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.

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.

The WCA, My Recovery and Me (Part Two)

Two months after the upset caused by the process of filling in and sending off the form (ESA50) (http://bpdlifeinthemoment.blogspot.co.uk/2016/04/the-wca-my-recovery-and-me.html) and five months after the initial letter landed on my doorstep, another official envelope arrived instructing me to attend my 'face to face assessment'. I had two weeks notice. I do not feel like reliving the experience of the assessment here. I have previously explained the impact of the WCA process on my emotional stability. Given the length of time taken from the start of the process to the actual assessment itself along with the usual day to day pressures and some pressures related to having elderly infirm parents, struggling financially, having plans to work towards more long term income solutions fall through, it is hardly surprising that I have found myself in a period of 'relapse' and was referred to the Crisis Team. Thankfully, the support and skills I have worked hard to develop kicked in and I have not had to have any further referrals to Mental Health Services.

I remain emotionally vulnerable and raw. I am moving myself back to the basics of recovery which helped me to get this far. I don't have the emotional wherewithal to explore the emotional fallout of the assessment, which was two weeks ago now. I do however, have some observations to make about a process which is not fit for purpose. For those implementing it and those of us with the misfortune to have to rely on any support resulting from it, should we be found not to be selfish, malingering, charlatans.

1) My assessor was as helpful and compassionate as she could be under the circumstances. This reinforced how ill conceived the WCA process is. She was faced with the emotional outpourings of both me and my friend, who attended, thankfully, to support me. We encountered at least one person in the waiting room in absolute distress, but with no company and the assessor seeing her off with just a tissue and some kind words. Who, I wonder, has to pick up the pieces?

2) The first letter arrived at my home at the end of January. It is now Midsummer's Eve and the process is still not complete - I anticipate I will get a decision some time in July. Should I be placed on the Work Related Activity (WRAG) ESA Group I will immediately lose £30 per week and be forced to undergo endless applications for jobs which are ill suited to me or my skills and experience, or risk losing all financial support through sanctions. If I choose to appeal (which we are officially told takes six months, but in practice takes much longer) all payments will be suspended pending the outcome - the DWP has now recruited and paid for a team legal experts to fight these appeals as they were losing at a rate of 85% of decisions being overturned on appeal. This is not about saving money or becoming more efficient or encouraging people like me to be confident enough to return to full time employment, but about dismantling a key component of our welfare system.

3) I am due to undergo the same process from November for the Personal Independence Payments (PIP) which are due to replace my current Disability Living Allowance. At this rate, my 'review' of benefits will have taken well over a year to complete. It has already set back my recovery and my progress towards meaningful employment, by at least three months. My question is, given there are two teams situated in the same building in my local county town, why am I going to have to complete exactly the same questions, provide exactly the same information about exactly the same conditions (albeit a few months later) for payments which have historically been inextricably linked, given that one (DLA) results from the assessment of physical and mental needs performed when applying for or reviewing. Once again, I am forced to conclude that the DWP are prepared to go through the tendering of contracts, with the costs that go with it, invest in putting those with disabilities through a system which is designed to 'test you to destruction' as my friend observed, in a bid to 'root out' malingerers.

There has to be a better way. When Benefit Fraud accounts for less than 1% of the Welfare Bill, when disability benefits are a tiny fraction of the total welfare budget compared to the State Pension and Tax Credits; just because I can be easily dismissed as 'emotionally unstable','mentally ill' - an outsider, does not mean that I and others struggling with long term, complex mental illness do not deserve better.

Bridging the Gulf

I was in a crowded room. I knew a large number of people there. I had managed some conversations and got myself a cup of tea. Suddenly, I was overwhelmed by an all pervading sense of alienation and aloneness. I have experienced such floods of negative emotions nearly all my life. The sense of being an alien, of being locked inside a glass prison unable to make myself heard or understood, is one that is familiar to me. As I sat there, I had a choice to stay and front it out, as I have done so many times before, or to make what I consider a 'tactical retreat'. Although leaving difficult situations in panic has been a response I have often used in the past, this time was different.

