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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Constant shifts and comforting words

I wrote this almost three weeks ago, over a weekend, and meant to take it to the first therapy session of the week with me and show it to my therapist. It was during the very early days of our ‘new approach’ of trying to restrict (or cut out) email contact outside of sessions. And so in that spirit, I wanted to show her the poem in person, rather than send it electronically.

However, my mood and attitude in session were different to how I had been feeling when I wrote the poem, even though there was no obvious reason behind the change. The change wasn’t even apparent until I was in the room – perhaps something that happened very close to the start of the session (and which I now can’t remember), triggered my defenses, or perhaps it was something else entirely.

By the end of the week, things had recovered, but there was a similar replay the following week; and by the time I hit a short therapy break (which I’m nearing the end of), I still hadn’t managed to show her the poem. I now suspect I simply won’t get the chance as there will be too much else to cover before we then hit a longer, four-week break.

The break itself has followed a similar pattern to those previous two weeks – a few ‘good days’ where I feel connected, vulnerable, open, and determined, followed by a fairly sudden change where it’s almost as if a switch is flipped. I then suddenly see everything through a lens of fear, self-hatred, and potential judgment, which closes me off and puts up my defenses. Whichever lens I’m looking through, it colours everything from my perceptions, to my thoughts, to my feelings, to my behaviour. It feels as though my worldview shifts into a different state, and that the changes in thoughts and feelings are symptoms, rather than causes of that shift. Which still leaves me searching for an explanation as to why this happens, and that in turn leaves me feeling incredibly frustrated and demoralised. It feels as though I have little control over these shifts; they are regular, and unpredictable, and I feel completely at their mercy. That is difficult at the best of times; but during a therapy break, when I need to try and maintain my equilibrium, it is even more problematic.

Thinking back, I think these shifts have always been there, but they are more noticeable in the context of no contact outside of sessions, where I cannot seek reassurance and try to reconnect ‘in absentia’. It also means that whatever is going on, the changes are much more clearly something to do with me and my own thoughts, as they are not happening in connection with anything my therapist might have said or not said, over email (or even my expectations of what she might have said, or not said). That is both a consolation (as it means I still feel secure in who she is) and a concern (as I have no easily identifiable trigger or explanation for what is going on).

As I was writing this poem, some of the language evoked images and memories of self-harm. Though initially it was unconsciously done, as I worked on the poem it became more intentional. Some of the images felt a little incongruous with the subject matter, which is essentially a positive statement about my determination, despite these mood/worldview shifts that I appear to be caught up in, to be open to everything my therapist has to give me, including the tough lessons that preparing to lose her, and then losing her (at the end of therapy), will bring. However, something about the images also felt right; if they are a little radical or a little unsettling, well, so is complete openness and vulnerability – at least for someone who is used to the very opposite of those things. They are unsettling because to someone who is not used to them, exercising them can feel like leaving one-self wide open to hurt and harm. And so it seemed fitting that the poem should somehow be a kind of re-interpretation of self-harm; that its words should give a different meaning to the images that they invoked.

Thoughts and images of self-harm have resurfaced more frequently since my therapist and I have virtually stopped email contact. However, I’m hoping that now, when that happens, the words of this poem will come to mind. And that instead of feeling desperate and afraid, I will remember that openness may hurt, but – just as oxygen binds to blood and keeps my body alive, the internal bond with my therapist and the love that I carry for her, sustains me. If she’s reading, I want her to know that I know that – even when that knowledge is a little buried or veiled from view, and even when that knowledge is difficult to feel.

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Memory Monday – “It feels like only blood”

This post is only six months old, but ahead of Self-Injury Awareness Day on 1 March, it felt appropriate to share it again. This is a poem I wrote on the subject of self-harm:

https://lifeinabind.com/2015/08/05/it-feels-like-only-blood/

In addition, the feelings described in the poem are very present at the moment, and they are one reason why it’s so hard to write about anything else right now. Over the last few days every area of my life has felt like a battleground at one point or another – therapy, my marriage, my relationship with my children. But most of all the battleground is in my head, and until that arena is better understood, a little quieter, and more in control,  I know that all my other conflicts don’t stand a chance.

I don’t want to have stand-offs with my children where no one is a winner, and no one is an adult, either. I don’t want to feel resentful every time I ‘give ground’ to my husband or ignore comments I’m unhappy with, just because it’s too reminiscent of not having some of my own needs met by my parents. And I don’t want to miss out on some of what therapy has to offer (including things I desperately crave, like unconditional acceptance), just because it always feels as though I ‘want more’ – words, emails, caring, attention – and because I find it so hard both to accept the boundaries and the things I cannot have in therapy, and also the unchanging and unfaltering nature of the things I do have.

I really want to work with my therapist, not against her. I don’t want to fight her – even if a part of me does, and tries to, often, and very successfully. The same issues, the same battles, are coming up again and again but in slightly different forms. I try to take comfort from the fact that this just means that there are clearly things we need to resolve – and it is becoming both more urgent and also easier for matters to make their way to the surface. And if all this is ultimately about me changing, I also take comfort in this wonderful quote about change by therapist Alison Crosthwait (from The Good Therapists): “In order to change you need repeated exposure to your own coming apart, to the border between conscious and unconscious, and to the parts of yourself that you resist being with“.

For the nth time this day, week, month, year, it feels as though I am fighting my own resistance and trying to prevent even the tiniest of victories from unraveling, and myself from coming apart. That fight is so exhausting; and the urge to try and find some peace from it by hurting myself is so tempting, it just feels like just another thing to fight against. But ultimately I know that self-harm is my attempt to avoid sitting with the parts of myself that I resist being with, and what I really need to do is not avoid, but to surrender. Surrender to the process of therapy and to the process of change, which inevitably, as described in my poem, will bring a great deal of grief, before it can bring a long-lasting  – rather than temporary – relief.


