Words (and their impact on Recovery)

'The verb is 'to crown'!' As I write I am shouting at a journalist, supposedly an artful practitioner of our language, telling me that someone is on in the process of being 'coronated'! Grrrrr. I would not call myself a grammatical tyrant, but really folks, English is so difficult to learn as a foreign language, precisely because we can carefully choose the words we want to use in any given context. I used to liken grammar to a train. It makes sense if you label in a very specific way... anyway I'm not about to launch into a Year 7 parts of speech lesson, although I have had a hankering for teaching recently. Anyway, the main thrust for my imagery was to convey to the children that how we structure our words is vital to helping us become really good at communicating what is in our heads to the world around us.

Of course as we grow older we find that not only have we left the childish belief that 'words can never hurt me' behind us, but we realise there are certain words which not only convey an idea, but can be loaded with judgement. Words like, 'unemployed', 'mentally ill', 'immigrant'carry with them sometimes very dark judgements, mostly about people who have a different background or experience to us.

One thing I have noticed as I have continued on my recovery journey, is that I am now more sensitive to certain words and, as a result, they can have a devastating impact on my emotions, often triggering feelings of failure. Sometimes it's a single word, at others it's a well worn phrase, or a sentence. Here is a selection:

Relapse. When I was working with drug users in recovery there was much discussion around 'lapses' and 'relapses'. Our mantra was 'a lapse is not a relapse...' I have found that when I face struggles in recovery from my emotional issues everyone refers just to a 'relapse' which to me means failure, going back to square one, letting myself and everyone else down. One word, but so much weight of judgement. I have combatted this by dropping the 're' and saying to myself 'a lapse is not a relapse' A lapse means that I have been overwhelmed by a moment, it is a temporary setback, recoverable. I can reset myself from a lapse. To me, for a relapse to happen means I have needed more extensive outside help to recover from out of control emotions and/or I have reverted to using self defeating coping mechanisms. It may seem a small thing, but the addition of a prefix totally changes my reactions and/or actions to recover again.

Mental Illness/Condition/Issues: I could call what I battle with, 'bagel', that way I can totally avoid judgements being loaded on me by others who have interpreted what suffering from a Mental Health Condition means. The problem is that without giving you my history and context the word is out of place and therefore fails to convey the ideas I am seeking to communicate. Hence it is problematic if I launch into my story by telling you that 'I was diagnosed with 'bagel' in 2011'. Sometimes I have the choice to ignore other people's judgements and values applied to certain labels and choose to redefine them for myself. If I believe that mental health conditions are just the same as physical health conditions, then why wouldn't I be willing to use commonly used phrases which are basically descriptive. The best way to tackle stigma is to introduce the ignorant to human reality. It is powerful to stand in front of a room and be able to admit that I struggle with my emotions and sometimes my thinking becomes clouded as a result. Particularly in recovery this can be more productive for me than focusing on trying to change people's use of specific words - why not simply introduce them to the person they avoid behind the labels?

Vulnerable v Fragile. One thing I heard through the DBT (dialectical behaviour therapy) programme was that although I may be emotionally vulnerable at times, I am not fragile. There is a song by Julia Fordham called 'Porcelain' and it expresses that frustration women often have when treated as 'weak', needful of protection. I know there is a paradox here. It is nice to be looked after, to know that people care for our needs. I guess there is a line, maybe it's similar to the one some relationships cross when 'protective' becomes 'possessive'. There is a sense of smothering, of not being trusted to be an adult, a loss of independence. I think there is an element of seeing patients as 'fragile' which contributes to the environments in Mental Health services which create dependence and that thorny little issue of 'learned helplessness'. Granted there are times when it would lovely to have a white knight swoop me up into his strong arms while he whisks me away from my daily grind and struggles. Except, those moments are really meant to stay in my childhood stories and now, sometimes in the cinema. Most importantly, for my ongoing recovery, to see myself as having vulnerabilities without being 'fragile' is important to giving me a sense of control over my life and more especially, my emotions. My goodness, if my experiences in life have not shattered me, there must be a core of steel in there somewhere. I may be a product of my past experiences, but I am no longer their prisoner.

The issues around Mental Health Stigma are part of a wider demonising and marginalising of certain groups nationally and internationally. I do listen to Donald Trump and worry that he is so oblivious to the power of words, particularly when conveying vacuous and bigoted ideas. In the end no word is an empty vessel, I need not only to take heed of my internal judgements, but also the fact that those who hear my words carry their own history which affects their interpretation of what I am saying.