Last week I was having a conversation with someone about the sense of isolation and overwhelming sense of emptiness experienced by people with my diagnosis and symptoms. She too has experienced these feelings, but would make herself get involved in groups of people and 'do' things. I think there is a right time to do that, for me. But yesterday was different. I have had a week of giving out to a lot of people in different contexts. In order for me to be able to regulate my emotions I need to be able to identify them. When I am tired I find my ability to feel anything is impaired because it takes so much energy to manage any emotions. Numbness is easier to manage, but clearly, makes it difficult to function at any social level. Over the past couple of weeks I have recognised that I was lapsing into numbness, because, for me I had had too much general human contact with a wide range of people, some of whom I struggled to connect with. I retreat into numbness when I am in a group of people and I am beginning to feel overwhelmed by my emotions.

Essentially, in the past couple of weeks I have not experienced negative emotions, but around people I am deeply uncertain about my ability to read other people and my acceptance in their groups - fear of rejection is an emotion often in the background, particularly when I am feeling uncertain or vulnerable.

I work hard at recognising and responding to emotional signals. Something most people take for granted. The development of my emotional abilities was fractured due to my experiences in childhood, this coupled with the emotional amplifier in my brain which means that all of my emotional responses are in dolby-surround-sound and full glorious HD technicolour, means I do need respite from being around people. I am happiest when I am on my own. That may come as a surprise to many who know me, because I have learned throughout my life, and from many embarrassing mistakes, how to behave around people. Again, it is not something which came easily to me, I would describe myself as a quiet, almost shy child. The sense of being an alien was ever present. One of my family nicknames was 'Moon-man'. Another was 'Droopy' after the little depressed dog, who when he got mad, he got 'real mad' - my angry outbursts were epic!

Emotions are exhausting for me, even with the DBT (Dialectical Behaviour Therapy) Emotion Regulation skills which help me maintain equilibrium most of the time. Today, I am back on an even keel. Here's what I did.

1. I gave myself a break. Yesterday was not a day to challenge myself to stay in a difficult situation. It takes self compassion to know when I need to accept things as they are and when I need to push myself to change the way I react. I needed some groceries so I went shopping before going home. This meant it didn't feel like I was running away. In the spirit of self kindness I bought some treats.

2. I watched some comedy on catch-up until I felt myself relax.

3. I breathed mindfully until I was able to identify the emotions I was feeling. Having named them, I accepted that, given the week I've had these emotions were understandable.

4. I listened to my 'belters' playlist which has some summery, upbeat songs on it. I spent time in the sun, colouring mindfully. Eventually I enjoyed and fully participated in the music and ended up dancing in my back yard. I enjoyed the warmth of the sun.

The process of bringing myself back from numbness used to take weeks or even days. Looking back on yesterday I realise it is progress that I was able to use skills to look after myself and bring myself back to equilibrium in an afternoon. It is now four years on since I started using DBT skills and it has and is taking time. Good to remind myself that I had over 40 years without using them. Rather than feeling unable to reach people across the gulf caused by my emotional dysregulation I am becoming my own bridge builder.

Keeping the Wellness Going

I've passed a milestone - well, probably more than one, but this one crept up on me. It is over a year since I was discharged from services. In the past, this would be about the point, when having immediately launched myself into another new life, I would be finding that life unravelling.

It is perhaps, a good thing that I have not kept a close eye on this milestone. Perhaps, I have learned to let go, at last of unrealistic expectations, particularly of myself and my ability to sustain a stable emotional life. Apart from this overall change in my attitude to life there have been one or two other factors which I believe have been helpful in getting me to this point in my recovery.

1) I have been able to sustain my commitment to the important spiritual and emotional disciplines which give me a foundation on which to build a life which has meaning and purpose. So my faith has been integral to my practice of keeping myself in the here and now. When my feelings tell me everything is wrong with my life, my belief in a purpose and in something bigger to belong to keeps me anchored. Sometimes this belief and faith can be as thin as a spider thread, but it has been enough to hold on to.

2) I have adapted DBT skills which I have found effective, so that I can use them in my everyday life. I have access to self soothing exercises, or activities on my IPod, home, in my handbag, and, when unable to connect through gadgets, that I can practise by simply finding a quiet space for a moment to be mindful.

3) I have managed to move from acknowledging the value of physical wellness to integrating it into my management of BPD symptoms. As suicidal thoughts and self harm urges have become less of a battle for me, my PLEASE skills have become more essential to my ongoing well being, than my Distress Tolerance and Crisis Management skills.