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The multiple meanings of self-injury: raising awareness and examining preconceptions

*TRIGGER WARNING: SELF-HARM*

Three years ago I was self-harming three or more times a week. It was such a big part of my life that it felt as though it had become my identity. My emotions were on a constant rollercoaster and my close relationships were under immense strain. I couldn’t make sense of the possibility of a future, or of having a place in the world. I felt helpless, life felt out of control, and depression was eating me up.

I started self-harming as an adult in my thirties. Although it is often perceived as a ‘young people’s issue’, self-harm affects all age groups and not all adults who self-harm will have started as teenagers. Self-harm is a coping strategy, and quite often the strategies we adopt are determined or influenced by the situations we find ourselves in. In my case, the coping strategies of my early twenties – mainly around intense relationships – were simply (and thankfully) not as readily accessible in my ‘married with kids’ situation. The first time I self-harmed, it was in response to perceived abandonment by a therapist; a couple of past coping strategies did come to the fore, but in desperation to find something that would alleviate the distress, helplessness and self-hatred that I felt, I turned to something more readily available, that I felt would be less destructive for those around me.

And it worked – for quite a while. I do not mean in any way to advocate self-harm; and I hope that ultimately I will be able to rely on ‘healthier’ ways of coping. But I think it’s important to acknowledge that those who self-injure do so because they find it helpful, or at least they did when they first started. For those who use it, it does alleviate distress, and many would say that it has afforded them the possibility of staying alive when their emotions felt almost too intolerable to be borne. As well as this fact, if there is one other thing that I have learned about self-injury that I am passionate about wanting to convey to others, it is that it is incredibly complex, and has multiple meanings. There are as many reasons why people self-injure, as there are people who do it. The reasons vary from person to person; but also, crucially, they can vary for the same person, at different times.

I have used it as a way of punishing myself when feeling worthless or guilty or ashamed. I have used it as a way of punishing others – even though they never knew about it – when I felt hurt by them but incapable of conveying it directly. I have self-harmed in order to try and cope with immense emotional pain by masking it with physical pain instead. Conversely, I have done it in order to feel something, anything, rather than bear with the truly horrific frustration of feeling emotionally numb and cut-off from myself. I have used it as a way of expressing acute distress, even if only to myself – a ‘silent scream’ as it is sometimes called. And I have used it as a way of self-validating my distress and keeping it and myself ‘real’. So often my ‘inner critical voice’ would accuse me of being a fraud and ‘making it all up’; seeing the cuts on my body was ‘evidence’ of the reality of what I was experiencing. As the days went by and the cuts started to heal a little, and as even more days went by and the marks started to fade, I used to become extremely anxious – as if the reality and legitimacy of my emotions depended completely on those marks.

But by far the strongest and most enduring factors behind my self-injury, have been a desire for comfort and control. When I first started self-harming my confidence and self-worth were at their lowest ebb, and it felt as though cutting myself was the only thing in my life that I had power over. And although I know how strange this will sound, the self-injury did not just represent something I could control, it represented the only thing I felt I could ‘get better at’. Having always been afraid of pain and the sight of blood, being able to overcome that actually felt like an achievement. As for comfort – I have never fully understood this aspect of my self-harm, and yet it is a powerful motivator for me. When I feel immense sadness, grief, or abandonment, pain itself seems like a great big, enveloping hug. I don’t understand why I have made a connection between pain and comfort, I just know that for some reason that connection has a great hold over me.

People talk about self-injury being addictive, and I do think that for a while, I was very emotionally dependent on it, if not physically dependent. At some of my worst times I have sat in meetings at work unable to get thoughts and images of self-harm out of my mind, and giving in to the desire to hurt myself only increased the need to do so again. At one point the desperation was so strong I went in search of ‘suitable tools’ in the stationery cupboards. When I first started self-harming I tried to ‘restrain myself’ and only use it when I felt ‘really bad’. I think I knew that if I started to give in to it regularly, it would become both more frequent and less effective. And that’s exactly what happened. It became my ‘go-to’ coping mechanism; my first port of call, rather than my last. It acquired a kind of habitual nature – and that too, can be a feature of self-harm for many people. It isn’t always carried out impulsively or in the height of emotion. For some people self-injury is ‘ritualistic’, involving particular times, places or tools. For me, the practical restrictions of having a partner and children in the house, meant that I was rarely able to self-harm impulsively and ‘in the moment’.

And perhaps the strangest thing of all – sometimes I self-harmed when I was happy. At the time in my life when self-injury felt like a core part of my identify and my main means of expression, it felt ‘natural’ for me to turn to it to express positive emotions as well. Moments of joy were incredibly rare at that time, and when they came my first thought was to respond by cutting. Perhaps it was connected with the part of myself that found it hard to accept and hold onto hope in any form, including accepting joy – but I have to be honest and say that I don’t really understand this aspect of my self-harming either. But it’s an example of how self-injury can confound people’s expectations and of how assumptions should never be made about what it means to any one individual.

My self-harming has gone from three to four times a week, to once a month or less. It has gone from involving numerous cuts on each occasion, to normally not more than one or two each time. The change has been very gradual, and thinking about how and why it has happened, leads me to believe that there are two key factors to reducing self-injury. The first is a close supportive relationship with someone who accepts and tries to understand both the person and the self-harm – in my case, this is my therapist, whose acceptance of my self-harm is just part of her unconditional acceptance of me as a person. The second is making the decision to ‘postpone’ self-harming. Putting a distance of time between the desire to self-injure and the act itself, has the effect of allowing the intensity of my feelings to reduce, as well as the desire to harm. In addition, postponement doesn’t feel as though I am trying to prohibit self-harm or replace it with something else. Postponing feels easier because I tell myself that I can still do it; but I will simply do it later. It doesn’t try and remove the option and I still feel I have some control. But 9 times out of 10 postponement does mean that I do not end up cutting.