Perhaps, the conclusion to my reflections here is that I should remind myself to hear what is behind others' words, as much as I expect others to move beyond their own (narrow) definitions of mine. Maybe we all need to take time to get to know people as people, take the pre-judgement out of our interactions. I know, I am Canute and the waves of words flooding our public spaces is the sea coming in around my feet. Only place I can start is here.

Mindfulness and the Art of watching Foreign Film

It used to be considered slightly pretentious to enjoy foreign language films. I remember when I and my uni friends endured rather than enjoyed turgid epics of incomprehensible philosophy in the guise of entertainment, just because someone we admired had told us it was a 'must see'. Another three hours I'll never see again.

In the last couple of years though, we have been introduced to the best of world television and you know what? It's really quite enjoyable. I've also found that watching programmes in a foreign language actually forces me to focus in a more mindful way. I cannot multi task, I can't let my mind wander - at least not without having to rewind. I don't watch foreign language television close to bed time - it's too stimulating. If you really must know, a good dose of Dave's output is enough to push me over into the land of nod, or at least to release myself from the iron grip of 'TV drift' as I reach for the remote. Foreign language television forces me to stop using the TV as wallpaper and to think about what I am getting from my television experience.

Before I was introduced to mindfulness I thought that my television habits were a useful way to escape from difficult emotions. But when I considered how I was watching, I realised the sheer immersive joy I once experienced as a child had been lost. TV had become bubble gum for my mind, and gum which had long ago lost any flavour or pleasure. This reflected by general inability to engage with life at that time. As I began to notice the world I inhabited again, as my concentration returned with treatment, I rediscovered my enjoyment of film.

That was in time to take advantage of the rise in really good foreign drama appearing on our screens. In addition to having to focus on following the story, it widens my horizons. London, New York, Manchester, LA, they've become over familiar. I love being exposed to different landscapes - yes when nordic, they're bleak, but it's really fascinating to see that their doors open outwards - I'm guessing so the snow doesn't fall inside??
So here they are my top foreign picks:

The Bridge (Series 1 & 2) - Danish with brilliant interplay between the Swedish and Danish cops. Copied as the Tunnel in English - good but definitely lacking something.

Isabel - Spanish Epic and really engrossing historical drama based on the life of Katherine of Aragon's Mum.

The Legacy - Danish family drama - simple idea but really delivers - apparently there'll be a second series.

Crimes of Passion - Swedish about a crime writer (female) set in the early 60s - funny too - at times.

Arne Dahl - Swedish Police Drama - what they call 'gritty'.

Wallander - Swedish and British - Love both versions something just quality about both.

Mammon - Swedish political thriller

And currently I'm watching my way through 'Spiral' French - excellent gritty police drama - with female leads.

Of course there's the Killing but I found that my recovery started too late for me to jump on that particular wagon.

When I need to get really absorbed and lose myself for a while, I set the TV up, switch off the lights and prepare to pay attention to the subtitles!

Why Not Me?

Yesterday I was discharged from Mental Health Services after four years. Unlike many people I read about on here my discharge was well managed and took account of some moments a few months ago when it was not appropriate to end the relationship. So it was a positive ending of a relationship with my Care Co-ordinator. I was able to express my gratitude to her and she in turn reinforced the positives in my progress. My week began with a visit to a Breast Cancer Unit following a routine screening which revealed some suspect lumps. In one way I had to laugh - timing was perfect - one week bookended with physical and mental health issues - I'm nothing if not equal opportunities with regard to illness!

In the past the uncertainty caused would have resulted in a whirlwind of thoughts and emotions centred on my (imagined) ability to mind read, predict and anticipate the future. At some points I found myself 'reading into' the kindness and professionalism of the clinic staff as confirmation of the worst news possible. I certainly felt the shock of the speed of appointments offered - not to mention the fact that within the space of two hours the clinic had: confirmed the presence of five tiny lumps, the fact that they couldn't tell from the range of tests whether they were benign, and then to have them removed, a dressing applied and instructions given about care for the small wound and details of the appointment to receive the results of the biopsy taken. However, I found myself using my mindfulness skills to keep me focused on what I knew, which was exactly what I had been told by the consultant, and what my senses could tell me was happening around me.

