The Up-Sides Of Mental Illness: Compassion

Recently, a friend shared with me a practice he's been using at the end of each day to boost his confidence, mood and sense of self.  Interestingly, this friend is of good mental health, but still finds it necessary to work on "improving moments" from time to time.

The technique is something most of us have probably heard of in one form or another.  It's to list three things at the end of each day that you are grateful for.

I initially didn't think much of this, until I actually gave it a go.  It's really helpful. 

Some days, even if it's been a really bad day, I am still grateful for something as simple as sanitation.  If this sounds like it's not that big a deal to you, then I am almost certain you have never been to China - believe me, when that pork dumpling platter started to go south on me, and there was nothing but a hole in the ground behind the restaurant where kids were playing... Well, you can take my word for it, access to a sanitation system is a blessing.

I've decided I'm going to use this more often, to get in the habit of changing my perspective on things to see all the angles.

So, I'm starting a series of posts about the positives of having mental illness.

Lately I've noticed that my own mental health struggles have allowed me to be much more compassionate to others experiencing the same.  This seems obvious, but it pops up in places I wouldn't expect.  

Today, when I was stopping by the shops to pick up some groceries, a man was being arrested in the car park and was causing quite the kerfuffle.  

It took four police officers to hold him down, and two more to keep pedestrians away and prepare the police van to transport him.  He was screaming and shouting that these weren't police officers, but were secret police, that had poisoned his water.  Most people were standing around rolling their eyes and shaking their heads.

But my first thought was that the guy probably suffered from mental illness, and that if he had a choice, I was sure he wouldn't want to be in the situation he was in.

I can guarantee that a few years ago, before becoming mentally unwell myself, there is no way I would even have considered that.  I still probably wouldn't have been as judgmental as the people standing around, but it wouldn't have immediately occurred to me how involuntary his predicament was.

In all honesty, I can say that I appreciate being able to access this compassion and understanding for anyone who is let down by their brain in the same way that I have been.  

This isn't to say that I'm Jesus or anything, but I think it actually feels better to experience the emotion of compassion rather than emotions like judgment or disgust.

Is It Hot In Here, Or Is It Just Me?

It's ALWAYS just me.   Today I will be telling you about my struggles with anxiety and... sweating. Please accept my apologies for grossness in advance.

As you may be aware, one of the telltale signs of Social Anxiety Disorder, or any form of anxiety, is sweating.  There are others - such as blushing, trembling, palpitations, nausea, stammering, and rapid speech.  And I experience all of these too.  

Blushing, however, can be overlooked as nerves, or a sign of alcohol ingestion.  I've also had a person tell me they just assumed I put on too much blusher make-up!

Trembling and palpitations can be hidden.  Even when holding a drink, it's possible to steady your arm across your body.  And nausea is also invisible to the naked eye.

Stammering and rapid speech are noticeable, but often written off as behavioural or personality traits.  Ironically, it sometimes happens that people will assume you're so relaxed you aren't even bothering to speak too formally!

But sweating.  Ugh, sweating.  Sweating is the give away.  Sweating is obvious, awkward, and embarrassing.  

It can't be hidden.  It can't be stopped or slowed on cue.  And everyone knows what it means - you're embarrassed, you're very uncomfortable, or there's just something wrong with you.

Here are a list of things that make me sweat:

• Being outside my house - this will often begin during the car journey
• Entering or exiting a store, restaurant, cafe, pub, building, or other venue
• Talking to anyone, be they friend or stranger
• Doing anything whilst being watched, by friends or strangers
• Meeting new people (this one's a killer)
• The point of check out and payment when shopping (also a killer)
• Lastly, the "normal" causes, such as hot weather or exertion

 

When I sweat, it's always concentrated on the eyebrows, forehead and upper lip.  If I'm trapped in the situation and can't leave, this will extend to the eye area, chin, and hairline.

The worse is when I sweat to the point of it being visible in my hair.  It's humiliating.

