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.

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.

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!

Reaching Into the Void

It is one of the most difficult aspects of the emotionally sensitive PD sufferer to communicate. It is a well of undefined emptiness, which seems to endlessly feed my fear of rejection, my sense that I am not made for this world, that life, many times, feels just too hard. It is the cause of so many devastated relationships and friendships, as my need to end the emptiness it brings, swallows up the capacity of those around me to keep loving me.

Recently, I have had the opportunity as a volunteer with lived experience to work alongside staff in a number of co-production projects. Along with the positive I have also had a glimpse at some of the more negative assumptions made about people with a diagnosis of Emotionally Sensitive Personality Disorder, ESPD (also previously known as Borderline Personality Disorder, BPD). Since I was diagnosed seven years ago, I've encountered sudden changes in relationships and friendships, based on ignorance and fear of the label. I have not experienced stigma from professionals who worked directly with me, although many with whom I have shared my treatment journey have told me their own stories of being treated as a 'headache', 'a problem patient', 'manipulative', 'difficult'. I did encounter these attitudes following my diagnosis being added to my medical history, mostly from those in the periphery of my journey, GPs, some A&E staff, those treating me for physical illness.

There is an unspoken expectation that I will be time consuming, difficult and, ultimately that I will not able to be 'boxed off' and 'sorted' by the time my intervention has ended. On reflection I know this does not reflect the compassion of the majority of professionals, but more reflects the lack of ability of the systems and organisation to deal with human beings who have seemingly intractable and complex needs. Our systems are more and more built around outcomes which can be measured and when I present with a complex web of biological and social needs, I mess up the system.

I've spent some time reflecting on the disconnect between the move from 'untreatable' to 'treatable' under the Mental Health Act 2007 and the frustration evident in eye rolling exasperation I can detect in some professionals.

At my worst I could never feel I belonged anywhere. At my worst my emotional pain was so searing and real it felt as if I were walking around with my sternum cracked open. As if it exposed every nerve in my body, pulsing in pain with each beat of my heart so that it felt as if the mere presence of another human in my personal space became unbearable. The core of these feelings centre on a void within which no person could fill.

The sense of helplessness this evokes in those who seek to show me love, often leads to the ultimate breakdown of the relationship as my see-sawing emotions create unending storms. For the person on the receiving end, this see-saw goes from 'love me', to 'I hate you', 'I knew you couldn't love me'. The intensity of loving me can be satisfying for a short time, until the void within swallows every ounce of emotional energy you have to give - many of my relationships ended because of the need of self preservation.

The pressures on the professional working with PD sufferers cannot be easily resolved by an end to the relationship. Indeed, there is a contract, mostly unspoken which says, 'but you can't abandon me, it's your job to care'. I believe from my own observation and experience of positive therapeutic relationships that this is at the heart of the exasperation of many professionals. No individual can possibly remove or fill the void and lack of self which underlies so much of my emotional dysfunction. I have seen the discussions between different agencies who step in to help, or more accurately rescue. After all, when all else fails and I am in so much emotional pain and feel that no one is listening I can always call 999. Police, A&E scoop me up and remove me from all responsibility for managing the void within. I am helped to rest with drugs, I am kept safe by restrictions placed upon me. The reality is that the emptiness remains when the drugs wear off and therefore it becomes a battle to return me to my everyday life.

Where Dialectical Behaviour Therapy (DBT) is different from other interventions is where it asks about my whole life. I need to find an answer to the void within. No one can reach into it for me. For me, meaning and hope come from a personal faith, which helps me to anchor my recovery in a belief that my life has purpose. The challenge for any professional is that the essential question is 'what does a life worth living look like to you?' and means that there is a need to listen to and explore with each individual how they find hope and meaning.

I believe the word 'holistic' is one of those trend words in psychology or medicine which we throw around without exploring to an effective degree what it means in practice. Traditionally, in my experience therapies focus on either my physiology, or my emotions, or thoughts, or all of the above. To be truly holistic we need to look at the core of our being, some would look to spirituality, others might focus on the sense of soul inherent in human relationships. Whatever, when looking at what has worked for me in DBT the difference was in helping me to accept the existence of the void within, whilst encouraging me towards finding out where I could find a sense of belonging and of purpose.

When I consider all of this it is hardly surprising that our longstanding systems and pathways don't fit the needs of the PD sufferer. So we become the 'problem patient', the awkward one that can't be 'treated and streeted'. In essence, though I think there is a need for a different approach for ESPD due to the all pervasive emptiness. I would also say that due to the impact of Mental Illness in general on our physical and spiritual well-being maybe a truly holistic approach to our therapeutic interventions is necessary to help people to rebuild lives with meaning and hope.

Recovery Story

I have been asked to tell my story at a conference of the World Association for Psychiatric Recovery at the end of April. As part of the preparation I was also asked to provide a written version for delegates to take away...this is it:

‘The past is a foreign country.’ Not for me. My emotional memory is highly tuned and sensitive to pain and suffering, which means that the memory of childhood trauma can hold the same emotional impact 30 or 40 years later as the moment it happened. I did not know that my emotional and mental battles had a name until I was 42 years old. I had first been referred for support from mental health services, by my teachers at the age of 16.

