Diagnosis, one year on.

I've been doing a lot of reflecting this week.

Yesterday marked the one year anniversary of my diagnosis of Borderline Personality Disorder . Unlike a lot of borderline's I welcomed my diagnosis.

It began with a visit to a GP I hadn’t met before. I spoke to her on the phone asking for a referral to the mental health crisis team. She stated that she felt uncomfortable about making a referral without first seeing me, so I booked a time to see her the next day. Ben (my long suffering husband) sat with me as I tried to explain (in under 8 minutes) my long and complicated mental health history. This is always a frustrating experience but it became apparent that she had read my notes extensively and spoken to the psychiatric nurse I had seen the previous year. I was in a desperate place begging for help and relief from endless low mood. She offered me a one week prescription of tranquillisers. As she was handing it to me she said “see me next week, but if this medication doesn’t help its your borderline personality disorder not depression”. I took the script not trusting what I had just heard. Walking back to the car I turned to Ben and asked “did I just hear that right”? We both sat in the car speechless and stunned.

What just happened?

Well, I immediately went hunting for information. I had never heard of Borderline Personality Disorder, and I wanted to know everything about it.

Then the most amazing thing happened.
For the first time in 15 years, I knew exactly what was wrong with me.

You have no idea how wonderful that was.
You see, I had long held the belief that I was just not trying hard enough.

One in four will experience depression at some point in their lifetime, and of those most make a full recovery. Most, at some point, pick up the pieces and go on with their life, go back to work, engage with the world again. I could not understand why I was unable to do that.

What was I doing wrong?
What was I missing?
Why couldn’t I get over this?
Was I just lazy?

As I read and read, it became clearer and clearer that BPD was the missing piece. I read case study after case study and it was like I had written it. All the weird things I do, all the weird reactions I have were all explained and experienced by others, I wasn’t alone. I wasn’t lazy or weak, I had a personality disorder.

Of course the next issue is, what do you do with that?

I wrote emails to family and friends asking them to consider if they thought the same way as I did? Was I just hoping for a diagnosis? Did it really fit? The reactions I received were mixed. One friend said there was no way, another said that she could see me fitting “a few of the criteria, but, don’t we all?”

But Ben, the person who knows me better then anyone, that sees my day to day struggle, agreed, that I fit all of the 9 criteria perfectly. I then wrote the document, where I outlined and listed all the evidence that showed how and why I met every single one of the nine points. (For a diagnosis of Borderline Personality Disorder you need to meet 5 out of 9).

The next hurdle was to have this diagnosis made official. By this point I was under the care of the local hospital crisis team again and I requested a meeting with the psychiatrist that has been a constant overseer of my care since 1996, but in all that time I had never met him. The psych nurse said that she would ask at the next meeting. She phoned 2 days later saying that the team felt it would be of more benefit if I met with a specialist nurse that could look at medication options.

I was not at all happy with this outcome and stated, “I need you to be my advocate and get me an appointment with the only Dr in the team that can officially give me a diagnosis”.

I was desperate.

Six weeks later the day arrived, I will forever be grateful to my brother for being present at the meeting. I felt it would be too upsetting for my parents to be there but thought it would be very helpful to have a family member present. And it was.

It was a difficult meeting, with frank conversation with many hard truths and tears. It seemed however that the Psychiatrist was reluctant to commit to a written diagnosis, and said “if I had a classroom of students with whom I was explaining the BPD condition, you would be a perfect case study, but I don’t see the benefit of a diagnosis”.

It's a position I will never, ever, understand.
I explained how I didn’t agree and after a little more discussion said he would be happy to concur.

It was an odd moment. I felt like the hugest weight had been lifted off my shoulders, that I never again had to berate myself for not trying hard enough or for being lazy.

And yet, I had a personality disorder. That takes time to adjust and come to terms with.

That evening I phoned my parents and significant family members to tell them the news. A couple of weeks later we had a family meeting with the psychiatrist so that they could ask question and gain some further understanding of the condition. My family had been hurt and bewildered by my behaviour. They didn't understand, I was closed off and withdrawn. They saw my erratic and chaotic relationships and said I was rude. they were right, I could be inconsiderate and rude, because of my distress and lack of social skills.

For 15 years I didn’t feel able to share my difficulties because they didn’t make sense to me.
How could I explain, or ask for help, when I didn’t understand or couldn’t articulate what the problem was. I felt inadequate and misunderstood. I knew I was hurting people but felt woefully unskilled to do anything about it. I thought that if I stayed away, if I didn’t interact with them, then I couldn’t hurt them. Clearly that didn’t work.

Even now I know I have along way to go.