And that's just my face!  I don't have enough hours in the day to go through all the places one sweats on the body, but suffice to say that anxiety promotes sweat better than anything...

So, if you ever see me in public, I'll usually be dabbing away.  Eventually it will become too much sweat, and the panic about sweat causes more panic, and I have to leave.  My options are usually only the bathroom.

Alcohol makes it worse.  Nicotine makes it worse.  Caffeine makes it worse.  Even a hot meal exacerbates the situation.

Basically anything you do socially can make it worse, but even if I stood there with a glass of chilled water, I'd still be sweating away.

The only time the sweating stops is when I am sitting in a cooled area and not talking to more than one person.  Or when I go home.

 

To be honest, it's horrible.  It gets in the way of every single thing I do outside of my house - work, meetings, university, friends, family, dates, shopping, errands, doctors.  I sweat them all.

And it's not just the embarrassment of being sweaty.  It's also deeply upsetting that your body is misrepresenting who you are to the world.  

Excessive sweat makes it look like I'm a deeply nervous person, or a drug/alcohol addict,  or someone who dislikes being around others.  There is nothing wrong with any of these things - but they aren't accurate about me, and I just want to be myself!  

I don't want to be sweating, I don't need to be sweating, I'm not hot/nervous/drunk - why so much sweat?!  

 

It's because anxiety is your body letting you down.  Anxiety is the firing of a bunch of physiological responses to perceived dangers or threats that aren't actually there.

To try and stop the sweat, I've tried botox, aluminum based skin products, and altering my diet.  No good results.  I've also used more natural alternatives, such Aloe Vera and Witch-hazel based skin products, which have helped a little more. 

And I am working through Cognitive Behaviour Therapy with my Psychologist so I can use better skills in everyday life.

So, that's my sweaty story.  I am sorry to post about something less than palatable, and believe me, it was a difficult post to write.  But I did it because I think it's important to to be speaking openly about symptoms of mental illness, and because maybe one day another sweater will read this, and feel just a bit less like an alien.

Delayed Sleep-Phase Disorder

I thought I would take a moment today to tell you all about another (yes, another!) condition I am living with: Delayed Sleep-Phase Disorder.

Essentially, your body clock runs between two to six hours behind everyone else, evidenced by its timing of sleep.  It sounds innocent at first, but bear with me!

 

Delayed Sleep-Phase Disorder (DSPD) belongs to a group of sleep disorders known as circadian rhythm sleep disorders - where individuals experience chronic sleep disturbance due to misalignment in their body's circadian timing.

    

   

For example, an individual whose circadian rhythm, or "body clock", is delayed may find that their ideal time for sleep is 4am with a rise time of 12noon. 

 

This schedule does not match the typical sleep window of most adults; and thus the main problems of those with DSPD relate to attempting to fall asleep (before their body clock is ready to) and attempting to wake up in the morning (before their body clock is ready to).

 

Now, I know what you're thinking, and trust me - people with DSPD are used to it!

"Just get out of bed you lazy bugger!"

"You're such a night owl!"

"Why don't you just go to sleep earlier!"

  

We spend our whole lives hearing this, because DSPD is a life-long condition.  Since I was a baby my parents would struggle every night trying to get me to bed.  Every.  Single.  Night. 

Sleep disorders are hugely under-diagnosed, because people often assume the problem is just a personal or behavioural trait.

Other than being life-long, the main diagnostic criteria for DSPD include:

• No other problems with length or quality of sleep once asleep,
• Not to be confused with insomnia,  
• If allowed to go to sleep when ready and rise when ready, can enjoy a normal balance of sleep,
• Sleep delay not caused by substances or other medications,
• Can be proven with testing of body temperature and polysomnographic monitoring, for example at a "sleep clinic".
   

Right now, it's 11:21pm, and I can feel my body shifting up a gear.  This is my prime time for creativity, productivity and energy.  Convenient, huh?

