Monday, December 9, 2013

Drugs and BPD

I wanted to talk about psychiatric medication that is only available with a prescription.

My "journey" with mental illness started around the time I entered high school, but I only started to receive treatment from the age of 17, as by this stage things had become fairly critical. This was also the age that I started taking antidepressants.

There are many different forms of antidepressants, but the one I was given, Effexor (venlafexine), is what is known as an SNRI. This stands for Serotonin and Norepinephrine Re-uptake Inhibitor. This differs from SSRI's, which most people have heard of, in that it effects two brain chemicals, not just serotonin.

Effexor is commonly used and has been seen to be quite effective in the treatment of depression and anxiety disorders.

Now I will say that to begin with Effexor worked really well. I'm pretty sure that it helped me to actually finish college and function fairly well for the next few years.

The problem occurred when my dosage was increased after a relationship breakup. 

One thing that is fairly common amongst drugs classified as antidepressants as that they often make the consumer feel a smaller range of emotion. It can be very helpful if you experience crippling lows, but it also means that it's harder to feel "highs" as well. While this effect for me was quite mild for the first few years I was taking Effexor, once my dosage was increased it became much worse.

Now just to note, my experience with Effexor cannot be used to indicate what someone else will experience. Everyone's brain is different, and as such it is very difficult to predict the effects that psychiatric medication will have on an individual.

I began to notice that I struggled to feel any empathy, which was previously very natural for me. When friends talked to me about problems, or I watched or read something upsetting, I would have no emotional reaction to it, where as previously I was emotionally moved very easily.

Unfortunately for me, the numbness became so bad that I began to self harm.

I changed medication twice and have been on my current medication for over a year.

Since my diagnosis (and acceptance) of BPD, it has been more difficult to notice whether or not my medication actually works. It is incredibly frustrating as I commonly get asked this question by health professionals and my answer is always "I don't know." 

Also having been taking antidepressants for 6 years, and especially during the years I was really forming and establishing my identity, I honestly don't know what I am like without them, and I'm not completely convinced that I would be the same person now had I not been on medication this whole time.

I have been lucky however in that the health professionals that I have seen since being first diagnosed were very careful about prescribing medication. Too often I have heard of people having medication basically thrown at them, and people being on so many drugs it honestly scares me, especially psychiatric medications.

I have only very recently been prescribed an antipsychotic (quetiapine). This class of drug is commonly used in patients with bipolar disorder to aid in the treatment of mania, but is also used in psychotic and personality disorders, as they can also experience mania like symptoms, or simply high distress.

I was hesitant to tell people this had happened, but it became difficult to avoid as I had to take it at night, at least an hour before bed, and it makes me quite drowsy (it really helps me sleep). This has had a significant impact on socialising (most of which I do in the evenings). It's also quite a horrible name for a class of drug, as people can immediately jump to the conclusion that you are now actually a crazy person, and to be honest I feel like this too sometimes. It's not uncommon for someone to be on antidepressants. In fact, it's incredibly common. But antipsychotics? Not so much.

It's hard not to feel like I'm officially a crazy person now. While I haven't been messed around medication wise as much as many people I know, this still feels like a step downhill in terms of my illness, and only seems to increase my sense of things getting worse instead of better over the last 18 months (if not longer).

Anyway, I made the decision after being prescribed Seroquel (quetiapine) that I would stop drinking alcohol. Upon reflection I know that I am not good at self control when it comes to alcohol consumption, and that more often than not it would cause me to become very depressed, make unwise decisions that were bad for my mental health, as well as spending money that I really don't have. It's already advised not to drink while on anti depressants, so now that I am also on medication that makes me drowsy at night it just seemed like a good time to make that decision. It is hard, but even after only a couple of weeks I am feeling generally better, and have been able to enjoy social activities without drinking. 

I don't like being medicated, but I am personally better off for it.

