Just keep swimming!

Pretty good quote from Disney there.

When I last posted on here I thought I was coming out of a blip, and then said blip continued. I 100% thought I could positive think myself out of the hole. I don’t really recall what happened but it worked very temporarily, perhaps a day, and then things became worse again. I ended up in hospital a couple of more times, but only overnight…and then slept a lot in the day time. I mean positive thinking is vital and I 100% believe that what we think, we become. That being said mental illness and being low is not exactly the same as being negative, and positive thinking can only do so much. I think when you are at rock bottom, it takes more than positivity to help you, but once you are beginning to feel a little better, positivity can really help.

Things are better now though! I went through a couple of days at the weekend where I was looking after myself better, but I felt incredibly low, which is the usual process after a blip. It’s like you are letting go of the ways you have been coping, so it’s relatively “normal” to feel a bit rubbish and it’s a lot like when you have been physically ill and it takes a few days to get your energy back, but here we are!

I can’t say I am entirely sure how things have turned around. On Friday I was in A&E from about 3am-7am…but I was determined to still go to work, but then I fell asleep. I was so angry with myself when I woke up. I woke up 15 minutes before I was due at the hospital for an appointment that I was planning to go to on my lunch break. I had to practically run to the hospital and I was not exactly wide awake. The clinic was running an hour late, and I basically slept in the waiting room for another hour and then saw them. They asked a lot of questions and were worried about me, so they wanted me assessed by the crisis team but I managed to avoid it. I walked home in a daze and really disappointed in myself. I think sometimes you get to the point where you are drained, tired, and sick of letting yourself down. I spoke to the mental health team I am under for a planned phone call and I attempted to act “fine”…but the plastic surgeons, police and the university mental health team had all contacted them within a day so the “I’m fine” routine didn’t work. When I got home I rested all afternoon/evening, and my pain levels were so high that even with prescription painkillers, I was struggling. It helped me to keep safe because the idea of more pain was, to be honest, intolerable.

I am still on extra meds, plus the pain killers and antibiotics. Apparently it’s harder to get antibiotics these days but I swear I’m given them so often! It can’t be healthy!

I’ve been to work, and the gym for the last 3 days. On Monday I saw my MA supervisor, and I’ve also been super challenging myself with food. At home especially. I had been eating the same things every day for all meals including my evening meal, and then having set rules about lunch at work that I won’t go into, but I’ve had different meals every evening, eaten foods I haven’t eaten in a long time (cheese, avocado, salmon, cous cous, houmous, crisps and more), and also eaten different things at work. Every time I start panicking about it and my head wants to go back to eating the same old things I actually get really angry with the thoughts and I feel like, and excuse the swearing, “f**k you, you don’t get to dictate my life any more” and I love it when I am able to have this attitude.

I actually feel like my recovery from my eating disorder has had two stages; stage one was forced treatment as a child, stage two was actively choosing to “recover” as an adult, and I feel like I am entering a third stage where I am no longer accepting what I previously have. I’ve not been “ill” in terms of my anorexia for a few years, but I have been making a deliberate effort to keep my weight at or just below the target weight range eating disorder services set for me, doing as much cardio as possible, eating at certain times, eating the same foods, avoiding a lot of foods and other similar things…and I feel like I am beginning to challenge that.

If I gain more weight, who cares?! I’d rather be happy. Just because my current weight is what I need to be to be regarded as “healthy”, doesn’t mean it is my bodies healthy weight. I mean BMI isn’t the most reliable of measures, everyone’s weight/BMI varies, and a minimally healthy weight doesn’t have to be the end goal. A BMI of 20 is healthy, but so is a BMI of 21-24. I choose a little extra weight, happiness and being able to eat dessert any day! More than that, I choose being mentally healthy over spending my life restricting what I eat, not eating things I enjoy and having to put so much energy into not gaining weight. There are far better things to be putting so much effort into, and some food is good for your body, some food is good for your soul!! A healthy body is important, but so is a healthy mind.

I am a big believer in lifestyle changes for anyone who has weight related issues, rather than dieting. I am a big believer in body acceptance – body positivity is great, but actually you don’t have to love your body all of the time, but you can accept it and not criticise every aspect of your appearance. I despise the money making diet industry. I despise the guilt that so many women (and men), feel over their bodies and what they eat. I despise body shaming of any description albeit fat shaming, or thin shaming, and I absolutely hate that some people feel they have to adhere to certain standards. I hate that we are bombarded with messages such as ‘fat is bad’, ‘low calorie = healthy’, and ‘no pain, no gain’ – and I want to practice what I preach!

AMEN.

Bad times happen. Good times happen too. We choose which we focus on.

I have had a difficult week. I mean bad days happen regularly, but they are normally just one-off days or hours, not days upon days, and probably not this bad. I don’t even really know where it came from, it just kind of hit me from nowhere and it worries me how this happens. I’m picking myself back up and eventually managed to get some help, but I know things could have become much worse and it scares me. It scares me that I will end up back in hospital long-term, or lose the good things in my life. It was like everything just hit me, like suddenly I hit a wall. I am a very active person, and as soon as I wake up I’m out of bed in 30 seconds. I exercise regularly. I never, ever, spend a whole day indoors. I can’t say when I last did, but it was years and years (except when I was in hospital because I wasn’t allowed out). But there have been a lot of periods of time this week where I haven’t even been able to leave my bedroom, nevermind the house. A couple of times where I couldn’t leave my bed. I just laid there, in the middle of the day, and felt paralysed.