I was the classic ‘quiet child’. I didn’t cry, I did not speak in groups, did not speak in school, communicating with adults through my brother or a close childhood friend who started school with me at the age of 4. My brother and I suffered similar, significant physical and emotional abuse. For me this was compounded by sexual abuse from a series of perpetrators until the age of 18 when I finally escaped to university. School was my safety, literature was my escape, although until an inspiring teacher noticed me when I was aged 9, my first school labelled me as educationally, ‘sub-normal’, despite the fact I was devouring books at home.

Despite our similar family experiences my brother and I have managed to live as adults with very different outcomes. He has never suffered any significant mental health issues. Here is where my brain reacts differently to the world from those around me. I have been given a number of labels since 2011 when it was first suggested by an assessment, following persistence from my GP that my symptoms and mental health history indicated a diagnosis of Borderline Personality Disorder (BPD). I know many patients find this label problematic, but, given the fact that I had successfully sidestepped hospitalisation despite entrenched patterns of self-harm and suicidal ideation, I viewed the news as an opportunity to move forward.

By 2011 I had been working as a Probation Officer for nearly ten years. I specialised in Domestic Abuse cases as well as those who were considered ‘untreatable’ by Mental Health professionals due to ‘Personality Disorder’ diagnosis. By 2007 the Mental Health Act stopped this loophole and stated that professionals could no longer pass the buck to Criminal Justice Agencies where prison certainly was not the appropriate setting in which to address both self-destructive and violent behaviours. I was able to work within a multi-disciplinary team, made up of Probation, Police, NHS and voluntary sector staff to address the key socio-economic factors, alongside mental health and addiction issues, in order to address offending behaviour. It was within this context that I first came across the work of Marsha Linehan in developing a specific therapeutic approach to BPD patients which has become the Dialectical Behaviour Therapy (DBT) model.

I recognised how effective DBT could be for some of our cases when set in the context of significant community support. Unfortunately, 2010 brought a new government who did not feel able to support such ‘end to end’ management of offenders with a rehabilitative continuum supporting people as they moved from prison and sought to re-integrate effectively within their communities.

All of this experience meant I was open to the possibilities offered to me by DBT to develop the skills necessary to manage the impact of my past whilst learning about my emotions and the impact of the world around me on my mental health. I recognised that having learned about emotions, DBT would offer me new coping skills to manage my emotions more effectively than all the self-destructive behaviours I had previously employed to ’survive’ life. I was grateful that my diagnosis came at the same time that LCFT started to deliver DBT as a pathway for BPD.

In telling my story I am keen to identify the factors within DBT and the Wellness Recovery Action Planning (WRAP) programme which have been instrumental in helping me to maintain my mental and emotional wellness.

1. Managing Expectations – Often I have observed in professionals a natural tendency to recoil from the levels of distress I have expressed when I am in crisis. My label has recently changed on my records from BPD to ESPD (Emotionally Sensitive Personality Disorder). It does not fully explain the complex mix of biology and social environments which result in me displaying extreme reactions to the world around me. It is Marsha Linehan who has articulated for me, the extent of my emotional distress:

‘Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.’

For the professional who encounters such apparent suffering, there is an almost unbearable pressure which seems to come from me, in despair crying, ‘help me’. This is where the professionals’ role in recovery perhaps needs to be adjusted, and I would suggest, is within the DBT model.

In my first meeting with my one to one therapist and the DBT Contract signed by me and my therapist, there is an acknowledgement that no human being, no matter how skilled, can stop me from feeling the pain of my life in the past, nor can they give me a prescription which immediately removes or dulls emotional pain. What I am offered is hope that together we can work to help me learn to manage my distress, make friends with my emotions and make changes to the behaviour which so far has served to prolong my suffering.

Throughout my experience of DBT I was encouraged to attend ‘training sessions’ (Group Skills) and apply those skills with the help of my DBT therapist (my ‘Coach’) to my own life. The question which after decades opened the door on hope for me, having ‘failed’ at numerous talking therapies, was ‘What does a life worth living look like for you?’ I was informed that no treatment or professional can undo my past experiences, nor can one person or therapy undo decades of maladaptive coping mechanisms in a limited period of time and within solely clinical settings. As with referrals to Physiotherapy for those with physical injuries, recovery means that there is a responsibility on the patient to take the exercises learned and practise them in the real life setting.

2. Managing Limits – From the beginning of the DBT therapeutic relationship, there is a clarity and agreement that both patient and professional will have their own personal and professional limits - it is helpful if an agreement is made about what those limits are and what the likely consequences of breaching those limits will be. There is also an understanding that each therapist has the backing of a team who understand and agree with the ethos of the DBT approach. This provides protection for both the patient and the therapist. In terms of carrying it into real life this models protective boundaries necessary to keep relationships going.

In the past my life patterns seemed to go in five year cycles. Every five years my central relationships would not only end, but explode with all kinds of collateral damage, resulting usually in a loss of accommodation and employment. I would spend some time in treatment, recovering, usually travelling abroad, in extreme settings (ie war zones), then restarting in a new location. Now I am building up a strong network of friends in a place I have lived and worked in for 16 years. When I was first diagnosed I was socially isolated and unable to find the emotional strength to start to build relationships outside myself and those necessary for a job to work.