4) I have the support of a GP who actively encourages me to follow my Relapse Prevention plan and has taken on board responsibility for her part in it. Having the regular reviews advocated in my Plan has allowed me to cope well with one or two 'bumps' in my emotional road, without fear of being re-referred to mental health services.

5) Almost imperceptibly, my social circle has both widened and deepened. As I have chosen to engage with the world outside me, I have actively become involved in making (and keeping) new friendships. I have learned by trusting, first one or two close friends, then learning about different types and functions of friends, to set boundaries for myself which mean that I can sustain healthy support networks. No longer am I in danger of burning out my friends.

6) I have stopped measuring my worth according to my status and the level of job I do. Rather I am learning to pace myself emotionally in what I engage in. I am accepting that it is difficult for me to sustain 9-5, five days a week commitment to paid work. Human relationships exhaust me due to the level of effort required to manage them. I therefore, need time to be alone and recharge my batteries. It is an acceptance of the reality of my struggles. I am finding ways to engage in meaningful work, both voluntary and some with limited payment. This is helping to rebuild my confidence without forcing me to over-reach my emotional resilience.

7) My past is no longer an intrusive visitor in my present and future.

Measuring Progress in Recovery

I'm at a strange stage in my recovery. It's not a 'crossroads', I'm not in 'limbo', I'm not even 'stagnating', but I am living with a sense of tension and unease. My problem is the future - or the fact that I cannot see what's going to happen in the future. Now, in reality I have never been able to see ahead in time, but I have always had plans, ambitions, career paths to follow, so it created the illusion that I had some control over how my life was progressing.

I don't think I'm any different or less able to read the future than anyone else, I have just become more acutely aware of how quickly my plans can go awry, just like Rabbie Burns' 'mice and men'. Having had an unremitting cycle of work and retraining, relocation and travel over the years, it is an alien experience to have lived in one place for more than a decade. Up until the last three years I have also had the stability of a career with a definite career progression. Surely that is what stability is built on? Yet, I don't think I have been as peaceful and untroubled by emotional storms as I have in the past year.

Nonetheless I am troubled by the short term nature of my ability to provide for myself. Going by the patterns of the past I SHOULD be relaunching myself in a new direction, be completely absorbed by a new job and praised for my external progression. My problem at the moment is that any opportunities to help out or volunteer are short term and sporadic. I feel the pressure to go back to work, but the idea of applying for full time work is so troubling that few people venture to ask and I daren't even consider the possibility, even though, on the surface, that would provide the greatest stability - financially.

As I write this, I realise I am in a process of adjusting my life to new priorities. My greatest needs are to manage my emotional life so that I don't regress to the inexorable daily cycles of damaging emotions and behaviours that have marked most of my life. That means that looking ahead is not helpful.

I am only able to plan up to a month in advance. I have a monthly meeting as part of the Experts by Experience group of my local NHS Trust. I am still meeting with people one to one to help them with Mental Health needs as part of my involvement in the church. Over the past three months, having had some disruption to my emotions caused by the pressures of managing the needs of elderly parents who live at a distance, I have learned to set the running of a five week course to one side - and learned that the sky didn't fall in because I put my own health first. Overall, it means that I have managed my mental health well and managed not to slip back into emotional dysfunction.

I need time to be able to reflect on these changes as realities which indicate that my progress in recovery and managing the symptoms of my BPD continues, but is not at an end, or, indeed an end in itself.

One of my biggest challenges is creating my own patterns without the regular hours of paid work. This includes valuing what I am able to do as helpful and contributing to those around me as I am able, without having the external validation of a pay packet at the end of the month. After over 35 years working in various jobs and careers this continues to be a battle. If I am able to turn up to events at church that means I am part of a community and I am valuable simply as myself. When I am asked to help out in developing a website and writing the odd article that means I can enjoy using skills and experience I have developed over the years. I need to change my internal validation compass to accept that I am contributing in a positive way without having a salary point to indicate my 'progress'.