At first I was angry with myself; I thought I was just being lazy and needed to “pull myself together”, but looking back it was nothing of the sort. The thing that made me realise that sounds a bit silly, and embarrassing, but basically I needed the toilet and I was in agony and yet the idea of moving, of walking…I just couldn’t. I was in so much pain and after 2 hours I was still just laid there. I was also crying non-stop and I NEVER cry. I’m always called the unemotional one in the family, which is awfully ironic given that by diagnosis is emotionally unstable personality disorder. I am emotional, but just not in a way that people can see. It’s often not visible. But when I get in a really bad place, that does change. The worst thing I’ve done is set myself up for failure…thinking “I’ll be fine tomorrow and I’ll do X, Y and Z” and then been the furthest thing from fine, and feeling guilty and telling myself I’ll be better tomorrow.

I have also been having horrendous headaches which they think is related to how I’ve been mentally feeling. It’s weird because the headaches started last week, before things got bad. I’ve had two types; one where it’s a dull ache that just will not go away, the other is very sudden and intense. For about 10 minutes max I will be in agony. It starts at the back of my neck and then runs around to my ears and it feels like the worst pain I’ve had in my life. And then as quick as it comes, it goes. I don’t know which is worse. The ones that won’t go away make the whole day even harder, but the short ones are agonising. Knowing it won’t last long helps. It’s really weird, and I feel like I am making them up because who gets a headache for ten minutes?!

I feel really guilty for how I have been this week, and really disappointed in myself. The only thing that is helping that is the fact that my mental health team think that I have been, and am, doing really well overall to manage it as safely as I can. Their number one priority is always safety, and between October and somewhere between January and March that was not something I was successfully doing. It got me taken out of treatment and that is why I am currently not really having any formal therapy, and it landed me on the psych ward. The team I am under were extremely vocal about their concerns and tried to get me into hospital sooner than I was admitted (I convinced the team that assess you for sections that I was ok to be at home more than once), and so I know that they genuinely think I am working hard at things; they would not say it if they did not mean it, and so it eases the guilt a bit. The last thing I want to do is ruin my hopes of returning to treatment.

I have had to spend some time in hospital this week, and the reality is that it might become necessary to have at least some time there over the weekend, but I am trying not to see that as failure neither. I have made some bad moves this week, and I’ll be honest and say that rather than admit to myself that I was disappointed or angry at myself, I took it out on professionals. I mean when I say that I don’t mean I was horrible or anything like that, and it was very brief, but in my head at points, they were the problem not me. I did not want to go into the hospital no matter how brief it would be. I find it embarrassing and I feel ashamed when it happens, and lets face it, nobody wants to be in a hospital.

I’ve had my meds temporarily increased. They’ve given me 9 days worth so I’m assuming it’s just for that long. I hate being overly medicated. Like I accept needing some medication and I take daily long-term medication…but I hate using PRN medication, and I hate that it just wipes me out. I am starting the PRN tonight and I know I am going to struggle to get up in mornings, and I’m going to feel zonked out. It feels like why on earth would I do that to myself? But I know the reasons. If it can prevent ending up in hospital and keep me stable so be it. But of course then I will also worry about coming off them so you can see why I want to avoid them; they wipe me out so being on them is hard, and then coming off them is also hard. But needs must, and this happens VERY infrequently for me so I can kind of accept it as a rare occasion kind of thing. Don’t think I am being critical of using PRN medication because I’m not, but it just isn’t really for me.

In terms of support I can go to the hospital any time. I can also ring my team between 9 and 5 Mon-Thurs, and 9-4 Friday. We have a scheduled 30min call next Fri, but I can ring before then. It’s reassuring just knowing it’s there as an option, and we spoke Monday, yesterday and today, plus I’ve had contact with my GP. Next week my mental health specialist mentor at university is increasing my contact with her to twice weekly (Monday and Thursday), and there’s room to consider having a 2hr session plus a 1hr, rather than two 1hrs. She is a life saver. She makes such a big difference to my life, and not only that but we genuinely get along. She said once I leave university she will keep in contact with me, and it just feels like we click. I feel like we are quite similar in some things and we don’t sit and talk about mental health related stuff all of the time, like we have genuine similar interests and good random conversations. I’m very lucky. (Also she is Irish and I love Irish accents).

My plan is to rest this weekend and take it easy while on these extra tablets. I have moments where I feel A LOT better and while they are brief, they seem to be lasting longer in the last day or so. The not so great moments, I need to start accepting. I make it so much harder for myself by getting frustrated and angry at how I feel…it just makes me even worse. Acceptance seems awfully important. I am also beginning to wonder if covering up what is going on from people is beneficial. I know I blog very openly, but in the rest of my life I’m not open at all so trying to be so is difficult. None of my friends know what is going on right now. But I think maybe not totally masking things helps, and I have shut myself from everyone this week which can’t be a helpful thing, and I think it is tough on the people who care.

I’m just going to take things as they come. The good and the bad. But I am going to push myself. I have to, because if I don’t I would trap myself in my room forever. Sure sometimes it is ok to have a rough week or day and need that, but it feels important to not let it turn into a ‘normal’ thing because otherwise I’d get really bad….so it means forcing myself to do things I don’t want to do. While I accept this week has happened and perhaps I needed it, I’m not going to be easy on myself because I don’t want to spiral downwards so next week I am going to do the things I need to, and usually, do and I am going to use the extra support available, take these meds, and push myself. I know that doing things, doing “normal” things, helps me, and it’s ok to have a down week, and to let myself, but it cannot continue for long. It’s that difficult thing between being compassionate to yourself and understanding bad weeks happen and it’s ok to withdraw from things a bit because as much as it doesn’t feel like it to me, this is an illness…while also taking responsibility and not letting yourself off from things, not giving up. A mental health problem is not a choice, but recovery is, and choices are involved.

