Ideas on a postcard, please

For the last 6 weeks I’ve yet again been suffering depression. That’s quite a short period of time really but it feels like it’s been so much longer. The good news is I’m improving. I’m feeling much better than I was – I have my appetite back and my concentration has improved but in other ways I am still struggling. In particular, I am struggling with urges for self harm and suicide.

Why am I having such difficulties with urges to self harm and suicide? I feel like I’ve reached the end. When I started this blog 2-3 years ago I defined what recovery meant and I was quite positive that I will have episodes of depression again but that I will overcome/recover from them. That might be true (although it doesn’t currently feel like it) but I’ve lost the will to fight. I can’t and don’t want to keep going through the desperation, devastation and isolation of depression. I don’t want to have to go through periods where I don’t experience joy and where I feel as though I am just an observer in life, where I have to force myself to eat. I don’t want to have to go through not being able to concentrate on anything – not being able to watch a TV programme without difficulty, not being able to read which, is one of my methods of escapism. I don’t want a life which will have constant absences from a job or lack of a job at all due to my mental health, as is the current situation. To me, none of this is a life worth living.

It’s not just the depression either. If it’s not depression, it’s psychosis, anxiety, or hypomania. It’s a never ending cycle of one mental health problem to another. My CPN says that the reality is I have “severe and enduring mental health conditions”. Hardly reassuring or positive is it but I suppose it is probably true – repeated episodes from which I will have to recover each time. The future is bleak.

So with all these thoughts in my head and the logical conclusion being to kill myself, why haven’t I? Because my friends say they will miss me, I’d be letting them down and family members. I feel as though they would be better off without me but I am assured otherwise. It sounds silly but I wouldn’t want to leave behind my guinea pig, Maisie, she relies on me and has been a companion throughout. I want to work again. But the biggie is that my younger sister is getting married in August. She’s the sister that I practically raised and we are very close. We are so close that it physically hurts me to think about leaving her behind. I would love to see her in her wedding dress. She is already beautiful but I can imagine she will be even more stunning in her wedding dress. So today I have ordered two dresses as my potential wedding outfit. I’m planning ahead despite all the thoughts, feelings and urges to end my life. I need to hang on for a few months. I need to find a way to stay alive. Ideas on a postcard, please.

 

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Self Harm & DBT

Apologies in advance if my thoughts are a little disjointed in this piece, I’m quite low at the moment, which messes with my concentration and ability to form coherent thoughts.

I’m not entirely sure what I am going to achieve with this blog but I feel like a post such as this is long overdue. I started self harming when I was 8 years old. No-one found out until my mid-twenties. It is a coping method that I have therefore used for a long time. I say have used now instead of had because I’ve fallen off the wagon.

During and after DBT, for a period of over 2 years (3 years for overdosing), I did not self harm. I thought I’d put it behind me, that I would no longer attempt to solve a situation or emotion by hurting myself. It was finally my past. It felt good, it felt as though I could achieve anything.

Then my world came crashing down around my ears. I hit a severe depression and self harmed a number of times. I thought I’d put the genie back in the bottle though and it was just a blip but then came the psychosis. The sheer fear the psychosis generated could only be quieted by the razor. I self harmed numerous times all over my body, and severely. Yet I managed a second period of psychosis without harming myself. Was that it? Had I finally cracked it once and for all?

No. This past week I have resorted to self harm again. I have self harmed twice, both times requiring A&E. I hate it, the long wait, the knowing look of the staff. Yet for some reason I feel ok with it in some ways. I don’t want to self harm but it isn’t the end of the world. Yet in other ways I feel like a fraud and a failure. The proud DBT wonder kid getting bitten in the butt.

I have today decided that it stops. It really does. I don’t want the increasing number of scars. My body is a mess and I don’t want to make it worse. I don’t want to have to waste my time in A&E, wondering if I am going to be treated with dignity on that occasion or not. I don’t want to identify as a cutter. It’s not me. I’m a fighter and I want to fight this. How? It’s back to the ol’ trusty DBT skills along with a healthy dose of will power. I have been choosing to cut instead of using skills, now I choose to use skills instead of cutting.

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Change

So, since my last blog I have had another episode of psychosis and the Clopixol had to be increased again to squash it. However, I’m still unhappy with this medication. I have numerous side effects due to this medication including:

• Being emotionally blunted and numb;
• I haven’t cried in a year, which is completely out of character for me;
• Blurred vision, for which I have to take procyclidine;
• A horrible dry mouth sensation;
• Random tics.

