Recovery Interrupted?

One of the occupying concerns I have had since social distancing was implemented in the UK, has been for those who have been attending our weekly community group. Online I have ongoing contact with many more in terms of numbers. However, I am aware of the needs of face to face contact and encouragement particularly for those who are waiting for referrals, or for those who are in the process of recovering from mental health issues, which means our group meetings have built (or were in the process of building) relationships which serve to support our members manage mental health in their daily lives.

We are doing our best to keep connected, but with the best will in the world, connection and relationships cannot be fully healed without the ability to meet up and read mood and body language. Easier for someone to shrug off low moods when online or through distancing messaging and go back into our cocoons. Never has it been easier for people to mask their emotional and mental struggles, particularly those of us who live alone.

This has been brought home to me through the rise in statistics around domestic abuse and some cases of people dying alone at home from Covid-19. Both physical illness and domestic abuse are major contributors to poor mental health.

So let's be more alert for signs that would normally go unnoticed.

1) We are all social distancing so if someone has not been seen out and about for a while that can easily be overlooked. Do you know if your friends are using their opportunity to get outside of their house. Honestly when you are at your lowest, the thought of such activity is almost impossible to contemplate. How can you check on those who live alone and are at risk from neglecting physical care?

2) Have your friends or family disappeared from all social media? Can you check if the green dot appears next to their name? Can you message them privately?

3) When did you last have a meaningful conversation with isolated people that wasn't about the current situation?

4) Do you make times to contact your friends and family to video chat? It is easier to check in if you have made definite arrangements, it also gives both you an opportunity to have appointments again to look forward to.

5) If you are unable to make any contact via distancing means it is reasonable to go to their door and check on them. That would be allowed.

6) All the usual people are available to seek help if you need to ask for it. It may take a different form, but you can still contact the person's GP or phone 111 for advice on what next steps to take. However, if you believe there is an immediate risk to the life of anyone then 999 is your option.

7) It is important that we all monitor our own moods and recognise when we need to ask for help. Again, your GP is still there and can do video chats and if necessary arrange for a face to face appointment. Organisations like the Samaritans have not gone anywhere. They can be contacted through their usual phone number 116 123 from any phone. You can also email if you feel unable to talk: jo@samaritans.org (this takes 24 hours to receive a response)

Above all, whether you are concerned about yourself or others, tell someone and get the help you deserve. Just because we are in the middle of a health crisis caused by a virus there is no competition which says, your needs or health issues are less important. All lives matter and it is okay to not be okay with what is happening around us. That is to be human.

Isolation - surviving on the desert island

'No Man is an island' the words of John Donne have never been more starkly in focus than during the current worldwide battle against a common invisible enemy. A virus has shown up the lies that tell us that we can be divided into different groups, that there is such an entity as 'them' and 'us'. An organism designed to attack human beings is currently ravaging every nation, every race, every creed, every age group, every shape, shade and form of humanity across the world.

I have often thought on and off about ideas of loneliness, isolation and solitude and the different qualities that each can bring to our experience.

At this very moment we are following government instructions to distance ourselves and to avoid social contact outside our homes. In reality we have been forced to put physical walls around behaviours which we have fallen into and which have always forced us into a kind of social distancing before we had a name for it. We have been forced in concrete terms to live out the reality of what impact dividing ourselves from the wider community and world outside our homes can have on us as human beings.

In thinking about what isolation and loneliness can mean to us as human beings I have found that it is helpful to have before me the complete sonnet from which the famous quote comes:

No Man is an island
Entire of itself,
Every man is a piece of the continent
A part of the main.
If a clod be washed away by the sea,
Europe is the less.
As well as if a promontory were as well as if a manor
Of thy friend's or thine own were:
Any man's death diminishes me,
Because I am involved in mankind.
And therefore never send to know
For whom the bell tolls,
It tolls for thee.