What came from the family meeting loud and clear is that they needed me to be open with my difficulties, at the moment the only way I feel able to do that is with writing them weekly emails. I am grateful that they are gracious and give me the opportunity to write. I understand this is the first step and one day I hope I wont be writing but phoning them. I know my writing has been hard for them to read at times and upsetting, but, I think this open, honest dialogue is helping. I feel like I'm learning the art of relationship much like children do. With the help of the intensive Dialectical Behaviour Therapy that I am now undergoing I am being taught skills that most learn naturally. Its very early days and I have good weeks and bad but I am hopeful that change is possible, that people do recover and go on to lead fulfilling lives. I'm working hard on “building a life worth living”, and learning that there is hope and BPD, that they can coexist.


Until next time,
Thank you for reading,
Clare

The Inner Critic

At Dilectical Behaviour Therapy (DBT) this week we examined the "Inner Critic".
We all have one of those don't we? Some maybe more familiar with theirs then others.
The inner critic is the voice of our "core beliefs". A core belief can obviously be both positive and negative. The inner critic however tends to shout about the negative aspects of those beliefs. They might sound something like this;
"I'm useless"
"I'm doing it all wrong"
"I'm a failure"
"I'm un lovable".

We each have our own brand of Inner Critic thinking. It tends to be tormenting and very powerful, which has the effect of wearing you down bringing about self doubt and exhaustion.
Together we looked at ways of challenging the Inner Critics narrative. The first and maybe most obvious is to reject its wrath with a firm "NO" or "Not True"!
The tutor called this a "Howitzer"
(The Howitzer is a piece of artillery a type of cannon. The etymology originates from the Czech word houfnice the suffix houf means "crowd" suggesting the cannons use against massed enemies.)
We have been given the challenge of countering the Inner Critic attacks with heavy duty Howitzers.

Its interesting to observe ones inner commentary.
How we talk to ourselves is very important.
Is it said with; Criticism or praise,
Judgment or acceptance,
Intolerance or patience,
Bullying or compassion,
Hate or love,
Nagging or encouragement? Etc...
Another way of challenging the inner critic is to count its cost. For me the inner critic has stopped me from having a career, stifled relationships and brought about a lot of pain.

Finally affirmations can be a powerful antidote to the inner critic.
Such as; "I have not failed",
"I am not to blame",
"I can tolerate my emotions",
"Its OK to feel this way",
"I have a future",
"I'm doing my best".

How we talk to ourselves can be so important.
I often feel like if I could just get out of my own way life would be easier.
Its no secret that my thoughts have held me captive and tormented me for too long. But, I do believe this is one of those topics that we can all relate to, whether you have experiences of mental illness or not. I get the impression that a lot of people could benefit from a little self compassion and a giant counter Howitzer!

Thank you for reading,
Until next time,
Clare.

My Secret

I'm going to let you in on my secret, it is hidden most the time, and hidden badly at other times. Please handle it gently it is precious to me.

My secret is that I'm feeling desolate, empty, devoid, barren, lost, confused, hopeless...
Dialectical Behaviour Therapy (DBT) feels like my final hope, and I hear it helps. But what if it doesn't?
I have a persistent nagging feeling that this hard slog, they call DBT is going to be pointless.
I have been told several times that DBT is not a miracle cure, that I will still have Borderline Personality Disorder when I'm done with the programme, that I will still be highly emotional and have bouts of depression.

A lady I have never met has completed DBT, she is working towards discharge from service. She is still "struggling" and finds life "difficult".
So why go through this gruelling process if difficult and struggling is the goal?
I can do difficult and struggling pretty well already, except now I'll have a whole new load of guilt to add to the mix. Guilt that once again I attended therapy with hope and it didn't "work", that I, yet again, didn't try hard enough.

My secret is that all this... all this work... all this fighting... all this hope is for nothing. I don't know if I could survive that.
It would be crushing.

I carry this secret close, yet hoping, that someday really soon it will fly away and leave me in peace.

I don't want to talk about the secret. I don't want to even acknowledge that you now know my secret. I'm hoping that by scattering it a little it will disperse and loose some of its power, some of its choking hold.

Thank you for listening

Run Your Race

Once every four years countries from all over the world come together to compete and celebrate at the Olympic Games. This time London has the privilege of hosting the 2012 games.

We watch on as elite athletes achieve amazing things, breaking world records and setting new standards in their chosen discipline.They stand on a podium, with tears often flowing, as they receive their medal and praise. A moment in time when all their efforts are brought to fruition. We see them on their best day, standing proud. As spectators we know that this podium moment has taken vast amounts of determination and commitment.
  
In 2006 my cousin and I took part in the Cardiff Half Marathon. I will remember that day forever, but maybe not for the reason you imagine.

I started training for this event in January of the same year. I was very overweight and had not ran a yard since leaving school. In the beginning training was tough, really tough, I hurt in places I didn't know you could hurt. As the months past my fitness improved and I began to enjoy my daily exercise regime. Later in June I realised that although I was getting fitter I was not going to be able to run a half marathon. So, undeterred I joined a local speed walking group and continued to train with them.