The worst one is the emotional numbness. It has robbed me of joy and sorrow. It has robbed me of my motivation and my will to live.

So, I am changing the Clopixol for Risperidone to see if that will better suit me. Apparently antipsychotics all have a blunting effect but the older ones (such as Clopixol) are renowned for being the worst at this. I’m going to give Risperidone (a newer, atypical antipsychotic) a go but I am scared. Scared that the psychosis will return because the Risperidone doesn’t work for me. Scared also of potential weight gain.

Risperidone isn’t like Olanzapine though for weight gain, it doesn’t tend to put anywhere as near much on and if Risperidone gives me back my motivation I will be up and about much more and even get back to the gym thus limiting any weight gain. That’s the hope anyway.

If I have another episode of psychosis* there are other antipsychotics still I can try to help me with that.

So, fingers crossed for the next few weeks or so during and after the changeover.

*I’m still in two minds as to whether it is psychosis or if I am just suppressing reality.

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Numb

This update blog has been on my mind for a little while but the impetus to finally writing it came through a conversation on Twitter about the new film, Inside Out. Surprise had been expressed that I hadn’t cried because of it. Usually anything sentimental like a sad part of a film would get me crying, I’m a highly emotional person. I say ‘usually’ and ‘highly emotional’ but highly felt emotions haven’t been a part of my life for a number of months now and the most likely reason is the Clopixol (an antipsychotic) I am taking for the episode of psychosis I endured for 5 months of last year.

I am flat, numb, living behind a sheet of glass, which the world moves around me and out of reach. I’ve been unable to cry for months and although I can notice things as good, such as a film or a book, I don’t *feel* the enjoyment. I’ve recently been on holiday and people ask me how it was. To be honest, it was ok, just like every other thing in my life. It’s ok.

I say ok because there isn’t really a word to describe me and my life right now. Even flat/numb can’t put across how things feel or rather not feel. I have no motivation and I sleep loads.

The problem is I’ve already reduced my Clopixol dose to the minimum effective dose and I am already having residual or breakthrough symptoms. I recognise to reduce it further would be the wrong thing to do due to the likelihood of the full blown psychosis rearing its head again. That’s a terror I can live without, thanks. In terms of alternatives, I would want a medication without weight gain and Clopixol is one of a very few of them, one of which didn’t work and I’m allergic to one of the others. Apparently all antipsychotics have a tendency to flatten people out like this anyway.

I’m trying to keep doing things in the hope that I will start to feel enjoyment (or even the release of so much needed of tears). I’ve even started to go back to the gym to see if that will give me a boost of energy and enjoyment. Self harm would be a sure fire way to get a temporary release but one I have chosen not to use. So, I’m stuck in this no man’s land of emotions. A medication I take to help the psychosis, and which undoubtedly does work in this regard, is in effect slowly draining me of the will to live.

 

 

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Leaving Behind my Self-worth?

Just a short update. I don’t know really how to explain this but today I informed my line managers that I am handing in my notice. I had spoken to them briefly a couple of weeks ago to let them know I was considering it but today I confirmed it. I spent time with family and friends and have discussed the issue with them. I am also being supported in this decision by my CPN.

This past year I had an episode of hypomania for a number of weeks followed by severe depression for 3 months. I had 2 months stability before enduring 5 months of psychosis. I am now currently in another episode of depression and have been for about a month and a half. I have had a lot of time off work due to these episodes and it is currently impacting on my ability to carry on with my job. In addition, the job itself is impacting on my health. I have had to face the truth that it is now becoming something that is untenable.

Handing in my notice has been one of the most difficult things I have had to do. It has caused tears and panic and much emotional turmoil. Employment to me is really important and I gain a lot of self-worth from being employed. It is difficult for me not to feel like a failure. I am trying to head this off and remember and practise the ideas of self-compassion I was introduced to whilst in DBT.

My plan now? It is to garner a little stability, become involved in the local foodbank at my church, participate in the next level of my Italian classes (ie put some structure into my week) and then once well enough again I will look for employment, perhaps with something that isn’t so emotionally draining or responsible.

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The Mindfulness Miracle

Fairly often on Twitter there is some sneering at mindfulness and mainly because, in the mental health sphere at least, it seems to be all the rage as a cure for all ills. I am acutely aware that it is being thrust upon some people with mental health difficulties in a way which can be unhelpful. However, mindfulness played a key part in me recovering from Borderline Personality Disorder and remains a key part in my life in general and me managing my Bipolar Disorder. In addition, I’m going to be training to teach mindfulness and I want to explain a bit in this blog about what mindfulness is (for me), how it has helped me, and what it isn’t*.