My biggest mistake this week was not facing up to things from the start. I took a long time to tell someone how things were, and therefore to seek help, and even longer to actually use the help. But that being said a week is nothing! I used to go months in that state of denial of what was going on and hiding away, avoiding help. I feel like in less than a week I’ve managed to go through a process that used to take often up to a year! And I mean that is what I am focusing on; not just how far I have to go, but how far I have come. It is so easy to forget where you were before, and to focus on the bad, when there is so much to be proud of.

(I don’t mean to make it sound like this totally came out of nowhere, which I probably have made it seem. I think there had been signs this was coming and at least one person around me knew that, and I was just pulling the wool over my eyes with the “I’m fine, it’s fine, everything is fine” thing, but I had been managing to just have bad moments rather than longer periods.)

I have my fingers and toes crossed for a hospital free weekend though! Lots of rest and calmness please! And I look forward to being hyper and silly again, hitting the gym, working and getting on with some uni work! There’s nothing better than feeling like your usual self. I know normal every day life can seem boring for some, and feeling ‘ok’ might not feel like enough, but I think when you are someone who does have very bad times with your mental health and where things such as being in hospital become necessary, there is nothing more you enjoy than the apparently boring, normal every day stuff. Even finally cleaning and doing an essay suddenly feels good when I’ve had a bad week! And don’t get me started on my own bed, a shower or a nice walk. These things sometimes feel like the most amazing thing in the whole world. The relief of coming home and falling asleep in my own bed with fresh sheets sometimes feels like winning the lottery. It’s the little things that often feel like the big things.

This has been an awfully long rant, but I feel like getting things out is an important part of trying to draw a line under a bad week and start fresh, and to acknowledge that you can both be fighting hard and doing better, while also having tough times. One of the most reassuring things for me has been reading the blogs of people who are overall successful and doing well, but seeing that they have bad times too. Seeing people who seem to always have everything together doesn’t actually inspire me or help me any where near as much as the people who are open about their difficult times. It helps me to see the bigger picture in life, and that having a bad time doesn’t mean it is how things always are, or how things always will be, so if you are having a bad evening, day, or week, it’s ok. I know it is hard to believe right now, but this is not permanent. The only thing in life that is guaranteed is change, and our feelings tend to be one of the things that can change the most in a shockingly small amount of time. I hold onto that thought a lot – and the fact that a bad week doesn’t delete all of the good days; they are still just as real.

BPD and Emotional Dysregulation: Part Two.

A month ago I wrote this post, and I called it “part one”, and then I forgot about it. Standard Natalie. But here we are!

I wanted to talk about ways of managing emotional dysregulation (ED).

There are so many different approaches, methods and techniques to manage ED, and while some work amazingly well for some people, they do not work at all for others. It is also VERY easy to disregard ideas because of assumptions we make; I hear about things like meditation, yoga and taking a long hot bath and my automatic reaction is to roll my eyes. Why would I want to sit quietly while struggling? I would rather go for a run, hit the gym or clean the house. Anything but sit still. But I am learning to open my mind to things; try guided meditations, for example. While not everything will work for you, you might be surprised that some things you do not even want to try, might work wonders.

The way I see it is, we have found ourselves in a rubbish situation, and we desperately want to learn how to manage better, and it seems like a pretty sensible thing to try every option no matter how silly it might seem. We have nothing to lose, and a lot to gain.

So first of all we have all of the things I think are airy fairy and I do not want to try, but which I do and will try; mindfulness, grounding techniques, yoga, arts and crafts. I am not going to go into detail on anything in this post as I have a lot to cover, but check out the links. (I wrote a post on this airy fairy stuff once!)

While in a day programme I absolutely hated art therapy, which they called “creative”, but towards the end I started writing rather than doing “typical” art, because the title of creative gave a lot more flexibility. Since then I have had a few periods of time where I have bought scrapbooks. I’ve had a “positive” scrapbook, and then a not so positive one, which I have yet to find a name for (I do not think “negative” is a good word for it). In the positive one it is simply lots of positive quotes or things I have read, with illustrations and things. I am not artistic. I am the least artistic person I know, but it is not about being an artist, it is about expressing yourself and creating something positive to look back at. In the other one I did the same but with quotes or poems that I could relate to in a different way; in a sad kind of way, but it was helpful because it allowed me to express some of my difficult feelings and find things I could relate to. Towards the end I also often just grabbed a sharpie and scribbled whatever was in my head onto the paper; messy and freely.

Here are some art journal prompts and writing prompts. If you really feel unsure about creating your own art, colouring in for adults is a huge thing now, as well as adult dot-to-dots!

Then there is exercise. Exercise is a complicated one. Sometimes I genuinely believe exercise is the last thing we need, especially if we are really low. There is a massive emphasis on exercise in mental health treatment, and while it is obviously backed by a lot of research, and often it is really helpful, what is not helpful is to feel like you SHOULD be exercising, but be unable to manage it, and then feel bad about it. But exercise can mean anything. Just because you do not like one thing, does not mean you will not like something else. Also, if you are really struggling you might not feel up to being in a busy gym, or intense exercise like running; but a 15 minute walk down a quiet footpath surrounded by nature, a swim, or a bike ride might be perfect for you; with this one you need to find what works for you, and this could be different things at different times. (If you struggle with, or have struggled with exercise addiction, an eating disorder, or any other addiction, be extremely careful about using exercise to manage your mood).