3. Managing Reality – When struggling with the basics of life, usually most forcefully at the beginning of the recovery journey, before diagnosis, there is a perception that I am the only one experiencing life in this way. I have a distorted view of the levels of my own failures. In a sense I believe I was like Supergirl, not only did I feel I was an alien on earth, I also expected of myself massively higher standards and limits than anyone else. Until, ESPD became my ‘Kryptonite’ reminding me that after all I am flawed and human, and therefore absolving me of responsibility for everything bad in the world. In short, as I was reminded during my DBT journey, the universe doesn’t actually revolve around me and there are many, oh so many, things I do not and cannot control.

Another reality that comes as a shock after years of trying to manage a daily rollercoaster ride of extreme feelings is that, most of everyday life is boring and uninspiring - when struggling with Mental Health issues there can be a distorted view of life on the 'other side' where life must be rosy, easy and better than that experienced by me.

This is where involvement in real communities, becomes essential to maintaining recovery. If I can only relate to those who have an experience of Mental Health Services, or who have a shared diagnosis, then I am not allowing myself to experience the variety of relationships around me. It is more positive and more akin to real life to join groups which are focused on a location, sport, or interest. I have developed a ‘wellness group’ which, after nearly 3 years is firmly established within a defined local community. This means that we offer not only a weekly group focused on a programme to help us engage with activities which are available locally and can help our mental, physical and spiritual wellness. We have a strong online community of over 100 people who have come through word of mouth. We recognise that people are on a different part of the recovery journey so our weekly group is flexible and adapts to the needs of the group membership. As such we do not have a static membership, some people attend during sickness absences from work as a support in returning to work and move on. Some attend not knowing much about how to ask for help and need signposting and practical support to access GP referrals. Some are carers. Since we began we have had 50 members of the weekly group with this year’s group running at 6-8 people attending each week. We also meet on a one to one basis to provide signposting and advice, contact is usually made via local community contacts or by Direct Message on our Facebook page.

We encourage people to move out from our group and try other community involvement through our contacts with local groups and businesses. Having the opportunity to contribute within a wider community is vital to recovery. There is such a thing as a meaningful life - this cannot include unlimited access to Mental Health services as that is not the experience of most people. There is something intrinsically unhelpful if the only safe places a person feels they have can only be within Mental Health services or in socialising with those who have similar experiences. This is different from peer support.

4. Managing Discharge – From day one the end of DBT therapy and discharge were discussed openly with me, even though my actual date of discharge was nearly two years away, I was preparing for it from the moment I started therapy. Unlike my previous experience of endings I was more than ready to move forward, even though I was not symptom free I was able to leave feeling confident that I could live with the limits caused by my ‘Kryptonite’.

5. Managing my condition - Everyone has the ability to manage their condition if provided with the right skills and therapy to help them build a meaningful life in spite of their diagnosis. Hope is always there from day one underpinning the efforts of both staff and patients.

A Word about Relapse

I was discharged from the Complex Care and Treatment Team in 2014. In April 2017 I suffered a relapse in my condition requiring the intervention of the Crisis Team and Home Treatment Team. This had been triggered by financial pressures caused by a 2/3 cut in my benefits. Apart from not having enough for food and utilities this could have resulted in the repossession of my home. Thankfully the work I had put into building strong relationships meant that some friends were able to buy a percentage of my house and secure my residence. At the same time, it was taking 18 months to appeal the assessment decision. Each stage in the appeals procedure was highly distressing and only ended in October 2017 when I had to present my case to a panel at the Magistrates’ Court. Sometimes the environment is too powerful for me to manage even with my DBT skills.
I did feel like a failure, but I was told the DBT team within LCFT had developed the Acute Therapy Service (ATS) which helped me to stay in my home with the support of the HTT and my social network. I travelled to the ATS unit daily and for six days was given respite from the relentless pressures, to sharpen my mindfulness and emotion management skills. It felt like I was able to reboot and return to the same pressures but with my hope restored.

When you have been on the recovery pathway for some time, relapse can feel devastating until I take a step back and recognise how far I’ve come. The skills I once relied on to prevent self-harm are no longer required, but other sets of DBT skills are habitual, particularly mindfulness.

Hope and Meaning

Hope and Meaning cannot properly be provided by medication or therapy within a clinical setting. For me, hope and meaning come from a personal faith in a God who is bigger than me and my past and problems. For anyone, whatever their belief system finding someone or something that is bigger is important to providing an answer to the question, ‘What do you get up for each day?’ I think that the journey through therapy can partly be a search to discover what this is for each individual. It’s important for me to know why I should comply or co-operate with interventions or medications. In the past when I was unable to find an appropriate answer I was the nightmare patient – ‘uncooperative’ and ‘disruptive’.

I have long held that all of life is a journey, we pass through different terrain and places. Along our life’s journey we may be joined by others who travel the same path. I have seen those who have helped me as Care Co-ordinators, Therapists and Facilitators as ‘journey friends’, people who join me for a part of the journey. Some, the best practitioners, walk alongside me. Others, run ahead, leaving me lagging behind. Others, stay behind me, out of sight, making me feel uneasy and judged.
I am grateful for a therapeutic pathway which offered me hope that things could be different one day.