Of course there is a daily reality of bills to pay. I know that it would be good if my progress could result in rejoining the ranks of those who are paid to work. At the moment I am learning to accept that whilst I am capable of working, my emotional resilience casts a question over how far I would be able to sustain a full time role. So, again I come back to looking ahead and seeing only bends in the road. Acceptance means that I settle my ambitious, career driven self to the here and now. Recognising the need some days to give myself a break means that I would not be the ideal employee at the moment, particularly in a nine to five, five days a week environment. Some structure would be nice, though.

It's one of those days... again

I still have them. Days when for no reason an overwhelming sense of grief sits on my heart. Now, I am aware of the deep source of the grief. Now, I can say 'this too will pass'. It doesn't make it any less painful to live with. Nor does it suddenly make it 'all right'.

On these days I need to remind myself that I need to be kind to me. I tell it to others and I believe it. My biggest problem remains an underlying belief that ultimately, I am not worth caring for. That somehow, somewhere in my history is a reason, a factor in me that means I deserve the suffering I have lived through. I carry the emotional hangover of the survivor of abuse, the belief, that somehow, somewhere in my past I must have done something bad.

Because this has been a lifelong belief which has resulted in self hatred and the behaviours which have made shipwreck of important moments and relationships in my life, I still have battles to fight. Today is one of those battles.

Unlike other days which I used to fear would stretch into the rest of my life, I am learning that this day is not all the days of my life. This day can be measured and will end. Today, the overwhelming sadness and grief comes in waves, in moments. I am becoming more aware of this as I recover.

So, here it is another day of painful emotions. Today, I will be mostly looking after me. That includes eating bacon butties, watching trashy TV, taking my time over my shower, and most of all not berating myself for grief and painful emotions which come from having lived through and survived some very difficult events. Most of all, this day and these emotions are not the whole of my story. This pain means that when I have a different day, a better day, it can shine even more brightly. Today, if I can be kind to myself I am replacing another more painful moment from my past and I am able to say, I am worth caring for.

Routine - Bars of Protection or Restriction?

One of the most difficult things about completing a long period of intensive therapy is the loss of routine. I used to think I was quite a random person, I'm not sure that I come across as needing structure in my life, that I'm a spontaneous, carefree person - WRONG! I don't cope well with unpredictability in relationships or life.

I arrive routinely at least fifteen minutes early for most appointments, no matter how trivial. If I've made a commitment I will be there! I will do practice runs to new locations, either in real life or online through google street view (that has saved me so much time I love it!). Even informal arrangements have to be made and pinned down for me in good time. This helps me manage anxiety that has in the past led to panic attacks. So, it is hardly surprising that after nearly two years of intensive therapy and five years of having the same Care Co-ordinator a certain level of apprehension flooded me when contemplating final discharge.

For over a year I had two, weekly appointments around which to build my routines. This was more than enough to provide stability as the levels of exhaustion experienced by me just trying to get by meant that any more structured activity was unsustainable.

I have come to the end of a period of two months during which I have tried to transition from those routines to new ones around which to structure my day to day life. As well as changes to formal appointments, I had major changes to two friendships which were part of my care plan throughout my time in therapy. One friend moved away and another got a job. These things happen - it's life. The challenge becomes, when you don't have work to structure your routines, where do you begin?

What has helped me is to take an idea I first came across in the film 'About A Boy'. In it the feckless hero didn't need to work, but rather than be bored he divided his days into 'units' of time - 1 unit equals 30 mins. So, Breakfast and Coffee counts as two units. Haircut could extend to four units etc. I have adopted this attitude and have begun by trying to establish a daily structure. I know for some people with PD issues this sounds like madness - but it is very much part of my managing my life in order to maintain stability in my emotions. This is how I structure my day:

Before breakfast - quiet time, pray, take time to be mindful. 1 Unit (30 mins)

Breakfast & large pot of coffee 2 units

Walk Dog - 4 units

Lunch - 1 unit

Blog/Gym/Meet Friends 4 units

Dinner - 3 units

Relaxation - 6 units (Includes Self Soothe activities, take a bath, watch good tv and films, Wii Sports, read, listen to music)

The daily structure works for me because it has the flexibility to include meeting with other people as well as allowing me space and time to care for myself and my animals.

I have taken more time to establish a weekly routine because, along with my therapy appointments I also had two fixed times in each week when I would spend time with my Care Plan friends. Now, I have used my voluntary work and socialising to build a loose routine which can be changed depending on whether I feel like 'people' or not.