In the past I would have collapsed under the weight of the uncertainty, whilst being swamped with the pain of every trauma I had lived through in my life - quite an emotional burden, I'm sure you'll agree. I would also have been plagued by the constant thoughts centred around 'Why Me?'. Such an event would have confirmed my life role as 'victim'.

This week, though, something had changed - the pain of the past is where it belongs - in the past. I really don't need to be carrying all of that as I deal with life as it is in the here and now. After all as the Bible says 'Today has enough trouble of its own.' (Jesus on the Sermon on the Mount). The other thing that has changed is that I have learned that I am not some toxic person who attracts trauma. Unfortunately, the term Borderline Personality Disorder does seem to confirm this thought, but just because that's the label they've chosen doesn't mean that it has to be a prediction of who I am or who I can become. I may have been a victim of circumstances, or other people in the past, but right now I am not a victim anymore. I am a human being who is experiencing the sort of difficulties that any other human can face. My thought has changed to 'Why not me?' In a week when children and whole families have been indiscriminately murdered in the Middle East and Ukraine, why not me, why should I escape the pain (both emotional and physical) of life in this world?

Pain and suffering is not something I have sought out. The trauma I have experienced throughout my life, has been survivable. The burden of guilt from the abuse perpetrated by others is where it belongs - with them. If they have any conscience about their actions, then it is only right that they bear the emotional burden of their own guilt - not me. Again, I continue the journey away from feeling guilty for the actions of others towards me. The pain and the emotional scars that were left have FELT as if they would kill me, but they didn't and they haven't. I have grown stronger through the life experiences I have gone through and today, along with all survivors, I am one strong 'Mama'.

My current health concerns have a physical pain associated with them - I have managed to cope with needles going into a sensitive part of my body. I know there are many who suffer unending physical pain, so why would I complain about something that has hurt only for a time? And yet I need to acknowledge that this is my pain, I have a right to feel it. My ability to cope with it is different from everyone else. I do not know what the limits of my coping are until I reach them.

With my mental health issues, though my biggest battle will always be with my emotional impulses and the circular thinking that has fed them in the past. I am learning through this experience that the DBT skills that have helped me to manage my emotional issues are helping me cope with the physical discomforts of my current experiences.

Keeping my "Life Train" on Track

I have recently been building new routines. Due to the turbulence of my life with BPD I have always sought out certainty and routine as a way of feeling more in control when my emotions are anything but. This may seem to contradict other aspects of my life which seem chaotic to the casual observer. My problem in the past has been that I have not been able to sustain life structures that help me live the life I want - or even to be the person that I wanted to be. This is symptomatic of the lack of emotional and personal stability that is the hallmark of BPD.

One of the benefits of having gone through lengthy periods of turbulence when I left behind previous jobs, relationships and areas is that I have had the opportunity to rebuild my life many times. I used to think I was good at it. But the lives I rebuilt before obviously were sustainable. Somehow this time is different. For the first time in my life I have stayed in one area of the country for over a decade. For the first time I have stayed put even when friendships and relationships have become difficult. This pattern continued until diagnosis and treatment, due to the fact that I had reached an age when mortgages and progress in my chosen profession made it difficult for me to uproot my life and move on. Effectively, my circumstances meant that I was forced to face my emotional instability and to take time to explore the reasons behind my turbulent, emotional and mental life.

So, I have found myself in unfamiliar territory. For once, I am not rebuilding my life from the foundations up. The basics of life, a home, relationships, the means of putting food on the table are already in place and have been allowed to mature over the past twelve years or so. There is another difference, in that I now know what I have been fighting against all my life. I have learned that some aspects of my condition and responses to the world will not change. My attitude to my condition and to myself have changed. I now have skills that are not self defeating to manage my emotions and my relationships.

As I've been thinking about what kind of life I want, I have found myself thinking in terms of trains. The engine is what provides the power to move the rest of the locomotive. The engine requires fuel and both engines and carriages require maintenance. No metaphor is perfect and there will be inevitable flaws in this one. However, I have found it helpful to think of my current track to recovery in these terms. Here is how I see my life train (once you've finished laughing at the poor artistry feel free to read on about how I think the parts of my life fit together):

1. The Engine - What I believe about myself and the world around me is essential to giving meaning and hope to my life. When my emotions drive me, my beliefs about life are vaguely in the background. Due to the twisted impression given to me about myself by an invalidating upbringing I am having to relearn self acceptance, care and compassion. In effect this builds on my beliefs about how I relate to others - the challenge is can I show the same compassion to myself as I can show to others? Do I really accept what my faith teaches me about my place in God's world? Can I absorb what I am taught about how much I am loved? In rebuilding my life it is essential before I put anything else in place that I develop and practice my beliefs about who I am and how my life fits into the world around me.

