Therapy Update

 Happy Tuesday everyone, 

Just wanted to let you all know that I have finally started my Dialectical Behavioural Therapy. Today I had my second session. It's been going really well so far. Last session was mainly an introduction to myself and the other participants and therapists. This week were getting into the more technical aspects such as Biosocial Theory and Wise Mind. I quite enjoy that style of learning so I found it interesting, but it was very content heavy. I suppose 2 hours a week is not a lot of time to cram in so much information. At the beginning of each session we do a mindfulness practice, and we have homework to do every week. 

So in terms of this blog you can look forward to me starting to share some of the skills I'm learning in group. I was thinking of doing a 'skill of the week' or something similar. Just a quick snippet of what i've learned so it can help others. I'm still going to be posting bigger posts around the topic of BPD and mental health; probably twice a month.

Hopefully you all enjoy the content. 

Out of Darkness
Xx

I Look Fine

I look fine today.

Well dressed, a smile somehow.

You didn’t see me yesterday,

All you care about is now.

Yesterday I hadn’t showered.

I hadn’t washed my hair.

I hadn’t had a change of clothes,

In a few days let’s be fair.

Dark thoughts as I took my meds.

I cried myself to sleep.

With sedatives and alcohol. 

A secret I will keep.

The first time I told someone.

“You’re young and pretty,” he said.

Because I looked fine that day,

But I wanted myself dead.

Weeks later in the hospital:

“Why didn’t you give us a sign?”

I tried my best to let you know, But you told me I looked fine.

Psychosis in BPD

Warning: This post contains some distressing content around psychosis, self-harm and physical restraint. Please be aware of this if you decide to read on.

What’s the first thing that comes up when someone asks you about symptoms of borderline personality disorder? Emotional instability, intense/rocky relationships and a lack of sense of self. There is a symptom I rarely ever hear talked about however.

Psychosis

There’s a reason you will almost never hear us talk about this to our friends and family. The stigma associated with people who experience psychosis is really scary, especially for people who feel like they’ve never fitted into society. It’s taken me a long time to come to terms with the fact that psychosis and delusions are a part of the BPD experience. Within the diagnostic criteria for BPD one of the symptoms is transient, stress related, paranoid ideations and extreme dissociation - which can both look very much like psychosis. The reason why Borderline Personality Disorder is named as such, is because it was believed it was on the line between neurosis and psychosis. Personally I don’t think that this goes far enough to explain the sorts of things we go through. 

Firstly, what exactly is psychosis?  

Psychosis describes a group of experiences where you interpret or perceive reality in a drastically different way from people around you. This often causes you to lose touch with reality. You might hear or see things that others can’t, or perhaps you might have strange/bizarre thoughts or beliefs called delusions. 

Although I have experienced hallucinations before, what I suffer with most are transient delusions. At times of extreme stress or shortly after very intense emotions, I often have thoughts which to others make no sense. My partner and I call them ‘episodes’ and I’ve only ever referred to them as ‘funny turns’ in front of my family. 

Here’s an account of what happens during my episodes: 

It starts off as a small thought in my subconscious. Sort of like I’ve forgotten to do something, but I don’t know what it is. It comes with a sensation of anxiety. I’ve gotten pretty good at spotting this and take this as the first sign of what’s to come. If I am careful I can distract myself from the thoughts that come next, but it is all too easy to be drawn into them. 

“Something isn’t right.” 

“You’re being watched.” 

Not voices, but thoughts inside my head. They don’t feel like my own and they feel like a warning. After this it all happens quite quickly if I can’t distract myself. Ideas pop into my head about having forgotten someone important. How? Your memories have been erased. Why? It’s all a big secret you’re not in on. Or maybe it’s more like I’m being watched. By who? Beings I cannot describe. Why? I’m in some sort of experiment. 