Monday - Evening Course

Tuesday - time to self

Wednesday - Women's group & spend afternoon with friend

Thursday - time to self/blogging/volunteering

Friday - Running Group - time to self

Saturday - time to self

Sunday - Church

You may notice there is a lot of time for myself - I enjoy my own company, but I need to ensure I make myself spend time with others. So, I have developed a balance of social and group activities that I can cope with. As long as I have space to myself and/or for writing then I feel my life is balanced. The amount of self space also allows me to build in more activities as and when I feel able.

I have found that, as I have recovered, I have been able to tolerate more social times than previously. Above all, if I can't keep to the routines, I don't just give up all together, I allow myself to have a Vacation (DBT Skill) and then begin the routine again at the next natural point. Usually the following day. For example, if Sunday at church has exhausted me, I give the dog a shorter walk on the Monday morning, take the afternoon to myself, so that I am better able to cope with the course on Monday evening.

Everyone is different, but, for me, structure and routine are essential elements of my long term recovery. It's also a good early warning sign that things may be going awry because both myself and my close friends can tell if I am struggling when the routines are disrupted for any length of time.

Recovery is not a Straight Line

I've had an interesting couple of weeks. I am facing a lot of change in my life, positive change. The problem is that, in the past, I have struggled with new situations and people simply because my trust in the relationships around me were shaky. It is now nearly six months since I completed the DBT programme and nearly three months since I was fully discharged from mental health services entirely. As with any routines and structures, the skills which have replaced my previous coping mechanisms have bedded in and become habit.

The problem for me comes when I find myself lapsing into old familiar patterns of coping and thinking, and allow myself to go back to the familiar rather than the helpful. After all, I am in the process of replacing over 30 years of self destructive behaviour with skills I have only been practicing for just a couple of years.

As ever, the problems for me have lain not in practical problems. I am currently organising and running a public event, I am more than capable of doing so. However, relationships and my emotional response to them remain a major challenge to me.

One working relationship has been particularly problematic to me. I am used to dealing with difficult people. I guess some would say I am a bit of a challenge myself! I have found myself shocked at how destabilising I have found this working relationship. My concerns grew when I found myself becoming disruptive in a training session. The result was that I have decided not to attend that particular group and to withdraw from that team for the time being. Initially I felt this as a failure - it has been a default response to many situations for me for so long. However, after a couple of days beating myself up about letting the world down, I actually took a step back and was able to reflect on positive steps forward.

1) I recognised that my response to the training was not helpful to my recovery.
2) I took action to look after myself in the situation.
3) I recognised my emotional limits had been reached before I exploded in frustration.
4) I managed to withdraw from the team by using the DBT FAST (be Fair, don't Apologise for being alive, Stick to your values, and stick to the Truth) interpersonal effectiveness skills.
5) I have found a way to continue with my work without putting myself under this emotional stress
6) I have managed not to damage any of the working relationships involved

(This sheet from DBT Self Help website explains in detail: http://www.dbtselfhelp.com/html/ie_handout_10.html)

In the past such interpersonal issues have resulted in me 'behaving badly', often making myself feel really bad about behaving like a stroppy teenager. In the past my self respect has taken a battering as a result of my out of control responses to professional situations.

For a number of days I grappled with conflicting emotions, I forgot to use my mindfulness skills to enable myself to be able to identify and manage the problem emotions in the situation. I was in danger of spiralling downwards. At certain points, I even found myself trying to resist self harming urges. The good news is, with some effort, I was able to use my DBT skills to avoid relapse. More than that, I have been able to manage both myself and a difficult situation. Most of all, I have not been left feeling that I have destroyed working relationships and I am able to reflect on where the difficulties have arisen within that particular relationship.

Incidents like this would have caused crises for me in the past and would have had a detrimental impact on my ability to even be in the same room as people involved. Not good for team cohesion! Although I was tempted to despair of my progress on recovery, I am pleased that this situation has been manageable for me. This is vital, because I am currently in the middle of applying for jobs after more than two years of redundancy. If I am to successfully move back into working life, I need to be able to build up my confidence in using the skills which have been helping me in my personal life.

