Last week I attended at conference in London titled ‘The Management and Treatment of Personality Disorder: Evidence Updates’. Perhaps it wasn’t the intention of the esteemed panel but it came across to me as though the expectations of recovery and what that recovery would look like was rather low amongst panel members and not at all comparable to my own expectations of ‘recovery’.
I got the impression at this conference that recovery was about learning to make friends, being able to join a social group and the reduction in ‘depression’ (which isn’t even a part of Borderline PD). This is obviously my broad impression and the reduction of depression point was as a result of needing a specific measurement in a study undertaken by one of the panel members (Professor Kate Davidson of the University of Glasgow), however, there wasn’t mention of people with personality disorder having meaningful employment or a “a life worth living”. One of the panel members (Dr Birgit Vollm of the University of Nottingham), during a question time with the panel, said that the reality is that Borderline PD is a “lifelong condition”. Further, it was explained by Lou Morgan of Emergence Plus that there is inbuilt within their organisation an assumption that at any one time, there will be a need for some of their employees to be on reduced hours or having time off due to PD difficulties.
All of this was uncomfortable to hear and at complete odds with my own expectations of recovery., which has led me to ponder whether my expectations of recovery are too high compared with the ideas and experiences of esteemed professionals with the PD field.
- Have I been deluded to believe getting back into a professional environment (i.e. using my previous legal training to re-train as an IMHA and gain paid employment in that role) is a real possibility when I shouldn’t be aiming to do that?
- Should I be happy that I am no longer self-harming or chronically suicidal and attempting suicide nor having lengthy hospital admissions? Perhaps, that combined with me currently undertaking undergraduate short courses in archaeology together with meeting up with friends is what I should be seeing as ‘recovery’?
- Am I deluded to think that undertaking the KUF awareness training this summer so as to be able to go on to undertake the “train the trainers” course and deliver the course in future is a realistic path?
- Am I deluded to think that this recovery of mine is going to be sustainable? Maybe I’ll be unable to continue my current voluntary work with the CAB and I should be joining a social group and treating myself as fragile, someone who is unable to manage the harsh realities of being (once again) a more fully integrated member of society?
Dr Paul Moran of the Institute of Psychiatry at King’s College London did say that education was a good predictor of recovery so perhaps I’m lucky and my Cambridge University degree and subsequent training and qualification as a solicitor gives me a better chance of recovery. Even so, there remains the idea that ‘recovery’ for that panel appears to be far removed from that of my own.
But even within an organisation of people with lived experience of personality disorder there is a built-in safety system to allow for reduced hours and time off due to PD difficulties. I don’t see myself taking time off for PD difficulties. I’ve had such struggles during my time at a placement with former colleagues at a national law firm last summer and as a volunteer this year at the CAB. Those difficulties haven’t led to me taking time off. Now I understand those difficulties and how to manage them, I don’t see myself as needing time off for those difficulties. Again, am I expecting too much of recovery?
As an aside, in individual DBT session this week it was brought up the reality of having a co-existing condition – statistically given the number of episodes of depression I have had, I’m pretty much guaranteed further episodes (as well as hypomania). This is what I see as potentially necessitating time off work or reduced hours in the future due to how it can incapacitate me in terms of concentration etc.
The conference also made me wonder if the attitudes of professionals can actually hinder the expectations and therefore achievements of recovery for those with a diagnosis of PD. Are there people with a diagnosis of PD out there that could be doing so much more and having a far more fulfilling life but their expectations and goals have been lowered by the expectations of the professionals with whom they come into contact?
Finally, the conference was interesting in a number of aspects and has sparked a few blog post ideas in me so please bear with me whilst I work through these thoughts over the next few blogs.