The poem above was recently posted on the Facebook page for the mental health charity SANE, by Michael, a supporter of the charity. It’s about the differences in how people react to mental and physical illness. I think it makes the point briefly but powerfully, and what particularly resonated with me, was the effect that others’ reactions have, on the individual with the illness. The question ‘Am I a fraud?’ is one that has plagued me for some time, and continues to play on repeat in my head, on a regular basis.

It’s as if there is a very small but very annoying and hurtful person living inside my head, who keeps up a running commentary trying to counter-act any feeling, thought or belief related to my diagnosis and my mental health difficulties. The voice likes to level accusations such as ‘you’re making it all up’, ‘you’re pretending’, ‘it’s not really that bad’, ‘you’re just being dramatic’ and ‘you just want to be ill’. All of which is accompanied by a secondary commentary along the lines of ‘what sort of person must you be if you’re doing all of this deliberately….’. A typical example of how the voice likes to operate is this. I can be driving in my car, feeling an oppressive yet somehow inaccessible sadness somewhere within me, and I will think ‘I feel really sad’. Immediately, the voice chips in with ‘you’re not really sad, don’t be silly. You’re not crying, you can’t possibly be sad. You just think that you’re sad. The reason you can’t access the feelings of sadness is that they’re not really there. Stop pretending.’

So powerful is this voice, that it even pops up in my dreams. On one occasion, I’d dreamt that I was in the process of travelling to an appointment, and one moment I was in my car, and the next I was standing in front of a house. It felt incredibly frightening, because I had no recollection of how I had arrived there, and I remember having the thought, in my dream, ‘I wonder if I don’t remember, because I dissociated’. Immediately the voice retaliated with ‘you just want to believe you’ve experienced dissociation in order to reinforce your belief that you have BPD. You’re just making it up’.

Those sorts of voices that many of us carry with us, are the ultimate invalidators, because we can’t just avoid them, or shut ourselves away from them – we have truly internalised them. They are often the offspring of real-life human invalidating influences in our pasts (or presents). It is well recognised that growing up in an invalidating atmosphere, where one’s thoughts and feelings are constantly being belittled or ignored, is a key environmental risk factor for the development of BPD. (Of course the causes of BPD are many and varied and the inter-play of contributing factors, both genetic and environmental, can be very complex, and is not well understood. However, for those who do go on to develop BPD, one can often trace a prior climate of invalidation).

Because of this history, many people with BPD are acutely sensitive to invalidation, whether perceived or actual. The sense that my feelings are being invalidated is a powerful trigger for me, and can result, depending on the situation, in acute distress, anger, feeling uncared for, or wanting to hurt myself. Feeling invalidated and worrying about potential invalidating reactions from others, is one of the key reasons why it took me so long to tell a few key people in my life, about my diagnosis. The voice inside my head, telling me I was a fraud, was so powerful and created so much doubt within me, that I couldn’t see why other people wouldn’t agree with that voice as well.

I have found it incredibly hard to accept my diagnosis – not because I found it shocking or disturbing, though I know this is the case for some – but simply because it is so hard to keep believing it to be true in the face of internal accusations and self-doubt. Even the fact that my husband thinks that ‘Stop walking on eggshells’ could have been written about me, simply reinforces, as far as ‘the voice’ inside my head is concerned, what a good job I have done of convincing myself and others of a lie.

In my own case, the ongoing sense of invalidation was exacerbated by the circumstances surrounding my diagnosis. A little while ago, I formed one of those very strong, quite obsessional attachments, that for me has been one of the hallmarks of my BPD. Having spent most of my life telling no one about my mental health difficulties, I decided to confide in one of my closest friends, who herself has severe mental health difficulties. Typically for me, it had to be an ‘all or nothing’ approach, and the process of completely ‘unburdening’ myself drew me in, and before I’d realised what was happening, I found myself on the roller-coaster ride of BPD attachment and the idealisation/devaluation cycle.

‘Identity disturbance/an unstable sense of self’ is one of the key diagnostic criteria for BPD, and one of the implications of this is that people with BPD often mould to their environment and take on the characteristics or tastes of other people, particularly when they are in a relationship with someone. They attempt to take on another’s identity, in the absence of a solid and determinate identity of their own. This has certainly been true of me in the past. When your partner is into opera, or hill-walking, or is a writer or a musician, that may not be too much of a problem. But when the object of your obsession has BPD, you’ve just handed your ‘critical inner voice’ the perfect weapon and means of invalidation. My ‘critical voice’ took advantage of the fact that I was desperate to get closer to my friend, and accused me of ‘bringing BPD on myself’, or ‘pretending I had the symptoms’ in order to achieve this aim. Never mind the fact that this was a circular argument in any case, as the obsessional desire to get closer and the taking on of another’s identity, were themselves symptoms of the condition!

Invalidation, or perceived invalidation, can take many forms. Sometimes, and with some people, I experience it as a lack of respect or acceptance of my views or feelings, or a sense that I’m not ‘allowed’ to have a different viewpoint – that I’m expected to be an extension of someone else, and conform to their expectations. This is particularly true for me, when it comes to my relationship with my parents. On other occasions, and with other individuals, I experience it as the sense that there is no point in putting an alternative viewpoint across in a debate or a discussion, as the other person will simply keep coming back with a counter-argument in an attempt to get me to agree with them, and this sets off another significant BPD trigger for me – the sense and fear of being controlled. Sometimes, almost anything that isn’t complete agreement with, or assent to, what I am doing or asserting, will be construed as invalidation.

I am far from  coming to a realisation or understanding about  how to address these issues of invalidation, and they continue to be daily struggles for me. For a time, the ‘inner critical voice’ rose up less frequently and was less intrusive, and, at least as far as my diagnosis was concerned, it seemed as though I was coming to a very gradual acceptance of its reality – I was starting to ‘let myself off the hook’. This was a time in which I was in therapy with someone who I felt truly understood me, accepted me, and cared for me. She understood how I struggled with the sense of ‘being a fraud’, and every now and then – not too often, but often enough – she would indicate that she could see how my behaviour or my feelings made sense in the context of my diagnosis. I don’t know if she would have done this anyway – I felt that she did it because she recognised what a difference it made to me – but it was incredibly validating.  Her acceptance of my diagnosis and what I was going through was the one thing, more than anything else, that had an impact on the ‘critical voice’, on my sense of invalidation, and on the degree to which I felt I could ‘accept myself’.

The progress I made during that therapy, in that one respect, was one of the yardsticks by which I measured its success and the ”fit’ that I had with my therapist. It brought me a greater degree of peace, a greater sense of acceptance – it helped me validate me, which at the end of the day, is where one’s sense of validation, ultimately, needs to come from. It was as if, held by that most intense and intimate of bonds between therapist and client, I was able to finally face my inner accuser, stand accused of fraud, hear the charge against me and say, with belief rather than self-doubt – not guilty…..NOT GUILTY.