Nowhere is the fragmentation and division within our communities more evident than in our collective response to death. Death and grieving has increasingly become private and individual. One of the most visible impacts of the current outbreak within Northern Ireland was a realisation that traditionally, we as a people, were out of step with much of the UK as we continue to grieve as a community. Families reported the difficulties of facing death without our cultural gathering together not only in emotional and spiritual support, but also in the very practical provision of sustenance to the bereaved. In a sense, the culture I belong to has come face to face with the isolation felt when death comes to call and it is not felt as a wider community.

This pandemic in contrast to our modern response to death has been to reinforce Donne's words, 'Any man's death diminishes me'. If anything, in the regular displays of support for the NHS and the bringing of help by neighbours and community groups is bringing us back to the idea of shared grief, for the first time since WWII. There is a natural desire to care communally which has been stifled by the way we have developed our modern way of living.

We have been living in a fractured world, separated and isolated into political, cultural and religious ghettos. Never more so than in the last five years or so. The danger in this is in believing that I or we don't need anyone else. However, community is not just a good idea but is bound up in our very nature. I am made for connection and my humanity is somehow wounded when I fail to acknowledge this.

Death in reality is the great leveller. It is the one experience that every single one of us will face, young or old, rich or poor, educated or uneducated. It is also the one life experience through which we see starkly our shared humanity. Suddenly in the face of death we are faced with a sense of something sacred about human life, something which day in, day out, in normal times we are able to ignore.

The core issue with loneliness and isolation is that both of these states result from a lack of connection. As we socially distance we are challenged by the fact that it may not be the physical proximity of others that influences how lonely we feel. We all know the moments when we experience being 'lonely in a crowd'. I live alone, so it is not an effort for me to 'socially distance', physically it is easy for me to be on my own, isolated or lonely. Yet in this period of isolation I am feeling more connected to my family and friends than usual. This crisis is enabling people to strip away the masks of social niceties and busyness which means that interactions can be deeper. It's a waste of a video call to reply 'fine' to the question 'how are you doing?' We can see it as being an opportunity to share a uniquely common experience, to share how it has affected us and our families, to share how we feel about it. In short I am finding that this situation is creating time for us to be honest with ourselves and our loved ones. And our relationships are feeling deeper and more connected as a result. Or is that just me?

In offering some steps to take I think the most helpful thing I can do is share with you the gift of solitude. It is different from isolation and loneliness, in that it provides a uniquely spiritual time to reflect and be honest with myself, so that I can more effectively reconnect with those I love once I have come out of solitude:

'Solitude is the furnace of transformation, without it we remain victims of our society and continue to be entangled in the illusions of the false self. Solitude is the place of the great struggle and the great encounter, the struggle against the the compulsion of the false self, and the encounter with loving God who offers himself as the substance of the new self' (Henri Nouwen, The Way of the Heart)

This reflection from Henri Nouwen clearly focuses on a Christian perspective where solitude allows him to connect with his God. When we begin to reconnect following isolation caused sometimes by mental illness, or physical illness, periods of time when we need to regroup before engaging again with the society around us, it is important that we establish from whence our hope and meaning come. For me, as I have often said in this blog I find it in my personal faith in God. For others it may be other 'higher powers', but this is a starting point.

When we seek to connect or reconnect in a meaningful way with those around us, I have found another Rule of Living helpful to encourage me to connect honestly, it comes from the Northumbria Community and is encompassed in two words: Vulnerability and Availability.

In the coming together of communities at this time I have witnessed both vulnerability: NHS staff willing to risk their lives on the frontline, neighbours helping the elderly out in their neighbourhoods despite having to go outside their own cocoons. Availability means breaking out of our walls and making ourselves available by being authentic and offering to share our real selves with those with whom we come into contact. When you are facing an mortal enemy, the social fears and anxieties pale beside them. I can only relearn trust if I am willing to be both vulnerable to disappointment, or rejection and if I am willing to break my own sense of reticence to engage with people and make connections as much as a I can.

Ultimately, because I have a shared humanity and 'because I am involved in mankind, any man's death diminishes me'. However, when I recognise our shared humanity and join with others to address sometimes boring, practical issues together, sometimes saving actual lives, then I am most profoundly connected not only with the people around me, but with the wider world and creation of which I am an intrinsic and valuable part.