Diagnosing Borderline

I was not officially diagnosed with Borderline Personality Disorder until very recently.

The thing that I must emphasise about being diagnosed with any mental health disorder is that it is meant to aid the direction of treatment, not be a constricting box that you can't move outside of, and not a life-sentencing label that will damn you for the rest of your life. The likelihood is that someone with a mental illness will have aspects of more than one illness, and there are some illnesses that are very often concurrent because they feed off each other.

Also a mental illness, unlike a physical illness, is not consistent from person to person. The differences in each individual's brain is enormous, and it's important to remember that the same illness can present differently in those individuals.

Borderline Personality Disorder is diagnosed when a person has shown consistent and repeated behavioural patterns in at least 5 of the following ways:
  1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in (5).
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. This is called "splitting."
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in (5).
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
  6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
  7. Chronic feelings of emptiness.
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
  9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
The fact that only 5 out of the 9 criteria need to be met for diagnosis is very important as it can mean a significant variation in the presentation of BPD in each individual. In fact, there are 256 different variations.

There is a great deal of negative stigma attached to BPD. Here is a website dispelling some of the most dangerous myths about Borderline sufferers.

My first diagnosis from a Clinical Psychologist was Major Depressive Disorder and General Anxiety Disorder. I was 17. For several years this seemed accurate, and medication helped me to retain a sense of functionality.

Last year though things appeared to be getting worse rather than better. Then earlier this year my psychologist said that I should look up BPD and see if I felt that I fit into the criteria, and that we would discuss in the following session how to go about treatment if we both agreed that BPD was a more accurate diagnosis.

After a great deal of research I felt certain that BPD made a great deal more sense than depression and anxiety. After talking to my psychologist, we decided that my treatment needed to move in a different direction to be more effective.

I really struggled once I came to terms with being someone with BPD. I had thought of myself as someone with depression and anxiety for so long, and had become to accustomed to seeing myself that way that I had to change my perception of how my illness affected me. Depression and anxiety symptoms are very common in BPD however, and once I realised this was the case, I started to tell people.

While BPD is relatively common, most people didn't seem to actually know much about it, and honestly to begin with, neither did I. So instead of just saying "So hey I have BPD" I included information on the disorder and types of treatment. I also made sure that I had enough of my own information to dispel any misconceptions people had about the illness, and emphasised the individuality of presentation.

I am now comfortable with my diagnosis, and am not ashamed of it. I answer people's questions with frank honesty and am constantly keeping updated with information on research and treatment. I stand up for my rights with the way that I am treated by professionals and keep my supports close and informed.


Wednesday, November 13, 2013

The truth

Two days ago, I told Facebook that I have tried to end my life twice in the last 6 months.

Two days ago, friends told me that they were glad I was still here.

The trouble really is that I am not.

The trouble is that what I want most is to be able to take this pain and fear and rage and loneliness and sickness and turn it into art but the words and pictures are all wrong and the only way I have found is just to say the words that don't make art.

One week and two days ago my father sat beside me in the same room I had been in 4 months ago to have the same conversation I had four months ago with my father beside me and I talked to the nurse and I talked to the pychiatrist but I told my father that I was so tired of being me, and that I had so much hatred for my mind and my body that I wanted to cause it as much pain as possible and I told my father that I felt that noone knew me better than him and I told my father that I was sorry because I loved him.

One week and two days ago I could not get the razor deep enough into my wrist, four months ago I could not swallow the right pills and today I remember that even when I was a child I was convinced I was dying.

The trouble really is that no-one knows what to say to me, that words are too hollow and strange and that sitting with a dying person feels like you are being sapped of all energy and the feeling of watching your daughter cry as the doctor bandages her wrists simply has no words to describe it.

The truth that lacks lyricism is that I am angry that I did not kill myself, and I am angry that I tried.