Medication can also be helpful in managing severe emotional dysregulation. While it is definitely not a “fix”, it can help when things are very unmanageable. This is something you will need to discuss with a medical professional, and is not something that will necessarily be an option for you. Different medications work for different people and therefore my experiences are limited in their usefulness for you as an individual, but I have found two medications particularly helpful; quetiapine and clomipramine, and while I did not think they were helping me, when I have been off them I have realised that they do. Like I said, they are not going to solve the problem to a seriously noticeable extent, but they can help ease things.

This next,and final one is a biggie! Acceptance. Acceptance of your emotions is key. Do not feel guilty or bad for feeling sad, or angry, or whatever it is you are feeling. It is ok to feel; a feeling cannot hurt you. Read more about radical acceptance, which is a key component of a famous treatment for Borderline Personality Disorder (DBT). Radical acceptance involves taking a non-judgemental stance about yourself, and the situations and people around you, and accepting them as they are. It is not about agreeing with something or someone, but simply accepting things you cannot change.

There are other things that can be helpful when experiencing emotional dysregulation:

  • Identifying your emotion(s) – if you struggle with this you can use an emotion wheel. An emotion is something that I believe is trying to tell you something. Ignoring your feelings will not help, but recognising how you are feeling and saying to yourself “right now I feel really sad” can often be helpful if you can be accepting of that, and aware that it will not last forever.
  • Distraction techniques – note that distracting yourself is not the same as ignoring your emotions; after distracting, your mood or emotions will at some point return to a more tolerable level, at which point you can address what you were feeling.
  • Longer-term you can keep a diary of triggers. It can be helpful to do an ‘ABC’, that is A (antecedent), B (behaviour) and C (consequence). For more information go here and use their blank template to record yours. This can allow you to identify frequent triggers and work on managing them. This was something I learnt from a mental health professional I used to see, and while I did not find it helpful at the time as she used it as the basis of my treatment (aka we spent all of our time doing it), it can be helpful as an aid.
  • Wise mind. This concept is also from DBT. Your ‘wise mind’ is the middle ground. The two extremes are reasonable mind and emotional mind, where wise mind is in the middle.

 

 

 

 

While There is Life, There is Hope.

Pre-warning: This is a long post (like 99.97% of my posts). Sorry, not sorry.

I have quite a lot of rough patches every week, often at night time. It is not uncommon for me to spend the early hours of the morning walking around the city. More often than not I wake up in the morning wondering why the hell I was in such a state (and tired!)

I have also been doing a lot of reflecting while walking.

I think I have mentioned in brief that things took a turn for the worse in late December. I went to my hometown for Christmas. I stayed at my sisters new house and it was nice to begin with, although a little weird to see my sister independent and in her own place. I was supposed to stay until after New Year, but then something happened on the 28th of December and on the 29th I got the early coach back to Leicester.

I was not in a good place. I had stopped taking one of my medications a few months before; at first it was forgetfulness more than anything else, then it was a case of “well I didn’t take it most of last week so clearly I don’t need it.” My mood was dropping rapidly, and the obsessions that the medication was prescribed to treat became a lot worse. I cannot say it was stopping the medication that caused that, because it could just be coincidental, but what it did mean was that when I got back to Leicester I had a huge amount of medication sat in my bedroom.

I took them.

It’s hard to admit this. I am not sure why. Fear of being judged maybe. Fear of being open having an impact on how people see me, and on my future prospects. Fear of people who know me reading this, when only my family and a couple of close friends know about it.

I fell asleep in 2016, and when I woke up it was 2017. I was confused. Apparently on the day I gained consciousness I made a nurse call my Mum, before falling to sleep for 24 hours. When I woke up I made a different nurse call my Mum, panicking about the fact she would be worried about not hearing from me over New Year. The nurse told me that my Mum was saying I had contacted her the day before, but I did not remember at all. I do not remember anything.

I know it was serious. I know things could have worked out differently. But I feel extremely aware of the fact that for me personally, it was not the worst experience I have had. I was unconscious, and if at any time I was aware of pain or what was going on around me, I sure as hell do not remember it now. The worst part of what happened was feeling embarrassed. I had a catheter in, and when I tried to walk for the first couple of days I couldn’t. The medication gave me the side effect of a tremor when I was taking the normal dose, so the overdose left me violently shaking and my legs just buckled underneath me. But it honestly was not that bad.

Not that bad in comparison to other less “serious” things that I have done. There have been things I have done to myself that have been far more terrifying, far more painful, and to be honest, quite horrific. Largely because I was conscious. I have also been arrested while in a crisis, and when you are in that kind of state and locked in a prison cell for 16 hours, I can tell you that you leave even worse than you were to start with.

I have been thinking about these things a lot while walking, and the consequences of the suicide attempt; I was assessed under the mental health act, and told I had a choice between voluntary admission, or being sectioned. I agreed to go in voluntarily, which I am beyond relieved about. I got myself out quick, and I mean quick. Even the psychiatrist admitted he would not normally let someone out as fast as I got out. I was determined. I was thinking that if I stayed in there I was choosing to fight, and if I was going to choose to fight, I would be far better off fighting at home.