Young People's Mental Health: The Clash Between Welfare & Achievement

I have hesitated for some time before putting in writing my thoughts on the subject of Young People's Mental Health within our current education system. I have witnessed the narrowing of what education means, from a distance. I have witnessed increased concern from parents and friends who are teachers and educators about the welfare of the children and young people in their care. I have tried to help young people with the support of their parents to negotiate the emotional minefields of their most significant educational milestones.

Sometimes when discussing young people's mental health, we are satisfied with laying the blame on new technology, social media and other things that are different from our day. However, unless you are involved in trying to provide a balanced creative and social education within the current education system, it is unlikely that you will be aware of the impact of successive diktats from government about focusing on exam results, to the detriment of a truly culturally diverse curriculum. Also the focus on needing to achieve, 'outstanding' according to OFSTED criteria seems to be taking focus away from preparing young people for a rounded and successful life, which enables them to weather the inevitable storms and challenges of life as it is.

Why decide to cover this in a Mental Health blog? Because I have recently had a more sustained glimpse inside for the first time since leaving teaching in the 1990s. I am currently trying to overcome my fears and have been applying for work so that I can make the step away from having to rely on benefits. This has meant I have been attending interviews for jobs which are focused on 'Pastoral', 'Welfare' and other 'caring' roles within schools and colleges. My CV obviously gives me some encouragement that I am being invited for interview. My teaching coupled with my lived experience of mental health, along with the work I've been doing in the community would seem to be a perfect fit.

However, following my interview at a local college, which on paper was all but perfect, I have felt deeply uneasy and, at times upset about the atmosphere and attitudes towards students' welfare. Although the role was designated as 'Pastoral' none of the discussion, observation or interview questions explored the link between mental well-being and 'success'. It upset me primarily because I know that one student from this college took their own life in a very public way last year and I am aware of the emotional issues currently being managed by students within the college.

On paper there is a 'counselling department' but I wondered about how effectively this works as there was no explanation of how this department worked alongside those trusted with the general welfare of the student body. Or even, if there is any wider conversation beyond referral and tick in box. In the end the aim of the Pastoral role was to ensure that students remain within the college and 'successfully' complete their courses.

As myself and the other unsuccessful candidate were sifted halfway through the day, I realised that we were the 'quirky', more experienced, more expensive candidates. We stood out, we were big personalities - too big and too experienced maybe to just deliver a proforma welfare programme of lessons. There did not seem to be any scope to individually tailor delivery of coping and mental well-being skills to the small tutorial groups in addition to the prescribed programme of social and health education.

I now know my main mistake was in focusing on helping young people develop a safe group of people and safe place within college so that they could feel supported emotionally as well as academically. The problem, I wanted to ensure that young people enjoyed their time and were able to manage stresses around exams and the future by providing a forum to share coping skills.

This I find is not the pastoral agenda for school and colleges. It can't be. Exam results and OFSTED reports are integral and essential to funding for all activities within the establishment. There can't be additional resources for the mental health initiatives the government has now loaded onto the already overstretched education system.

There are a large number of these posts being advertised and not every school or college I have attended for interview have had such a narrow emphasis. In fact I have been encouraged by conversations with school leaders who recognise the need for a compassionate and responsive mental health strategy which is willing to consider building up resilience and crisis management skills for all of their students. While educational success is dictated by government and political ideology and narrowly assessed based on exam results, we will continue to face growing issues around young people's battles with anxiety, depression and other related issues such as substance misuse.

Unfortunately, on a wider note the pressure to maintain successful exam results, in some settings seems to resulting in a more chalk and talk form of teaching for A Level. This again, saddens me, as one of the joys of the Socratic Method is to build on students' strengths and natural interests to encourage, a questioning, inquiring, critical frame of mind, which can be the foundation to the independent learning essential to be successful at degree level. I found student areas to be quieter than expected, and classes less discursive and confident in expressing their own opinions. There are few times for reflection it seems to me, within these most formative years.

