Life in a Bind – BPD and me

My therapy journey, recovering from Borderline Personality Disorder and Generalized Anxiety Disorder. I write for welldoing.org , for Planet Mindful magazine, and for Muse Magazine Australia, under the name Clara Bridges. Listed in Top Ten Resources for BPD in 2016 by goodtherapy.org.


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Dignity in mental health – and what that means for attitudes to recovery

The theme of this year’s World Mental Health Day on 10 October, is ‘Dignity in Mental Health’. According to the Royal College of Nursing’s (RCN) definition of ‘dignity’:

Dignity is concerned with how people feel, think and behave in relation to the worth or value of themselves and others. To treat someone with dignity is to treat them as being of worth, in a way that is respectful of them as valued individuals.

One of the ways in which those with mental illness are frequently treated with less dignity than those with ‘more obvious’ or ‘physical’ illnesses – though I think the distinction can be misleading – is the way in which recovery is viewed. People tend to view physical illness as something outside a person’s control, to the extent that they cannot simply ‘will‘ the condition away, or spontaneously decide to get better. One tends to assume that a physical illness leads to symptoms which may make it difficult to do certain things, and it would be unreasonable to expect someone to do them (for example, to walk with a broken leg), until they had recovered sufficiently. If someone has a physical illness, unless that illness is terminal, one is naturally optimistic and hopeful of recovery. There is an expectation, even, of recovery – where this doesn’t necessarily mean a complete eradication of symptoms or of a condition, but a restored ability to live a full and meaningful life. Recovery is possible; it is to be expected; and it is probably going to take time and some sort of intervention over and above simply ‘willing it’ to happen.

In contrast, people’s views of recovery from mental illness are sometimes polarized between two extremes. On the one hand, there is the view (rarely stated explicitly, but often implied by well-meaning but nevertheless ill-thought-out words or actions), that someone can ‘just decide’ to get better. That, as mental illness is ‘all in the mind’, if you try hard enough to really galvanize your thoughts, feelings, willpower and strength, all your difficulties will melt away. And on the other hand there is the view (also rarely stated explicitly anymore, but still hanging around from an earlier age), that if you have a mental illness there is something fundamentally wrong with you, and you are ‘doomed for life’, with no hope of recovery and no possibility of a fulfilling or mostly symptom-free existence.

I don’t want to deny that recovery from a mental health condition may mean something slightly different to recovery from many physical illnesses. It may be difficult to define, for example, when someone has ‘recovered’: is it when they no longer meet the diagnostic criteria for a particular condition; or when they no longer need medication or therapy; or when they simply feel well enough, in themselves? It’s also true to say that even when recovered, someone with a mental health difficulty may continue to be susceptible to ‘relapses’, for example during periods of great stress or change. However, although some mental health conditions (but not as many as you might think) may be life-long in that sense, we need to careful that we don’t give the impression that a diagnosis is a life-sentence: not just for the sake of the person being diagnosed, but so that we can start to enculturate ourselves in a way of thinking which aligns our attitudes towards recovery from a mental health condition, much more with our attitudes towards recovery from a physical condition. Recovery is possible; it is to be expected; and it is probably going to take time and some sort of intervention over and above simply ‘willing it’ to happen.

It is important to remember this, too: when people do not recover from a mental health condition, or take some time to recover – they are not suffering from a lack of will, or emotional weakness, or a character flaw, anymore than someone whose physical recovery is impeded by a vulnerable immune system, for example, is suffering from those things. True, some people choose not to take the help available to them, or may choose to continue in behaviours which will lead to a deterioration in their health – but this is true of some with a physical condition, just as it is of some with a mental health condition.