The much anticipated day finally arrived. I was ready, I had completed my training schedule including a 15 mile walk 2 weeks previously. My cousin and I got up early and made our way to Cardiff.

It was a cool dry day, perfect conditions. We stood in a huge crowd of other competitors waiting and eager to start. The starting pistol was heard and 10 minutes later we crossed the start line and began our race.

For the first two miles we were in a very large but decreasing pack of people. Gradually the group around us got smaller and smaller as other competitors hit their running stride and took off. Then it got smaller and smaller again. The group dwindled till it was just my cousin and I. Alone.
No one around us.

Nobody.

It slowly dawned on us that we were last. I'm not talking near the back, I mean we were the last two competitors. (I should add here that I was the one making us last not my much fitter companion, thank you for staying with me Anna!) When you are last you are accompanied by two cyclists who ride right next to you to make sure you are safe. In that realisation moment I had to make a decision. Was I going to quit? Was I going to be so embarrassed that I give up and turn around? Was I going to get despondent and depressed, that even after training daily for 10 months I was last?
No!

No I didn't. I had the best time, with my cousin and our two cycling chaperone's. We were last and loving it. The traffic was still stopped for us, spectators still cheered and encouraged us, and I had the biggest smile on my face because I was walking my race and I was winning. I was winning by the very simple fact that I was there.

As the miles passed we began to pass other people that maybe ran at the start when they should have walked. We didn't finish first, we didn't finish last, but it had become unimportant. What was important, was that we were there, and we finished.

I don't know what "race" or "marathon" you are running. Maybe your race of endurance is illness, pain or depression. Maybe you are enduring loss or grief. Debt or uncertainty.Maybe you are studying, working for a promotion? Or are you a parent, struggling with the demands of young children? What ever marathon you are running I want to encourage you to keep going! Your race, may feel like it will never end. That you are hurting in ways you didn't think possible. That you are running and not making any progress, that you're not sure if you can take another step.

Keep going!

Keep going because this marathon that you are in will end and you will get your podium moment when you finally see the fruit of all your hard work, grit determination and perseverance. Keep going, you are making progress, you will get there, you will make it and what a glorious day it will be.

Thank you for reading.
Clare

Time To Change. Stamp out Stigma!

Mental illness and the stigma associated has been looked at head on this week, during Channel Fours 4GoesMad programming, http://4goesmad.channel4.com/, headlined by Ruby Wax of Black Dog Tribe http://www.blackdogtribe.com/

I have signed a pledge on the Time To Change website www.time-to-change.org.uk to be more open and honest about my chronic poor mental health in its various disguises of Borderline Personality Disorder, Depression and Social Phobia.
As I was thinking about this I wondered what that would entail. I thought I was quite open about my mental health. But I have come to realise I have been dodging this issue by omission, by that I mean, not telling the whole truth.

We all do it. How many of us, when asked how we are say, "I'm fine". "I'm fine" is not always an honest answer. Obviously there are many times and many people who are not really looking for the honest answer or people we would not want to share the honest response. But to those closest to us, who, maybe do, want an honest answer, do we just brush them off?

I was chatting with @stephintoronto on Twitter about depression yesterday and she said this;
"when u don't have a Chronic/Mental Illness u don't have to will the energy to just brush your teeth"

If you have experienced depression you know exactly what she's talking about. And therein lies the problem. Who wants to be that honest! Who wants to list the blow by blow, hour by hour account of how difficult it is to be alive sometimes, and, who wants to listen to that?

Obviously we need to find a middle ground. I definitely haven't discovered that yet, but am working on it.

In my depression I tend to withdraw completely. I refer to it as going AWOL. The problem is I don't even do it consciously. I can go weeks at a time and not talk to anyone except those that I live with. When I emerge from my solitude I rarely talk about what happened and how I got through it.

When I received my diagnosis of Borderline Personality Disorder the Psychiatrist invited those closest to me to attend a family session to discuss and answer questions about my mental health, and the then, new diagnosis. It was a very important and influential meeting. What came from it loud and clear was that my hibernating behaviour or strategy was confusing and even hurtful to my nearest and dearest. What my family wanted from me, more than anything else, was for me to be open and honest about my struggles.
Over the years, my dishonesty by omission has caused strife, because no one understood each other. My family had to learn about my condition and I had to learn to be less closed off. This has involved a compromise.
Due to my social phobia I dislike using the phone, and on difficult days I simply can't call so I would tend to only correspond via text. My loved ones understandably don't like communicating only via text so I have been writing weekly emails. This has been a big step for me. I'm trying to be more open, articulating exactly how my week has been and they have been gracious enough to give me the space I need.
This has made a huge positive impact on our relationship. My family have a better understanding of my condition and are no longer completely bewildered by my BPD behaviour and I feel better understood and supported.
The best result is that they all say; "we better understand, and now we can help you more appropriately". Better understanding is never going to be a bad thing. Better understanding is always going to bring people together, and hopefully bring, with it, more compassion.