The frequency of my self-harm started to change very soon after I started blogging. That is because my main method of postponement is writing; and I am using it now. Earlier, I felt a strong desire to ‘punish myself’ but I made a decision to write instead – and it is what has kept me from self-harm on countless occasions over the last two years. These days, the strength of the bond with my therapist (who I have been seeing for two and a half years) also means that I want to stop for her – and although I know that eventually the desire to stop has to come from within me, at the moment I will take any motivation I can find! Postponement works for me, most of the time; but fundamentally, it is the relationship with my therapist and the ongoing work that we have been doing in understanding and addressing my underlying difficulties and distress, that is the key to helping me reduce and eventually to stop self-harming. Self-harm is not the message, but the messenger; and we shouldn’t be looking to shoot the messenger – but to figure out who sent them, why, and what it is that they are trying to express. I believe that that is the most compassionate, patient, respectful and enduring way of making the messenger, finally, redundant.

[Self-injury awareness day takes place on 1 March each year. Please note that although I have used the words self-injury and self-harm interchangeably in this post, they are slightly different. Self-injury is behaviour that causes direct harm or damage to one’s body (such as cutting or burning). Self-harm is a broader concept that includes self-injury, but which covers other behaviours such as eating disorders, risk-taking behaviour, and substance misuse.]


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I admit it – I need a rainbow butterfly unicorn kitten too

cat unicorn

Once again I appear to be behind the times – this picture has been spreading across the internet like wildfire for quite some time, but I only came across it recently. Apologies to whoever is responsible for the image, for the lack of attribution – I can’t find one anywhere!

The picture made me smile as soon as I saw it – and then I felt silly for smiling, as part of me thought it was quite plainly one of the most ridiculous pictures I had ever seen. And I had never quite understood what appeared to be the mental health world’s fascination with unicorns. (I make this gross generalization based on the fact that when I first started reading mental health blogs, I came across captioned images of unicorns on a very regular basis).

But the fact remains – I still smile every time I see this picture. It actually makes me happy to look at it. Maybe it’s just that I love kittens. To the extent that I can almost ignore the fact that this kitten has an odd sort of protrusion on its forehead. But in this context, even that seems apt and appears to have a place – if anything can be said to ‘have a place’ in this bizarre creation of ridiculous (some might take that literally) cuteness.

To be serious for a moment – if that is possible under the circumstances; this one picture brings together some powerful symbolism, and that, undoubtedly, is part of its appeal, particularly in relation to mental health. Depending on the context, rainbows symbolize hope and/or freedom; unicorns remind us of gentleness, innocence, mystery, beauty – or, indeed, of almost any positive virtue. They are a symbol of ‘the good’ – and at the same time their mythical and mystical nature is a representation of our longing for something perfect and unattainable. As for the butterfly – it is a powerful symbol of transformation, and in the mental health world it is also associated with recovery and self-care; the ‘butterfly project’, for example, aims to support and motivate individuals who wish to stop self-harming. As for the kitten – well, a kitten is a kitten. It’s adorable – who could resist? (I’m going to ignore the dream interpretation website I saw, that claimed that kittens are a symbol of sexual fantasies and irrational beliefs. If you start believing that the rainbow butterfly unicorn kitten is real, I will direct you to that website).

So, sometimes, it seems you really do need a rainbow butterfly unicorn kitten. Or, at least, I do. How did I never realize this before?!

 


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My ally against self-harm

*TRIGGER WARNING: SELF-HARM*

Five minutes before the end of my last therapy session before the summer break, I asked my therapist if she would be disappointed in me if I self-harmed that evening. I think I took her by surprise – I hadn’t mentioned self-harm for quite some time. She didn’t say ‘no’ – but then, she rarely gives a direct answer to my requests for reassurance! Instead, she encouraged me to think about why I wanted to self-harm, and why I wanted to punish myself. She said that I had other coping mechanisms – for example, I had talked about communicating more with friends, and about learning to play a particular piece on the piano. She would never tell me not to self-harm, and in the past our conversations about it have focused on trying to understand why I do it and what it means. So I think this was the first time she had actually gone as far as to try and encourage me to resist. It was a risky strategy – I’m incredibly sensitive to control and she couldn’t be sure I wouldn’t react against it.

But the strategy (if it was one – she hardly had time to think!) paid off. I saw her encouragement as caring – it felt good that she trusted me and our relationship enough, to tell me something that might be hard to hear and that I could so easily misinterpret. It felt good that she thought I might have come far enough to be able to consider the possibility of resisting the impulse to self-harm, without simply feeling panic at the thought of a vital coping strategy being taken away. Not that it was physically being removed as an option; but I would find it very difficult to do anything that I knew would disappoint her.

As well as encouraging me to think about why I wanted to hurt myself, and pointing out I could use other strategies to deal with my intense feelings, she did acknowledge that I may, despite those things, feel that I needed to do it. But she didn’t ‘let me off the hook’ of having to really think about it if I were tempted, by simply telling me she wouldn’t be disappointed. And perhaps she knows that in many ways, she has already done all that she needs to do, to reassure me in that regard.

Strangely, though I sometimes doubt her acceptance in other ways, I am confident that she does not judge my self-harming. I cannot doubt it, after I asked her many months ago if I could show her some recent cuts, and she said that I could. I was shocked, and completely unprepared for the fact that she might say yes. It was an incredibly important, personal, and emotionally intimate moment. I had shown her something no one else had seen, and however she might have felt about it, she was prepared to see what I had to show her and to share that with me. For me, it was a very bonding experience, and it spoke of her acceptance. I am sure she feels it would be better if I did not hurt myself in that way – but I have never felt any pressure from her to stop, and her comment at the start of the therapy break, did not change that.

I emailed her during the break to let her know that I was happy she had responded in the way that she did. I said that I had felt that she trusted me and that she’d taken a risk in encouraging me to refrain, when I might have reacted negatively. She turned my email on its head, and said that I had taken a big risk in asking her to support the part of me that wanted to stop. And until she wrote that, I hadn’t realised that it was true.

