Braaains

Anyone who has suffered through a mental illness knows all too well that it is not something you just "get over" or "snap out" of.  Mental illness is real and tangible suffering.

Need proof?  Here is a link to a very excellent science blog that lists hundreds of recent studies, tests and trials that scientists are working on around the world: The Neuroscience of Borderline Personality Disorder.

The more research that is done on BPD and other psychiatric conditions, the more that science is unfolding the physiological structures of the brain that contribute to their symptoms.

From the bits and pieces I've read so far, when it comes to BPD symptoms, the overwhelming trends are prefrontal cortex and amygdala dysfunction relating to structure and reactivity. 

When we talk about balancing Emotion Mind with our Reasonable Mind - in order to use both and be in our Wise Mind - it's possible to understand the regions of the brain that affect each.

Studies are able to show BPDs often have a smaller and hyperreactive amygdala.  This is the organ in the brain that plays a crucial role in emotional learning, memory and responses.

It's even been demonstrated that the larger your amygdala, the larger and more complex your social circle is likely to be.  This doesn't mean that BPDs are unpopular, but rather that we are more likely to struggle with emotional activities like intense social interactions, and so perhaps do them less.

The prefrontal cortex of the brain (essentially the forehead part) is responsible for the type of executive-level thinking that makes us humans as opposed to just cavemen by giving us the ability to visualise what is not physically visible - for example, the future consequences of making a decision. This means you need this part of the brain to work well in order for decision making, planning, moderating social and emotional behaviours, impulse control and goal setting.

Research in this area has shown that BPDs often demonstrate difficulty in getting parts of the prefrontal cortex to coordinate with other parts of the brain, especially the amygdala.

Generally speaking, this means it's possible to see on MRI scans the physical aspect of the struggle between Emotion Mind and Reasonable Mind when someone with BPD is emotionally triggered.

While it might be some time before we fully understand the neuropathophysiologic (yes, that's a word apparently!) basis of BPD, there is no doubt as to its existence, and no one should ever be made to feel that their mental health is any less "real" that their physical health.

BPD & Object Constancy, Or, Why I Love Presents

Anyone in therapy or studying a form of psychology might be familiar with the concept of "object constancy".  This refers to a person's ability to recreate or remember feelings of love that were present between themselves and another person after the other person is no longer physically there.
 
For as long as I can remember, this has been something I have struggled with.  Even in primary school, I can recall how much I'd treasure scraps of notepaper from class that would "prove" I had interacted with a friend via some scribbles, or any other token or souvenir that could only be attained by being someone's friend.  Photos or presents are ideal.  Whatever the keepsake, I never have enough.  It never feels like enough.
 
This is because of my ineptness at maintaining object constancy.  I always struggle to feel loved by a person unless they are in the process of demonstrating it to me - I just can't feel it unless I'm seeing it, touching it, or hearing it.  Otherwise I feel totally disconnected, and potentially abandoned.

It's not that I don't love or appreciate the aspects of relationships that have lasted over time, it's just that I just can't remember them on my own.  I need prompting.  I have to be reminded of individual events, stories, and resulting emotions from throughout the relationship to get the full benefit of them having occurred. 

I can only imagine how exhausting this is to those who love me.  My relationships are a never-ending quest for the other person to prove their loyalty, devotion, and caring.

But because my brain can't preserve those efforts, it's the emotional equivalent of typing up a Microsoft Word document that can't save.  Every time you close the window, whatever you've written is gone, and you have to start again.

I'm not sure who gets the worst end of the deal with this symptom.  My loved ones, who can never do enough, or myself, given I can never feel permanently loved.

It's entirely feasible that a boyfriend of years has met a new partner since I saw them two hours ago, or that a best friend hates me after one cranky text message, or that a family member has disowned me because I didn't give them a Christmas hug.  It's feasible that people would do this to me, because I could do it to them.

It's that classic BPD trait of being able to "switch" or "split" and see someone as either all good or all bad.  Lacking object constancy is a big part of what makes this possible.  It's easy to switch to hating someone for one wrong move if you're unable to remind yourself of the many, many times they've done something right.

In reverse, I can honestly say that it is entirely possible for me to love a friend I have known for one day as much as a friend I have known for one decade, if the chemistry is right and if I view them as "all good".
 
Researchers have linked problems with object constancy to dysfunction in the area of the brain that deals with emotional memory.  The memories are there, but some parts of the brain just aren't talking to each other for me to be able to access them.
 
Dealing with this symptom is just another case of having to intervene in my thought processes manually, where a mentally healthy person would enjoy it on automatic.  

For me, I find it helpful to carry around pictures and notes from loved ones, as well as any gifts I've been given. Also, on the more extreme end of things, I've got my four closest family member's names tattooed on my back.  Every morning I look in the mirror and am reminded.

If I come up with other ways to deal with this, I'll be sure to post them here.

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!