Joy and the Emotionally Sensitive Person

'Sassy', I think this is one of my favourite words, and attitudes! There have been a large number of words used to describe me down the years: 'moody', 'drama queen', 'over sensitive', 'touchy', I could go on. However, the 'Sass' in me is fed up of the negative vocabulary attached to my diagnosis, that in itself seems confused. On my medical records the labels have changed from 'borderline', to 'emotionally unstable', to 'emotionally sensitive'. None really adequately conveys the reality of living in the emotionally sensitive skin.

As I progress in my recovery, I am beginning to find more positive words to describe my experience of life. When I see the worst in the world, the pain can almost certainly cause distress and unbearable pain. The flip side is that when I allow myself to focus on the good things in life, pleasant feelings are amplified into joy. I can really enjoy the small pleasures of life. Just as the pain and distress of life can be experienced by me to its depths, I am able to enjoy good feelings in wonderful technicolour. This is the freedom of owning my emotions and embracing the times of enjoyment, sometimes to the embarrassment of my companions. Dancing down the steps of the cinema, then taking a bow, following two hours of really enjoying a musical, is me allowing myself to express real joy, as much as I have let the reins go on my more destructive emotions. The difference is a little public expression of happy feelings is not destructive, in fact, perhaps my expression of strongly felt emotion was an echo of fellow cinema goers' enjoyment of the same film. The spontaneous applause from them as I skipped to the bottom step and turned round, was a moment of real shared joy, in a pretty unpleasant national and international setting.

I am good company, because I can take the smallest glimmer of enjoyment and amplify it (when I allow myself not to fear the strength of my positive emotions). Balance is important so that light feelings don't spiral out of control - but for too long the negatives of emotional sensitivity have led to me keeping my strengths in check.

I love the poem 'When I am Old I shall wear purple', except, now I'm 50 I'm not willing to wait until I'm old to embrace the best of my life experiences. Part of that is because I have allowed others to define what responses to my life are 'acceptable' for too long. The words I apply to me need to become: colourful, fun, strong, empathetic, sensitive to others, creative, optimistic - yes, really! I've realised recently simply because of my ability to come back from knockdowns and how I see what is possible, that I am an optimist. I believe in enjoying small pleasures just like a toddler - not out of control - but absolutely one hundred per cent, totally involving myself, body, mind and soul in enjoying the moment. Not childish, but childlike. It's no accident that the feel good clips most enjoyed on YouTube tend to focus on young children, kittens and puppies.

I'm currently watching the Winter Olympics and once again Elise Christie (GB Short Track Skater) has experienced unbelievable setbacks. One thing that a friend of hers said about her emotional responses struck me; she is able to embrace the pain and the feelings of despair so strongly, but unlike others, who can't do that, having faced the worst she can feel, she very quickly comes right back up again, ready to fight. Sometimes the emotional impact of the worst in life floors us for longer than we want. The fact that so many emotionally sensitive people face the worst thoughts and feelings about themselves and life, yet keep going, shows me there is always a seed of hope within. Building up the experiences of our most joyful moments, so they become a buffer against the bleaker times of life, helps us to be even more resilient than we give ourselves credit for.

Expectations (Not Resolutions)

We all have them. We've all suffered from our own and others'. Many times they are too high for anyone to fulfil. Sometimes we most misjudge our own of ourselves. Expectations and their failure or perceived failure have caused me untold tears of disappointment and frustration. I am certain I am not alone - that expectation is bound to be met!

Misplaced and excessive expectations can cause increased distress and emotional pain at any time, but never more so than in our yearly build up to Christmas and New Year celebrations.

For the past few years I have abandoned the frankly masochistic practice of setting resolutions - why do we have to become abstemious and self denying, immediately assuming we can rid ourselves of all the behaviours which cause us untold misery over years at the stroke of midnight on the 31st of December each year? Was it Einstein who said that the definition of insanity is to keep doing the same thing, expecting a different result?

So, now I tend to adjust expectations - a bit like the Team GB Cycling Team - I now aim for 'marginal gains' making small adjustments to how I've been doing things over the past year. Looking back at my path on recovery I recognise that I have changed so many of my habits and behaviours and honestly I can say that I am in a better place this year than last. Doesn't mean that everything is hunky dory or that the past year hasn't had its battles or disappointments.

What expectations do I have for 2018?

1. For Myself. Setting unrealistic goals for myself has put unnecessary pressure on me over the years. Aspiration is all very well, but honestly, I believe that expecting myself to be perfect, to hold myself to a higher standard than I have for others has meant that a significant level of anxiety has been a constant in my life. So I need to adjust my expectations.

I am living with a condition (Emotionally Unstable Personality Disorder) which means that my emotional stability is constantly adjusting to changes in my circumstances, my body, my nutrition, the presence of other people, the absence of other people, making plans, too much work, too little work etc. This means that I quickly become exhausted if I do not 'give myself a break'. I have had to adjust my expectation that I can keep on going without any regard for my own emotional and physical needs. In the past this has led me to experience repeating cycles of recovery, giving out too much, for too long and ending up exhausted and unable to function.

