What happens after a breakdown?

As you may have guessed from my post recent posts, I’ve been going through a tough time. At the beginning of January my emotional breakdown peaked and I was admitted to hospital, for a week of respite. I’ve spoken a lot about when things start to break down and when I’m deep in a crisis state, but never about what happens after. Usually when people come out the other side of a crisis, they aren’t just miraculously better. The mental and physical toll of being in such a state, really can have an affect on you. It’s this that I want to talk about today.

About a week after I was discharged was when I finally came out of my crisis. I remember laying in bed feeling absolutely exhausted. I had been feeling anxious and out of control for so long, all I wanted to do was sleep. Being signed off from work, I had no reason to leave the house and therefore no reason to take care of my personal hygiene. My friends went out of their way to try and include me and invite me to things, but I simply declined. With no motivation to get out of bed and no drive to socialise, I was quickly declining again.

For you to understand the behaviours you need to understand what was actually happening to me. For the most part of my life my moods can fluctuate quite dramatically. I go between two mental states; deep depression and chaos/anxiety. As I approach a crisis these two states, with differing BPD symptoms, have more of an effect on my life. After the crisis these fluctuations are still present, continue to cause me trouble and could potentially affect my recovery.

In the deep depression phase my baseline mood is extremely low. I would go as far to say it is dysphoric. It feels like the world is a dark and lonely place. I feel like I’m weak and that I’m a failure for not being able to cope. My self esteem drops and I bully myself at every opportunity. Physically I am also drained and often it’s like walking through custard. When you combine all of these things, it leads to not taking care of myself. Not showering, eating badly as I don’t have the energy to cook, staying in bed all day and not taking part in my usual hobbies.

In my chaos or anxiety phase my emotional arousal reaches a high. It’s a bit like mania in the way that my brain is buzzing with activity and I can make rash decisions, but in no way am I ever euphoric or joyful during this phase. Often I am filled with panic and fear about my future or sometimes even the next few hours. I worry that I am making the wrong decisions and that will ultimately lead to my unhappiness. Because of my heightened emotional state I can become irritable and angry. My social anxiety increases causing me to withdraw socially. I become emotionally fragile, so I can easily take things personally or misunderstand. Physical effects can include appetite changes, excessive nail biting, digestive problems and exhaustion.

When these moods are fluctuating uncontrollably and my BPD symptoms increase, it becomes difficult to function in society. The empty feeling inside is unavoidable. I try everything and anything to fill it, which leads to unhealthy coping mechanisms; like drinking and binge eating. My anxiety often causes me to want to run away from the situation and start over, without the ghost of my past. I mean literally run away. Once I had my bags packed and ready to disappear into the night, when my partner was at work. I had nowhere to go, but I was going to do it. It puts pressure on my relationships as no matter what they do for me, I don’t feel loved. If I don’t make the effort to intervene here, I could make some pretty catastrophic decisions. This has often been the reason I have struggled to keep a job or relationship in the past.

With all this going on it can be easy to slip straight back into a crisis. You will often have to take positive steps and actions in order to stay on the road to recovery. In my next post I will be talking about the self-care needed in order to do this. It’s important to note that recovery isn’t necessarily one simple route. There will be dips and setbacks. What matters the most is that you find the strength to dust yourself off and try again.

Out of Darkness. Xx

What's it like to be hospitalised? (Part two)

TRIGGER WARNING: Content that covers topics of self harm, suicide, hospital environments and family issues.

I was admitted on the Friday and had a review with the consultant on the Tuesday. I was at boiling point. I had been holding so much in that my kind and understanding facade was starting to crack. The consultant was one of the most dismissive men I had ever encountered in the mental health system. He asked me why I had been admitted to hospital and I explained I had been actively suicidal. He then proceeded to tell me that nothing was going wrong in my life so I had no reason to feel the way I was and promptly offered me no help whatsoever. How could someone that gets paid so much to care, simply not? I finally erupted. I don’t remember much of what happened next but I was seeing red. The rage prickled my entire body and I found myself shouting that they didn’t care and that I didn’t see a point to anything in life. I stormed out of the room and kicked the wall until I felt the anger subsiding. I don’t act like that, ever, but I felt I had been pushed over the edge by the complete lack of care.

