Life in a Bind – BPD and me

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


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Fear – a haiku or two

On New Year’s Eve some words were going round my head and I realised that they made a pattern. One I hadn’t written down since childhood, as an exercise at school – a haiku. Seventeen syllables, three lines, a 5-7-5 pattern. Remarkably, with only a little alteration, the pattern fit:

I’m scared of living,

I’m scared of dying; I don’t

Know which scares me more.

But then I remembered that haikus are supposed to have a contrasting final section, and are supposed to convey an image or feeling but without subjective judgement or analysis. They are supposed to show not tell, perhaps even to be ambiguous, in order to allow the reader to feel their own emotions in response, and to draw their own conclusions. And so I tried again, in a different way, to write another imperfect haiku about fear.

haiku fear 2


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World Suicide Prevention Day – 10 September

World Suicide Prevention Day is observed on 10 September every year. It promotes awareness, commitment and action towards preventing suicide, with events and activities being held around the world. Suicide is still a taboo subject, though more people die through completing suicide than through murder or war – more than one million every year worldwide, with twenty times that number attempting suicide. Over the last few months I have written about the importance of talking more openly about suicide, and the factors that might prevent us from doing so.

But for this World Suicide Prevention Day I wanted to re-post I poem I wrote just as I started to come out of a three week period of feeling suicidal in August 2014. What prompted the poem, and the start of that emergence from suicidal feelings, was the incredibly supportive response to a post I wrote describing my depression and desire to escape from life. That support helped me to turn a corner; and as I drove past a beautifully lit medieval castle at night, which only days before had triggered mental images of falling from its crumbling walls into the shadows below – words of strength started to flow through my mind instead. I hope this poem can be an encouragement to anyone who is struggling with suicidal thoughts now, on 10 September itself, or in the days afterwards. An image of death and despair can become an image of strength and survival, and sometimes all it takes are a few words from some one or some others who can see that you have a place in the world – however impossible that might feel to believe right now.

The poem is called ‘If the shadow falls’.

when shadows fall final


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What holds us back from talking to someone who is suicidal

The ‘National Attitudes to Mental Illness’ survey, carried out annually since 2003,  has shown a very encouraging shift in the attitudes of people in the UK towards those with mental illness. According to the mental health charity Mind, since the launch of the current Time to Change campaign in 2011, an estimated two million people (almost five per cent of the population) have improved in their perceptions of mental illness. More people than ever before are admitting to knowing someone with a mental health problem (more than 6o% of those surveyed in 2013) – and yet, almost half of respondents still say they would feel uncomfortable talking to an employer about their mental health difficulties.

The evidence of a general increase in tolerance is persuasive, and the worries individuals still have about trusting in that tolerance when it comes to their employer (a worry that I have to say I share),  may  over time start to lessen as more and more employers are putting time, money and often a great deal of passion, into promoting positive attitudes to mental health within their organisations. Employers are running raising awareness campaigns; they are training up staff members in mental health first aid; they are holding charity events to raise money; well-being and mindfulness events to reduce stress. It’s happening in the workplaces of my friends up and down the country, and my own workplace is no exception. There is definitely more talk about mental health in the corridors and in the tea room, than I have ever heard before.

It’s not just a welcome change – it’s an intriguing one. People are voicing what they actually think, what their own fears and reservations are around talking about mental health; and it demonstrates just why these campaigns are needed. When it comes to talking about suicide, there is a particular nervousness, and there are two completely contradictory views that I have often heard spoken – occasionally by the same people. It’s not necessarily that individuals are afraid that by talking about suicide they will almost ‘encourage‘ it or make it more likely to happen – most campaigns that I know of (for example, the excellent STOP Suicide campaign, which I have written about previously), tackle that particular myth head-on and make it clear that this is NOT the case. My feeling is (though I have no evidence to back this up) that this is also more of an ‘organisational concern’ (which includes a subconscious paranoia that suicidal thoughts might somehow be ‘catching’), than one which operates at an individual level. The two contradictory views that I am thinking of, can be summed up as “my words will have no impact and so I am not responsible/don’t need to do anything“; and “my words could have a huge impact, and if something happens I will be responsible“.

