Recovery Story

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

A Word about Relapse

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

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

Hope and Meaning

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

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

Joy and the Emotionally Sensitive Person

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

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

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

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

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

Groundhogs and Finding the Words

Groundhog Day is a bizarre American public holiday based around the behaviour of a brown, furry rodent, upon which the nation apparently bases its expectation for how much longer winter will last. Until the release of the film 'Groundhog Day', so far, so obscure. Now, we use the phrase to mean recurring events or conversations. Over the past two weeks, I've had that sense of 'Groundhog Day' as I have had conversation after conversation on the same lines. 'My husband/partner/brother/sister/friend/carer keep asking me how they can help me, they keep asking, how they can 'fix' me.'

It's a familiar conundrum, we wish we felt loved, but need to know that with love comes a desire to do 'something' to take the pain and hurt from us. For us, the issue is to prevent pushing the love away with the offer rescue. So often, the conversations continue, 'I wish (he/she) knew that all I want is a hug and reassurance.' So often, it seems that even to find a way to say something this simple is so hard.

I'm no expert, but I have gleaned some wisdom from those who have managed to voice their thoughts to their loved ones and found a way forward together.

1. If You Can't Say it, Try Writing It. Write a letter to your loved one and pin it to the family memo board, or to the fridge, or on the loo door; somewhere they can't miss it.

2. Relieve Them of The Duty to Be Your Saviour. I've stated before that it is an impossibility for one person to provide all of our emotional needs. Those closest to us need to know that we don't expect them to rescue us. Just as I have to accept that I can't rid myself of all pain, so I need to absolve those closest to me from the pressure of believing they have to take the pain away from me. Together we need to work together - I have lived my life, survived my trauma. I do not need to share the fallout from those past experiences as a burden on my current relationships. What I would welcome is someone to walk alongside me, to build me up with present positives, particularly when carrying the burden of my condition or my past wears me down. In the healthiest ways possible I need my current relationships to be nurturing and equal.

3. Be honest. Express to them what other things, practical things would really help when you are feeling overwhelmed. For example, it's okay for children to spend one to one time with a parent if that allows time for the other parent to restore batteries. Support one another in becoming involved in social and other positive activities outside the home. Empty vessels have nothing to offer others.

Expectations (Not Resolutions)

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

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

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

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

What expectations do I have for 2018?

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

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

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

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

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

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

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

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

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

Intricate and inextricable knots

'O time, thou must untangle this, not I.
It is too hard a knot for me to untie!'
Twelfth Night - act II sc ii

I am not just a collection of interconnecting muscles, nerves, blood vessels and bone. On its own my body is a miracle of complex engineering, but within this body there are many complex chemical and electrical interactions and reactions all with different functions - perhaps I could see these as the fuel and lubricant which ensures the machinery keeps working effectively - there are hormones which determine my readiness for creating children, my moods, my appetite. Then there is the product of my mind, my thoughts, the core of who I am. This is indefinable in purely physical or chemical terms, although some argue that even the most complex of human interactions are just the result of biochemistry, I tend towards believing that there is something intangible, the essence of who I am, which I call the Human Spirit, or soul, so there is a spiritual side to consider.

When I consider all three aspects of who I am I recognise that there is no part of me that does not impact on the others. So when I fall over in the street, which I did recently, it is not just my hand which is hurt. That, it has to be said was the first part of me to connect with the shock of hitting the ground. In short succession, physical pain, was followed by a wave of grief - I wanted to cry. Then I caught sight of the shocked faces looking out of the bus window as it passed. Grief was replaced by embarrassment and then shame. Then my personality came to the fore as a kind passerby offered some help and I waved her away and too quickly got to my feet. The blood in my circulatory system was unable to keep up with what I, as me, wanted to do, so I nearly collapsed again, the physical working in opposition to my spirit. You get the idea - if anyone had asked me what part of me was hurting I could answer, honestly; my hand, my shoulder, my ribs, my knees, my pride, my sense of independence, my self confidence, my conscience (guilt for refusing a helping hand). Had I been taken for medical treatment only those parts of me which were evidently hurt would have been treated.

Too often we experience health services which treat only one aspect of our person. So we treat the 'flu, but neglect the emotional impact of feeling drained physically. The plaster cast, sets the bones and supports physical healing, but the emotional cost of a physical trauma is neglected until it becomes unavoidable.

I have been thinking about this silo approach to well being recently in regard to mental health and disability. Too often services and benefits tend to separate physical disability from mental illness or emotional challenges. This is why so many disability assessments have been running into difficulties and result in so many appeals which are overturned nearly 70% of the time. The reality is that 'seen' difficulties are the most easily identified and therefore treated or managed. It does not require a hard pressed NHS service to take time to investigate or have to spend time on treatment when presented with bruises or broken bones. When presented with emotional or mental distress, time is required as well as to change the approach from 'What is wrong with you?' to 'What is causing so much distress?'. The first question allows the professional to decide how to fix the problem, the second question opens up the need for a more long term intervention. Often Mental Health interventions are time limited when mental health issues require time and relationship, something that a six week hourly intervention cannot offer.

The thing is if you can help me to manage my emotional and mental responses to the physical pain or trauma I have experienced it is more likely that the physical therapies and interventions are likely to help me recover from or manage my physical challenges. Equally if you can help me address the physical causes of my exhaustion then I am more likely to be able to manage feelings of depression and anxiety.

I have been reflecting on my own recovery in these terms and recognising that persevering with looking after my physical health will help me to continue to manage my mental health. It is common sense, it also makes financial sense when applied to a resource-and-time-poor NHS. Yet I have to piece my recovery plan together from different silo'd teams under my own initiative. I am effectively the wellness hub for my own recovery.

When I worked within criminal justice I was privileged to be part of an multi-disciplinary team made up of police, nhs, probation and charities staff each working with individuals to address the complex factors which were stopping them from reforming and ending their offending careers. As long as an individual undertook to manage their own offending behaviour, our team would provide a range of support to help them with housing, employment, substance misuse, education etc. It was effective and when the people we were targeting were responsible for 80% of local car, thefts and burglaries was arguably an excellent investment. Even with the costs involved it was still cheaper than prison for most of the people we worked with.

What do I learn from this when applied to health? Well first there was a concept of 'end to end management' from the point of arrest to the point of end of sentence. Our team picked people up and worked with them through court, into prison, out of prison and to the end of licence or community sentence. If they re-offended they came back to the same team to begin again.

What if health and social care teams in hospitals and the community were integrated and worked in the same place? What if every person who has undergone significant surgery, or who is managing a significant physical disability has access to evidence based mental health well being practices as part of their recovery? What if mental health was seen as part and parcel of recovery from significant physical illness? What if we stopped separating off mental health units from the rest of the hospital except for those requiring the most intensive mental health support? What if we actually practised our interventions on both physical and mental health as if there were parity of esteem? What then?

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.