I think that ultimately, the only way to deal effectively with self-harm is to deal with the underlying issues that give rise to the urge to harm, and at the same time to learn to try and sit with those feelings until their intensity diminishes. But the very very first step, I think, is that some part of you must want to stop. I’m not sure how that happens – for me, there was a realisation at the start of the Easter therapy break, that part of me wanted to stop for her (my therapist). Although lasting change would need to be based on internal motivating factors, I’m not convinced there is any harm in taking motivation, initially, where one finds it! And then waiting for that motivation to shift, and for it to become something that you want for yourself, and not ‘only’ for another.

I had wanted to discuss these feelings with my therapist a few months ago, but somehow never got round to it, and they faded. And so when I asked her in late July, if she would be disappointed in me if I self-harmed, those feelings were the furthest things from my (conscious) mind, and I genuinely believed I was asking for reassurance and ‘permission’ to self-harm. But her interpretation was exactly right. Part of me did want to stop – and unlike a few months ago, I think it may even have been more for my sake than hers. I was asking for her support – even if I hadn’t realised it. But I’m so grateful that she did; and that she provided it.

Did I let her down? Yes and no. ‘No’ because she accepts me and that acceptance doesn’t depend on whether or not I turn my pain in upon myself, or express it in a less self-destructive way. And ‘no’ because this is not a question of ‘balancing’ the harming acts against the non-harming acts, and nothing can negate the fact that for the vast majority of the therapy break, the way in which I approached the desire to self-harm was different to how I have approached it in the past. In the last couple of months I have played the piano more than I have in the last few years. As well as giving me an insight into how significant it must have been in helping me to deal with my emotions and circumstances when I was growing up (even though I didn’t realise it at the time); it also gave me an immediate and concrete way of both seeking and expressing connection with my therapist, while also putting a distance of time between my desire to self-harm, and the possibility of acting on that desire.

But eventually I did self-harm, a few days before the end of the therapy break. And so although I know that she is not disappointed, it’s still difficult to completely eradicate the sense that I let my therapist (and myself) down. The incident was not directly connected to her – it was related to an argument I had had with my husband. However, it may be that my feelings of being alone (and possibly of being abandoned) during the last few days of the break, contributed to the fact that I did not even try and resist. I realised afterwards that it had felt as though there was absolutely no part of me left that wanted to stop, or refrain. And that was what was different at the start of September, compared to the start of August.

Earlier in the summer, a few mental health charities put out through social media a number of strategies or alternatives for dealing with the desire to self-harm (for example, holding an ice cube, ‘pinging’ an elastic band against the skin). For me, there has been no better strategy for trying to resist self-harm, than postponement, although I can appreciate that this won’t necessarily work for those whose self-harm is very ‘immediate’ and ‘of the moment’. For me, it’s often the case that I cannot self-harm when the feelings are most intense (for example, because my children or my husband are around), and the passage of time, even sometimes of short duration, allows the intensity of the feelings to subside a little, and with it, the intensity of the desire to harm. Although I know they work for many people, the difficulty I have with a number of suggested strategies is that they are essentially seen as ‘alternatives’ – and yet self-harm is such a very complex thing, that it feels very difficult to simply try and substitute something else in its place. Whereas ‘postponement’ does not try and replace it or forbid it – it very much leaves the option open, but it simply says ‘later, in a little while, in a few minutes – you can do it later’. And that, particularly in the absence of other motivating factors, has often been my biggest ally.

But what this therapy break has taught me is this: with my therapist’s support, I have an even more powerful ally in my struggle against self-harm; and that ally is, quite literally, a part of me.


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It feels like only blood

*TRIGGER WARNING – SELF HARM*

[Note: the picture on which the poem is superimposed is of red paint. The image was obtained from Morguefile at http://www.morguefile.com/archive/display/910529 . Although the image is meant to represent the subject matter of the poem, it is intended neither to offend nor to ‘promote’ self-harm.]

I wrote this poem a few months ago, possibly during a therapy break, although I cannot remember the exact circumstances. I remember thinking it was unfinished – but then when I came back to it a few weeks ago, it felt as though it was complete as it was. Trying to ‘tidy it up’ or add a more ‘positive’ ending felt like a denial, an attempt to ‘tidy up’ something that is anything but tidy. This is how it feels to me, when I want to self-harm – not the sum-total of how it feels; and not how it feels every single time. But it captures some key elements of most of my urges to hurt myself. I wrote it ‘in the moment’ – it’s un-tampered-with emotion.

And so I think it’s important to present it as it is.

It feels like only blood FINAL

 


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Memory Monday – “What’s in a name?”

**TRIGGER WARNING – SELF-HARM**

To tie in with Mental Health Awareness Week last week, my workplace ran a course covering topics such as stigma, depression, anxiety and self-harm. It was an excellent initiative, and I was keen to attend, though I anticipated it being a difficult and perhaps triggering experience. I went with a number of colleagues, and it was interesting to hear people’s views of mental illness, and their descriptions of their own encounters with it through friends or family.

Although I felt a little strange sitting there and contributing to the discussion in the full knowledge that no one else had any knowledge at all of the fact that I shared many of the difficulties being described, I thought I had ‘got off lightly’ in terms of my response. The discussions of suicide and self-harm hadn’t felt particularly triggering, and I didn’t feel hugely anxious about whether I was ‘giving the game away’ through my contributions.

