical surgery to remove large tumours by removing all his large intestine. Unfortunately, as is the case with elderly people he has not followed the 'plan' ie discharged after 7 days followed by steady rehab and recovery at home. In the past three weeks as a smaller family unit of three we have been watching our father fight numerous infections and have to undergo another significant operation to save his life. The words that are repeated to us are 'there is a lot going on in there' and 'we cannot say he is improving, nor can we say he is deteriorating'. So we wait, in no man's land.

My previous post was reflecting on grief after losing a parent, when there is a conclusion. There is a different range of challenging emotions when in the waiting space of someone who is critically ill. In the past because of my fears about toxic emotions and the overwhelming power of them to paralyse me, I have frozen my sadness, stopped myself crying, for fear that the floods would overwhelm me. It continues to be my default position, so it was that I found myself starting to cry over the dishes one day and, even though I was alone, found myself trying to deviate from the feelings and thoughts.

What's so wrong with tears? When I am in my rational/wise mind I know the answer is nothing. These tears are necessary, these tears are natural within them is so much more than grief and loss. Within them are more complex feelings, like frustration, impatience, the sense of powerlessness in the face of life's realities. I was struck by the need to allow myself the release of tears when a nurse came into the room and asked 'How are you?', I responded 'I'm ok', then checked myself, 'Or were asking about my Dad?', 'No, how are you doing today?' I was so focused on the ups and downs of my Dad's journey, I realised I wasn't able to answer, the answer is 'I don't know.' One thing I do know is that even if I couldn't explain to you the reasons for my tears, I am learning to let them go - as an important part of my own self-care at the moment.

'Feelings....Nothing More than Feelings...'

A central workshop in our All of Us group, is one where we encourage one another to 'make friends with our feelings'. For many seeking help from mental health services, the power of feelings can at times feel overwhelming and entirely outside of the individual's ability to cope with their effects. Often over the years I have thought despairingly of my overwhelmingly powerful negative feelings as anything but 'friends'. However, the reality of trying to live a life with purpose and connection with others means that I need to acknowledge the value and importance of feelings.

My Mum died earlier this year. My Dad is currently working through the news of bowel cancer along with the need to undergo a lot of significant surgery, in his 80's. I have been aware in the past of experiencing overwhelming feelings of grief and loss, which all but rendered me incapable of functioning. However, I am aware at the moment of not responding emotionally to the loss of significant people in my life. I know that at sometime I will feel the grief and loss, it is a necessary rite of passage. Having been given a diagnosis my emotional responses to this significant life stage, when I and my siblings move into being the 'older generation', throws up an additional question...do I need to refer myself for clinical support?

My own grief journey has coincided with some thoughts I have been having around the issue of medicalising emotional responses to difficult life experiences. I wonder if this need to address the pain of some life experiences is another aspect of our risk averse attitude to life in general.

Following my Mum's funeral, which happened during half term, I returned to my job at an after school club for primary age children. The questions about 'how was your holiday?' are a natural way to speak to one another following a break. My response to the children's question: 'Did you have a good holiday?' was instinctively, 'No, because it was sad for me.' Naturally, the question will follow: 'Why?' I find that I have been direct and honest in speaking about my loss, I seem to have an aversion to the euphemisms, 'Passed on', 'passed away' etc. My response is 'My Mum died.' I like that the children didn't hesitate to either tell me about their experience of grandparents, or for some, parents who have died. The other response which was common was curiosity, 'was she poorly?' That allowed me to talk about my Mum's long illness (18 years) and the fact that she wasn't in pain anymore. Speaking like this to the children was initially completely natural, we all returned to focusing on enjoying games and playing. However, later, at home doubts crept in, should I have protected the children more? Well, on reflection, no, they saw that I was sad, it was ok, I was ok, there was a reason for my sadness, which some had experienced in their own families and in those moments there was a connection in our shared humanity.

As someone with ESPD (Emotionally Sensitive Personality Disorder, formerly Borderline PD) my emotions have been swirling masses of indistinct, out of kilter, responses to the most insignificant stimuli. Naming emotions, was initially my biggest challenge, simply because I was seething within a fog of powerful, negative emotions. Happiness was problematic simply because I didn't enjoy it because I always expected it to come crashing in on my head. Such had been my often self fulfilling prophecy. The feelings themselves were not the enemy, nor were events that are a part of life. Like weeds in a garden, feelings need to be managed with help, when they are out of place or proportion to the stimulus.

Sometimes life hurts. Sometimes I will experience happiness. There is an expectation I think which is prevalent in our society, which demands that life should be smooth sailing, otherwise there is something deficient in my environment or, in me. Having lived for so long with rapidly cycling extremes of emotion, from absolute despair to almost unbelievable highs, the balance I worked hard to find through DBT felt 'boring'. The epiphany for me was that real life is mostly routine, that when I am well, I can experience life by enjoying moments along with being able to feel sad, or flat without it being the extremes of depression.

I am only part way along my path through grief for my parents. There are complexities because ours was not the ideal upbringing and there will be other emotions mixed in with feelings of loss. When we love others and they hurt themselves, we instinctively reach for the painkillers and seek to stop any bleeding, or put bones back together. If we could we would stop our children from feeling lonely, uncertain, sad because that means that something in life has hurt them. But I cannot take away the pain of a child's grazed knee, anymore than a psychologist or psychiatrist can remove the emotional pain of past trauma through medication alone.