The more I think about it the more distressed I become. I start looking for ways to escape or begin panicking about the world I live in not being real. This often leads to strange or self-injurious behaviour. I recall biting my wrists, because I thought it would get me back to the real world somehow. At this point my partner will usually notice and intervene in an attempt to stop me from hurting myself or running out of our flat. In my paranoid state I often think that he’s working against me, or is just a puppet for those trying to cause me harm. This can lead to me becoming verbally aggressive and on a few occasions in the past I have lashed out at him. I refuse to take my medication, as I think if I take it I will no longer ‘see the truth’. Which is just a part of the delusion. At this point suicide and self harm are a serious risk, because of a mixture of dissociation and time passing really slowly; which makes me feel as if my suffering will go on endlessly. I have to be watched really carefully to make sure I don’t hurt myself. My partner will often sit me on the sofa or the bed, and just watch me until I start to come out the otherside; making sure there is nothing in my reach. On occasion he has had to physically restrain me, which isn’t pleasant for either of us. I honestly don’t blame him for that, as it’s a last resort and the only way to keep me safe. 

As quickly as it began, the thoughts start to subside. My medication kicks in (if i managed to take it) or I come back around of my own accord. I return to my usual self and start to see that everything I believed doesn’t make sense in the context of the real world. At this point it's better not to question things and to try to relax and distract from the thoughts. These episodes leave me feeling depressed and exhausted. Not to mention guilty about whatever embarrassing or hurtful things I’ve done and said. I’m really lucky to have a partner who understands what’s happening to me, and is able to make sure I stay safe.

As you can see these episodes of psychosis can be really distressing. They don’t last very long and that means that it’s very difficult to get any sort of help with them. The most advice I have ever got is to simply ride it out. Which when your primary carer is having to hold you down whilst you’re kicking and screaming, is not really helpful at all. The worst part for me is coming back to reality and realising the upsetting things I’ve done. I can become so low in mood afterwards that I can’t do anything for days, including my job or my blog. It has a significant impact on my life, yet most of my friends don’t even know this happens to me, because honestly I fear it might scare them away. It’ll probably come as a bit of a surprise to those that read my blog.

It’s important to know that everyone experiences psychosis in BPD differently. Some people see shadows, whilst others hear voices telling them they’re worthless. Once I was having a panic attack in a shopping centre and suddenly I couldn’t see anyones faces; which was terrifying. 

Finally, I want all you out there to realise you are not alone. I encourage people within the BPD community to talk more about psychosis amongst ourselves. Maybe one day it’ll give us the courage to fight the silence around this symptom. 

Out of Darkness. Xx 

Update: 14/08

 Hi everyone

Firstly I have to apologise for my posts slowing down recently. I don’t think I wrote anything in July. A little update for what’s going on in my life right now. I finally have a start date for my Dialectical Behavioural Therapy (DBT)! Hopefully this time it won’t be delayed 9 months, because of Covid-19 here in the UK. This group therapy is going to be via the NHS’ version of Microsoft teams to begin with, which should mean if we go back into lockdown it won’t be disrupted. In one way it’s good, because it’s finally happening after half a decade of waiting, but it’ll be different from what I was expecting. I guess we’re all having to change and adapt our lives to the new normal. 

The second big thing going on in my life is that I’ve been accepted onto a level 2 counselling course, which starts mid-september. It’s something I’ve been thinking about doing for a while. I currently work as a support worker in mental health and have dreams of becoming a qualified counsellor. I really enjoy the 1:1 aspect of the support I give, and would love my role to be focused on helping people set and achieve their personal and mental health goals. 

Despite being very busy, I do have a really interesting piece in the works. It’s a topic not often talked about by people with BPD and I think it’s really important we start to speak up about it, so others don’t feel so alone. I hope you enjoy it when it's ready.

In the meantime, take care of yourselves. We’re not on dry land just yet, but we’ll pull through these difficult times. 

Out of Darkness. Xx

Online Support: Helpful or Harmful?