However, as I discovered the next day, I was suffering from a severe case of ‘delayed reaction’. The whole of the next day at work I had immense feelings of frustration and unease that are best described by referring to my ‘What’s in a name?’ post from September, which can be found here:

https://lifeinabind.com/2014/09/20/whats-in-a-name/

I was a complete mass of agitation – as though there was a writhing, screaming whirlwind trying to tear its way out of me. But the writhing and the screaming were covered by a thick and suffocating layer of dense fog, so that they weren’t directly accessible but could still be sensed in a way that was driving me mad with confusion. I could not stop thinking about self-harm – hurting myself was the strongest impulse I could feel all day. I had a therapy session straight after work and I took a penknife into session with me, in full view of my therapist – it’s the only time I’ve done that and I had no intention of using it, but somehow I had to have it with me, if only to illustrate how present and urgent the desire was.

I’ve tried to figure out what lead to those feelings, and the best explanation I can come up with is that they were the result of a severe case of a kind of cognitive dissonance. A dissonance related not so much to opposing thoughts, but to opposing world-views and identities.

For most of my life I have hidden away my feelings and put my ‘very best foot forward’ as far as external appearances were concerned. It was not that I was intentionally lying or pretending to be someone I wasn’t – it was simply that externally I was one person, and internally I was someone quite different. It wasn’t even a particular effort to do so – it was, and is,  just the way things are. My parents expected me to be a certain way; some emotions were not acceptable (for example, anger); and my mother found it hard enough to cope with her own emotions, let alone my own. I was successful at school and at work and it was easy to appear always happy and confident in those environments, and in quite a large part, it wasn’t just about appearances. Those were environments in which I received praise, in which I felt I could achieve something and do something right, and in which I could immerse myself to the exclusion of much else that was going on. But I would never have dreamed of allowing ‘weakness’ (that is, emotion, as I saw it) to infect that part of my life. Giving any sign that I was ‘not okay’ was simply not okay.

This is still how I feel, very strongly, about work. I try to fight it, as I know in my heart that it is a false view – that it IS okay not to be okay. But fighting it feels utterly at odds with everything I’ve ever known. The thought that anyone at work might find out about my mental health difficulties is frightening, and I have no idea how I would even behave or function in an environment in which I was ‘no longer hiding’. Given those feelings and views, the experience of sitting in a room and discussing mental health issues with work colleagues, was like the coming together and overlapping of two worlds/selves which had until now been kept completely separate and compartmentalised. And the impact of that shook me up more than I could have imagined. I didn’t know how to deal with bringing those two areas into contact with each other – the feeling of hiding in plain sight and of part of me being buried and not being heard, was profoundly unsettling. But even worse, was simply the effort of trying to hold those two opposing selves side by side rather than keeping them miles apart. They were fighting with each other – perhaps the intense urge to hurt myself was an expression of the hidden part of me, trying to get out. I don’t know. All I know is that it felt like this, and that that feeling is one I really don’t want to have to experience very often. Maybe that means trying to find a way for those two selves to co-exist or to draw closer to each other and to occupy some common ground. I don’t think it can mean keeping them even further apart – that way lies only further madness.

Interestingly, I think this is a dilemma that I will need to solve in other areas of my life as well. Last week I had dinner for the first time with a woman from church who is a psychiatrist, and who I recently confided in with regard to my BPD. She confessed that she wasn’t sure how to approach a friendship with me while avoiding the pitfalls of trying to be my therapist or asking too many questions; I confessed that I wasn’t sure how to approach a friendship where my mental health difficulties were known right from the very start, as opposed to being revealed after many years of having known each other. We agreed that we would just take it as it comes, and be honest with each other. It is so freeing not to have to hide  – not to have that feeling of dissonance. Maybe at some point, I can find a way of allowing myself to be a little more ‘real’ at work. I know I have a long way to go, but ultimately, I think my recovery depends on it.

 


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What’s in a name?

*TRIGGER WARNING – SELF-HARM*

I am in the grip of something that I don’t understand. It’s happened before, and it’s always disquieting, as unlike many of the symptoms or feelings I experience, this is one for which I don’t have a name. For a while I wondered whether it was a type of dissociation, but I thought dissociation was meant to protect you from painful emotions, and this is one of the worst feelings that I know.

There is something within me to which I don’t have access, and the frustration that this inaccessibility engenders, builds and puts increasing pressure on my insides. Sometimes the frustration builds and builds until the force of it is so strong I feel as though I need to explode outwards but I can’t. Sometimes I am dimly aware of it  – it builds for a day or two and then dies down, without any explanation, either for its arrival, or its departure. There is the feeling and the meta-feeling- the ‘inaccessible’ emotion, and the unbearable frustration.

My school friend who also has BPD was telling me that she feels bereft because she is struggling so much and yet is completely unable to put her feelings into words. I feel very grateful that for me, writing is not daunting, but a delight, and that it is one of the very few ways in which I am able to communicate emotion. But although I had to admit that I could not directly empathise with her ‘writers’ block, I do know how it feels to be ‘emotionally blocked’.

She struggles to capture feelings in words and to make them known to others; ‘inaccessibility’, for me, means struggling to capture emotions in feelings, and to make them felt to myself. And because I know that that sounds all but incomprehensible, I will try and explain it a little bit more.

This is what I wrote to my friend, when she told me about feeling bereft:

“I think I can understand the utter frustration of not being able to express something, though I don’t necessarily experience it in relation to words. Not being able to express something leaves you feeling deprived, because you can’t let ‘it’ out; and neither can you let someone else in to see ‘it’, because you cannot paint a picture for them. ‘It’ is inexpressible and incommunicable and that leaves you utterly isolated, with no bridge to another mind.”

That sense of being ‘cut off’, bereft, not being able to paint a picture of what is wrong, or to transfer the information to someone else where it can be understood and felt  – that is how I experience ‘inaccessibility’, but in relation to myself. That is how I experience ‘inaccessibility’ in relation to an emotion that I can sense but cannot feel; a disquiet that I can intuit, but that does not reveal itself to me.