Unlike the times when my emotional responses in the here and now connected in a torrent to the pain of unhealed trauma from childhood, my grief is natural, a response to life as it is. I will move through it in my own time and using my own ways of coping. I do not want to numb the pain of the grief, because, whatever the complexities of our relationship, there was love in our family and, a truism, I know, love hurts. I know I am well because I am able to accept that emotional pain in the right context is okay and 'this too will pass...' because life is about seasons.

One final note about seeking to take away emotional pain too soon through medications; I think that an unintended consequence of having an NHS which provides healthcare free at the point of need, is that we too readily turn to clinicians to remove our pain as humans. For mental ill health, this sometimes puts unrealistic pressure on the clinicians to protect me from the pain of life as it is, or it means that I become too dependent on medications which dull the pain.

Without being flippant, one lesson I have learned from waxing is that intense, quick pain may sting, but in the long term helps me to remove the hairs that betray my age and so escape endless internal monologues about whether people have noticed!

For years, I was so fearful of feeling the pain associated with some life traumas from my childhood. I imagined a huge torrent of feelings that would, literally kill me. However, when I was guided through facing up to the realities of what happened to me, (avoidance is a big way of evading pain) although it hurt, ultimately I learned that my feelings wouldn't kill me, even if at times it felt as if they might!

Noticing

One of the most popular activities in our weekly group is our 'noticing'. We spend up to 30 minutes outside (particularly positive when Spring is in the air) and focus on each of our senses in turn as follows:

1. Notice 5 things you can see.
2. Notice 4 things you can hear.
3. Notice 3 things you can smell.
4. Notice 2 things you can touch.
5. Notice 1 thing you can taste.

It's a simple exercise and it builds on our regular practise of mindfulness. So the aim is not to focus on the number of the things we notice but on the experience of focusing on the world around us, rather than being stuck inside our own heads. Above all we are not judgemental of ourselves and we try hard not to be competitive. Some days it is easier than others to be mindful of what's around us. What is most important is that we try so that we learn to 'give our heads peace' - if only for a moment.

I. Am. Not. My. Diagnosis....(Some (Personal) Do's and Don'ts of Lived Experience Involvement)

Since I received a diagnosis which gave me access to Mental Health Services, I have spent a number of years being asked to 'be involved' with different projects within my local NHS. Some of them felt effective and useful, but many despite initially being a positive way to improve services for others with similar experiences have fizzled out - or come to an abrupt end, with little or no feedback to me regarding the reasons for the project ending.

Over the years I have come to the conclusion that the main reason for mine and others' with Lived Experience ending up being discounted, lies in a strange dissonance between Professionals' belief in encouraging self management and self advocacy for 'service users' and an aversion to risk. Usually this is articulated as concern for the fragility of 'Peer Workers', statements around avoiding 're-traumatising' me when I am asked to use my experience to inform my perspectives on Mental Health Services.

Above all, I think the main hurdles to true involvement for those of us with 'Lived Experience' lies in assumptions around individual diagnoses. Unlike medics who deal with physical well being, there are few direct treatments which act as 'magic bullets' to 'cure' mental ill health. There are few commonalities in causes even of the most commonly diagnosed mental health conditions. Nor is there often consensus among professionals about the most effective interventions for everyone with the same 'Label'. Mental Health is so challenging because we need to address issues of the whole life. Assessment may take months, or even years to provide clear understanding of my complexities, let alone begin to help me manage my condition so that I can achieve a 'life worth living'. To understand the risks of my condition, means that you need to understand me as a whole person. To learn to respect my recovery journey means understanding what works for me in managing myself so that I can function effectively. If I am in Recovery and I believe I have something to offer to your project, please trust me to know myself, my risks and what works to restore stability. If I take on the role of colleague, then I do not ask of colleagues therapeutic support, anymore than if I were working in any other context.

As with most aspects of Mental Health, much can be solved by addressing assumptions and expectations - on both sides. My experiences have led to me developing some Do's and Don'ts for helping make my involvement effective for both.

Don’t overpromise – if I have had a good experience of services any inability to deliver on what you have promised will erode any trust. If I have had a poor experience it will reinforce my lack of trust in the NHS as a whole.

Don’t get me to commit to projects without everyone involved being in agreement. I cannot tolerate conflict when seeking to rebuild work confidence. Nor can I on my own change an organisation's culture.

Don’t ask me to go through recruitment procedures, unless there is a definite green light.

Don’t tell me you will be in contact, then fail to make any contact. If there is a vacuum in communication I will fill it with my self-critical beliefs that I really am useless and unwanted.



Do keep me informed of delays/concerns about NHS policies and procedures.

Do be honest with me about the challenges of changing staff culture and assumptions about working with people with Lived Experience.

Do give me the opportunity to talk directly to staff on teams/departments who are considering peer roles. Hearing real stories and meeting real people challenges stigma.

Do trust me to manage my own condition – I am not relying on colleagues to be part of my recovery plan and that needs to be made explicit.

Do make role descriptions and remuneration clear before engaging me in any work voluntary or otherwise.

Do be upfront and honest with me if you have any concerns about my wellbeing and then expect me to be responsible for putting my Recovery Plan into action.

Do be honest if there are organisational/policy changes which will affect my continued involvement – try to give me as much notice as possible so I can adjust. As much as I try any ending that is unforeseen will feel like an immense rejection and may impact negatively on my feelings of self esteem.