Mindfulness is simply being in the present moment and observing that moment’s experience, without judgment; allowing it to just ‘be’. Such a simple theory, however, in practice it is actually quite difficult to get the hang of and it is just that, a practice. One which must be continued lifelong.

When I had struggles that were labelled as a Personality Disorder (PD) my emotions were extreme and out of control, constantly switching from one to another and, at times, totally overwhelming. Mindfulness (as part of DBT) enabled me to learn to identify what emotions I was experiencing by listening to what was going on in my body and my mind. It also led to me being able to regulate my emotions more effectively so that they became less heightened and had far less of an impact on my life. This isn’t by blocking those emotions but recognising them coming on far earlier than I used to and to allow them to be and respond to them constructively rather than ignoring or blocking them until they become extreme and overwhelming. Mindfulness gives me the opportunity to choose how to deal with my thoughts, emotions and experiences.

Mindfulness also helps me with my Bipolar Disorder. The self-awareness cultivated through mindfulness allows me to intervene in hypomania (well, at the beginnings of it before losing insight) and depression in a way that helps lessen the damage that both of those extreme moods can cause.

However, mindfulness is not a panacea for all mental health difficulties. The practice of mindfulness doesn’t magically “make things better” but gives an individual the opportunity to honour thoughts, emotions and experiences, and respond compassionately and effectively to them. It isn’t something you can force upon an individual by way of referral through mental health services as an only choice. An individual has to want to try the practice and continue to practice it. It is a commitment. I personally don’t believe it is suitable for all circumstances. When I had/have my recent episode of psychosis it felt unsafe to engage in formal meditations but I could engage in informal practice. I was able to adjust this because of my experience and this must be done at all times. Another example would be not using body focused meditations such as body scans when working with someone with eating disorders (as was an example provided on Twitter). Safety is paramount. I do worry that unqualified teachers can cause dangers here and that any course provider must have gone through rigorous training such as that provided by an organisation such as Breathworks.

I feel that I haven’t really accomplished what I set out to in this blog but perhaps that’s because I was hoping to achieve too much with it. For now, at least, I have laid out briefly how mindfulness has helped me and how it can be unhelpful. Further blogs, during my teacher training, are to be expected 🙂

* I will be training through Breathworks in Manchester. They have many resources available on their website: http://www.breathworks-mindfulness.org.uk/ 

Recommended Readings

There’s a mass of literature on mindfulness. The ones set out below are foundation ones that I have found helpful:

Aldina, S. Mindfulness for Dummies (2010) Wiley

Germer, C.K. The Mindful Path to Self-Compassion (2009) The Guildford Press

McKay, M, Wood, J.C, Brantley, J. The Dialectical Behavior Therapy Skills Workbook (2007) Harbinger Publications

Williams & Penman Mindfulness: Finding Peace in a Frantic World (2011) Piaktus

Williams, M, Kabat-Zinn, et al. The Mindful Way Through Depression (2007) Guildford Press.

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#AdventBookClub Chapter 4, Casper

Just a very short one in the #AdventBookClub series.

Chapter 4 of Stephen Cottrell’s book, Walking Backwards to Christmas focuses on the story of

Casper, a wise man. The reading for the chapter is Matthew 2: 1-2, 10-12 (NLT):

Jesus was born in Bethlehem in Judea, during the reign of King Herod. About that time some wise men from eastern lands arrived in Jerusalem, asking “Where is the new born king of the Jews? We saw his star as it rose, and we have come to worship him”…When they saw the star, they were filled with joy” They entered the house and saw the child with his mother, Mary and they bowed down and worshipped him. Then they opened their treasure chests and gave him gifts of gold, frankincense, and myrrh.

When it was time to leave, they returned to their own country by another route, for God had warned then in a dream not to return to Herod.

There was a sign in this story marking an event so (geographically) far away from the wise men but they responded to it faithfully and continually until they reached Jesus (God made man). They were expecting to see the Messiah and that is who they saw.

That faithfulness is something I would love to be able to cultivate in my own life but the problem is whenever something goes wrong (or rather, not how I would like it to go) I find myself struggling to look up towards God and His way. Even when times are not hard I take my focus off God, I become complacent in the knowledge that oneday I will also see the Messiah. But what is it I am missing out on in the meantime? What joy and strength do I miss out on by losing that focus? I hope during this time of Advent I can bring back my focus a little more to God and His way. How great would it be to be looking towards God still at death or the Second Coming?

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