 

My body will not fall asleep naturally until after 3am.  That's when it thinks the sun goes down.  And, obviously, I won't get up any earlier than 12noon.

This of course has negative effects on, well, everything.  I'm known for running late.  People ask if we're meeting at our agreed time, or at "Jess time", which allows an extra 30 minutes.

It has caused me significant, repeated problems in attending school and work.

And the treatment for DSPD is - not a lot!  There's nothing that works in the long term, or that "fixes" the problem.  Melatonin and "bright light therapy" only work as long as you're actively using them; once you stop, your body goes back to its ways.  

 

Of course, you need to keep up good sleep hygiene (e.g. avoiding caffeine, regular bed times) but this won't alter the body clock of someone with a sleep disorder.

 

Luckily (sort of!) for me, my current psychological conditions mean I am on several medications, one of which puts me to sleep.  So for now, I can artificially control my bed time. 

 

I just have to aim to have a job that fits into an afternoon or night shift fixture when the day comes that I'm not on medication.  If that day comes!

 

Wising Up To My Old Tricks!

Today I was reading a blog post from a new and different source to what I normally read, and I found myself becoming suspicious of this person and angry at them.

I did my usual trick of trying to Distract by continuing to read the post.  For me, Distraction is a good first step tool to use, as my emotions come and go so quickly it is always worth seeing if they will dart off as fast as they came.

The feelings persisted though.  I realised I had to consciously address them when I noticed myself wanting to react to these emotions.

So I spoke to myself out loud.  I non-judgementally listed how I was feeling and what thoughts those feelings were giving rise to.  Straight away, I was able to tell myself that these emotions were coming from past experiences, where I had been hurt by people who this blogger was now reminding me of.

It's amazing how often the purpose of my emotions turns out to be my brain trying to protect me from a perceived threat or harm.

After realising this, it's hard to be all that frustrated with myself or my disorder.  I mean, in its own way, my brain is just trying to look after me.  It's even kind of sweet! 

But, I know that more often than not, having BPD means my brain is using ineffective or misinformed methods when it comes to emotions and relationships.

I just need to practise rewiring and redirecting these good intentions so that they more effectively respond to what is really happening.

 

Being Right or Being Happy?

Yesterday I found myself in a tricky situation.  I was visiting my Dad, and had naturally parked my car on the street in front of his house when I arrived.  

We were chatting away inside when we heard a loud car horn being beeped and someone yelling.  When we went out to see what was going on, his neighbour from directly across the road screamed several profanities out her car window at us, before driving off in a hurry.

It turns out that this neighbour believes no one should be allowed to park across from their house because it means she can't just reverse carelessly out of their drive-way without looking.  Despite this having no legal standing whatsoever, she had verbally abused my family before about this.

Immediately, my Dad went walking over to this neighbour's house to have a word with whoever was home, and I went with him to share my dissastifaction at being yelled at.

The husband was home and had a conversation with us.  He also preferred no one park there, but didn't believe his wife should have yelled about it.  

In actual fact, it's a completely normal parking spot on Australian roads.

When it became clear he would not shift his views, I had to decide: do I want to be right, or do I want to be happy?

I could have stood there for another thirty minutes debating the point to try and make him agree it's a perfectly valid parking spot.  However, we had family to meet up with, and this would have caused us to run later than we already were.

I had to stop and think about using DBT Interpersonal Effectiveness skills.

I also had to balance the "wants-to-shoulds" - as in, find a balance between what I wanted and what I should do.

I wanted to argue with this man until he accepted that he and his wife were mistaken in trying to enforce non-existent road rules.  (Which they were!)  But, my wants weren't the only things that mattered, and I knew I should have wrapped up the conversation before it intruded on any more family time.

In the end I was able to achieve my main goals as recommended in DBT:

• Get my opinions taken seriously: he was definitely listening to us.
• Get others to do things: he said he would talk to his wife and calm her down.
• Say no to unwanted requests: I made no commitment to park elsewhere given that this is unreasonable, has no legal standing and is not what I want to do.