Whether you’ve been battling with your mental health for decades or you’re just finding your feet on your journey to recovery, online support is probably something that you’ve considered or taken part in. As many of us living with BPD have, I’ve sought out countless forums on social media and bespoke websites. I certainly have my fair share of opinions of which ones to avoid. From a professional aspect (source: my day job), social media is not recommended for dealing with moderate to serious mental health problems. Especially on sites like facebook, tumblr or reddit, where moderation isn’t as tight as it needs to be. However, when accessing professional treatment takes years, you can understand why people would try to use these sites for healing. 

Today I wanted to discuss my thoughts on online support systems and try to come to some sort of conclusion that might guide others to make a decision for themselves. I can only include my own experiences, so if you have a different story to tell it would be great if you could leave a comment. 

So firstly, what am I talking about when I say online support systems? I am referring to either specific groups or forums on social media that deal with mental health, OR sites dedicated to providing a safe space to talk about mental health. They might offer a place to relate to others or just simply somewhere to vent. You can find them just about anywhere on the internet and they are normally easily accessible and come at no financial cost. They allow you to connect with people in similar situations to yourself, which when you have BPD isn’t easy; we often try to hide our symptoms away in our day to day lives and are unlikely to confide in others. In these communities I always felt more free to be myself. Some online support has the capacity to teach you healthier coping skills and learn from others further ahead in their journey to recovery. In this way it can be used to help with milder symptoms.  

As with all things there is a light and dark side to these support systems. The keyword for this part of my evaluation is Toxicity. In this case a toxic environment is one where there is a continual pattern of negative actions and narratives that cause harm to individuals and the group as a whole. In online BPD communities this can be a culture of peer pressure, berating others for having different opinions, or even becoming unhealthily reliant on one another. At times I’ve also seen a lot of “one-up-manship” due to the group invalidating each other; for example, saying that because someone is not as severe a self harmer that their BPD is somehow lesser than. This usually results in the person feeling they have something to prove, leading to a self-harm incident (one of the worst examples of toxicity I have witnessed). Without having the skills to spot toxicity and detach yourself from those environments, they become detrimental to mental health and recovery.  

Looking around on a search engine like google will find more results than you can count, so here are a few I’ve encountered; plus my honest opinions on their usefulness. 

Facebook - Yikes, let’s start with the worst then. Finding a private BPD group on facebook is easy. You simply search for one, apply to join and promise to follow the rules. The moderators warn you from the start about certain behaviours that will not be tolerated. Brilliant, you say. Fantastic! Except for it doesn’t happen. The group was abundant with arguments that usually ended in suicide threats. The moderators would try to calm the situation, but only ended up joining the argument themselves. For people who are highly sensitive and emotional (like us with BPD) it was an incredibly unhealthy environment. In general I would describe Facebook as a virtual hellscape for mental health, but these groups really took the biscuit. Avoid.

Reddit - Not all of you will be familiar with Reddit. For those that don’t know it’s a site that has forums for everything, literally. From cute animals to BDSM and other subjects in between, including BPD and other mental health conditions. Their moderation is slightly better and some of the forums can be really helpful. If you need to find a way to relate to others with similar experiences then it’s okay in my book; plus the BPD memes forum is a great way to inject some relatable humour into your life. However, avoid BPD carers or loved ones if you don’t want to relive all your abandonment fears. Be cautious.

Tumblr - If you’ve ever struggled with eating disorders then just avoid it. All together! There is a very prevalent Pro-Ana/Mia community and it’s the most triggering place I’ve ever been. It’s tempting to ignore Tumblr’s clear warning about getting help and honestly I have no idea why those blogs haven’t been removed. Avoid.

Elefriends - Now finally I get to talk about my favourite support platform. Elefriends has been specifically designed to provide a safe space and bespoke support to people with mental health problems. It was created by the UK charity Mind. It’s moderators are trained, you can report posts easily, and you can turn private messages on and off. The Elephant posts topics of discussion, helpful self-care hints, and other activities for users to get involved in. Unlike other social media sites, Elefriends boasts an “I need urgent help” button, which gives you the choice of emergency advice, helplines, crisis coping tools, and advice on how to help someone you’re worried about. Another thoughtful feature is that if the Elephant finds a post from you about struggling to cope or having a crisis, you’ll get a message checking in on you. Elefriends gets a 10/10 and I’d recommend it for those seeking a safe community online. Thumbs up!