The hospital environment was bad for my eating; I was not eating at all and my weight was dropping, and I felt like my anorexia was re-gaining control shockingly fast. I knew if I stayed in there I was going to find myself with more problems, rather than less. I was dizzy and light-headed, and more to the point, it was making me feel better. I knew that was not good, and I knew it needed to stop. I was also due to start an internship, and that felt extremely important to me, and I made it very clear to the psychiatrist. I knew that I needed to prove to myself that I was capable of doing it, and that not doing it would have a really negative impact on me. I was terrified, of course. I wanted to run a mile, make up excuses not to do it, and avoid facing my anxiety; but I also wanted it, badly. I wanted it more than I was afraid of it, and doing it was one of the best decisions I made. In fact, in January it was just about the only good decision I made.

I was scared. I begged and begged my way out of hospital. I jumped through the hoops. I did what was expected of me to prove I was safe. I gave them no reason to use the mental health act against me again. It could probably have gone two ways; it could have gone badly. I remember getting home and while I was insanely relieved to get my freedom back because I cannot cope being stuck indoors for a whole day, never mind longer…I walked into my house very overwhelmed. I panicked. I thought I had made a mistake. I remembered what things had been like leading up to the admission, and as to be expected, I was doubting my ability to cope.

It also could have gone well. And it did. Sometimes there is such thing as ‘positive risk taking’ and this was that.

I still get myself in bad places. Having Borderline Personality Disorder means I often get myself into the worst kind of states, and then several hours later I am thinking “Girl, what was that about?!” It is extreme, a little dramatic and very frightening; I know I can do things that feel right in the moment, that in less than 24hrs time will seem ridiculous.

At my worst points, and on my walks, I have established some facts that help me to keep safe:

  1. I want my life to mean something. I do not want to be remembered as the girl who ended her own life. I want to do things that help people, and make my mark. I do not care how big or small that mark is, but I want to make it. Even in the darkest of times, the idea that in my lifetime I might make a difference to a single persons life, feels like a good enough reason to fight.
  2. People. And I do not mean fighting for people, or because people love me and losing me would hurt them…but that there are people who have done so much to help me, and I just cannot chuck that away. My Mum and sister have stood by me through thick and thin, even when I least deserved it. And professionals including my previous psychiatrist and various people at my secondary school, college and university who have still believed in me when I lost all hope, who have fought for me and simply never given up on me.
  3. Things can change for the better, and quickly. Just as things can get suddenly worse, they can get suddenly better. There are endless nights I have survived, and woke up relieved. One of the hardest things to do is be in a state of despair and believe that it is not permanent, but one thing I remind myself is that change is actually the only thing in life that is guaranteed.
  4. One of my common thoughts when struggling is that I have been fighting for so long, and that giving up is only logical. My mentor at university challenged this by saying that surely having been fighting for so long is a reason not to give up now, not to throw all of that hard work away. I’m not going to lie, when she first said that I was thinking that she did not get it, and it was a load of rubbish. BUT, on reflection, it is true. I did not come this far, to only come this far.
  5. Future treatment. During a recent bad night it hit me; I have an opportunity to go back to the therapeutic community and dedicate some time to working on myself. If I truly put everything into it, and do not self-sabotage it, it could really make a difference. I mean it might not, but it might. What is more the point is that it is with a service that I have gained a lot of faith in, with people I have begun to trust, which I did not previously. I mean regardless of whether the treatment method is ideal, I know the staff and other patients from experience are in equal amounts supportive and challenging; they are tough and sometimes hard on you, but in a helpful way. How can I give up before I have exhausted all options?

The biggest thing is, how can I throw my life away when there is hope for change, people who will stand by me, people who will not give up on me even when I do, and when I have the power within me in some small form, to do good?

If I give up there will be no more trying.  And while often trying feels much more like struggling, I will take the struggle because struggling can lead somewhere. I hate struggling, but at least struggling means there is hope.

While there is life, there is hope. 

I hope that if you cannot see a reason to make it through another day, you can hold onto the possibility that one day you will find a reason. I hope you know that although I am just a random stranger sat behind a computer screen who does not even know your name, I believe in you.

I hope you know that your kindness has to extend to yourself, and that your place in this world is important.

And I know this is cheesy, but I hope that you know that I am a human. I am real. And I am always only a message away. I care.

The Life Plan

My life plan right now is better known as the treatment plan. I’ve had a bit of a dilemma recently. I have a place at an assessment centre for a grad scheme. It was unexpected and it threw a spanner in the works. My plan was to fight to get back into the therapeutic community aka take time out, and then when I got onto the assessment centre I was thinking ‘Maybe I could just never go back to treatment and get “better” by just “getting on” with my life’. And it could work out. Treatment isn’t always the way to get better. Sometimes living life is. Maybe moving to London and doing a full-time grad scheme would help me get “better”.

However a draft email has been sat in my outlook account for the last week. A draft email stating that right now, due to health reasons, I can’t accept a grad scheme offer, therefore I need to pull out now. The reluctance to send it is the ‘But what if I actually got offered a place on the scheme? How can I turn that down?’ which is why I need to hit send. Because if I did get offered it, it would make my life even harder.

I had an “interim appointment” with the PD service today. A brief explanation if you don’t already know from my other posts is that in November I was, in short, chucked out of the therapeutic community (TC). I was “too unstable” and “too high risk”. I ended up on an acute psychiatric ward, and if you are deemed as being acutely unwell, you are not deemed ready for therapy. Since then I have just had an interim appointment in March.