I spent the rest of the day crying uncontrollably. I managed to sneak a plastic spoon which I broke in order to self harm. I hid in my room or in the toilet and cried so much my chest and face hurt. The world was a darker shade. “They don’t care, no one cares, they don’t care,” echoed throughout my thoughts. Before I knew it I was thinking about my how my dad left, how he never turned up for visitation, hours waiting by the window. Every single rejection in my life popped into my head. “You are nothing and you will always be alone, always be left.” I sat on the floor. I must have cried myself to sleep.

When I woke up it wasn’t so bad. All the emotions I had been holding inside had released. I made my way to the dining room and sat at one of the tables in a daze. I can’t remember what time of the evening it was, but the sounds were all muffled. I spoke to one of the other BPD girls who asked me what happened in the doctors meeting. I told her I just didn’t care anymore.
“You’ve just been defeated, haven’t you.”
She was right. I couldn’t fight anymore. I was totally drained from begging and pleading for someone to do something. From that moment on I felt lost. I knew I was going to be discharged in a few days, regardless of whether I was ready or not. It’s a shame that this has been a common occurrence for me. The doctors and nurses always try to convince me that there will be help on the other side, but community mental health services have been stretched to breaking point.

Going into my discharge meeting I had lost hope of receiving any kind of help. My partner had been invited to attend as often professionals will take what he says more seriously; It’s ridiculous. We were called in front of the doctor, the crisis team and staff from the ward. The doctor then proceeded to read all of my notes back to me, about why I was admitted and what I had done since I had been in hospital. He was literally reading from his computer screen and barely made eye contact with us.
“So she’s been taking part in ward activities.” He said.
“Umm, no I haven’t.” I interjected.

He peered over his screen at me in a disgruntled fashion.
“I haven’t taken part in any activities, because there weren’t any.”
He was practically fuming. “Well that’s the nature of this ward.”
“It’s okay, I just don’t want you to put down what I haven’t done.”

Honestly I’m not sure I ever saw a doctor lie like that so blatantly. The rest of the exchange was a chilly one indeed. After he read out my notes, very matter of factly, he moved onto saying that he would be discharging me with no further support. My partner tried to argue the case that if I didn’t get any help from the crisis team or a community team, that I would be back through the door a few months down the line. Now my partner is a very skilled critical thinker and can easily hold his own in a discussion. However, he was simply brushed aside and we were simply asked to leave. I honestly could not believe the unprofessional attitude of that consultant.

Though I was upset I would be receiving no support, I was so glad to walk out of those doors. Inside hospital I felt I was treated like a child; told when to eat and when to sleep. I found myself regressing back to a childlike state to match the environment. Admission to a short term facility will likely not be therapeutic. However, it is important to realise if you are in an unstable and unsafe place, then admission might be your only choice. I used it as it was intended, as a place of safety, where it was harder to make the poor decisions that might cost me my life.

My intention was not to provide a negative view on NHS short term psychiatric units, but a realistic one. I would like to say I’ve had different experiences that were more therapeutic, but the only one was my first admission, which was onto a different ward. I have heard from others that long term admission is often more beneficial, if that is what you need. Personally I would say that if you need a short term admission then simply treat it as respite. A few days where you can fall apart and then put the pieces back together safely.

Lastly before I end, I want to briefly mention the sorry state that our mental health services are in. Hospitals rarely have beds and there is little funding for activities, community teams are pushed to their limits and there is a dramatic shortage of registered nurses, thanks to tuition fees being raised to ridiculous levels. There is more money available and clinical commissioners and associated politicians, need to be thinking of the long term effects to services. You have a say in what these people do, to what is one of the most vital services in the UK. Treatment should always be free at the point of care and available to all, not just those who are rich enough to afford the private therapy costs. Read those party policies and manifestos, get out there and vote.      