And wouldn't you know it - as we were walking away and saying goodbye, he THEN managed to slip in TWO apologies for his wife's behaviour.

That was all we had really wanted all along! 

Past Hurts

Today's post, "Do You Deserve Happiness?" by Debbie at Healing From BPD really brought up some big, unexpected realisations for me.

She has written about how many of us with BPD respond to positive experiences in our life with hesitancy, trepidation and suspicion. We have often experienced traumatic events in our past that colour how we see our present and future. We struggle with trusting people and ourselves, and do not believe that we are worthy of good things.

Reading this post really surprised me. I already knew that when good things happen to me, I spend most of the time telling myself that it's only temporary, and miss out on enjoying positive feelings. I just thought of this as being overly protective of myself, and on guard.

But when I stopped to really think about it - I realised there is a lot more going on beneath the surface for me. I am actually telling myself things like:

• "This is going to end or turn out to have been false, like everything."
• "You will ruin this, like you always do, because you are an incompetent failure."
• "Someone you love will ruin this because they hate you and never really loved you back and want to see you suffer."

Whoa. Turns out there's a bit more going on in my head than just mild suspicion.

I am actually telling myself some really toxic things. A lot of it stems from some very traumatic times I had in a past romantic relationship. There might be some of it that comes from another place, but I'm not sure.

Clearly I have some issues to think about for myself. I might need to start by turning my mind to enjoying positive experiences.

This is especially important because it doesn't make sense for me to stop myself from enjoying things like friends, family and personal time because of past trauma in a relationship. It is not even relevant to the present experiences I'm having.

There are also some self-esteem issues that I'll look at, in terms of expecting myself to fail.

Once again, I am deeply grateful for Debbie's blog. And once again, I have lots of work to do!

Coming Out

Recently on Twitter I mentioned that I had been "coming out" to some people in my life about my BPD diagnosis. I've also started using my real name - Jess! - on Twitter and now on here for my blog posts.

This has been inspired, like so many aspects of my journey towards recovery have, by Debbie at Healing From BPD.

Reactions have varied, but whatever they have been, the first few minutes seem to be irrelevant as the person is usually just processing everything during this time. You need to explain it and give them a few moments to comprehend before you get the full measure of understanding and empathy that most people will offer.

In fact, so far there haven't been any "bad" reactions, just different ones. Anything from total surprise, to curiosity, to condolences. Interestingly though, a very common response has been the person then telling me about a loved one who also suffers from mental illness.

I have been genuinely taken aback by how many people already know someone they care about that struggles with mental health.

This shouldn't be surprising, as in Australia statistics are that 1 in 5 people will face a mental health challenge in any given year.

I believe that the more we are open and honest about the challenges we face, the easier we make it for other people who are facing similar challenges. Even for those who may never suffer from mental illness, statistics guarantee they will interact with people who do, and learning about one person can inform their caring and sensitivity towards another.

I also believe that there are benefits in naming a part of you and owning it for the world to see. There should not have to be any shame in suffering from mental illness, any more than there would be for having a heart condition or blood disorder.

Understandably, this doesn't mean anyone should have to shout their diagnosis from the rooftops, walk around in a t-shirt saying "ASK ME ABOUT MY BPD!!!" or begin every conversation they have with a disclosure of their mental health. I have chosen carefully who I am choosing to open up to and in what context. And if someone is just not up to talking about their mental health, then that is just fine too. Everyone is at a different point in their journey.

But no one with a mental illness has chosen to have that illness. We should all be proud of ourselves and the path we are traveling, because it is just a part of life that none of us are perfect. (Except you, dear reader!)

Am I Scared Of Getting Better?

Now that I am discharged as an outpatient and living at home with my folks while I work on my recovery, we are looking at my options for next year.