Today a plan was made. My options were private, self-funded counselling which I was assessed for, and found for a VERY reasonable price; it’s with a charity, and they do student rates of £12 an hour! If you’ve ever looked into private counselling you’ll know you can pay £40-50 an hour minimum. So that was option 1, and would involve being discharged from the PD team with re-referral for the TC once ready and suitable (I’m not allowed back while people I was in treatment with last year are still there). Option 2 was to do a smaller, once weekly group for 6 months, starting in Jan with an interim appointment in May and fortnightly scheduled telephone support, then re-referral to the TC in July 2018. Option 3, which was the option I put forward, was to skip the once weekly group, have the interim appointment/phonecalls, and be re-referred to the TC as soon as I can be.

We are going with option 3! The downside is I won’t be having any formal support until that time comes, which should be November/December – but I will have an appointment in August, and fortnightly phone calls with my lead professional. They are going to work out the date they *think* should be the point at which I can go back into the TC process and let me know. I’m expecting it to be no later than December.

The TC process is a long one. You have to do a prep group first, on a Tuesday morning. If I started that in January, I’d expect to be finished in March/April. It took 4 months last time but I think this time I could be quicker. Then the actual TC is for one year. The TC is 3 days per week, with the occasional extra half day where you are expected to help run the prep group in blocks. Halfway (or 3/4 way) through the TC you join another group called Thrive, which would increase it further…Thrive is basically like the prep group, but it’s a post-therapy group…it’s preparing you for leaving the TC…and when you leave the TC after the one year, you continue going to thrive for either three or six months, I can’t remember. All in all you’re looking at 18-24months.

I am dreading it. The TC was the most exhausting, at times soul destroying, intense, sometimes toxic, environment I have ever been in. I found going there three days per week more exhausting than I would find a full-time job. All I wanted to do when I left each day was sleep. Weekends were spent recovering from the week.

The idea of going back terrifies me. It is by no means the easy option. It would actually be easier for me to try get on this grad scheme. I wouldn’t have to feel bad for not being in full-time employment. I wouldn’t feel like a failure because all of my friends are working and living their lives and going somewhere…and I am sat in a hospital. I wouldn’t have to turn down an amazing grad scheme. I wouldn’t have to worry about money. I wouldn’t have to go through intense therapy that is going to bring up some tough stuff; I am not a person who openly talks about stuff with people, so group therapy is really difficult for me. I am sat here right now thinking ‘oh f**ck what am I doing?!’.

But it’s the plan. And it is a good one. I can finish my current job because I will still be here in September, and honestly I was worried at the idea of having to leave the job early to move away for a grad scheme (grad schemes start in Sept) because I would honestly be absolutely gutted about it. People kept saying to me that I can’t not take a 1-2yr grad scheme because I want to finish the last month of a temporary contract and I was like UMMMM YES I CAN IF I CARE. So this works out soooo well for that. A grad scheme would also mean moving from Leicester at the start of Sept when my MA finishes on the 31st aka I would need to get my dissertation finished a month early which would be fun!

And how I am seeing this is…yes I am 25 this year and I thought I would be well into a career by now…but what is 1-2 years of my life if this treatment actually helps? Do I want a full time job where I am struggling and spending evenings and weekends in hospital or prison cells? Or do I want to focus on treatment, get myself sorted, and then focus on my career? In the long-term this could be the best decision I have made. I will be fully dedicating myself to treatment this time…rather than doing treatment plus university. This time I am going to give it everything. If I am taking a year or two out, I am going to make it worth it. While I do want to find part-time work, the part-time work will have to be second on my list of priorities.

So now I just need to work out how to get myself ready for returning so that I don’t get chucked out for a second time!

PLAN.

We also had some interesting conversations regarding diagnosis which I might write about another day, and it was raised that my exercise might be becoming excessive and/or obsessive and how to manage that.

The Morning After the Night Before

I don’t drink. That’s right, not at all. A lot of people seem to struggle with the concept of not drinking at all and I’m pretty sure that says more about them, than me. I’ve had medical professionals be shocked because “people like me” usually drink and shouldn’t. When I say I don’t they have responded with “ok, but you shouldn’t drink at all if you can help it” like I don’t drink means I drink sometimes. Then there are the other times…taxi journeys where the driver brings up being a student in a city, and the night life. When I say I don’t go out they will usually go down the lines of “so you’re a pub girl”. No, not particularly. Next it’s “so do you just drink at home?”, followed by “a student that doesn’t drink, that’s odd!”.

It isn’t actually odd. I imagine many more students don’t drink that we would expect. My reasons for not drinking are complicated. I always say it is because of issues people in my life have had with alcohol and that it has put me off, but that would be a stretch of the truth. I want to say it is because when I first developed mental health problems at 14, I used to sneak alcohol out of my Mum’s vodka supply and take it to school in a water bottle and one time I went to a small party, got drunk, had a meltdown and locked myself in a bathroom, but again, the fact that drinking probably wouldn’t be good for me has very little to do with not actually drinking…just a lot to do with why it is probably a good thing. The honest reason is that it is a part of my eating disorder I have never overcome and really don’t feel a need to.