I would always suggest seeking professional mental health help, but there is no reason you can’t use online support networks alongside help you’re seeking. Especially during this time where we have little contact with our usual support networks. In an isolated world it can be very effective if used properly. So the answer to the question “Is online support helpful or harmful?” is that it can be both. It’s up to you to decide what works for you, although I hope my little guide might give you some direction. 

Remember...  

Is it helping you Heal?

Are you Happy with how you and others are treated?

Is it Hurting or triggering more than you can manage?

Finally, online support is not for everyone all the time. You should dip in and out depending on your wellbeing. For this reason I find it helpful to not get attached to individuals, which helps to stop you from feeling obligated. There are alternatives to online support for those times when it’s not what you need. Charities like Mind and Rethink usually have a local branch in your area where you can take part in creative groups, coffee groups or even walking groups. Recovery colleges are also scattered about that provide free or low cost courses on mental health and wellbeing. Whilst we cannot access many of those currently due to the Covid situation, when things get rolling again we should have them back. If you’re completely isolated, either because of Covid or other illness, then I find personal experience books to be really relatable and some books have really changed the way I see myself for the better. I personally love reading and a good book is exactly what I need to pull me away from my screens. Pair that up with a hot mug of tea and it’s my idea of a perfect afternoon. 

Keep staying safe guys. 

Out of Darkness Xx.

I take medication to function, and that's okay!

Medication. It’s a topic heavily discussed and often argued by anyone with a connection to mental health. Whether that be health care professionals, carers, those directly affected, or even just friends and family. It seems that everyone has an opinion and some of these can lead to a lot of disagreement and upset. I remember one family gathering (in public I might add) several members of my extended family brought up the fact I was on mental health meds and proceeded to say how ridiculous this was. 

“You’ve never been depressed. You were always such a happy child. You don’t want to start taking those.” A well meaning, but hurtful comment a relative made. Unfortunately my father chimed in that I was doing all this for attention. 

I’m sure this is a familiar situation that a lot of people who read this blog may have gone through. It’s certainly an uncomfortable one. Especially when you’re fighting with your own paranoia over continuing to take your meds. 

Other misconceptions (AKA stupid stuff) I have heard include: 

“My boyfriend told me to stop taking my medication, because he didn’t want to date the product of a pill.” - An old friend suffering with Body Dysmorphia

“You don’t need to be on SSRIs, just do a really good workout.” - Random gym dude

I was first prescribed antidepressants (SSRIs) at age 19, after being diagnosed with atypical depression by my GP. I knew that something was deeply wrong with how I felt. The emotions were unbearably strong and the only thing I could liken it to was despair. We hadn’t heard about Borderline Personality Disorder at that time. As a result of this, I have tried many different antidepressants over the years. Not surprisingly none of these did much for me and they came with some unpleasant side effects. 

It wasn’t until I was diagnosed correctly around age 23, that I was prescribed a medication that really helped me. Quetiapine is a multi-purpose drug. It can be used as an antipsychotic or a mood stabiliser; depending on the dosage. For me personally it helped my moods, my delusional thinking, my sleep and even some of my obsessive tendencies. Before I started taking it I was really suffering with my symptoms. I had dropped out of university because of them and I hadn’t even been able to work. I was suicidal most days and couldn’t resist the impulses I had surrounding that. For me, I wasn’t living a life worth living. Quetiapine didn’t fix all this, but it dampened the emotionally painful symptoms, making it easier for me to function. After a year or so of taking it I was able to live more ‘normally’. I started attending group therapy and also got myself a part-time job. I was still suicidal, but I acted on it a lot less and the self-harm was reducing. 