I now recognise that helping others requires me to look after myself as much as I care for others. Part of the healing process is accepting that I need to be cared for in order to care for others. I cannot expect to feel connected to others by either keeping myself locked away so I do not become exhausted or becoming unreliable as a friend because I wear myself out by giving out when I have run out of emotional resources. The goals I set for myself will be helpful if I keep an eye on my limits, my realistic strengths and my need to care for myself as well as others.

2. For Others When feeling intense emotional distress it is easy to expect way too much of others. In particular, I have demanded of professionals and my friends the impossible. No human being can remove my past from me, no human being can undo the harm done to me. I think sometimes within a service which is free at the point of delivery, we have expectations of staff which are not humanly possible.

If I have waited nearly a year for a treatment, there is a sense in which I expect that on day one the therapist will wave a magic wand and all the emotional turmoil and sense of emptiness will disappear. In black and white that is clearly unfair, and if you presented me with this as an objective observation I would be shocked and deny it as an expectation. However, the reality is that sometimes my anger and frustration has been directed at those who are seeking to help me, simply because deep down my expectation is that they SHOULD be able to stop me from feeling so much pain. I have often created barriers and 'tests' which have become self fulfilling prophesies as I maintained my expectation and belief that 'No one can cope with me' and 'I am incapable of being loved and giving love'. Of course people give up when they are pushed to their limits and beyond. Unrealistic expectations result in the very rejection I always fear and, ironically, expect.

Adjusting my expectations means that the limits of the therapeutic relationship and friendship which maintain effective connection can provide a stable framework in which they can survive my emotional storms. Friends and therapists alike have their limits. I have no right to expect a friend to carry the burden of my past hurts or my present struggles. A friend is someone who walks alongside - no one - not even in the most intimate of relationships can actually live my pain for me. The therapist is there as a sounding board, not a whipping boy, as a guide, or coach. They are not a fount of all knowledge, nor are they able to 'prescribe' chemicals which can remove every painful emotion or memory. In a sense, because I have survived the actual events, the emotional pain and distress I continue to feel are the 'aftershocks'. I have the strength to deal with them, I do not have to inflict the same distress on my friends or my therapist in order for them to come alongside and help me cope in the here and now.

The most pervasive expectation I have had has been that of the 'perfect relationship'. If my loved one really understood and loved me, they would know at every moment exactly what is happening emotionally to me. They would be so entwined with me that they would be able to read my mind. Most destructive of all is the expectation that if my partner loves me 'enough' then all the pain and emptiness inside from my early experiences, coupled with my physiological make up would end. Man, what a burden to put on any relationship let alone any individual. Often, this impossible expectation is coupled with the twin one of myself, ie that no matter how self destructive to me, I will do anything to 'prove' my love. Sometimes, this toxic combination has resulted in abusive relationships which have perpetuated the destructive experiences of trauma in the past. Adjusting my expectations to taking responsibility for my own emotional balance allows me to enjoy connection and relationships which are not burdened by unrealistic expectations. Accepting that our shared humanity means we all have our limits allows greater honesty and more secure relationships.

3. For Life Life is tough. For everyone. When we are at our lowest we often assume, wrongly, that everyone else and everything else is experiencing a life that is so much more than our own. The reality is that most of life is boring when people are not dealing with crisis or enjoying high points. Often I have assumed that no one else is struggling to extent that I am. It is a symptom of emotional struggles that we fail to perceive the daily grind of most people. No one exists on mountaintops in terms of their life experience. Mountains stand out because the terrain around them is lower. The lives and experiences of others we think are better, stand out because of the relative 'normalness' of those around them. I do not know what other people's experience is of life, nor can I tell anyone else what a meaningful existence consists of. I can only decide that for myself. I cannot possibly compare myself or my feelings about life to another. There are too many variables in our comparative experiences. Nor do I have a right to judge another person for struggling, particularly if I expect that their life experience has been 'easier' than mine. I have no right to call another person's mountain a molehill. Accepting myself and the life I am living as unique to me, without comparing it that of others means that my expectations of my own life shift and don't suffer in comparison. This means that material and physical circumstances become less vital to my expectations of life.

If you are finding yourself under pressure at this time of year, ask yourself what you expect, or expected from the festive period? What do you expect of yourself and others going into a new year? Are your expectations for recovery/managing your mental health realistic? Do you expect too much from yourself and others? Do you ignore the limits of living in the real world? Are your expectations of medications/professionals/human relationships for your mental health realistic? Accept what cannot be changed, change what you can, within your own limits and maybe learn to enjoy what there is to be enjoyed, moment by moment. Resolutions sound so definite, expectations can be adjusted.

Reflecting on Relapse and Resilience

We were walking uphill. I had known that the walk involved going up. I can see the woods at the top of the walk from my house. However, a sudden emotional storm engulfed me and I started sobbing and becoming angry towards my dog, who was running UP. With me attached to her lead. Looking back I'm laughing, in fact, my snapped responses to my friend who was with me, you know, 'I'm fine.', 'what's wrong with me', 'stupid dog', just as suddenly as my anger had arrived prompted sudden laughter. 'No wonder you're struggling, you swam half a mile this morning!' Common sense. Check the facts. Don't rely on how I'm feeling. Fluctuating moods is how it is described. Hardly surprising then that when I am physically tired and continue to push myself, my emotional control goes out the window. Fluctuating moods is basically 'what's wrong with me'!