My conclusion is that there is no room for a teacher like me anymore within education. I believe too much in the individuality of life experience and the fact that each student does not come to us as an empty vessel passively waiting to be filled by the prescribed knowledge which can be measured by exams and tests and reassure those in power who wish to avoid questioning minds.

Where that leaves our need to support young people so that they can be resilient enough to cope with all that life throws at them, I don't know. I do know that educators need expertise from outside as well as resources which can help them feel more confident in speaking to young people about issues around self injury and suicide in particular. It requires investment in pastoral staffing which is separate from the academic staff and curriculum, where young people can have confidence that there is a safe place and safe people with whom they can be open. The school nurse service maybe a model which can offer one pathway, or designated mental Health leads, which I believe is in the pipeline. I would say that given the current pressures on management, such a role does need to be seen as not linked to a student's academic progress.

Small short term projects are a good start. However, I do believe there needs to be a completely different approach to school pastoral structures, particularly in the post 16 world.

These are simply my personal views.

Both....And....Life's Balancing Act

In the wee small hours of the morning, when I have tossed and turned all night, with anxious thoughts, all is darkness. Although the opposite point of view - the rose tinted glasses view that life is a bowl of cherries, seems less problematic, it is no less damaging, if it causes us to be unable to engage with life as it is.

The Dialectical part of DBT (Dialectical Behaviour Therapy) recognises that life is not all black or white, darkness or light, it can be both at the same time. For those of us who experience rapidly seesawing emotions acknowledging the reality of competing truths, can be difficult to negotiate, particularly when our emotions are informing our thinking that the 'truth' is either all black or all white. The sweet spot lies between accepting competing realities and fighting against one or other truth to the point of exhaustion.

In DBT, the decision sweet spot is called Wise Mind, a balance between being all rational or all emotion. This helps us to balance our purely rational, impassive, view of life with our instinctive, emotion driven knee jerk reaction to our life experience in making decisions which are ultimately helpful.

I understand Dialectics as the balance beam along which my view of life in all its light and shade can lead to me accepting the ups and downs of my life. It is an essential part of the Radical Acceptance which helps me to accept my past, build on my present and move forward into the future.

Dictionary definition: 'Dialectical thinking refers to the ability to view issues from multiple perspectives and to arrive at the most economical and reasonable reconciliation of seemingly contradictory information and postures.'

In applying it to my recovery and use of DBT skills, it is an extension of Wise Mind and moves us from the wilfulness of persisting with long discredited ways of coping with the contradictions of life to an acceptance of life as it is. It helps me to stop being a captive to my instinctive, emotional responses to life, which can be out of kilter with the reality I am experiencing.

Looking back on 2019, following the General Election, just before Christmas which rounded off an awful year, all seemed dark. Then I looked for other perspectives. I am grateful for the blogs of @sarah.styles.bessey who often reflects on the difficult experiences of life. She sums up for me the practical application of thinking dialectically about what we are going through:

'This was the year I learned all over again to reconcile that many things can be true at the same time:

...we miss who we used to be and we love the person we are becoming;...

love and grief;

hope and lament;

there are miracles and there are not;

there are funerals and there are baptisms;

this world is devastatingly broken, filled with weeping and suffering and this world is so freaking beautiful and good you could cry at the sight of a baby’s thigh or catch your breath at the sight of pine trees against a rose coloured sky or turn up the music to sing in the car with the windows down.

All of it: true.'

Life is not all darkness, nor is it all happiness and light. The difference between joy and happiness is that happiness is mostly dependent on what is happening to me. Nobody can be happy all the time.

Joy goes deeper and can exist at the same time as some of the most difficult of times. We can be grieving a major loss, or be struggling with the most difficult of circumstances, but in the midst of those times I can also experience the joy of a good cup of coffee, shared laughter, the warmth of my dog cuddling next to me.