Five years later and I’m still taking Quetiapine. The dosage has had to be tweaked here and there, and I have to have medication reviews every six months. I attended a lot of psychodynamic therapy, which also has really helped me. Without my medication however I don’t think I could have attended it. I also take Promethazine now, for anxiety. 

It’s important to know that any mental health medications you take can be a double-edged sword. Whilst they can dampen symptoms and keep you functional, you may also experience side effects. There are prescription costs and even dependency in some cases. You have to look at the benefits versus the monetary and physical cost. For me, the positives far outweigh the negatives. I am certain that without my medication I wouldn’t be here. 

Another thing to consider is medication versus therapy. We know that specific therapies are often more effective than medications, because they deal with the root cause of the problem rather than the symptoms. However, therapy takes time and can be expensive/hard to access, depending on if it has NHS funding or not. Most people with BPD have experienced mixture of both, with a view to eventually come off medication when their clinician feels they are ready. In some cases (like mine) medication may be needed long term. 

  Trust me when I say I am not ashamed.

No one should be made to feel bad about needing to take mental health medication. You wouldn’t feel bad for taking paracetamol for a headache. You wouldn’t shame a diabetic for taking their insulin. Mental health is viewed under a different lens than physical health. That is changing though and speaking out about the issue is helping. That’s why I write blog posts like this one. For all of you taking medication out there, I hope that my experiences and words will help to ease your mind. 

Stay safe
Out of Darkness Xx

What can I do to prevent my mental health declining during the lockdown? Part two (extra bits for Keyworkers)

I’m a Keyworker!

Firstly, thank you and keep up the outstanding work. The solidarity I’ve seen as an NHS support worker (mental health services) has been truly amazing. More than ever we have each other’s backs, even when it seems we are more understaffed and underfunded than ever. Remember we are the ones who have the strength to keep the world turning in this crisis. As well as my day job, I wanted to help out by reminding you to look after yourselves during these times and giving you a few tips that have been helping me. 

• We matter - Our lives revolve around making sure others are safe, but if we don’t look after ourselves during this pandemic, then many more lives could be lost. Make sure you have the PPE you need and make sure you’re shown how to wear it correctly. If you cannot get the correct PPE then you need to contact your union immediately. Recently the staff at a London NHS trust have protested over a lack of PPE and I commend them for it. We are not sacrificial! That’s the message the whole world needs to hear. Also, if you show any symptoms, isolate immediately. It’s only natural that we would want to stay and help, but this actually causes more harm than good.
• Talk to your colleagues - No one knows what you’re going through quite like these people. The team around me during my 13.5 hour shifts have done wonders keeping from falling apart. Even if it’s just to vent together it’s more beneficial than you’d think. 
• Put your devices down - If like me you’ve been following the COVD-19 events unfolding, like the infection and death rates, it’s enough to start seeping into your nightmares. Facebook as usual is a hive of misinformation and negativity. I found it helpful to disconnect every few days. Spend the time you have talking to your family/friends or doing something where the news can’t disturb you for a few hours. 
• Avoid NHS shopping times  - Controversial, but this is based on my own experience in the area where I live. I have had absolutely no luck with these designated early times. I have found that if you work shifts, then you can use this to your advantage; go at weird times. Also my local Lidl (which has no specified times set aside) seems to be fully stocked on Monday mornings around 8am, with very little queueing. Shops like B&M and Home Bargains are practically empty (but well stocked) come about 3pm. If you work at an NHS hospital check and see if they are offering free food to staff; mine started last week. 
• Take advantage of FREE - There are a selection of usually ‘pay for’ apps for improving your mental health, that are now free with an NHS email until the end of 2020. My personal favourites are Headspace and Unmind. It’s a brilliant time to get into mindfulness and meditation. If you have your phone on your breaks, then a 5 minute session will really help to clear your head and prepare you for the rest of the shift. 

Once again I just want to thank you all. Not just the emergency services and NHS, but also the people keeping our shops stocked, delivering our mail and a huge shoutout to our local councils who are working tirelessly to ensure our communities stay safe. 

OutofDarkness Xx