I didn’t go through the whole turning 18 and going out thing. I was at home starving myself to death, isolating myself from everyone and everything, and in my mind alcohol = a waste of calories. Why would I drink alcohol when I was only allowing myself 200 calories per day? Two vodkas and that would be all I could consume for the day. No thanks. And now I am “better” I challenge all of my disordered behaviours and thoughts, but with this one I just have no desire to. Take avoiding eating desserts. I have bundles of motivation to challenge that because you know, desserts are amazing and I genuinely want to be able to eat them. Hello cheesecake my long lost friend! But I’ve never enjoyed alcohol and it doesn’t interest me. I feel like I would be forcing myself to drink for the sake of drinking.

I do, however, know the feeling of the morning after the night before because having borderline personality disorder is great like that.

My mornings after the night before are filled with shame, embarrassment, and regret, and it is horrendous. Even months later the memories fill me with these emotions and when it is immediately after it quite literally makes me feel sick. I had one of these episodes this weekend. I won’t be going into the details because honestly, I am ashamed, and I really excelled myself this time. It went to a whole new level and the only thing I can think of to make myself feel better is ‘I won’t ever have to see the people involved again”. It has been a truly rock bottom moment and when it hit me what was going on and where I had led myself, I almost thought I was dreaming.

It is hard not to absolutely hate yourself for how you behave and feel at your worst. I feel like I want to rewind time and grab my own shoulders and give myself a good shake. WHAT ARE YOU DOING YOU FOOL?! Don’t be an idiot. Pull yourself together. Stop being so angry and take help.

However, there is a fine line between taking responsibility for your behaviour when you are mentally struggling, and blaming yourself to the point of hating yourself. While I absolutely believe I need to feel some degree of shame and regret in order to change, hating myself and over worrying about the way I was and the state others saw me in (aka what they were thinking of me) is not helpful; it makes me worse not better.

So after you have had a blip, a lapse, an episode or whatever else you want to call it, it is healthy to have some regrets and it’s a good thing to consider how you could have prevented yourself from getting to the stage of being out of control. BUT, if you blame yourself too much and are too hard on yourself, the guilt is going to eat you alive and you’re going to end up having another blip to cope with the guilt. Say your issue is drinking, and you get drunk and do something stupid and feel far too much guilt and self-blame…the risk is that you’re going to end up drinking again to manage that guilt. It’s counter-productive.

The line is fine and difficult to find, but it is a part of ‘recovery’ that you are going to have to keep working on because it is absolutely key to getting better. It’s all really about radical acceptance after these blips; you cannot change what has happened, and while you don’t have to be ok with what happened, you cannot punish yourself for it.

Learn. That is what you can do. Life is a series of lessons.

Borderline Personality Disorder and Emotional Dysregulation: Part One

There is a frequent debate about the term ‘Borderline Personality Disorder’ (BPD).

The term ‘borderline’ was coined in 1937 when it was believed that patients with the disorder were on the borderline between psychosis and neurosis. This is no longer seen as necessarily the case, and definitely not the case for everyone with the diagnosis, and today people prefer to call BPD ‘Emotionally Unstable Personality Disorder (EUPD).

I was actually asked which I prefer my diagnosis to be called, and I chose BPD. I know so many people hate this and choose EUPD, but being called ’emotionally unstable’, while probably accurate, just does not sit comfortably with me. To me, I think EUPD is a much more stigmatising label. ‘Emotionally unstable’ makes you sound, well, like an overly emotional mess and like someone to be avoided. It also sounds much more like one symptom of the disorder, albeit a major one, rather than a collective term for a set of symptoms. Ignoring that issue, I would prefer the term ‘Emotional Dysregulation Disorder’ which is occasionally used, but I actually think that BPD is more of an attachment disorder than anything else. There is a disorder called ‘Reactive Attachment Disorder’ but this is usually only diagnosed in children. I wonder what they think happens to these children when they hit 18? I think they probably, if their problems continue past that age, get diagnosed with BPD (which is usually only diagnosed in over 18’s).

That bothers me. Under 18 and I have an attachment disorder. Over 18 and I have a personality disorder, which is far more stigmatising.

Emotional instability, usually referred to as ’emotional dysregulation’ is a huge part of BPD. But this instability goes much further than emotions; it can be instability in a person’s sense of self/identity, and I think this can stem from being brought up in a very unstable environment. I think people would find out things about my childhood and call it pretty bad, and it was, sometimes. And sometimes it was not. Sometimes we were like any other family; happy and sad in “normal” ways. But things changed quickly and suddenly, usually without warning. I reckon growing up in that kind of environment, where you do not know what things are going to be like hour to hour, it makes you feel like nothing is safe, and that you do not know where you are going. One minute I had two solid, grounded parents and then in a blink of an eye one was back to abusing alcohol and the other was violent and would disappear off the face of the planet for a few days. There would be periods of stability in my Mum’s mental health, and then in the blink of an eye she would be carted off back to the psychiatric ward.

And to be honest, it felt normal. It was our normal. And when you live your life always ready for things to get worse, not knowing when it is going to happen, you become incredibly hypervigilant, and you develop ways of coping with it. Sometimes these coping mechanisms are unhealthy and dangerous, but regardless of that, they serve some kind of purpose. With regards to my anorexia and self-harm, I have often felt like those two things were always going to be there for me, that they were not going to abandon me, and so I clung onto them, sometimes with all my might, and other times just loosely, in case I needed them – never able to fully let go.