About five years ago, such a process of understanding the waves washing over me would not have been possible. Understanding my condition does not stop my emotional reactions. What it allows me to do is to take a step back, pause long enough to stop the feelings overwhelming my ability to see the world around me with some degree of balance.

My recent travails with the system of 'reformed' benefits and the consequent relapse has given me reason to reflect on the state of 'recovery' and the nature of resilience.

By reaching the age of fifty despite the emotional and other storms of my life, I have shown resilience. I have bounced back from setbacks, again and again. That's resilience, right? I think it is, but I am also learning that rather than just waiting for my 'bounce back' to kick in when I am in crisis, there are everyday routines and activities which feed by resilience. This, I think is the main occupation of the person in recovery, to feed and nurture the parts of me which keep me involved in living.

Part of this task is recognising the restrictions, boundaries and limits that my condition places on me. For example, if I want to do a full time job odds are it needs to be emotionally neutral, have limited contact with people and probably be very non challenging. However, I also need to recognise that as someone with skills and experience in certain areas I still need to be challenged in my day to day occupations. So the compromise I make, in order to make my commitments sustainable, is to limit the hours I work/volunteer so that I have recovery and nurture time. As someone who worked full time in challenging careers since I left university, admitting that this was a need to maintain my recovery and prevent relapse has been a struggle.

I have had to accept that if I am to break the patterns of over-commitment, exhaustion and breakdown, I need to focus on what I can realistically sustain while managing the fluctuations in my moods.

Here are some ways I am trying to maintain my recovery and build up my resilience:

1) Set realistic limits and be honest with myself and others about what those limits are. I am mostly involved in running a community well being group and that has been my focus for the past couple of years. In addition for short periods of time I help deliver a six week course which links in with my involvement with the other group. I was asked if I wanted to help with a group aimed at helping older people. In terms of time that came to 6 hours a week. Surely manageable for someone who has worked full time most of their life? What I need to remember is that when I did work full time I had constant meltdowns, high levels of emotional instability resulting in emotional exhaustion and necessitating me leaving job after job, usually in five year cycles. I am more than capable, but my emotional and mental resilience needs constant monitoring and maintenance and I was never able to sustain that when 40 hours of my week were taken up with work alongside volunteering in the evenings and at weekends. This week I found out how my limits have changed. In addition to the four hours involved in the group and course I had two separate meetings on two consecutive days, meaning my routines were interrupted four days in the five day week. By Thursday, my busiest day, I had become tired and confused about meeting times, something I usually never am. As a consequence I recognise that I need spaces in my week to give me a breather from giving out. So my pattern will become, Monday morning small group meeting, Tuesday focus on my own health, Wednesday writing and work at home, Thursday morning, course, Thursday evening, group, and Friday time and space. The time and space needs to include time with friends and family who are nurturing. Against my instinct that I will be letting people down I have had to pull out from my involvement with the older group.

2) I am recognising that my needs are important too. We all know the feeling of pressure and obligation that comes when we have taken on too much. When there is so much need and there seems to be so few community resources, as a compassionate person it feels like a personal failure if I am unable to meet all those needs. Except, no one asked me to. I am reminded of the words of a co-worker in a charity when I was visiting the Sudan and witnessed firsthand the extreme suffering and need of refugees, 'You can't change the world, but you could change the world of one person, just by witnessing and reporting what you see.' It was easy to connect with the suffering and allow myself to be overwhelmed by it, but again, no one asked me to. Just because I see the need does not mean that I have to be the person to meet it, indeed I may not be the best person to meet that particular need. When I am focused in helping out and when I make space for my own needs, then I am better able and equipped to give out, without burning out and consequently resenting those I am trying to help. I have recognised this in others, particular mothers of young children who feel guilty because somehow their children have become burdensome....one question, when did you last have space to yourself, to just relax and enjoy a moment or two of pampering? We are very bad at prioritising time to recharge.

3) Physical fitness has a direct impact on my ability to manage my emotional health. This is different from saying, when you feel low, go out and have a walk, or just do something. This is about preparing much as an athlete prepares for competition. The years before the Olympic finals are vital long before the need to perform at the top of their ability. I now work as hard at maintaining my weight, balancing my food and maintaining my sleep patterns. When in the early stages of recovery from emotional exhaustion I needed all my energy to practice my emotional and distress management skills. As my emotional health recovered was the time to think ahead, admit that there will continue to challenges which will sap my emotional strength and admit that to give myself the best chance to manage these life events well, I also need my body to be functioning as well as possible. Sounds mechanical but we often forget that we are one fully integrated unit, so when I have a cold I feel lousy. In the same way I give myself the best chance of coping with mental and emotional illness if I am not also fighting my own body. As with everything balance is important - I need to watch that I don't over do the exercise or become obsessed with eating and food.

4) Above all I need to be aware and notice what is happening to my thinking and my physical wellness. The easiest route to fixing a problem is to notice it early. Most of my life the strategies and skills I was using to 'get through' did not help me towards a meaningful and fulfilling life. It is better for me to practice skills which help me monitor how things are emotionally and physically so that I can take the appropriate action and end up in a spiral downwards in my health. There are some early signs... routines with the dog and cleaning the house, losing track of appointments and time, becoming obsessed with online games. I can do something about what is happening at this point if I notice in time and do something about it, including talking to my GP or to trusted friends and getting help in working out what has triggered issues.