It does not accord someone dignity, to treat them as if they are perpetuating their own misery through choice (or rather by not making a choice to get better). Neither does it accord them dignity to assume that they have no choice but to continue in that state for the rest of their lives. That is a position which robs them of one of life’s essentials – hope. When life seems very bleak, reinforcing the possibility of a life worth living is part and parcel of treating someone as being of worth, and of showing them how much they are valued. To quote from the RCN’s definition of dignity again: “When dignity is present people feel in control“. I hope that on this World Mental Health Day, we can start to think about recovery from mental illness in a way that does not make those with a mental health condition feel helpless: either because they are expected to ‘will away’ their difficulties but cannot; or because they have been made to feel that no change is possible. Instead, I hope that we can try and dignify individuals’ daily struggles with their own minds and bodies, with a response that conveys compassion, understanding, support – and every expectation of recovery and the ability to fully embrace life.

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Memory Monday – “Depression is like….struggling to breathe”

I haven’t done a ‘Memory Monday’ post for a while – in which I re-share an earlier post of mine which is particularly significant or appropriate at this time. However, in the lead-up to World Mental Health Day on Saturday 10 October, I wanted to re-share a guest post I wrote for Sunny Spells and Scattered Showers back in February. The post was about the following image, which Fiona Kennedy (author of Sunny Spells and Scattered Showers) shared on her blog:

Though I have seen a number of images or cartoons on a similar theme (comparing ‘physical’ and mental illness), this one struck me immediately, and more forcefully than those others. I still find it incredibly powerful, and if you do too, here’s some reasons why I think that might be – do let me know if you agree!

http://sunnyspellsandscatteredshowers.org/guest-pos/

 

 

 


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Staying connected to my therapist – and trying to be kind to myself

I drove past the house of Jane (my ex-therapist) again last week. It was only a very short detour this time, as I happened to be in the neighbourhood. It was the first time I had driven past since writing ‘Have you googled your therapist?’ and the difference, on this occasion, was that it was the first time I didn’t feel shame or fear at doing so. I didn’t feel I was doing something wrong – and although I think I was still nervous that she might see me, the thought didn’t worry me quite so much.

This happened only a couple of days after I received an email from someone who had read my blog and was wondering whether to tell her therapist about how attached she felt to him, and of how she ‘stalked him online’ (her words). Her email resonated so much with the feelings of guilt I used to experience over such ‘stalking’, and it brought home to me how much had changed over the last few months, in how I view this subject. And that change is due entirely to the way in my therapist has responded, and the conversations we have had about it.

On every occasion on which I have mentioned trying to get close to her outside of session (whether online, or in terms of physical distance), her response has surprised and amazed me. Take a couple of weeks ago, for example, when I told her that in the middle of our summer therapy break, on the day that I knew she was going on holiday, I happened to drive very close to her house and had an enormous urge to turn off the main road and drive right past it. But I didn’t. And instead of saying ‘well done for resisting the urge and not driving past’ (which was the sort of response I was expecting), she implied that it would have been fine, and perfectly reasonable, had I done so. I was completely taken aback and wasn’t sure what to say, until ‘you’re amazing’ slipped out, because that was exactly how I felt.

She had responded in a very similar way when I told her, as few months ago, that I had spent the day with my children in the playground and by the river near her house. I walked them to within fifty metres or so of her house, and then turned back. Her response was to call me ‘creative’ – I had found a way not just of spending special time with the kids, but of bridging the gap between sessions and continuing to feel connected to her. Far from commenting on or being displeased about how close I’d come to her house, she remarked on the fact that I hadn’t closed the gap all the way and walked right past her front door. In her mind, it showed that I was learning to tolerate some distance and I was becoming more able to bridge that gap myself, while still keeping her real.

Her understanding and her tolerance might seem extraordinary (they certainly did to me), but I think it’s easy to forget that not only have our therapists worked with many clients (who no doubt have had similar feelings), they have also been clients themselves. They may well have experienced the same feelings, and acted in similar ways. And so perhaps they don’t feel threatened by our behaviour (as we imagine they may do) and perhaps they understand it better than we think. Although she didn’t tell me of her own experiences, my therapist did mention that she had once had a colleague (another therapist) who took a certain route to get to town in order to drive past her own counsellor’s house on a regular basis. It was a huge relief to hear that – and suddenly I felt as if my behaviour was not so unusual or so unacceptable after all.