Education was my one positive coping mechanism, as I have wrote about before. School and college were always going to be there on a Monday morning at 9am. The supportive tutors, lecturers and support workers were always going to be there too. It was a safe haven, and especially during my time at school, it was the one place I did not have to pretend. This is quite different to some people’s experiences, where school is a place where they put on a mask, but for me school was where I could let myself feel my emotions and express them, and home was where I concealed everything. This was at times problematic as things would spill out uncontrollably. I would fall apart. But it was also needed at times. As I have become older I have gained a lot of control over this and while that seems like a good thing, it does mean that university tends to be a place I wear a mask to some extent – but I have a support worker within the university who I do not do this too. I guess it is more controlled now.

So, what is emotional dysregulation?

Emotional dysregulation (ED) is a term used in the mental health community to refer to an emotional response that is poorly modulated, and does not fall within the conventionally accepted range of emotive response. ED may be referred to as labile mood (marked fluctuation of mood) or mood swings.

This is something I have become increasingly aware of in myself over time. When I was in a child and adolescent psychiatric unit aged 15, I was diagnosed with cyclothymia, which is basically (and this is very simplified), a form of rapid cycling Bipolar disorder. This has never been mentioned again, and this is because while cyclothymia means that your moods change more frequently than found in typical Bipolar cases, my moods change much quicker than in cyclothymia, and approximately 50% of the time, in reaction to something happening around me.

It can be quite scary. Last Friday I ended up in A&E as I mentioned in my last post. I felt like I was at one of my worst points in a long time, and that was fair to say. Now, five days later, I am at one of my best points. It is a very unpredictable thing, that makes living difficult. I know that while I am feeling pretty good at this moment in time, in a few hours I could be laid in bed trying to sleep and having really negative, dangerous, thoughts and urges. While thoughts cannot hurt me, they can lead to me acting on them, which can hurt me. Learning to have these thoughts and feelings, these urges, and not act on them is one of the hardest parts of ‘recovery’.

When I am in the mindset of wanting to act on those thoughts, practically none of me can see any reason not to. I mean it varies; sometimes I can. Sometimes I can be very rational and recognise that feelings will pass, but other times the feelings are so intense and I lose grip of what I would call my “true self”, and there really is no talking me around when I am in that place.

I really want to end treatment and “get on with my life” as I keep saying. My support worker at university told me that while that would be very lovely for me to do, I need to think realistically about my ability to handle the responsibility of a full-time job right now. On my good days, I would be fantastic for a full-time job, but on my bad days, or during my rough patches, it would be a disaster. Right now, being a full-time student and working part-time is perfect for me. Work is absolutely perfect. I will admit I feel like I stumble my way through university. How I managed to get a degree, sometimes I really do not know. But it is manageable, and I am really lucky to have really accommodating lecturers. But in the working world, especially a full-time graduate scheme, this would be less likely to be the case which is why I am spending the next two days deciding whether it would be best to pull out of the graduate scheme assessment centre and focus on continuing with my treatment plan.

Does this mean someone with BPD can never have a full-time job? Of course not. I am sure thousands do. There are many extremely high-functioning people with BPD. BPD is often categorised into low functioning and high functioning (and I am pretty sure people can be a combination of the two). I think I am a combination of the two. Just the other day an A&E doctor told me he had never met someone with my diagnosis who was doing as well as I am, nor doing a masters. I reckon he would be surprised how many other people with BPD are doing high level qualifications, but that most of the people with BPD who find their ways into emergency departments are the ones who perhaps are not.

 

  • Low Functioning Borderline – The “Low Functioning” borderline is what most people think of when they are first introduced to the condition. Low functioning BPDs are a living train wreck. They have intense difficulties taking care of their basic needs, are constantly experiencing mood swings. They also have an extremely hard time managing any sort of relationship with another human being. Low Functioning BPDs are often hospitalized more than other BPD types, for the very reason that they can’t live productively without constant coaching and supervision. These patients are challenging for all but the most experienced psychiatrists. Unless otherwise treated, low functioning borderlines lead self destructive lives and attempt to manipulate those around them with desperate acts, including self harm (cutting, etc.).

(The comment regarding manipulation is not necessarily accurate. Often what appears like manipulation in BPD is just a person’s lack of ability to get their needs met, or express themselves, in a normal way – someone without BPD might need some extra support, and turn to a close friend and ask for it, whereas someone with BPD may struggle to recognise what they need and therefore find other ways to manage their feelings i.e. self-harm. Contrary to believing self-harm is a manipulative and attention seeking behaviour, self-harm is usually a very private, secretive thing – and any way, needing attention is not a bad thing. We all need attention.)

  • High Functioning Borderline – The High Functioning Borderline Personality shares many core aspects of the low functioning borderline personality, except for the fact that they can manage their lives, appear to be productive, and generally keep their relationships civil (even diplomatic in nature). High Functioning borderlines can appear to be normal, driven people one moment; then moody, inconsolable, and manipulative the next. Somehow, there is a mechanism within the minds of High Functioning Borderlines that allows them to lead somewhat “competent” lives, despite the fact that they are in a constant battle with BPD. High functioning BPDs are no better than low functioning: it’s basically the same face wearing a different mask.

 

 

These two “categories” are a bit too black and white for my liking. I am high functioning in terms of work and academically with my current workload. If I had a full-time job this would probably reduce. I am very low functioning in terms of mood swings, social functioning and self-destructive tendencies.

The thing about emotional dysregulation is, you can learn ways to manage it – and there are a huge number of ways that may or may not work for you personally, which I will discuss in a following blog (because I am on 1800 words and quite frankly that is ridiculous!)