What's it like to be hospitalised? (Part one)

TRIGGER WARNING: Content covers topics of self harm, suicide, hospital environments and family issues.

As I mentioned in the previous post I recently spent six days in a psychiatric hospital. It wasn’t my first time, but I hadn’t been admitted for two years; not even after my last serious overdose in October. It was quite a shock to me as I felt I had been doing really well. It’s been almost a year since I started working for the NHS again and I had recently been promoted. Looking back on it, finding out I was unable to complete my nursing degree, having to deal with my dad coming in and out of my life again and realising that my life maybe isn’t taking the route I wanted it to, were causing a lot of emotional turmoil. It was all bubbling under the surface and I desperately tried to ignore it again. Favouring to focus on the light is fine, until you start ignoring the dark. That’s when it takes its opportunity and strikes. Suddenly I found myself feeling hopeless, which angered me. “Nothing is going wrong so why do I feel this way?”

I noticed I was spiralling down and sought support from A&E and mental health teams. After a while they assessed that I was unsafe to stay at home. My partner and I waited for a little bit of time for the crisis team to find me a bed. Within a couple of hours they rang to say they had found me a bed and I was admitted to the mental health assessment unit at our local hospital. Having been there before I packed my essential items. A wash kit with a roll on deodorant, enough clothes for 3-4 days and some activities like fiction and puzzle books. I knew if I was staying longer I’d be able to ask my partner to bring in extra.

When I arrived at the hospital it was about midday. We were let in through the airlock (two sets of doors where one will only open when the other is fully closed) and made our way around the assessment unit. We were greeted by a support worker who took my things off my partner, to be searched. Unfortunately he wasn’t allowed to come in with me as it wasn’t visiting hours. I remember feeling really fragile and lost as I waited outside the nurses office to be shown to my room. A staff member showed me to the communal lounge to await the nurse who would be completing my admission paperwork with me.

In my experience there is always something about psychiatric hospitals that I find hard to explain. There is a clinical feel with all the chairs made out of fake leather and plastic. The floors always smell of disinfectant and the lights in the corridor never go out at night. Everything you see in there is anti-ligature; there are no proper door handles, there’s nowhere to hang clothes, in the assessment unit there aren’t even toilet seats. The mattresses are not unlike crash matts you might have used at school for gymnastics. You each get your own room, but toilets, sinks and showers are shared. I would recommend flip flops if you don’t want to chance getting athletes foot or a verruca (maybe I’m a bit paranoid).   

After the support worker had asked me a few questions about what had led to me being admitted and took my vital signs, I was left again to my own devices in the communal lounge. There were a few more patients milling about now, either watching bad TV, pacing in the corridor or falling asleep in their chairs. A few people sort of smiled at me and one asked if it was my first time in. As a general rule other patients tend to be really nice and supportive. I met a few people I found it really easy to talk to. Unknowingly, people with BPD tend to group together in these settings. There was a small group of us (about 6), that sat together at meals, spent time colouring and speaking about our life experiences. It’s important to note that whilst you feel a strong connection you shouldn’t try to be friends outside of hospital. It’s best not to be in contact because it’s all too easy to get sucked into someone else’s troubled life, rather than focussing on your own health.

Overall my stay was fine. I won’t say it was good, because in that sort of environment it’s never really going to be enjoyable. You’re there to be kept safe and to be helped to move through your crisis. I have to be honest when I say that sometimes when you get admitted, everything seems to get worse for a while. After having the courage to ask for help you often find yourself trapped in an environment that isn’t conducive to the healing process. On most short term wards there is little to do and activities are hard to come by due to funding.

For the first few days I was quite unwell. I felt like my life was falling apart again. I had suicidal thoughts and thoughts of self harm filling my world. I barely cried because I had got past that point. I watched the girls around me whose arms were covered with scars and bandages. I could see in their eyes what I felt too; society has never been kind to the sensitive. We were broken, but also it gave us a strength. The things we had gone through as children were things most adults hadn’t had to face.