Having been clients themselves, our therapists hopefully also understand the process by which dependence and attachment and a need for the therapist’s physical presence, turn, over time, into greater independence and the ability to ‘internalise’ the therapist and carry them within, even when they are not present. This, as I understand it, is where my therapy will eventually lead me; up to the point where I have internalised my therapist and the process sufficiently, that I will be equipped to manage on my own. However, she has pointed out that until this happens, therapy (and the therapist) are strongly tied to the tangible factors that surround them. And so we ‘place’ the therapist in a particular location in which they exist powerfully, with their reality diminishing the further we get from that point. We associate therapy with the room in which it happens; with the objects in that room, the colour of the walls, or the view outside the window. And if any of those things changes it can be incredibly unsettling, even if our therapist is still there, because the person and the process are so bound up in our minds with one particular set of co-ordinates in three-dimensional space. And so it’s natural, when wanting to feel close to our therapists, that we seek out the place where they feel most real.

I found that hearing it explained in this way, went a long way towards enabling my feelings of guilt and shame to melt away. And I think very similar arguments can be applied to trying to stay connected to one’s therapist via ‘virtual’ means as well. In the months after I stopped seeing Jane, I used to find that googling her and seeing her name in print was immensely important in keeping her alive in my mind, in what I had originally assumed was a gap of few months until I could return to therapy with her again.

“But” – you might respond – “there is a big difference between something being understandable and it being right. It feels wrong to violate someone’s privacy in that way – whether that happens in the ‘real world’ or online”. It’s why my discussions with my therapist on this topic have felt so much like ‘confessions’ – I felt I had ‘morally transgressed’; that I had ‘sinned against her’. But in response to this, my therapist made a very valuable observation which really struck home and provided a great deal of food for thought. She said that it was almost as though I was placing something ‘out of bounds’ – even though it wasn’t – in order to recreate an old dynamic in which I wanted desperately to reach out for something that was inaccessible or forbidden. By making something forbidden that was not in fact so, I was guaranteeing that if I did reach out for it, I would be hurt by the burden of guilt and self-reproach that I would then feel.

This made immediate sense – but why would I recreate such a situation, and why would I invent a moral imperative for myself that I then felt bound to transgress? I realised that the guilt and shame I felt was not so much about driving past my therapist’s house, or googling her; but about the overwhelming desire to be close, which itself led to those behaviours. In many ways, it is easier to deal with punishing ourselves for violating someone else’s boundary (as we see it) than to deal with the neediness, dependence and desire for connection that we may feel for our therapists. Perhaps there is even a sense in which that neediness feels self-violating – it impinges on our solitariness and the sense that we should manage life alone, without the fear of being hurt. It seems easier to try and replace that sense of self-violation (which we may feel we have no defences against, or any idea how to handle) with the more familiar sense of ‘doing the wrong thing’. It makes the problem an external one – we have defined the line that has been crossed; and there is a difficult but obvious solution – confession and the hoped for absolution.

I don’t fully understand this yet – and I’m not sure what exactly the dynamic is that I am recreating from my past. However, this is one area in which I am incredibly grateful to my therapist for helping me to see things in a way which enables me to be kinder to myself. The challenge for me now, I think, is to apply this to other areas of my life. I suspect that there are a number of ways in which I needlessly place things ‘out of bounds’ or in some sort of ‘moral category’, which just enables me to criticize or punish myself if I ‘reach for things I shouldn’t’ or act in ways I perceive as ‘wrong’. I also suspect there are a number of circumstances in which my feelings (for example, shame or anger) relate to the underlying motivations driving my actions, rather than to the actions themselves. But if there is one thing that continues to inspire me to try and be kind to myself, it is her own kindness to me, and her openness to the ways in which I express my needs and my desire to stay connected. And for that, I will always be grateful.