Research shows that feelings last approximately 90 seconds and are fleeting - if we do not constantly fuel them with underlying triggering thoughts. This means that the most negative of emotions is survivable and passing. It also means that there is an opportunity to enjoy moments of positive emotions and allow them the same space to breathe as we give our negative feelings. When your life has been dominated by believing that your darkest moments far outweigh the times that were good, reflect and give space to those moments of light and hope which have sustained you. If we can give the times of light more weight than our negative feelings allow, we will be able to recognise that our lives are both light and shade and our challenge is to keep our focus on balancing these truths about life.

Where do I go from Here?

This year: my mother died, my Dad was critically ill for a long period, as siblings we had to travel back and forward throughout the time he was in hospital, there were times we were told he might not make it, but he has and now needs ongoing care. I continue to struggle to find a place of security financially, my benefits review has resulted in another 1/3 cut to my income (still waiting for final outcome, but could become another battle right down to a Tribunal), I was taken ill and spent a week in hospital and am still undergoing tests to find out what exactly is going on, I've had disappointment after disappointment when seemingly earning from my voluntary work has ended due to....I know not what? Stigma? Risk aversion? Fear that I'm overqualified? Too old? Too honest? Making use of my 'Lived Experience' is fine when I do work for free, but apply for a 'proper' job and suddenly all the skills and abilities, which have prompted well intentioned people to encourage me to apply for jobs, seems to count for nothing. I've been battling a particularly persistent viral cold/'flu and know I am physically exhausted. Finally, when there was some hope that the wider society attitudes towards people in need, poverty, illness, relationship breakdown, homelessness, hunger (in the UK, in 2019!) were changing. Bang. An uncaring, self-centred government has been returned with the power to pursue a kamikaze direction which will continue to drag us all down with them. I now hope that all the prevailing wealth of evidence I've read is wrong for the sake of all those who are already suffering from this national preoccupation.

Today, I know I have reached the end of my resources. It's understandable. It's human. It's okay to be not okay about all of this. Tomorrow I have a choice. Where do I go from here? The song from Evita has been running through my mind today and I recall that from this point in her story, such a low point, she begins her climb to superstardom. I totally have reservations about her path and indeed the trajectory she finally followed, but I look at it as a lesson in picking yourself up and starting again.

So, what is my own answer to the question, where do I go from here?

1) Accept that this is painful. Allow myself to grieve. Name the feelings. Disappointment, hopelessness, sadness, fear. Don't judge myself when I cry. Life is hard.

2) Life needs purpose and meaning. I have written before about where I anchor myself when looking at finding meaning in both good and hard times in life. Because I have invested my belief in someone who is bigger than me and my feelings, I use my prayer times to take a step back and look at the bigger picture. Within this space I find hope and perspective, both personal and for the wider world.

3) Engaging in life means that we need to be able to engage with other people. People often hurt other people, either from intent or carelessness. However, there are acts of human kindness and there are good things in the world around us, when we take a step back. I can be encouraged at the willingness of the younger generations to carefully consider what is going on around them and, rather than shrug at the enormity of the work need to bring change, they have been prepared to act. We are made for relationship.

One of the greatest sadnesses for me during the political upheavals has been the breakdown of our society into camps/tribes who cannot articulate or even engage with opinions which differ from their/our own. Relationship means we need to listen to others, sometimes we need to hear things that may be painful for us to hear. One of my personal values is honesty and integrity. If I have wronged someone it is my job to repair that wrong. If I can learn about myself, myself in relation to others, or the world around me, then no experience will be wasted. That doesn't mean that it's easy to say, 'lesson learned', often I need to work through pain and cry tears and wait until I am in a place that is distant enough for me to make some sense of what has happened. And sometimes, there is no sense to be made; it is what it is. Life is not logical.

4) I have a choice to make. I can choose to revert to my favoured coping mechanism and retreat from engaging with life. At this point in my recovery, however, I am no longer satisfied by this as a way of managing the worst of times. It does not help me to remain paralysed by fear or anticipation that nothing can change. If I can't change the environment around me, then I need to accept that it is my task to adapt to that environment. So I can't indulge myself in pursuing the unknowable, 'Wny?' or 'Why me?' or 'Why not them?'. I have wasted too much time in the past feeling aggrieved by real injustices, but asking 'Why me?' when no one can give me an answer. Anger in response to injustice is not wasted if it drives us to challenge the general causes of those injustices.