‘Inaccessibility’ is always connected, for me, with a strong desire to self-harm. It is part of what grips me and intrudes upon my thoughts. It may be intended as an ‘antidote’ but it’s also part of the poison, as it feeds the meta-feeling with its own brand of frustration. My cutting has almost always been restricted to a small and easily concealed area of my body, in order to be able to keep it absolutely hidden. The need to be restrictive has always been frustrating, and occasionally that frustration spills over into minor cuts on more visible parts of my body.

In these times, the need within me is to start cutting and not to stop. The desire to be able to keep going, to fill up all of me with pain, and to blood-let out of every pore, is intense. The fact that I cannot do so  – that my life, as it is now, depends on not doing so – just adds fuel to the fire, and deepens the compulsion. In these times, the self-harming serves a double purpose. It tries to block and distract from the frustration by creating pain that is louder, more immediate. At the same time, it tries to make the ‘inaccessible’ present by removing the vacuum and giving me something concrete to feel.

I never know when the disquiet is going to arrive – and I never know how much it will build, or how long it is going to stay. I felt it when I visited that same school friend two years ago, and we spent an intense weekend closeted in her flat, sharing our experiences and talking about our relationship. By the end of the weekend, my internal state reflected the pressure-cooker environment we had immersed ourselves in, but I had no release valve and I felt as though I was bursting at the seams with anguish.

I felt it grow for about ten days last year, when I was having counselling sessions with my ex-therapist, Jane. It started off as pain that I could sense was there but could not feel or express, and it grew into something so unbearable that every day, I wanted to die. Our session over-ran a little one day, as I desperately clutched my arms around my body, folded over double in my chair, needing frantically to feel and cry but not being able to give birth to a single tear.

This time, my mind keeps coming back to a recent therapy session where I was describing thoughts and dreams I’d had, related to what it would have been like to be my therapist’s daughter. I can’t really describe why it felt like such a ‘special’ session. Particularly because other than ‘special’, I’m not sure it felt like anything much at all. I’ve been feeling ‘high’ following on from my recent Escape into suicidal ideation, but this seems to go hand in hand with a sense of not connecting with my emotions, and of being detached from them. But I keep wanting to come back to that ‘special’ session – to dwell in it. I want to talk about it all again, even though I’ve got nothing to new to say. Something powerful is drawing me, but it wants to stay unnamed and unfelt. And this ‘inaccessible’ something has flicked a switch inside my mind that keeps the same sentence playing on repeat: ‘I need to cut; I need to cut’.

I can’t pretend to understand it, though I do want to ‘name it’. I want to be able to look it up, to read about it, to have someone say ‘This, this, is what you are experiencing, and this is why it happens’. I want to know whether it is a fundamental part of my diagnosis, or something unrelated. I want to know whether others experience it too.

But would I really feel more in control of it, be better able to deal with it, if I knew what this ‘inaccessibility’, this ‘disconnect’ was called? Knowledge is power – I believe that. But at the same time, ‘a rose by any other name….’ – or perhaps by no name – would still be the same bloody set of thorns.


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Escape

* TRIGGER WARNING – DESCRIPTIONS/THOUGHTS ON SUICIDAL IDEATION AND SELF-HARM*

Part I

Lately it seems that my mind has been filled with thoughts of escape. Sometimes the thoughts are just there, a bit like a day dream; or in the background, filling up the spaces not taken up by life, as it happens. At other times, they wash over me like waves, taking me with them; filling me with a keen desire to break free, and to crash upon a distant shore.

Escape…..to some far off place, perhaps. What would it be like, to just run away? To leave everything and everyone behind? What is it, that that kind of escape would achieve? Who or what would I be looking for? I don’t want another romantic partner – I’m not sure anyone else would be strong enough to bear the immense strain that my mental health difficulties put on our relationship. And I know that if I wasn’t with him, I would end up in a string of twelve to twenty four month relationships, moving from one to the other in a tragic parade of almost-serial and barely-overlapping monogamy. I don’t want other friends  – I am incredibly fortunate to have a few close friends who, though mostly living some distance away, are still wonderfully supportive despite the fact that I am sometimes obstinate, self-centred, and difficult to support. I don’t believe that I would find better ones, even if I travelled to the other side of the world.

When I imagine leaving everything behind, it’s not in order to become someone else, with a new life, a new job, new friends. It’s in order to not think, feel and be, all the things that I think, feel and am. When I imagine leaving everything behind, it’s in order to be better able to retreat, without it being noticed. To be able to withdraw, without the constant need to interact. To be alone with my thoughts and with myself.

But what do I know about being alone? I have never managed it. I have always been either in the ‘parental fold’ or in a romantic relationship. Although part of me likes the idea of aloneness, I also know that it scares me. I know that in practice, it would be only a matter of time before that fear drove me into the arms of new lovers, new friends, a new life. A life still full of the same flaws, the same hurts, the same mistakes.

“She knew that the fault was not in the world but in herself, and so, it was her own self that she hated and wanted to be free of…..”. [From ‘In the Springtime of the Year’ by Susan Hill]

Part II

I know that I could never run away from this life. But my head is full of thoughts of escaping from life itself. Since my ‘therapy break’ started four weeks ago (my therapist is on holiday), I am heaping isolation upon isolation, but it is not enough. I don’t understand this drive to ‘finish what she [my therapist] started’ – to cut myself off even further, as a response to feeling cut off. I persist in not contacting those who do not contact me; I ignore those who do, though I’m grateful for their caring. I must have none of them, because I want to not be. But why, why? It’s not catching, this desire to not exist. I don’t know, I don’t know. I just know that I need to hold it within myself.

***

My eldest child asked me to help him draw a picture on my tablet. He chose a blank brown canvas, and a jet-black pen. He drew tangled lines, and then asked me to do some of the colouring myself. I drew my finger over the screen and coloured in one corner, completely black. We took it in turns, until he got bored, and I was left to finish colouring in the screen. I kept going until the whole picture  became a mirror and was covered in darkness.