Resilience and maintaining recovery require daily and even moment by moment awareness of what is going on around me and within me. This is not about being self absorbed but is about recognising that one of the ways I maintain my wellness is to be aware of events and their emotional and physical impact on me and my condition.

Dealing with the 'Robinson Crusoe Effect'

For an image of isolation, it is hard to find a more complete picture than that of the person stranded on a deserted island. I was first introduced to Robinson Crusoe through the black and white, dubbed series which was shown every summer on Saturday mornings throughout my childhood. I was familiar with the story of loneliness told - of the desire to find the owner of one solitary footprint Crusoe found on 'his' beach. Later on, I was able to read the original novel and found that the story does not end on the island. Crusoe is eventually rescued and returns to England. What I find interesting is that he does not embrace his return to society with unfettered joy. There is a challenge to breaking the isolation.

For many of us the isolation caused by emotional and mental storms is like being stranded on our own islands. Recovery is our story of rescue and return to our communities or our families. If you are like me, being solitary feels safer than being a part of wider groups. It is a constant challenge to myself to break away from my island where I feel safe, with my pets. It is comfortable most of the time as most of my struggles are evident in relationship with other human beings. However, the reality is that we are made to relate to others, to something bigger than ourselves. For me I have a personal faith in someone who is so much bigger than me and the island I inhabit. Others may find their something bigger in other things. What I need to acknowledge is that often the pain of relationship is temporary and persevering with those relationships is important to my long term recovery.

I love the imagery of John Donne, a poet who mixed images of every day experience with the deeper spiritual experiences of humanity. He sums up best the reality of needing to reject isolation in favour of being a part of community: "No man is an island, entire of itself; every man is a piece of the continent, a part of the main". If one part of our coastline erodes, there is loss for the whole island. Sometimes we focus so much on joining with others, that we neglect our own value in contributing to the whole.

This is a critical result of low self esteem. We are unable to value ourselves as a necessary part of the whole yet, moving forward in recovery means that we continue to learn about our value in relation to others.

So where do I begin if I have been isolated and become comfortable with my 'own company'? I have found that the best way to get to know others is to do something together. It is so much easier if there is a task or activity to complete with others, than having to 'socialise' which can be so problematic. Here are the steps I have taken to avoid growing into my isolation:

1. This week I have received my 10 badge from Blood Transfusion. It is one of the easiest ways to feel a part of wider society and to know that I have something valuable to contribute. The benefit is that staff and others donating are good at offering a welcome - it is time limited, and you get a brew and a choice of choccy biscuit or crisps.

2. I have been blogging and sharing my story online within different forums. I would say be protective of yourself if you go on social media. Keep yourself safe by not giving too much away. Even though I have blogged for a number of years on here, I have never told every detail of my experience. Partly because over exposure of my personal struggles is probably unhelpful to others and also because I do not want to make myself more vulnerable - once it has been published it is out there and I have lost control over who sees it and how far it is shared. The benefits are that you are not alone in your experiences and you hopefully will find support.

3. Volunteer. There are different ways to get involved in different ways. If people are a real struggle for you, think about local pet charities. Locally, there is a hedgehog hospital near me, a Cats Protection League and ways to get involved. I am a member of a local church. I have been able to go along when I feel able to the larger meetings, but through the week I can offer to help out with refreshments for the Parent & Toddler groups - no need to go in among the seething mass of toddlers! It is good to be part of a group which has a wide range of ages and therefore different needs.

4. Sport and Exercise. I have managed to get back to swimming after nearly 8 years of trying. I have found times when the pool is less busy and a bonus has been that people are creatures of habit so I am getting to know staff and other swimmers. The benefit of a sport like swimming is that if I don't feel like 'doing social' I can just do my swim and get out and go home. My GP has also signed me up for a 3 month health and fitness group. This gives me the push I need to extend my social circles because I am given free access to the leisure facilities if I attend a weekly class. It is a good way to find out about other groups that I can continue with after the 3 months is up. The big help is that I am using my DBT PLEASE skills which are a big part of keeping myself well and stable.

5. Keeping in touch. I actively try to keep in touch with friends by setting up time for coffee and/or walks. My dog is a big help to get me out of the house. When I am unable to attend the big church services, I try to keep in touch with at least one friend through the week.

These are things which have helped me. One thing I have had to learn is that because of my emotional ups and downs, I will have times when I feel so alone, even though my head tells me I have a strong network of caring friends. For me, I need to accept that is the way I feel, sometimes but it is not my whole life. Even in the most stable of relationships people without emotional fluctuations can feel alone. I need to remember 'this too shall pass' and do my best to think of my efforts to connect with others as one of the essential skills to maintaining my recovery.

Oceans of Emotions

I've always loved water. Being in it, on it and under it. I've enjoyed swimming in all kinds of swimming pools, beautiful Victorian bath houses with cold little cubicles, my modesty sheltered by Circus tent-striped curtains, modern circular 'fun' pools, aimed at frustrating the serious swimmer, rivers, lakes, and most exhilarating of all, the sea. Again and again I have returned to water imagery to try to explain the complexities of my own mental health struggles.