2. The Fuel Truck - My beliefs help to determine the nature of my spiritual practice. I need to maintain those beliefs and this means that I need to maintain myself spiritually. I need to pray, I need to maintain my relationship with my God, this helps me to relate to others and to my day to day life according to how I believe I fit with those. So my daily activities include: prayer, maintaining my understanding of my beliefs by being part of a Church family, meditation on positive beliefs about who I am in my God's eyes and how that impacts on how I live my life.

3. The Emotions - With BPD I need to keep my emotions regulated. This means a combination of skills, including making sure I get enough sleep, food and water. It also means that I show myself compassion when I am emotionally sensitive. Within friendships and relationships I need to maintain my DBT interpersonal skills - ensuring that I do not allow my over sensitivity at times to prevent me being wise in my reactions to things that happen. Above all, I need to be kind to myself and keep learning about what it means for me to live with the symptoms of BPD.

4. My Physical Well Being - I have begun looking after myself - this is one sign that self compassion and self care are beginning to become a habit for me. As I have lost weight and am enjoying being part of a gym and a group of others trying to feel better, physically, I have found that the other parts of my life are improving.

These are the basic components of my life. They need to be linked together and need to work as one for my life to be more effective. All of which means that in every day of my life there is a basic framework which means that I attend to the spiritual, emotional and physical needs and that my life consists of holding these parts of my life in balance.

Putting the Jigsaw Together - Learning to fit the pieces of My Life together

One of my favourite puzzles as a child was a much loved and very battered jigsaw puzzle of the teddy bears' picnic. In the midst of a chaotic life the satisfaction of putting the last piece in place to make a familiar picture was so satisfying.

In the past couple of days, I started thinking about my life as a jigsaw - it's not a new thought for me, I loved Carole King's 'Tapestry' album and really loved the lyrics of the title track. Tapestries are things of beauty woven from disparit bits of thread or wool. Looking at the back there is no sense, no beauty, only a chaos of unconnected threads. Only when the picture is complete and viewed by taking a step back, can the onlooker see any beauty or sense from it.

So it is with my life, particularly when considering the part my MH condition has played in it. I mean who really wants to acknowledge that any good can come from something so difficult and painful? Whether I like it or not, for good or ill it is one of the things that has shaped the person I am today. A few years ago I actively hated that person to my very core - in the reflection of other people's treatment of me, I could see no value in my being.

Having battled my unseen and unnamed demons for many years my life resembled the jumbled mess of pieces when I first tip a jigsaw puzzle from the box. I could see the perfection I aspired to, almost like the completed picture on the front of the puzzle box. Somehow, knowing how I wanted my life to be made my struggles all the more painful.

I don't know my bookshelf is wonky until I put a spirit level against it. I think it is part of being human, some masochistic streak in us which means we always compare ourselves with others. Particularly, in regard to the life I've lived, I used to resent and envy, in equal measure, the 'ease' with which others seemed to float through life. It has taken me a long time and honest conversations with many friends and family to realise that no one has a perfect life. If I set that as my goal, particularly when learning to live with my mental illness, I will constantly feel like a failure.

I have spent the last nearly five years learning about BPD and how I can manage to live with it, without it ruining my life. When trying to complete my jigsaw puzzles I cannot simply start to put pieces together without first having an idea of the picture I am trying to create. Before I can know if I am managing my BPD I need to first know what a 'good life' means for me. As anyone with BPD knows this is so challenging, because one of the basic building blocks of life - our identity - is one of the central aspects of life that are disrupted by this condition. My sense of who I am has been so warped and distorted by my experiences, particularly in my experience of being parented, that, nearing my fifties, for the first time I am in a place where I can begin to define what makes me, me. For as long as I can remember before my diagnosis, my sense of self was created by what was being reflected back to me by others. Just as the moon's brightness depends on the brightness of the sun that it reflects, so how I felt about myself became a reflection of how others perceived me.