So, where do I go from here? What now? I do what I can do, when I can do it. I accept what I cannot change (on my own) and build on what is certain in my life. Simple everyday successes can be essential building blocks to climb our way back up. Getting up, feeding myself, looking after my hygiene, making sure I am doing all I can to stay physically well is a good start. Do what is effective for you having acknowledged where you are emotionally and physically.

Most of all, look for glimpses of hope. The small green shoots of new life.

The Waiting Game

I'm not a patient person. As I have learned to manage my emotional storms, I'm realising I am an ultimate optimist. If I believe something needs to be said or done to change a situation I want to immediately act to do that. Since 2010, following my diagnosis and entering the wonderful world of mental health services, so much of my life suddenly spun out of my control. I could try to give my perspective on why so much of my experience of waiting has been linked to going on a list to be assessed for suitability for 'treatment' but I don't think or believe that it helps to identify factors that are beyond my control.

Recently I've experienced the same frustrations while waiting for assessment of a physical problem. It has given me pause to consider the things that I do which make that waiting time either painful or bearable for me. There is something in the power of my thinking to either make time seem like eternity or go quicker than I expected. I've realised that rather than being powerless during these times, I can control those things which I have control of. I've recognised a number of ways that I have been able to manage these times better than in the past.

1. EXPECTATIONS. There is nothing worse than time on my hands to make my mind increase or decrease the importance of small things to the final outcome when whatever I am waiting for arrives. If I have waited for two years for 'treatment' the importance I place on that longed for appointment becomes enormous in comparison to the what the human being behind the date is able to deliver. I think this is the most important element to manage so that long waiting times do not become a matter of gambling with how quickly my initial presentation at assessment may deteriorate. Too often waiting periods end up being shortened due to lapse into crisis. Sometimes my self harming behaviour is a way of short-circuiting the process because I feel that if I go on feeling this way much longer, I will literally die. I need some help to get through the heights of emotional pain, so that each of those moments is not necessarily going to end up with an inpatient admission. I need help to create in my own environment a safe place to wait. I wonder if equipping me again becomes part of the triage and assessment stage? This could mean that I don't have an assessment appointment followed by between six months and two years of nothing. THAT feels like I'm in limbo, abandoned, in no mans' land, helpless and more importantly as waiting magnifies my negative thoughts and feelings: not worthy of help.

I wonder if, while waiting for specialist service appointments, there is scope for equipping people with self management and distress management skills. Mindfulness which was core to my DBT therapy has been so helpful in so many waiting times for me. Could it be useful as a tool, among others, to help people manage the time spent waiting (given that the prevailing economic and political realities prevent these times from shortening in the short term.)?

I have noticed that when I break a leg or an arm, while I am waiting for the orthopaedic specialists the emergency staff have measures to support the broken bones, and alleviate the physical pain. Of course no one can remove from me the emotional pain and distress I am experiencing, even when I end up before the professional I have been referred to. No one can fix me. No one can undo my past traumas. No one can stop me feeling this lousy. BUT I can be helped to learn to manage such pain and distress in less self-destructive ways. Can I be offered some first aid for my emotions which can hold me while I wait?

2. PERSPECTIVES. My feelings and their imbalance within me cause my perspectives on the world around me to become skewed. Given the extent of my distress small things had huge impacts on my mental health. I tried two different interventions and waited 18 months before I started my DBT journey. During the time between diagnosis and about six months in the DBT programme I was still trying to remain in my demanding job. My perspective on waiting for treatment and starting treatment was heavily influenced by the sickness procedures which seemed to place some kind of magical aura on the idea that I had started being 'treated' for my 'condition'. The expectation became that because I had two days off a week to attend my group skills and individual therapy, then there should be no further issues from my mental health that would affect my work. In other words, having supported me during the waiting time, my employers then expected me to be magically 'fixed', ignoring the fact that my long term mental health struggles would require long term management, including re-learning how to adapt myself to any work environments, without ending up emotionally exhausted.