Life is not a drift through a glassy calm mill pond. At least, my life hasn't been. Having learned skills to manage distress, emotions and relationships, it follows that there will inevitably be situations where I will need to use those skills. I think one of my mistakes which led to me feeling shock at how quickly I felt destabilised was that I had deluded myself into thinking that acquiring the skills in itself would protect me from life's problems. D'oh - I'm with Homer Simpson - when I see it in black and white, of course that is daft. Any skill takes practice - when I was a competitive swimmer there were times when I was training for six days a week. Perfecting the stroke technique, building up my physical fitness, practicing starts, turns, finishes. I didn't really make use of those skills and that fitness until I raced. So it is with managing my condition. There are routine practises which are designed to keep my stability: I need to keep taking my medication, I need to maintain my physical health, my sleep patterns, my eating, mindfulness should be part of my day to day emotional life. However, I will not really know how effective my DBT skills are until I use them in situations which in the past I would have avoided or I would have responded badly to.

Recovery is not a procession, it is part of my life journey. There will be ups, downs, twists and turns along the way. My challenge is not to put my energy into looking back at the things I fear creeping up on me, but to keep my focus and energy facing forward.

Learning to Ride the Emotional Waves

Emotions for most people naturally seem to come and go. Most people experience either euphoria, grief or anger as passing extremes. For me, I get stuck with damaging emotions, experiencing the emotional pain as a groove I cannot break out from. Hyper emotions are similar I find it hard to manage myself in social situations when I am 'up'. I have been known to follow urges to self destruct in an effort to short circuit emotional distress. After these periods of extreme emotion I am exhausted and vulnerable. Unlike other conditions which can cycle between extremes of emotion over longer periods, I can experience the extremes of the swing from extreme grief and distress to euphoria several times in a day. These periods of swinging emotions can last for hours or can last up to two or three days. It is like constantly riding a roller coaster, without any hope of being able to escape from the constant rise and fall of feelings. Feeling sick (a lot of the time physically) over and over with the constant, sudden changes in mood. My overall experience of life has been lack of control.

It was a revelation to me when I was told during DBT skills group that my moods were not constantly either up or down, that they actually come and go, more swiftly than I thought. For anyone who struggles with emotional dysfunction this seems to contradict the day to day experience. For me, the distress I felt was so overwhelming that it felt as if I was experiencing my feelings as emotional 'white noise'. I cycled constantly through distress, relief, exhaustion so rapidly I was unaware of any distinctly identifiable feelings.

I worked for some time with people who struggled with addiction to Class A drugs. I learned a lot from them about the extremes of cravings and the need to give in to the urge to use their drug of choice. One of the skills they learned was to 'surf the urge'. I could not imagine at that time the extremes of the pain of their cravings. However, as they developed the urge surfing skills a number of them would talk about the moment they realised that the height of their cravings was relatively short lived. Of course managing Class A drug addiction takes a lot more than the realisation that cravings are not actually constant even if it feels like it. But it was a small step in helping those who were ready to regain control from the ravages of their addictions.

It is not an exact parallel but for those of us with a diagnosis of Borderline Personality Disorder (BPD) the realisation that the extremes of our emotions do not have to be out of our control, is also a key moment in recovery. In DBT the Emotion Regulation Module includes the skill of 'surfing the emotion wave'. For me this skill has been all about first recognising that the fast cycling of emotions can be slowed down. I no longer see myself under a constant cloud of unidentified emotional mists.

There are a number of steps towards 'surfing the emotion'. Here is how I see them:

1. I press the 'pause' button. Using Mindfulness I focus on what is certain around me. 'This is a cup of coffee, I can smell, it, I can notice the warmth spreading to my hands from the mug, I can enjoy the sensations and taste as I drink it'. I allow myself to use my senses, I take the time to experience what I am doing in that moment, noticing my feelings, but not allowing myself to get stuck with them. I also slow myself down by using breathing skills. Either deep breathing focusing on my lungs, the rise and fall of my tummy. In these ways I take my mind away from trying to analyse feelings which cannot be rationalised and simply focus on what is certain. Grounding myself in my surroundings.

2. Once I am able to focus on my breathing or on my surroundings, I try to name the feelings. Often the most immediate feeling is not the problem. My main problem is when my immediate emotional response to the present trigger connects with feelings about and from my past. Often these historic feelings are painful and linked to past traumas. I need to be able to separate present feelings from those from the past. If I can name my 'enemy' I have a better chance of winning.