I would encourage you to "Step Out", be a little more open and honest about your day to day, share the good the bad and everything in between. Do it in a way that is comfortable and safe for you, but do it none the less. You deserved to be heard and have your struggles validated. Take the risk and share with whom ever you feel safest.

If we were all a little more open and honest I feel sure we can Stamp Out Stigma!

Make your pledge and help to end mental health discrimination today!
http://www.time-to-change.org.uk/

Thank You For Reading.
Clare.

The Guest House Of Acceptence

Mindfulness and Radical Acceptance are two of the key elements of DBT.
It is described beautifully in this poem by Jelaluddin Rumi, a 13th-century Sufi poet.

The Guest House

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honourably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice.
meet them at the door laughing and invite them in.

Be grateful for whatever comes.
Because each has been sent as a guide from beyond.
-- Jelaluddin Rumi,

I first heard this poem while being taught the practice of Mindfulness. My teacher is an amazing woman who teaches the delicate art of being compassionate to oneself.

It is human nature to want to dismiss negative emotions and feelings, the thought of embracing them seems alien and counterproductive. Surely, I surmised, embracing difficult emotions, compulsion or urges would make them more powerful somehow and make me feel worse. But, in my practise of mindfulness I have discovered the very opposite to be true.

When we gently bring awareness and compassion to a current feeling emotion or hurt we are inviting ourselves to "look after" or "care for" ourselves. The key here is to be tender, gentle and ultimately accepting of this very moment. Not concerning ourselves with what was, or what will be, but this very second. After all the emotion is already here, our striving to ignore that fact serves only to add to the pain, discomfort or confusion.
The feeling is here, accept it with a gentle care.

When I practise this, I literally, name every emotion I am experiencing.
I ask myself..."What is here right now"?
Then follow with naming them individually.
"Anxiety is here."
"Sadness is here"
"Depression is here"

When we invite these moment by moment labelling of emotions with gentleness and compassion we open our "Guest House" to all, accepting what is here
and giving ourselves the opportunity to heal. In my experience denial only prolongs the anguish.

What is "here" for you today?
Label it."Here is..."
Be gentle, caring and compassionate for the self that is here right now.

Thank you for reading.
Clare.

One Day At A Time.

For our family today, marks the end of something great, and the beginning of something new.

It is our daughters last day at Primary School. When I think of the nervous, shy little girl that started school all those years ago, and see the beautiful, confident, fun loving, articulate young lady that she is today, I am humbled and inspired.

Our girl has had to overcome a lot in her first 11 years! She had a Statement Of Special Educational Needs at age four. It was very obvious that mainstream schooling was not appropriate for her as she had a severe speech and language disorder. At reception age she attended a specialist unit that taught her how to communicate. She still has some residual difficulties but overall she has progressed and exceeded all expectations.
So today was a celebration day for all she has achieved.
When I think about all the meetings and appointments we had to attend, the endless hours of speech therapy. The extra care needed when parenting a special needs child. If I was able to look in the future 7 years ago and see the effort, the heartbreak, the tears, and worry. The fighting to get her the provision that she needed and deserved. If I could see all that. I would have crumbled.I wouldn't know where to start. What to do first. I would be buried under the pressure and emotional toll.

Today, however, is a celebration day. A day we have captured on film to remember forever.
The smiles and tears of triumph.

We got to today, to this celebration, through all the difficulties.
One day at a time.

We got through all the struggle, one day at a time and this brings me enormous peace.

Recovery from depression and mental illness, is hard. It is tough, it involves lots of tears, lots of meetings with Doctors and professionals. It involves getting up, getting on with the day, even when your not sure you can survive the next hour. It involves pain and pushing through discomfort. But, you only have to do it, one day at a time. Sometimes one whole day is just too much. In those times, I am learning to pay attention to this very moment.

This very second.

I am learning to "make the next right decision". All you need to concern yourself with is, what you are doing right now, and what you need to do to stay safe or to comfort yourself.

Make the next right decision.

When we break down what can feel like the biggest mountain of recovery, into one moment at a time intervals. Anything is possible. You can only get to that mountain top, one step at a time.
One minute at a time.
One hour at a time.
One day at a time.

I believe that a Victory, Celebratory day is already ours because we have already made it this far!
We have made it this far and if we stay in the moment we can rebuild a life for ourselves. As we start to appreciate how far we have come and what strength and determination that took!
We can take hold of that and let it lead us into a future with hope.