I am in a period of experimentation with new people, experiences and attitudes to life. I am learning to define my own responses to relationships and situations, rather than rely on behaviours and reactions I have learned from avoiding the emotional fallout of my BPD.

Finally, I have stopped looking to rebuild my life on an unattainable model. Whether that is the life I wish for, or someone else's life, that is not the template of my life as it is. My life as it is has parts that work well together, like my enjoyment of walking and my dog - they just naturally go together. Other parts of my life I need to adapt to - my BPD is one of those parts. My life has changed out of all recognition from five years ago. My goals in life are different. I now accept and enjoy aspects of my life I could never have ever imagined accepting previously.

Getting rid of my car, having never been without one since I learned to drive at the age of 17, has taught me that my problem solving skills are very good. I am learning to trust and realise that I do not have to 'bare my soul' for people to accept me. I don't need to explain my reasons for things such as not going to social events. In the past I would either force myself into these situations, then resent the friends I was with, or I would cancel and then over explain in a bid to avoid rejection from my friends. This has given me a new freedom in friendships, where every interaction is not a make or break, life or death decision.

Although I am at the end of my time in Mental Health services (I hope for the long term, but who knows?), I know my life is not completely 'sorted' - despite the panic inside I am realising that the long term nature of BPD means that no matter how long I had been in services I would never have a completed jigsaw with a perfect life at the end of it. When I remind myself that my jigsaw is still in progress and the last piece will never be put in place until my life is completed, I can stop feeling that I have 'failed' at treatment. I can stop putting pressure on myself to have everything in place in time for my last Care Co-ordinator meeting. I can stop panicking that I don't know what job I will do in the future. I don't have to beat myself up that I don't have any long term relationships on the horizon.

Recovery for me no longer means that I have everything sorted from my childhood, or that I have a perfect life, or that I will never be troubled by my condition again. That puts way too much pressure on me along with the fear of failure. I don't have to pretend I have it all sorted, or that I have a perfect life. I do recognise that I have moments of contentment and happiness, more often than in the past. I am no longer suffering the physical effects of long term anxieties and depression, although I remain on medication which maybe has to continue as part of my treatment at the moment. My life jigsaw is not complete, but it is no longer a jumbled mess of pieces, there is a more cohesive picture of me emerging - that's something that is satisfying.

Not all Memories are to be Feared

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

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

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



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



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

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

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

Pilgrim
by Dom Helder Camara

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

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

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

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

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

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

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

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

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

Learning to Manage the Calm

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

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

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

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

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


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

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

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

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

Taming the Wild Horse

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

It's Whistlejacket by Stubbs.

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

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

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

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

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

The Long Road to Self Compassion

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

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

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

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

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

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

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

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

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

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

My DBT House

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

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

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

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

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

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

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

Time to Talk

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

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

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

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

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

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

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

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

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

Why do you have to be so mean?

This week I have come across what can only described as 'hatred' for people with Borderline Personality Disorder. It shocked me. Don't get me wrong, years ago, before I was diagnosed with BPD, I used to work in the Criminal Justice System, and my specialism was Mentally Disordered Offenders, the majority of whom were diagnosed with some form of Personality Disorder.So, I was aware of negative attitudes to people with Mental Illnesses, and in particular, those with diagnoses of PD.

My colleagues used to groan if case notes included the dreaded BPD diagnosis. 1) because people with BPD are 'difficult' 2) because at the time, BPD was considered 'untreatable' by local NHS Trusts and refused to admit even suicidal cases 3) because there was a high likelihood of suicide/self harm from this 'group'. In short I believe BPD sufferers as a group have received and continue to receive a bad press from a number of sources.

I found that being consistent and listening closely to what was being said to me, often helped me to manage my cases, in other words: compassionately treating people, regardless of labels, as if they were human beings seemed to work. (not rocket science is it?)

Anyway, back to the guy who has obviously had a bad relationship with someone with BPD. His take was that BPD doesn't deserve to be treated as a mental illness, but is just down us being some kind of 'crazy ass' (his words). He even managed to intimate that the abusive backgrounds of a large number of people with BPD was actually the fault of the victims. Initially I felt defensive of myself and others who have suffered from what some describe as 'emotional sensitivity' rather than BPD. Then I considered that perhaps, following a messy break up (I've been involved in my fair share of those!) his anger was robbing him of his humanity. Which is understandable.