I have heard colleagues say that they would worry about talking to someone who was feeling suicidal, in case they ‘said the wrong thing’, or ‘made matters worse’. Though it is mostly unspoken, it is clear that there is an underlying fear here. “What if this person, who I am trying to help, does actually attempt or complete suicide? What if I said something which  made them feel worse; or what if I didn’t think of saying ‘the right thing’ that would have helped? Am I responsible?

NO. Assuming you are a genuine and caring person and that you have not been subjecting your colleague to harassment, bullying, or other words or behaviour which could potentially make you culpable in some way – you are not responsible for their subsequent actions and you are not responsible for saving them. If they have come to you in need and confided in you, you may well have a moral duty to try – but that is far as it goes. It would be entirely natural, I think, to feel guilty in such a situation -but that doesn’t mean that there would actually be something that you are guilty of. And I’m not going to lie to you and say that it will never happen. It is possible that, despite your best efforts, someone that you try and help, may complete suicide. They may even do it within a few hours or days of talking to you. But it is NOT your fault. Remember this – your conversation with them was part of a large and complex history of events and conversations, in all likelihood stretching way back in time, possibly before you ever met that person. The interaction of all those words and circumstances; the way in which they became linked with and interpreted in the light of the past, and through the lens of depression or another mental health condition – none of that is within your control. Will this situation happen to you if you start talking to people about their suicidal feelings? It is unlikely – and here’s why.

The vast majority of people are helped by talking about their suicidal feelings. And saying absolutely nothing, or walking away from someone who is clearly in distress, is likely to be much more upsetting than saying something which is ‘not quite the right thing’. And you really don’t have to say very much at all. Helping someone who is feeling suicidal is about letting them know that you’re there for them, that you see them and their distress, that you accept them and what they may want to tell you – and that you’re listening. Listening, and just being present. Your presence, and a small number of caring words, is all that is required. Everyone is different – you don’t know exactly how this person in front of you, got to this point in their lives. You couldn’t possibly know what the ‘exact right thing’ to say in this situation would be – they probably don’t know either. But it doesn’t matter. Emotional isolation is a killer – literally – and by interacting honestly and compassionately with someone who is feeling suicidal, you are doing the right thing in that situation. And yes, it’s okay – more than okay – to ask them if they have a suicide plan, and if they have the means to carry it out. Trust me, they are likely to see it as evidence that you care, and that you are not judging them, and that in itself, is a HUGE deal to someone who may feel invisible and worthless.

Which is why, your words are both less powerful than you fear, and more powerful than you hope. If you are concerned that the impact of saying ‘a negative thing’ would be so significant, why would you be unwilling to believe that the impact of saying ‘a positive thing’ could be significant? Acting on the belief that ‘whatever I say or do won’t make a difference because if someone really wants to complete suicide, they will’, is doubly flawed. Flawed because it significantly underestimates the power of a few caring words in such a situation, and flawed because fundamentally, you have no way of knowing whether any particular individual ‘really wants to complete suicide’. The individual themselves may be ambivalent about it – they may have an intense desire to die combined with an intense fear of death. They may be absolutely sure they want to leave this world – until hope, or at least doubt, enters in. And you can provide that. And it’s very, very simple for me to prove that to you.

Look at the story of Jonny Benjamin and his ‘Find Mike’ campaign, which tracked down the person who talked him down from the edge of a bridge in 2008. Look at the story, which has gone viral, of a young man who saved someone’s life by asking them if they were okay. Three words  – but packed with meaning. I see you; I care about what happens to you; talk to me, I’m listening; I’m here. A hundred words in three – with COMPASSION tying them all together. Compassion – from the Latin word meaning ‘to suffer with‘. To be really present with someone in their suffering.

I have said that you may never know what brought someone to the point in their lives at which all they want is to die. I have said that that journey may have been long, complicated, and multi-faceted. But here’s the beauty of compassion, and of ‘suffering with‘. It’s about the here and now, not about what has gone before. It stands out because it is different from the rest of the landscape in which that person is currently standing. It’s not that what has gone before is not important – it’s that ‘suffering with‘  shows that what has gone before is not all that there is. It’s that it enables the person to answer the question ‘Are you okay?’ with ‘No, no I’m not okay. And I’m so glad that you see’.

As for ‘no, I’m not okay – but will I be’? Well, that is for another day, a day beyond the brink. Because that is another way in which ‘suffering with‘ is powerful- it leads to hope. And hope is about knowing that what has gone before is not all that there will ever be.