If we see our struggles with mental health as tackling pathogens, then we will end up having major conflicts between the needs of people using services and, particularly the medically trained professionals who determine pathways. I WILL blame you if you do not 'cure' me, you WILL blame me if your medications or treatments are not as effective as you had hoped. So many times during my experiences of different interventions I was told I had not made the most of the help on offer. DBT was the first time I was told that if I was not making progress then we needed to review how suitable the intervention was for me.

Another aspect, particularly when waiting and expecting the magic bullet of 'help' is time itself. I had experienced significant trauma from early childhood right up to leaving home at 18. Then again as an adult I experienced rape and sexual assault on two other occasions (as a woman there were other lesser assaults which were just part and parcel of life in the 80s and 90s), last being when I was 40. I was diagnosed with BPD (Borderline PD) at the age of 42 although I had been through many experiences with Psychiatrists, Psychologists, Counsellors of various shades and theories from the age of 15. It is now ten years since my diagnosis. Only five of those years involved regular contact with Mental Health Practitioners. In pure terms of number of hours spent with those practitioners compared to the number of years of turbulence and unhelpful coping methods, including self harm and self destructive behaviours. Given this, it would truly be miraculous if any Mental Health Practitioner was able to 'fix' the impact of so much trauma in my life. If during the time I have to wait for a first appointment I can be prepared to recognise these realities and to accept that, at best, I will have the support and expertise of someone to walk alongside me for a time as I begin to learn new ways of coping.

3. TIME. There is something in our culture at the moment which seems to encourage us all to wish our lives away. How many of us set our sights on our next break from work, be that the weekend or our next holiday. When I am struggling most, I find it easiest to live one day at a time. I have to. I don't have the emotional capacity to imagine or hope for more than one day at a time. When I have been at that stage, I have taught myself to look at moments as more significant than something to be endured while I wait for something in the distant future. If I can focus on each moment as a span of time which I can experience fully, either to be enjoyed or endured, then I know I can survive. And as things improve, those moments begin to lengthen until I can imagine myself engaging in life more than a day at a time.

4. RUNNING AHEAD OF MYSELF. One of the hardest things I face during recovery is my impatience to get to some goal or other. At the moment I am tired of not being able to negotiate the complexities of returning to paid employment. I am managing my condition, but I don't know yet if I am ready for increased hours and pressure yet. Most of all I find the temporary nature of so much of the voluntary work I'm involved in difficult to manage, apart from the uncertainty thrown in every 18 months of having my benefits reviewed. I find the system itself is a major hurdle to negotiate to try to build up paid work. Most of all I face tremendous stigma based simply on the diagnosis I received, having worked successfully in some challenging areas. I have found with small projects and part time work, once I have reached interview or even people have seen me in action, there is usually no problem with my suitability. Sadly for the first time in my life I find that the thing which gives me added experience and expertise in working with people with complex needs, something I previously had paper qualifications and work experience for, means that my application is likely to end up in the bin, without me even being considered a serious contender. This puts a pressure on to prove myself to people who have a skewed view of Mental illness and PD in particular. So, I find myself wanting to change the universe in order to push deadlines which I know are immovable. I cannot make Christmas Day move forward from 25th December if I simply put my tree and lights up. I cannot make Colleges and Universities or potential employers change their admission/application times or procedures. Ultimately, I cannot know if I am ready for more hours of work, until someone gives me a chance. Until then I need to accept that there is a lot about the world of work and attitudes of employers to mental health that I cannot change.

Ultimately, time spent waiting can either be painful and feel like time wasted, or I can try to redeem the time:

- by not focusing on the event, appointment or occasions I am waiting for.
- It helps to go back to basics and try to live one day at a time.
- To admit when the environment is too difficult for me to change.
- To accept that moaning and allowing myself to stoke feelings of anticipation and anxiety will only make the passage of time feel as if it is slowing.
- To notice the positive things about having this time to work on things I rarely have time to work on...such as my yard, my dog, my fitness.