Part III

My ex-therapist, Jane, asked me whether I would tell her, if I was feeling suicidal. I said that I didn’t know. Although I knew what it was like to feel desperate and to want to die, I didn’t know what it felt like to be poised on the brink, as it were – to actually be on verge of taking my own life. Under those circumstances, I had no idea whether I would tell anyone about it – but I imagined not. I wondered whether acting upon suicidal thoughts was a similar experience to the one I had had with self-harm. For a lifetime it had seemed like the very last thing I would do, and all of a sudden, I had a ‘light-bulb’ moment:  a complete shift in worldview occurred, the concept clicked into place for me, and it seemed like the most logical thing in the world. Once I realised that pain, which I was so afraid of, was not the undesirable by-product of self-harm, but the very point, and the potential source of much-needed relief, it became the obvious and rational answer to a difficult and intractable problem. Does that sound too ‘rational’, or could that also be the way in which suicidal ideation turns into action?  I’m sure there isn’t a single answer to that question – but for some, perhaps that is the way.

***

There is much debate about whether suicide can ever be a rational decision. Some claim that the desire of a terminally ill patient to take their own life, can be an example of a ‘rational’ decision to die. But the debate always seems to be between rationality versus mental illness – as if a diagnosis of the latter precludes rational decision making, at least where it concerns matters of life and death. And yet there is a growing interest in whether unbearable psychological pain may be the same as the suffering associated with a terminal physical condition, and so this may be another example of an unhelpful distinction between physical and mental illness. Perhaps the key factor is not whether or not a mental health diagnosis exists, but whether there is emotional distress. And is it purely a matter of linguistic definition that suicidal thoughts, in the presence of emotional distress, are always irrational, or is there something more going on?

A few months ago, I decided to start down a path of taking an increasing number of ibuprofen tablets (one more on each occasion), every time I was greatly distressed and wanted to self-harm (which at that time, was frequently). The decision was motivated by a desire both to damage and to prepare, as well by a need to feel in control of a part of my life. I have always found it very difficult to swallow tablets, and I reasoned that if I reached the point where I wished to take a large number of them in one sitting, it would be best to have conquered that particular hurdle in advance. And along the way perhaps I would manage, in any case, to achieve the desired self-destructive result, slowly, without the need to take ‘drastic action’. In the end, I didn’t go very far down that particular path, but that was an example of the ‘rationality’ of my emotional distress. Would a neuroscientist, looking at a scan of my brain, have been able to tell whether my thinking was ‘disordered’ at that point?

Part IV

In 1990, Roy Baumeister published an article in Psychological Review entitled “Suicide as escape from the Self.” There are six primary steps in his theory – a tick in all six boxes renders suicide a ‘probability’. A helpful summary of that paper can be found in this blog post, entitled, “Being suicidal: what it feels like to want to kill yourself”. The abstract to the article itself, reads as follows:

“Suicide is analyzed in terms of motivations to escape from aversive self-awareness. The causal chain begins with events that fall severely short of standards and expectations. These failures are attributed internally, which makes self-awareness painful. Awareness of the self’s inadequacies generates negative affect, and the individual therefore desires to escape from self-awareness and the associated affect. The person tries to achieve a state of cognitive deconstruction (constricted temporal focus, concrete thinking, immediate or proximal goals, cognitive rigidity, and rejection of meaning), which helps prevent meaningful self-awareness and emotion. The deconstructed state brings irrationality and disinhibition, making drastic measures seem acceptable. Suicide can be seen as an ultimate step in the effort to escape from self and world.”

The first four steps in the causal chain seem so easy for me to tick off, although the following is a very incomplete summary of what they entail: falling short of standards, my own and others’; not meeting others’ expectations and having my own set too high and being constantly disappointed; awareness of what I’m feeling or doing and why, but with no power to change those feelings, or for the self-awareness to change me; negative, destructive, judgemental, harsh emotions about myself. Feelings of complete lack of self-worth.

In the UK charity SANE’s latest research on suicide and suicidal thinking, lack of self-worth is one of three key factors identified, that contribute to suicide. The other two are lack of trust (in others and in ourselves), and “suicidal exhaustion”.  The SANE researchers talked to people who had attempted suicide, and one of them said this:

“Throughout all my depression I’ve always been able to be okay for other people. But I couldn’t do it anymore, I just couldn’t. And they kept saying to me, what is it, what is it? I’m going “I’m just so tired”. That’s all I kept saying, “I’m so tired”. For ages. And they were going “but why?” And I couldn’t explain what that meant, I just knew that I was so tired. And I wanted peace, I wanted some peace. And suicide was the only way.”

Part V

Back in January, I was in a deep depression. Every morning, for the briefest nanosecond on the threshold between sleep and semi-consciousness, my spirit felt light and unencumbered. But almost immediately the immense weight of fear, desperation, darkness and of wanting die, settled down upon me, and the only relief from it came at night, with the oblivion of sleep.

I’m not sure how to explain how this feeling, over the last week or so, differs. Except to say this: the darkness is not weighing me down as much, but it feels as though the tiredness, the sheer, utter psychological exhaustion, is bringing me to the end of the road. At times, I have felt calm, rather than desperate. Clear, rather than confused. I feel so little as if I exist, would it make much difference if, in fact, I did not? Somewhere, right at the back of my mind, common sense is ringing out a bell – is this the calmness of ‘madness’, of a rationality gone wrong?

***

I believe unquestionably in the benefits and importance of increased self-awareness, but living with it can be beyond painful. I’ve opened up worlds of thoughts and emotions that I was never aware of, and that I can’t now escape. And despite my protestations whenever my husband voices doubts about the possibility of recovery, I realise I have very little hope of it myself.