3. Accept that 'this too will pass'. No matter how I feel about the intensity and life of my feelings, they don't last forever. And there is a rise and fall in the intensity. Again, using mindfulness exercises which allow me to observe my feelings without losing control, helps me to notice and observe the rise and fall of the feelings. They do come in waves. If I can survive the 'crest of the wave' for a time, it will ease. This is a safe place visualisation I use when I need to calm myself and cope with waves of intense emotions: It's a You Tube video, https://www.youtube.com/watch?v=pPBxNLpOLNU

4. Sitting with the emotion. If I recognise that the feelings are not permanent, or that they don't have to remain as painful all the time, I can then allow myself to learn that no matter how painful, they cannot kill me. Sitting with the emotion has so often been the last thing I have wanted to do. However, DBT acceptance skills tell me that trying to avoid or push away the emotions will not help in the long run. In a sense I need to allow the wave to wash over me, in the knowledge that I will be safe and once the wave has receded I will still be standing. Again, the ability to allow myself to feel the emotion is a mindfulness skill. I use a mindfulness visualisation which identifies the feeling, then gives the feeling a visual form in my mind. As I breathe through the waves of emotion, I return to my image of the feeling and observe it. I continue to switch focus between my surroundings and my image of the emotion until finally I can observe it grow smaller and disappear. There is a version of this in The Dialectical Behaviour Therapy Skills Workbook (2007, McKay, Wood and Brantley - New Harbinger Publications, Inc).

5. Another way of managing the wave of emotion is to listen to classical music. Popular music is not complex enough, I feel, to be able to help ride the emotion wave, although I do listen to pop music as Opposite Emotion exercises. However, movements from the classics have shades of emotion. They rise and fall, the orchestra builds to crescendo then dies away. Allowing myself to focus on the rise and fall of the music, allows me to naturally fall into the concept of waves. Once I am comfortable I can connect my emotions in a similar way and allow them to rise and fall along with the emotions. I have explained a bit more about how this works for me in this blog: http://bpdlifeinthemoment.blogspot.co.uk/2014/07/my-dbt-classical-music-playlist.html

I have found these explanation of the DBT Emotion Wave helpful too:

Caught between Two Minds - the problem of 'Apparent Competence'

'Treating someone with borderline personality disorder can be one of the toughest challenges a [social worker] encounters. Life for such a client is like trying to drive a car that is constantly careening out of control. Emotional vulnerability, fear of abandonment, and a seemingly invalid environment push the car from one side of the road to the other. The tiniest stressors can force the car into a ditch.'

Quote from: Dialectical Behavior Therapy — Treating Borderline Personality Disorder
By Christina Olenchek
Social Work Today
Vol. 8 No. 6 P. 22

I have found myself grappling with some old familiar 'friends' (or rather enemies) this week. If I may borrow from the quote above, anyone observing the ‘car’ of my life would have seen significant progress. Success in life, even. I had achieved academically, I was a champion swimmer, I had managed to hold down highly responsible and well paid jobs, for significant periods of time. However, look closer at the ‘driver’ and any casual observer could see the panic as I struggled to keep my ‘car’ from careering from one side of the road to the other. My life had developed into a pattern of emotional collapse, which resulted in my resigning jobs, selling houses and usually prompted the dissolution of all relationships.

As I learned more about BPD and particularly the research and therapy of Marsha Linehan, who developed Dialectical Behaviour Therapy, I came across a phenomenon known as ‘apparent competence’. This relates to the ‘Swan Effect’ where on the surface I was not obviously struggling with life, but underneath I was frantically trying to keep myself going, paddling wildly against the waves of emotional distress which threatened to drag me under.