As I have widened my experience of explaining, discussing and challenging assumptions about mental health in general and my own diagnosis in particular, I have realised that, because I cannot show you operation scars, or other visible symptoms, it becomes difficult to help you understand my experiences.

When your primary symptoms are centred around emotional volatility and their impact on your behaviour, most people think that you are describing being 'moody'. That or words and phrases like: over-dramatic, highly strung, over-sensitive melodramatic, emotionally manipulative, serve to dismiss my experience and need for additional support. This has come sharply into focus throughout my recent experience of going through the Work Capability and Personal Independence Payment assessments. So, once again, I will try to explain how come time and resources have been spent on treating my 'moodiness' since my diagnosis in 2011.

Mablethorpe V Maui

I grew up with visits to the seaside on the North Antrim coast, which means that I became used to waves crashing in from the Atlantic. As a strong swimmer I enjoy riding on the top of waves as they hurl me towards the shore. Once when visiting Ghana, I experienced huge Atlantic waves with swirling undertows which were far too strong even for me to cope with. I certainly learned the limits of my ability in the huge Rollers off Sir Charles Beach on the Gold Coast.

Imagine then, my first visit to the North Lincolnshire coast, when after nearly a year in South Yorkshire a group of us went for a day out at the beach. As the flat beach gave way to water, I was deflated, as the 'waves' (or rather ripples) lapped at my ankles providing none of the excitement or exhilaration I normally associated with sea swimming.

My point is? Imagine that you live your life with emotions which never reach the ripples of Mablethorpe. Imagine that every day you awake with an emotional arousal akin to the waves crashing in off the Atlantic onto the Antrim coast. You never manage to start or return to 'neutral'. Then imagine that the everyday events and trials begin. Someone cuts me up in traffic - I am not able to be annoyed, because my emotional temperature is already raised, one small event can provoke an outpouring of rage.

So what? A lot of people experience road rage. Problem being that the waves of emotion are at Gold Coast levels and continue that way for a sustained period of time. Now imagine that before I can return to smaller waves of emotion, I receive an important phone call at work, which puts additional pressure on my deadlines for the day. The emotion switches, but returns to huge crashing wave levels, this time of anxiety. As a result of this heightened emotion I find I have physical symptoms, nausea, triggering migraine symptoms. Sometimes I may throw up. Sometimes I may find I succumb to a debilitating migraine attack lasting 48 to 72 hours. I am only half way through a normal day.

In the past sometimes the only way I had of reducing the high levels of emotion was to self harm - thus somehow releasing the building pressure. Imagine cycling through a full range of emotions from anger, anxiety, to relief and feeling excessively giddy several times in one day, like this. Is it any wonder contact with other people and life in general is exhausting?

Oceans V Brooks

One of the observations commonly made by others about the behaviour of people with Emotionally Sensitive Personality Disorder (formerly Borderline PD) is that my reaction is out of proportion to the triggering event. There are a number of reasons for this, some biological, some due to my experiences in life. Research has shown that the emotion centre of the brain (Amygdala) is more highly attuned and sensitive than average. For those who have experienced childhood trauma this emotional disfunction means that memories, particularly the emotions evoked are overly vivid and are experienced with the immediacy of immediate experiences - as if I am reliving the original trauma related to the given emotion.

Sometimes the encouragement to 'just let go of the past' adds to the pain, as I feel judged for feeling the fear, rejection, sense of shame with the same power as if it had happened in the immediate present. When I fear that I am going to lose a friendship, I am not only filled with the fear in this moment, it connects with every time I have experienced rejection throughout my life. So, I am not only dealing with one wave of emotion at a time, I am trying to manage oceans of the same emotion, an accumulation of every time I have felt, particularly, painful emotions. Again, is it any wonder that my emotional reactions are out of proportion to the triggering event in the here and now?

Self Defeating V Effective

There are effective ways of managing life but there are also self defeating behaviours which over the years I have developed to help me get through the crashing emotional waves, but which do nothing to take the power from them. Symptoms related to the emotional turmoil of ESPD (BPD) include, self harming behaviour, substance misuse, overspending, excessive speeding, or reckless driving, problems with eating, an unstable sense of self, major problems in relationships. When I am struggling to maintain day to day life in the face of my turbulent internal struggles, it becomes impossible to think of more effective ways of coping. However, those self defeating behaviours, which, however, flawed, have kept me going over the years, need time, patience and space to be replaced by more effective coping skills.

Having painted part of the picture I hope this explains why Dialectical Behaviour Therapy (DBT) is such an intensive course of therapy. Once I was discharged, it was only the beginning of managing my emotions daily using the skills taught to me during the DBT programme. When talking of mental health conditions, I think people become confused particularly once direct care ends. If I am discharged from hospital following an operation, then the problem has been dealt with and my condition, hopefully improves. For some mental health and physical diagnoses there is no end point. Just as the diabetic needs to undertake both medication and lifestyle changes to manage their condition effectively, so I need some medication, alongside the DBT skills to be able to keep the waves of emotions manageable. 'Manageable' is not 'dealt with'.