The truth is that everyone tells me that there must be part of me that wants to live because I made that phone call and the truth is that they are right. The parts of me that don't want to die are the parts held onto with gentle hands by a father suffering from chronic clinical depression who tried to take his own life thirty years ago and a sister who hid her pain from the world for years and a mother who does not have the words or the experience but holds me in her arms like I am the strongest and most fragile thing she will ever hold.

Today I carry my pain on my wrists and my arms and my legs and my ribs and the word that will never go away is

Why

Monday, November 4, 2013

Trapped in the unwell mind (trigger warning: self harm, suicidal ideation)

It's been a really difficult couple of weeks for me. My study schedule is more than twice as big as it was last term, and I now have a casual job to deal with on top of that which is causing me stress for a variety of reasons. Because of the extra stress I have been getting insomnia, and this has put my mental health on a bit of a downward spiral as much as I am trying to hold on to some semblance of sanity.

I thought today that I would talk about isolation and loneliness, because it has been a large part of why I have not been feeling so great lately, aside from the insomnia of course. I say not so great but what I really mean is a decaying pile of misery and numbness.

Now I think I give off a fairly good semblance of being a functional person at the moment. Going to classes, going to work, going to social events, making and going to appointments.

But any time I'm alone, I'm struggling to hold the pieces together. After all the energy I expend being "functional" I'm left with no energy to deal with my own mental decay.

I am currently doing schema therapy with my psychologist. It was developed for people with personality disorders, and the basic idea is to revisit why and when certain maladaptive behaviours and coping mechanisms were formed and try to reformat them. It is emotional and not very easy be any means but it is a wonderful way of learning what has led to such a traumatic existence and how to remodel these horrible things into a healthier lifestyle.

I am basically made of maladaptive schema modes. Angry, hurt, abandoned and punitive. My healthy adult mode exists, but in a very small capacity as it is basically overwhelmed by all the others.

My healthy adult is what I am when I am at school, at work, or in a rare moment of mental clarity where I can focus and organise my life. She is very weak however, as well as being very eager to be healthy and functional. She is the mumma bear who tries to take care of everything.

The rest of the time I am a mess of childlike schemas, scared and angry and paranoid and jealous and self hating, and punitive parent. Adult Ruth only has so much energy and can't always be the one in control when all the others have worked for so long to establish themselves and feed on my illness.

It is very lonely in my head, and often extremely difficult to articulate what it's like. Sometimes, like this week, I became so completely overwhelmed by the noise of all the negativity and the sense of isolation that I ended up in hospital late at night, crying as the lovely doctor from Edinburgh patched up my wrists and wished with all my heart and soul that this wasn't me.

I self harmed again in the same place feeling completely and utterly overwhelmed by how angry at myself I felt, and how much I detested my own existence.

It's often said that most of the time that when people say they want to kill themselves, they really just want it all to end. I know that's been true for me. I just get so tired of trying to do all the right things, all the healthy things, going to appointments, fighting to get into programs, trying to ask for help, but continuously ending up in a place where I feel so alone that I could be on a totally different planet to all the people around me.

There is almost nothing lonelier than mental illness. The awkward silences in conversation. The pitying looks. The awkward comments of children to their parents about the red scars on your arms. The way every conversation is just about how terrible you feel so you stop talking. The way relatively think you're rude for leaving the room. Not really knowing what it is when you ask for help. The shattering feeling you get when you just need a friend to be with you and they are busy and you don't want to tell them that you feel like dying.

I talk to Lifeline. I talk to my psychologist. Sometimes I talk to my friends. I talk to a girl from London who draws amazing comics about BPD and her own struggles with illness. I talk to this blog.

But most of the time, I can't talk. My words get stuck in the tar of fear on the way to my mouth and I just smile wanly.

I am not alone. But I am so lonely that I feel crushed by it, layered under the words I wish people said, the gentle hands I wish had held me, and the people I have scared and scarred because I am sick.

I don't want this.