Finding the Words

'Shall I compare thee to a summer's day?' (W Shakespeare, Sonnet 18) or how on earth do I describe you? Finding the right words is an essential skill in trying to identify for ourselves and articulate to others, the deepest hidden feelings, experiences and thoughts. Too often when it is a problem, we find ourselves inside the 'belljar'. Locked away. One of my often repeated phrases when I was most in distress and struggling to get help, was 'I am inside my own head, screaming. No one can hear'.

That is why I found the Emotion Regulation module of DBT (Dialectical Behaviour Therapy) so helpful. I started to learn how to first identify the individual feelings from the morass of turbulent, violent waves of panic, anger, fear and self-hatred that used to tumble incessantly through my head. This step was the crucial first one towards learning how to manage the power and frequency of such self destructive and exhausting experiences. That's where having the time and safety to find and express what is going on inside is so important to begin to manage the fast cycling moods I so often experienced.

There has been a constant debate since I was first diagnosed - given the label 'Borderline Personality Disorder' (BPD) - in 2011 about what to call the clusters of symptoms and behaviour patterns which I exhibit. In one sense I don't care, my bigger battle is to find a sense of who I am among the shifting sands of invalidating parenting, my own confused sense of the world and the relationship difficulties this led to. However there are times when I am jealous of other sufferers who have a vernacular with an agreed understanding of their diagnoses: Chronic Fatigue Syndrome, Generalised Anxiety Disorder, Depression. There are always disagreements caused by stereotypes/stigma. Getting passed the minimising attitudes which get in the way of educating people about the real impact of Mental Illness is an ongoing struggle to get beyond the surface meaning of the diagnosis.

For those of us who have the complex roots both biologically and socially of emotional dysregulation, our diagnosis rarely, if at all offers any real language of understanding our experiences. We have gone through a number of versions: Emotionally Sensitive PD, Emotionally Unstable PD. Today I read of the World Health Organisation latest attempt to give us a workable diagnosis: Mild, Moderate, Severe Personality Disorder, with sub classes related to things such as experience of complex trauma, obsessive compulsivity, detachment, dissociation and disinhibition. This to me is a more positive move forward in giving a shared language between sufferer and professional to help explain the main areas where I have problems in life.

However, as with all diagnoses there is the problem of individualised responses to words and language: where I impose on them judgements and assumptions based on my personal experience and history. So, for some people being told that their condition is 'mild' may create some problems which makes them feel 'less than'. Whether we like it or not, there is a reality born of experience which tells me that words, like 'severe', 'acute', 'urgent' bring with them the resources I may feel I am in desperate need of.

I don't care in my moment of crisis where I sit in terms of others who may be more 'severe' than me. My fear becomes, if you give me the label 'mild' or 'moderate' then it follows that will not be given the help I feel I need until I prove to you I am 'severe'. In many ways this has always been an issue with perceived PD 'problem behaviour'. In reality if every team working with people like me is adequately and appropriately trained and resourced to provide the right level of intervention for me, then I can be reassured and given the right level of intervention for my needs - in theory.

It is good to work towards clarity of diagnosis, but, for me, the priority must be the reassurance that if I am given this diagnosis then it follows that I will then receive the appropriate level of help I need to learn to manage my condition.

"Personality disorders will no longer be classified categorically, but rather using dimensions of severity—mild, moderate, or severe.1 An additional category of personality difficulty will be demarcated not as a disorder, but as the equivalent of a z-code in ICD-10—ie, a non-disease factor that affects health status and encounters with health services. Following assessment of severity, clinicians will then have the option of specifying one or more of five domain trait qualifiers: negative affectivity, anankastia, detachment, dissociality, and disinhibition. ICD-11 will include new guidance for personality disorders to be diagnosed during childhood, albeit with caution, as they had previously been “inappropriately set at late adolescence or early life adult life”.1 Additionally, the revision will include a borderline pattern qualifier that is not dissimilar to the symptom profiles outlined in ICD-10 and the Diagnostic and Statistical Manual of Mental Disorder, 5th edition." (From the Lancet - Problems with the ICD-11 classification of Personality Disorders - Jay Watts - June 2019)