So if you have been tempted to think, as some of my colleagues do, that when speaking to someone who is feeling suicidal your words may either too powerful or too weak – I would say that in the moment, they can powerful enough. Speak them with boldness, but most of all with compassion. Be present, suffer with.

 

[If you would like more information on how to talk to someone who is feeling suicidal, please do look up the resources on websites such STOP Suicide, Grassroots Suicide Prevention, and the Samaritans.]


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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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Suicide – Blog for Mental Health 2014

*TRIGGER WARNING – SUICIDAL IDEATION*

I have spent a couple of weeks thinking about what I wanted to write about in my ‘Blog for Mental Health 2014’ post. Being in pain has crystallised that for me, and what I’m writing about is not quite what I expected. I thought I would expand upon the summary in my ‘About’ page, of who I am, and my diagnosis. But I knew this morning that I had to write about something else.

I spent yesterday evening reading through the Lost All Hope website. The first time I came across the site, many months ago, I was looking for a quick and painless way to die. Yesterday, although I felt unsafe, desperate for connection to someone or something to keep me anchored and feeling as though I was still a part of humanity, I knew deep down that I was extremely unlikely to ever cut the ropes of this life in a bind. But I did know that I needed help. Suicidal ideation – ‘Help me’.

I wanted to write, but I didn’t feel that I could. I didn’t feel it would be fair – on you. I have always handled my emotional and mental health difficulties alone, and the damaged part of me very strongly believes that I should continue to do so, that  grown-ups shouldn’t need support. The scared part of the damaged part is also afraid of being overwhelmed by emotion, either her own, or others’. She is therefore terrified of overwhelming you and driving you away with hers. The scared part is hard to own, hard to integrate, and she feels so very very young.

I couldn’t write, so instead I read. Maybe it’s the style in which the pages are written –very personal, very conversational. I felt as though there was someone there with me, talking me through what I was feeling. Trying to convince me that hope was not all lost. I was struck by this particular paragraph on the page describing the author’s own story:

“ ..if there is anything missing from the lives of the suicidal, it is connection with others. Being seen and loved as we are. To think, there are millions of people crying out for the same thing…..and it isn’t even something that requires great skill or money to attain.”

And that is why I’m writing about suicide in my ‘Blog for Mental Health 2014’ post. Because a large part of blogging for mental health, at least for me, is connection with others. Despite (for those of us who find it necessary)  the anonymity or pseudonyms, we write to be ‘seen and loved as we are’. To find those tens, hundreds, even thousands of others who are crying out for the same thing.

Connection, understanding, compassion, support – the desire to give and to receive them, without judgment, but just with love. The Lost All Hope website talks about the fact that ‘helping people’ can provide a possible reason for living. The author says that it can be as easy as speaking to someone.

I hope that my blog can speak to someone. I would like to help. To show support, to provide understanding, to educate, to make the smallest contribution towards erasing stigma so that maybe one day, more of us can use our real names when talking about our real stories.

Through writing, I want to try and re-educate the part of me that feels I have no right to speak out, or to lean on others. I want to give myself permission to feel angry, hurt, scared, and yes, angry, and to be able to express those feelings in words. I have talked about therapy being some of the best care that we can seek for ourselves, but so is this.

Finally, I would like to take part in the ‘Blog for Mental Health 2014’ project because I have been inspired by so many wonderful bloggers who have been open and raw and honest about their mental health difficulties. But it goes beyond inspiration – I am immensely privileged and hugely grateful to be able to call a couple of them my friends. And I am touched beyond measure that one of them was just a text away yesterday and today.

So here is my ‘Blog for Mental Health 2014’ pledge:

“I pledge my commitment to the Blog for Mental Health 2014 Project. I will blog about mental health topics not only for myself, but for others. By displaying this badge, I show my pride, dedication, and acceptance for mental health. I use this to promote mental health education in the struggle to erase stigma.”  

If you would like to learn more about the project, or take part yourself, do visit this page.

Suicide is a dark topic to write about, but I hope that the message of this post is hopeful. I didn’t want these words to be about what led me to the place I was in last night. I wanted it to be about the lights that can illuminate small corners in those dark places that we sometimes find ourselves in, and guide us to safer waters, when we need it most.