How do I respond to his point that I'm just an emotional mess? That I do not deserve treatment? Well, I think that I would point him to Marsha Linehan's (the creator of Dialectical Behaviour Therapy for BPD) explanation of BPD as equivalent to suffering 3rd degree burns.

Imagine suffering emotional and psychological pain that is so deep and so painful that the only solution you can think of is either to inflict physical pain to distract from it, or to believe that dying is the only way to stop it? Does that sound like something that you could sustain while maintaining a functional life? Yet many sufferers of BPD do manage to do just that, while holding down very respectable jobs and being creative and dynamic in certain spheres. This 'apparent competence' in certain spheres, my BPD-hating 'friend' points out as proof that BPD is made up by selfish women seeking to justify messy love lives and as an excuse to be nasty to men.

I think at this point we can recognise the ignorance and stigma evidenced here towards Mental illness in general. I mean you can't possibly run a country with a severely debilitating clinical depression, can you? Winston Churchill, anyone? Just because my professionalism and training allow me to carry out a job from 9-5 does not mean that the emotional distress I am experiencing is not real and does not have an impact on my mental and physical health.

If I may, I need to return to the burns analogy, even when time allows a skin to grow over the burned area, there remains a sensitivity that often never leaves. The levels of abuse I suffered as a child have left me with emotional and psychological scars. My diagnosis whilst not perfect, has allowed me to access help to develop skills which mean that I no longer consider death to be a solution. My treatment means that I am able to begin to 'function' again, after a complete breakdown two years ago.

I am responsible for the people I may have hurt throughout my life. I would say, though, if you rip the dressing off a burns victim, you can expect a strong reaction! My plea is: try to listen, try to understand, try to give space, and, if you think you are too angry or too hurt to see the human behind the label, make it a clean break.

http://bpdlifeinthemoment.blogspot.co.uk/

Taking off the Training Wheels

I've never liked endings. That's because I've always been very bad at them. In the past, due to the 'push-me, pull-you' emotions of BPD I'd never managed to maintain any relationship for longer than three years. So when my CPN and DBT Therapist are giving me actual dates for 'discharge' my natural suspicion of my ability to cope raises its ugly head. Especially as I started working with my CPN in 2010.

It's not that this is a shock. After all, from day one on DBT they prepare you for life after DBT and emphasise the fact that the therapy will end. The problem is that most of my endings in my life have been accompanied by some form of relationship, or other, trauma. To be honest, one of things I am getting used to is the lack of trauma in this ending. I mean, suddenly I am aware that I am coping better with all sorts of new experiences - stable friendships and lack of crisis in my family relationships. Or should I say, I am not allowing my emotions about these relationships to overwhelm me - one result of the DBT skills I have learned and practised over the past 18 months.

I still have anxiety about the future - will I ever be employable? When treatment ends, will I continue with my recovery? How do I cope with the realisation that some very key relationships with my CPN and Therapist are ending? I'm bound to have anxieties because I have never travelled this road before and certainly never been equipped with the tools to manage my overwhelming responses to the world before.

What I have learned is 'do not worry about tomorrow, because today has enough troubles of its own' (Matthew Chap 6 v 34 The Sermon on the Mount). Rather than racing ahead in anticipation of everything coming crashing in round my ears, as it has so many times in the past, I have learned to accept each day as it is right now. It has included ups AND downs over the past 18 months. Treatment has not changed my life into an amazingly problem or crisis free road.

Rather, I have changed, I have learned not to trust the extremes of my thoughts and feelings - the Black and White thinking symptomatic of BPD. I now check out some of my knee jerk reactions to life and have moved from the rocking to and fro of a small boat tossed about in stormy seas, to being able to wait for the storm to pass, as I have learned that both thoughts and emotions come and go. The most important thing I have learned about my feelings is that they won't kill me, no matter how intensely I feel them. I have also learned that my thoughts and feelings, alone are not reliable enough to build my life responses and choices on. As the serenity prayer says: 'Lord, grant me the serenity to accept the things I cannot change. The Courage to change the things I can and the wisdom to know the difference.' This is a summary of the DBT skills I have learned. Learning to manage BPD depends on a balance between acceptance and change. Acceptance of the things that are an essential part of my experience and character. Ability to change those things which are in my power to change in my response to my environment and relationships.