Wednesday, October 30, 2013

Who am I? - The struggle with identity

When people talk about identity I'm pretty sure they don't really know what they mean. Identity is something that is really important and also really difficult to define. According to developmental psychology, most people go through their "identity development" stage in their teens, sometimes into their twenties. Of course, there are people out there who are probably going "I'm way past 20 and still have no freaking clue who I am!" That's not too unusual, but it is fairly well established that your sense of self tends to settle down by at the latest around 25.

There is also recent evidence that the brain is still doing a great deal of development into the 20's and even 30's. There is a great video on TED (if you don't know about TED then go look it up, it is awesome) on this very topic. Just a snippet of some neat info there.

What I really want to get into is one of the diagnostic criteria for Borderline Personality Disorder:
Identity disturbance: markedly and persistently unstable self-image or sense of self
When I had a look through the diagnostic criteria for myself, as was suggested by my psychologist (she trusts me not to self diagnose) I nodded my head when I saw this one, but when I thought about it later I realised that I didn't really know what I thought identity was, or what it meant to have a "sense of self".

I still don't. And I think most people would say that I have a very strong identity. Perhaps to them I do. But I would strongly disagree.

Firstly, I am a personality sponge. I adapt very quickly and thoroughly to my surroundings and change my behaviour accordingly. It may not be anything new to be a different person depending on who you're with, but it makes a big difference when your mind starts getting confused about which one is really you.

I change my hair colour quite often. I tell people it's because I get bored easily, but that's not really the case. I can't figure out what I'm supposed to look like. My face seems to change with every hair colour change and I never get comfortable with how it looks.

The way I see my body changes regularly. Sometimes I see myself as quite thin, other times I look enormous. Sometimes I can be quite pretty, other times I see an alien type creature. Parts of my body can appear distorted, especially the areas where I've self harmed.

I started wearing makeup and becoming quite adept in it when I was around 19, when previously I had little interest in makeup. For years I've been experimenting with different styles and colours and techniques, feeling like I was expressing myself somehow. Over time I realised that I was frightened of the way my own face looks, and felt much safer putting a mask on than to expose the alien beneath it.

I have strong morals, I know there are facets of my personality that have been pretty much the same, but over the years I have been gradually losing sight of who and what I really am.

Self harm has played a strong part in my dysphoria with my own body. Before I started self harming, which was only about 18 months ago, I was very comfortable in my own skin. I liked my body and what it could do. I wasn't totally happy, but I was still proud. When the self harm started I became very disoriented. I became shameful of my body. I felt disconnected. I could not remember what it felt like to be totally comfortable with myself and who I was and how I looked. I detached.

Speaking with others I know with BPD this is not an unusual position to be in. Accepting yourself and loving yourself is something so completely foreign, like it's in a language no-one has spoken for thousands of years. Your reflection is not an accurate representation. You can't recognise yourself in your own features.

I do not know a place that isn't inherently filled with shame and self hatred. When I feel too overwhelmed by these feelings, I detach, and become numb, or I become highly distressed, and both of these can lead to some very dangerous place.

It's very difficult to feel like "yourself" when you don't even know who that is.

Friday, October 25, 2013

A frank conversation: Self Harm

I want to have a frank conversation about self harm.

I get very frustrated that it's something that is very difficult to have a frank conversation about because it's such a delicate topic for others and so poorly understood. There's too much emotion attached to it and I just need to speak my mind without worrying that I'm going to upset someone. The only person who I can be totally frank with who totally understands is another friend with BPD and is very unwell and difficult to see. When I talk to my psychologist about it I tend to be the one doing the educating. I have to explain why I cut, and I am not the one who needs to know that. I already know. I just want to talk about it.

I want to say that I hate it. I can't look at my reflection without feeling sad. Sometimes I look at my limbs and they don't look like a part of me. What are these strange stripey things attached to my torso? They can't be mine. I look at photos of myself without scars and think "That is what I look like really, these limbs can't be mine."

