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.

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

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

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

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

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

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

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

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

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

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

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

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

* DBT PLEASE Skills can be remembered as follows:

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

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

I have downloaded the Loving Kindness meditation from the UCLA website (http://marc.ucla.edu/body.cfm?id=22) This again is something which will feel painful if you are starting to work on self care, but over time allow yourself to keep going - non-judgement will be your friend.

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

Self Compassion and Knickers

Something has changed in me. I am slowly learning to be kind to myself.

Growing up in invalidating environments over time sucks all of the self worth and self compassion from the child until the adult emerges, uncertain of their feelings about themselves, the world around them, and their own intrinsic value as a human being. Rebuilding who I am from the wreckage of my childhood has been a long, slow process. Much of my self destructive behaviour in the past has its roots in feelings of self loathing born of the consistent invalidating messages of my key relationships as I grew up.

Invalidation has many forms, from the simple act of ignoring or discounting the voice of the child to the acts of abuse which say that every part of who I am is so worthless I can be used and abused at the whim of others. The distress and pain of these experiences takes a lifetime to emerge from. Perhaps, if you are in a relationship with someone who has suffered in these ways, you recognise the gaping emotional void, that you feel you are expected to fill.

In rebuilding my life I am in a long term process of learning to validate myself, of valuing who I am, of first of all accepting who I am. In the experience of Borderline Personality Disorder, one major building block of the personality, the sense of self, is damaged. I need to build relationships which patiently reflect back to me the value that others find in me, without me seeking to grab hold and cling to those relationships, or create the self fulfilling prophesy of rejection by my demands.

This means that boundaries, time and trust building are pre-requisites to any level of relationship for me. I used to be a 'hook line and sinker' committer to friendships and relationships. They burned bright and short, and always ended traumatically with major drama and self destruction. Given the emotional void within, this proved overwhelming to most who became involved with me in the past and I have lost many friends, and boyfriends in the process, confirming my lack of worth. 'No one can love me', was my mantra, or 'I am not worthy of love'. And my life was a process of confirming the 'truth' of those beliefs. Given the invalidation I have experienced from so many, including my own mother, over such a long period of time, these kind of thoughts and patterns are understandable.

In the end, having been rejected one time too many in 2000 I gave up on all human relationships. Life was safer that way. As I have gone through treatment and learned DBT interpersonal skills which take account of my invalidating background I have learned to set boundaries for myself. In essence I have learned to protect myself. This again is something which for the invalidated person is not natural. After all, I have to believe that there is something of value in myself to be protected. I have learned to articulate when I am not happy about situations - appropriately. In the past, I have not felt able to voice my needs, so anger at the world has built up until I have exploded at whoever is nearest to me. Not very pretty. It was a revelation to me that people can be interested in listening to me when I speak up about something I feel is wrong. That has taken time.

I realise that, as I keep moving forward and taking small steps, there is one range of skills that are critical in helping me repair and learn to build relationships. Self Compassion is essential to my ongoing recovery. It begins with the simple basics of looking after myself - the DBT PLEASE Skills (treat Physical iLlness, balanced Eating, off mood Altering substances, balanced Sleep and Exercise) and moves on to Mastery of those skills. If I feel I am worth the basics of eating, sleeping etc, then that is the most fundamental way in which I can care for myself.

As I have started to feel better about managing the swings up and down of my moods, I have been building up my mastery of these day to day necessities. This has now extended to my environment and I feel I am on top of my housework and have a reasonable living environment.

So where do my knickers come in? One of my responses to my childhood has been to hide away from who I am at heart. I am a sensitive, creative, articulate person. I love good things. I actually love feeling feminine. However, as a result of people disrupting my sense of my own sexuality and sensuality, I have swamped myself in tomboyish clothes and behaviours, which protect me from others by denying that I might be attractive to others physically. In essence I have tried to express myself as an asexual being. It has been safer that way, or so I thought, although this hasn't stopped perpetrators assaulting me as an adult, so maybe the fault is theirs. This is an essential building block of self compassion: I am not to blame for the wrong behaviour and damage done to me by others. There is nothing that I need to punish myself for. My bad feelings about myself are not accurate or reliable. When I do wrong, I need to do something to make a repair to those I have wronged. But feeling ashamed of myself simply because of what I survived in my past, will not achieve anything and serves to keep me trapped in the pain of the past.

At the risk of being accused of 'too much information', in the past six months, I have started wearing really nice underwear. I enjoy being feminine. I love perfumes, bubble bath, pampering, and the feel of silk against my skin.

I wore a skirt last week for the first time in years along with my favourite perfume and accessorised with jewellery, handbag and boots. 'elegant' was one word used to describe me. With a shock instead of dismissing the compliments, I accepted them, at face value, no critical analysis or suspicious thoughts about the motives of others. It helped that I had had nearly two hours pampering at my hairdressers and he had given me a new sleek haircut which he felt matched what he saw in me - or so he told me. I have a great relationship with him and trust him with my hair! I felt really good about myself and it was not a mask. I've done that too in the past. Because it began from how I felt about myself inside, moved on to my underwear to the outer shell of my clothes.

Learning to love myself is still a new skill in my arsenal. It has had to start with small things like getting help from the GP when I feel ill. The pressure is no longer on me to achieve in my working life, driven to try and find the validation that was missing from my childhood. I don't need to be in a 'successful' relationship to be a person of value. I am enjoying doing the things that give me satisfaction in life. I am able to feel that I have something to offer the community around me and I am free to accept the gifts that they offer me, in return. I think I'm actually ok and I do deserve that really nice lingerie set. Gives me a whole new reason for my 'secret smile'.

DBT PLEASE Skills - my latest challenge

I've got myself into bad habits - again. My Therapist even admitted to having a 'judgemental' thought when I told her my average sleep over the past three weeks has been between 3 and 4 hours. I know, I know, Churchill and Thatcher - but I'm a definite 7-8 hours a night woman myself. When I don't get enough sleep everything starts to go 'weird'. My emotions and thinking become befuddled - not unlike the sensation of being drunk or on sedative drugs. This would be fine if I wasn't trying to manage the emotional instability of BPD. Why? Why is it so hard for me to look after the most basic of my needs? I would think judgementally about myself too - I mean I'm one appointment away from discharge! And I've been doing really well.

I don't have a definitive answer. Except that my mind has been so free from negative, circular, black and white thinking that I have been 'buzzing' off a fresh creative surge which usually emerges around the end of the Evening News. This I am beginning to recognise is also part of my BPD. Part of the swing in moods between negative and positive. The other, deeper and therefore avoided reason is my lack of basic self care. I am still working on believing that I am worth looking after.

So, just as I would apply DBT skills to managing negative thinking I need to use the same skills to manage my more 'manic' phases. They too come in waves, and they reach a crescendo before receding. If I can manage the 'ups' without self destructing, then I will have learned even more about a balanced and stable life. Above all other skills the emotion regulation skills are needed right now. I need to manage my sleep patterns, have routines and eat regularly. So basic, but so necessary.

So this week I will be mostly working on my PLEASE skills. (P&L - treat Physical ILlness, Eating, Avoid mood altering substances, Sleep and Exercise)