Given that it is over a year since I last self harmed, I have been managing my BPD with the skills I have learned. The training wheels came off a long time ago. My therapist has been coaching me from alongside, having pushed me off to balance on my own some time ago. The problem at the moment is that the impending end date has made me suddenly aware that I am moving forward with only myself and my new skills to keep me balanced. Wobble I may well do, but I am moving forward and, (to carry the bike riding analogy to breaking point), as long as I am moving forward I will keep my balance and I am unlikely to fall off. However, I have also learned that even if I do fall, it is not the end of the journey. I can pick myself up and continue on my way.

'Stop Being so Silly' Said the A&E Consultant

TRIGGER WARNING: This blog describes a distressing incident and discusses suicidal feelings and feelings of frustration and helplessness.If you are affected by discussion of these subjects, don't read on

It was early on a Sunday Morning during the Queen's Jubilee Bank Holiday weekend. I had implemented my Crisis Plan following a week of sleepless nights and five days of constant vomiting, which gave way to dry retching. I was not physically ill, but vomiting spasms were one of my most obvious symptoms, during periods of emotional distress.

I was feeling suicidal and needed help - desperately. I phoned the Crisis Team, as per my Plan and after ten minutes was instructed to attend the local A&E and ask to see a member of the Team as they were on site in my local hospital. So, I did as instructed and reported to the A&E reception, where the Receptionist was helpful and clear that I had already spoken to the team and had been told to report to them. So far so good. Thankfully, for a holiday weekend at 4.00 a.m. the unit was relatively quiet, just three others along with me in the waiting room.

The Triage Nurse, again was efficient and reassuring, I had continued to retch violently and had soiled and wet myself by this stage and so was in obvious distress. She was empathic and quickly ascertained that I was already open to the local CMHT and therefore was responding correctly to my Crisis Plan. Again, no regrets, relief that the plan was working. Then it went dramatically wrong.

Enter, the A&E Consultant. Opening gambit: 'Why have you come to the Emergency Department tonight?' I told him I was diagnosed recently with BPD and was experiencing a sustained period of emotional distress. Again, a long explanation about the building distress, finally admitting that I was feeling suicidal had contacted the Crisis Team and they had told me to report to them via A&E, could I please speak to them. 'No, you must speak to me' - cue frustrated banging of head against wall. 'You must stop being so silly and speak to me'. 'What is all this nonsense about suicide?''You are being very difficult and I'm not prepared to refer you on'. I decided to try pleading, 'Please, I don't want to explain anymore, I need to speak to the team, I have already spoken to them on the phone and they told me to come here immediately. That was two hours ago.' He again told me that talking about suicide was 'silly' at which point I exploded: 'Get this bastard away from me, I don't want to talk to him anymore'. Again, banging my head against the wall.

He continued to refuse to refer me on until I had 'stopped this nonsense and calmed down.' Then, a Staff Nurse and HCA appeared, alerted by my shouting, and quickly removed the Consultant. For the first time since speaking to the Triage Nurse, someone asked me if there was anything they could do to help me. It was the HCA. I was able to tell her about my soiled clothes. She quickly arranged some scrubs for me to change into and offered me a cup of tea. Then she and the nurse put me on a trolley and tried to get me to put my head down.

Within thirty minutes of their intervention, a member of the Crisis Team appeared and assessed me. She prescribed a sedative to stop the vomiting spasms and arranged a home visit from the Home Resolution Team the next day. Admission was never an aim of mine, as it is noted in my Crisis Plan that this is counter-productive unless there is an imminent risk of harm to myself. Having removed the Consultant and feeling listened to, my risk of harm had reduced significantly.I was allowed to go home at 6.00 a.m. and had a visit from the Team at home by 10.00 a.m.

The team responsible for my care had helped, but there seemed to be such a disconnect between their response and the response of the Consultant.

Given that the Receptionist and Triage Nurse had noted the involvement of the MH team, why did this man not recognise the fact that my case had a solution in place? Why did he feel that it was okay to belittle my response? Why did he not notice my physical discomfort and embarrassment? Given that I was dealing with BPD symptoms and risk of suicide attached to this condition, why did he not carry out a more thorough assessment of my suicidal ideation?

I guess there are no answers as to why, only he may know that. What worked in soothing my distress and stopping my self harming behaviour from escalating, was common sense responses to a human being in need. In a word, compassion.