However, any time I think about recovering and the bigger picture, like future plans, I feel overwhelmed and extremely anxious. I think I'm scared of relapsing worse than previously. At every stage of my illness I have truly thought that it was rock bottom, and every time I have thought this there has always been further to fall later on.

One year ago I was living independently alone, working full-time in an Executive level job, seeing friends not often but when I could, paying bills, driving my car, flying interstate for work or for leisure, planning my round-the-world trip... Just generally keeping things roughly together.

Now my main activity for the day can be something like beading a necklace. And even this can be a challenge - to physically bring myself to outpatient therapy, to ride fluctuations in my moods, to deal with the social anxiety that comes with leaving my room.

I feel like I have lost so much ground, that I don't want to regain it and feel the loss of losing it again. Thinking about this, I have two strategies for tackling my fears. 

1. Opposite Action. This is meant to be used whenever the fear of something is not useful or proportional to the threat. For example, I shouldn't be scared of feeling better, because this is a good thing that I will find enjoyable. So I am trying to chose the actions that a non-scaredy-cat would chose. Today I looked online at rental properties just to get an idea of costs and locations.

2. Achievable Goals.  Breaking things down into achievable parts is useful and realistic. No one is expecting me to wake up one morning and miraculously recover from mental illness. I don't have to immediately fix my life overnight. In fact, this isn't possible. Recovery is done in bits and pieces over time.

It's ok to not be perfect and to go backwards as well as forwards. I also won't morph into a younger version of myself and be back in the middle of a previous crisis, because that isn't possible - the experience that I've gained can't be lost or taken away.

So while my future might not be Easy Street, and there will be ups and downs, I know that this is normal for everyone - even people without mental illness - and that the experiences I've already had will help me deal with things better as they come.

New BPD Diagnostic Criteria

I couldn't resist posting my thoughts on the newly announced updates to the diagnostic criteria for Borderline Personality Disorder.

Alicia Paz runs a very excellent and informative BPD blog, where she has recently posted the Borderline Changes for DSM-5. It has gone from a list of nine criteria of which five must be met, to a list of key areas with sub-categories of symptoms.

To summarise in basic terms, the areas of BPD diagnosis were previously listed as:

• Avoiding Abandonment
• Intense/Unstable Relationships
• Identity Disturbance
• Impulsivity
• Suicidal Behaviour
• Affective Instability
• Emptiness
• Anger
• Dissociation/Paranoia

To summarise in basic terms, the areas of BPD diagnosis will now be organised as:

A: Significant Impairments in Personality Functioning
     1. Self
         a. Identity
         b. Self-Direction
     2. Interpersonal
         a. Empathy
         b. Intimacy

B: Pathological Personality Traits
     1. Negative Affectivity
         a. Emotional Lability
         b. Anxiousness
         c. Separation Insecurity
         d. Depressivity
     2. Disinhibition
         a. Impulsivity
         b. Risk-Taking
     3. Antagonism
         a. Hostility

(Obviously the criteria - new and old - go into much further specifics than that, but to me I find it most helpful to understand these changes by starting with general summaries as above.)

In my (humble) opinion, I think the new diagnostic criteria provides clarity for some of these symptoms by including more details, even if this means more scientific terminology in parts.

Less emphasis on Emptiness does seem useful as although this is a persistent feeling for me it's better explained by listing it as part of a lack of identity and self-direction, rather than the other way around.

Specific thought processes that are outlined in the new criteria, like "worry about the negative effects of past unpleasant experiences" and "feeling threatened by uncertainty" and "denial of the reality of personal danger", seem especially accurate to me.

Dropping the description "difficulty controlling anger" and instead having "persistent... angry feelings" is less helpful in my view. I easily identified with the original definition on this one.

And lastly, even though this is probably just semantics, I am not thrilled about the word "Pathological" being used to describe anything about me.. but, in it's technical use, it does apply.