Paradoxically, whilst constructing a mask of competence and coping with excessive levels of stress and responsibility, I would vilify those closest to me along with medical professionals for not seeing my real needs. Effectively, I would blame everyone around me for not being mind readers. This is one of the greatest challenges to professionals trying to help those with BPD who display apparent competence. I will not openly tell you about my emotional distress, but I will hold you accountable for not seeing 'through' my mask of competence and I will make you 'suffer' as a consequence. My outward co-operation as a service user was tempered by a harsh assessment of those seeking to help me, particularly if I felt they couldn't see through my outward competence. If anyone failed to ask the 'right' question, or misread my mood on any given day, then progress for that day would be painful if not halted. Of course this is another example of my own self defeating behaviour prior to DBT. A practitioner is not responsible for the management of my BPD, I am. If I frustrate the learning of those skills which will help me manage my emotions, then I am going to end up frustrating myself. I managed to reflect on this when I was hard on DBT facilitators a couple of times and was helped by my one to one therapist to recognise when I was in danger of preventing myself from moving forward. It was a hard learning curve, but absolutely necessary for me to learn to manage my BPD.

The other issue is that there are times when I really can cope, when I do possess the skills to manage - to undermine that competence by putting me in an environment which patronises me is to undermine my sense of self validation. So, for me, my treatment plans have all stated clearly that inpatient treatment is detrimental to my progress, no matter how desperate I may be at times, admission to hospital at this stage of my life would be retrograde, except in the most risky of circumstances.

The problem comes for me when I do need help. I have had to learn how to ask for it effectively. This has been one of the most challenging DBT skill sets for me to learn. Interpersonal Effectiveness includes the ability to break down my mask of apparent competence so that I can be honest with those around me about the times when I know I am BEGINNING to struggle. If I wait until the point where it becomes painful for me to keep going, then I am likely to swing to the other end of the dialectic and expect the rest of the world to sort me out.

In the past week I have found myself swinging back to this see saw, despite having real encouragements in my voluntary work. When I consider the past six months with my 'wise mind' I can see that I have achieved a lot and it is real competence, not just apparent competence, because I have found myself enjoying the moments of success, without short circuiting them, or trying to negate them by self-defeating statements or actions.

However in the past couple of weeks in my role as Mental Health Volunteer, I have had meetings with other service users who are also going through recovery and discharge processes. I have found myself asking 'Why don't I get that level of support?' 'Does my experience not rate in being acceptable to professionals looking for 'lived experience?' 'Why do I have to forge my own path?' 'Can't they see that I need support and help too?' Maybe these thoughts are familiar to you. A friend who was discharged before me reminded me that, 'aren't we lucky that we don't need ongoing support workers? And isn't it great that it's been over two years since you were last near an A&E or phoned the crisis team?' And, in the cold light of day, of course it is. My life is good, I have managed to devise and write a Mental Health well being, course that has been running for nearly a year. It has helped people with a range of mental health problems, as well as some who are family or friends caring for them. I have a strong network of friends and support that has no links with Mental Health services. My therapy group, however supportive, was not and is not my main social group.

For many who are coming to the end of their contact with services, due to much of the stigma around mental health and, perhaps, the intensive nature of the treatment offered, the skills and time needed to build up support and social networks outside of services has not been possible. A number of people who came through services with me, felt really bereft when contemplating discharge, because of this. I am grateful that from day one of DBT I was prepared for the day the therapy would end, that the main goal of my treatment was to prepare me for a life without professional help.

That is what I need to remind myself of, when the 'apparent competence martyr' rears her head. If I need support and emotional validation I need to either find it in reminding myself of how far I've come, or seek the reassurance of those who I am accepting care for me and love me as I am. I love the fact that many of my friends are straight talkers, they have earned the right with me to challenge my faulty thinking in much the same way that my group facilitators and therapist did when learning DBT skills.

Instead of feeling invalidated because I am meeting other BPD sufferers who have support workers and are being offered ongoing treatment and counselling, I should really reflect on the fact that I have come a long way. I do have competence in the skills that are keeping me on an even keel. I would be frustrated by having to refer to someone else, or go through a team for approval of my plans. I am trusted to manage myself in my role, with some management support. It is validating to be trusted to develop my own ideas and resources. The skills I have built up over many years in a number of arenas are now helping me to move from unemployment to voluntary work and hopefully on to paid employment. Essentially, I was ready for discharge, I have not looked back since I finished the skills acquisition of DBT and I am actively building 'mastery'. It is still an ongoing battle with the voices from the past who tell me I am unworthy, but slowly I am able to validate myself and know that my competence has moved from 'apparent' to real.

Keeping my "Life Train" on Track

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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