It feels like such a simple, logical thing. I don’t want the waves upon waves of loss. I don’t want the perpetual bitterness of the bittersweet moments. I don’t want everything that is, to remind me of everything that will, at some point, cease to be. I don’t want the constant reminders of death or abandonment. I don’t want the intense yearning for what I didn’t have or for what I can never have. I don’t want to keep remembering those that I need to forget. I don’t want the corroding regret, or the anguish of time lost or wasted. I don’t want to never be held by those I want to be held by, or to even want to be held by them.

“The world was quite empty, although the sun still shone, the birds sang……there seemed nothing whatsoever that might comfort her or give her strength and protection.” [From ‘In the Springtime of the Year’, by Susan Hill]

***

I keep asking myself, over and over again: if I didn’t have children, if death was as easy and as painless as flicking a switch, if someone else would do it for me, would I ask them to? Do I want it as much as I think I do?

***

Random thoughts keep entering my mind.

“I must fill in that form to indicate how I would want my pension lump sum to be distributed in the event of my death.” “Do pension funds pay out lump sums if death is self-inflicted?” “I need to ask my therapist if she will let Jane know if something happens to me.” “I wonder what the drug is called that vets use to put animals to sleep?” “I don’t know any vets. I don’t know any vets….”

Practical details – there must be no loose ends. But this is all backwards – how can I think of the incidentals, when I haven’t yet decided on a ‘how’, or a ‘when’? But when the impulse comes, if it comes powerfully, there must be no loose ends. Nothing left to chance.

***

The briefest, silent prayer, runs through my head. The first one in a long time. I feel guilty and irreverent – full of cheek and ingratitude. But if He’s the one who gave me life, who else can I plead with but Him, to take my life away?

 

 

 


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Self-harm: a few thoughts

*TRIGGER WARNING*

I admit it. I have an interest in self-harm. I feel almost guilty for saying it – as if I’m admitting to having a morbid curiosity in an inappropriate and forbidden subject. But that’s simply indicative, I think, of the fact that it’s hard to escape the feeling that self-harm is a taboo subject, even within the mental health community, and amongst those for whom it is very much a part of life.

I remember one occasion, soon after a fellow BPD blogger and I started corresponding outside the context of blog-posts, when we hesitantly started to explore the subject of self-harm in our messages, and to ask each other questions. It was clear that we were interested in the other person’s self-harm – how, where, why – but at the same time felt uncomfortable and guilty for being so curious. But it was also clear that we both felt a profound sense of relief (and almost of liberation and excitement) at being able to talk about this so personal of subjects, with someone else who really understood, and didn’t judge. Our ‘morbid curiosity’ was born simply out of a desire to know that we were not alone, that we were accepted and acceptable, and to try and understand more about what self-harm meant to each of us, and what it means to others.

Many of those who self-harm feel a sense of guilt, shame or self-loathing at doing so.  Those feelings can lead to a self-perpetuating cycle in which more self-harm is used to try and cope with the intense negative feelings about one-self, associated with the act of self-harming. These negative feelings can be compounded by fears about how others might react to, or perceive, the behaviour, and the fact that self-harming carries a great deal of stigma within our society.

I am very thankful that I do not personally suffer a sense of guilt or shame at my self-harm, and I feel a huge sense of compassion for those who do. I do understand the cycle of negative feelings leading to more self-harm, although in my own case, these tend to be feelings of immense frustration and failure when self-harm ‘doesn’t work’ in adequately dealing with the feelings it was meant to address. I also understand the fear of stigma and lack of understanding from others, and this was brought home to me in a powerful way by the reaction of a friend of mine, when I admitted to her that I am an active self-harmer. Her shock, shocked me. The fact that, on the basis of this one revelation, she felt that she no longer knew me (although indeed, she didn’t) – shocked me. I still find it hard to fully understand others’ reactions to self-harm. I’m not in any way advocating self-harm, or trying to undermine the immense and courageous efforts of those who struggle daily to stay free of it. It’s just that, although it sounds somewhat bizarre, for me personally it felt like such a logical way to cope with pain. It still does.

However, I know, even if I cannot fully understand, that self-harm does indeed elicit strong reactions from others, and that those reactions are often based on fear, ignorance, and misconceptions. And my own experience of that ignorance and misconceptions, in the context of a supposedly ‘safe’ therapeutic environment, has given me a strong desire to write about self-harm, and to try, in my own small way, to address those views, and to help others understand.

And not just those ‘on the outside’, but those who self-harm as well. My own understanding of ‘my hobby’ (as a very accepting friend of mine describes it) has been greatly helped by reading both personal experiences and research studies of self-harm. Although I don’t feel great guilt at self-harming, perhaps it is testament to my innate perfectionism and my sensitivity to invalidation, that I have  felt very troubled, in the past, by the sense that I wasn’t ‘doing it right’. That if my self-harming didn’t fit a particular stereotype, then it wasn’t ‘real’ self-harming at all (and therefore, by implication, neither was my pain, or my diagnosis, real). Reading about others’ diverse experiences of self-harm has helped me to feel less alone, and to really appreciate that self-harm means different things to different people, and different things to the same person, at different times.

I want to write about the misconceptions. About the view that self-harm is a ‘young person’s phenomenon’; that it is manipulative or attention-seeking; that it is a failed suicide attempt. About the view that self-harm is always impulsive; that the pain inflicted is proportional to the pain felt; and that one can simply ‘choose to stop’ self-harming.

I want to write about the motivations. About the need for comfort and control; the desire to punish, either oneself or others; the desire to either feel more, or to feel (or think) less, or nothing at all; the ‘silent scream’ or cry for help. About the experience of wanting to ‘make the inner, outer’, and to give mental distress a physical form; the habitual nature of self-harm and how it can become part of one’s identity; and the fear of not self-harming, which can lead to pre-emptively self-harming in order to cope with upcoming, rather than present, stresses.

But for the moment, I just want to say this.

I admit it. I have an interest in self-harm. And for the sake of the thousands of those who suffer, in one way or another, and who use self-harm to both express and cope with that suffering – I hope that you do too.