Overall I think the new criteria explains BPD just as well as the previous criteria.

Doing My Homework

Recently, Debbie at Healing From BPD posted the DBT Emotion Regulation Worksheet 1A and encouraged us to consider using it in times of intense emotions.

I have just taken this advice and have found it extremely helpful, as with all aspects of DBT! 

It has allowed me to think a bit more clearly about what is going on in my head when I re-experience traumatic events in my mind. I hope that over time I will become stronger in dealing with this.

For now, here is my "homework" below. I hope to use this worksheet more often.

Emotion Names:

Hurt, Sadness, Anger, Abandonment, Panic, Anxious

Intensity:

75

Prompting Event:

Reading my journal from a time of distress in a previous relationship.

--- TRIGGER WARNING ---

Interpretations:

No one will ever want to be in a relationship with me, I am worthless. My ex-partner has moved on and is extremely happy. I will never feel this way and will be stuck living in the past painfully forever.

Body Changes and Sensing:

Tight chest, sick in the stomach, mild headache, lump in throat.

Body Language:

Frowning, tensed.

Action Urges:

Contact him to beg him to understand the pain he caused me and still causes me. Hurt myself by cutting/scratching my leg to distract me.

--- END TRIGGER WARNING ---

What I Said or Did:

Filled out this sheet. Tried to Radically Accept my emotions without suppressing or blocking them as this can only make them worse. Mindfully listened to crickets chirping outside.

After Effect of Emotions:

Emotions eventually eased, still felt waves of anxiety and hurt from time to time.

Function of Emotion:

These emotions are trying to tell me that I was treated badly by someone who did not love me and that I need to look after myself because I am still recovering. For me, painful and invalidating relationships should be ended as they are unhealthy and unsustainable.

Who Am I? No, Seriously.

Today I am thinking about the diagnostic criteria for Borderline Personality Disorder that relates to Identity Disturbance:

   "3. Identity Disturbance: markedly and persistently unstable self-image or sense of self."

I spent my two hour day leave from hospital today shopping with my Mum. Shopping is one of my favourite activities, but one that I have to be careful with to make sure I don't become overly impulsive about purchases (impulsiveness - another BPD criteria!) and to make sure that I don't spend more than I have.

However, while I was shopping today I kept noticing little internal struggles about which item looked like my "style" or what sort of "look" to go for. I began to feel really confused to the point of being overwhelmed. 

I realised that I honestly feel I have no defined sense of style for myself. 

I also realised that I am far more likely to feel confused about this if I see examples of other young women who do have a very strong sense of their own "look". 

In this case, last night I was catching up with an old school friend on Facebook, and saw lots of great photos of them and their band. I was simultaneously really glad for her and her career taking off, while depressed that I don't have a similar lifestyle for myself. 

So today when I was wandering through stores, I found myself trying to emulate certain aspects of this friend's style, and feeling even more confused about what I like or don't like as a result.

I have often felt this confusion in regard to many things: hobbies, interests, career, friends, music.

I can remember as a kid waking up one day and wanting to play the violin, convinced this was going to be my new thing, only to lose all interest two weeks and one lesson later. (I also remember my Dad driving two hours to a stockist to purchase the specific violin I wanted, and then of course having to drive there again to return it! My Dad is very lovely.)

This unstable sense of self is apparently classic BPD, and is also why we are sometimes known as "chameleons" for being so ready to alter ourselves.

I am not sure how to tackle this. I know I want to understand myself better, and then be assertive about who I am as well as pursue what I want. I think this is tied in with having better self-esteem as well.

I have started by writing a list of things I am absolutely certain are true about me. I only have a few items on there so far, but I add to it when things come up.

From time to time, I might get some help with this too, when a friend or family member will make an observation about me. For example, "Of course you don't like action films!" I guess I know I don't, but I can be surprised when I'm reminded of some things.

Other than this, perhaps it will all just have to be worked on through experience.. And maybe some more shopping.