I want to tell people that I feel horrendously ugly. That when I spend time making myself look nice I am fighting against this sense that I am inherently hideous. I'm putting on a wellness mask. I hide behind a fastidious exterior because on the inside I feel like a freak. I don't want people to say "No you're not, you're beautiful!" It's nice and all, but it's extremely unhelpful. I need someone to KNOW what it feels like to be covered in scars that were self inflicted, to feel like the person in the mirror isn't us, that that thing is gross and awful and alien.

I look at these scars and I think "who did this to you?" I feel so angry that someone hurt me. Then I remember that it was me. I did this. No-one else. And then I feel really confused. Why would I hurt myself? Why would I cause pain to my own body? How could I do that? I am not a mean or violent person. So then I have to separate myself from this person who hurts my body. I am not them.

I split myself into different people quite often. I am not able to genuinely be okay with being both someone who hurts themselves and someone who loves their body.

It has been extremely difficult adjusting to having scars. I was always very confident about my body, especially sexually. I liked how I looked naked, I liked all my freckles, my curves, my boobs and hips.

After I started self harming I became very anxious about people seeing my body, where as before that I was proud of it, almost over confident. It was in such contrast to what I was used too that it really threw my head out of whack (more so than it was already). I didn't understand what it felt like to hate my body, and suddenly I did. So I split myself off from this part of myself. I am not myself when I self harm, I am my disordered self, and I blame her. I love my body; she hates it. This only begins to help me cope with how I look.

I got a job recently. My first job in over 18 months. My first job since starting to self harm. And it's in retail.

It's already getting to a point with the weather that covering up is just not comfortable. But at work, I need to really look the part. My manager doesn't want to ask me to cover them up, but unfortunately it's not for her to decide. I'm the face of the company now. Self harm scars can really upset some people. They can make people really uncomfortable. I know it's really not fair, but I understand that it's necessary.

It still hurts. I don't WANT to cover up. I'm not proud, but it's not anything for other people to be scared of. It doesn't mean I'm any less able to do my job. I know it doesn't look nice. But I go to a great deal of effort to look clean and well dressed because I believe in presentation being important. It's not like I don't care about my appearance. My self harm has nothing to do with how much care I take of my appearance.

I'm just tired of feeling shame. I'm so tired of it. I'm tired of worrying about customers being put off because I have self harm scars. I'm tired of not being able to love every part of my body. I'm tired of feeling so incredibly fucking sad that I have done this to myself.

I have wonderful people in my life who still love me. I have been intimate with people who still think I'm attractive. But it's harder being the person inside this body than the one looking at it.

Thursday, October 10, 2013

How feminism helped me deal with anger

So many ideas for my first blog post! There are certainly many things on my mind lately, but I think what I really want to talk about today is anger. Here is Google's answer to the definition of anger:

Anger:
NounA strong feeling of annoyance, displeasure, or hostility.VerbFill (someone) with such a feeling; provoke anger in.Synonymsnoun.   wrath - ire - rage - dander - fury - irritationverb.   irritate - vex - exasperate - incense - provoke - rile
Humph. I don't know about you but that doesn't really describe anger for me. Anger is like white hot fire under your skin. Anger is furious shaking and racing heartbeat, rushing adrenaline pushing you to fight and scream and break everything. Anger is, frankly, scary.

But here's my question: did our society make it scary, or is it inherently scary?


Mostly we associate anger with verbal or physical violence. So it's no wonder it seems scary. But perhaps the problem isn't anger itself, but the lack of our society's ability to acknowledge and deal with anger as an acceptable and sometimes useful human emotion. From what I can tell, we are all taught to push anger away. Anger is bad. You can't feel anger. That's just wrong.

I am no stranger to anger. I freely admit that I have anger problems. Maybe not quite as obviously as others, but I definitely struggle with it. On top of anxiety, anger is very comfortable in my brain. It has a great deal of support from my brain chemicals. If you aren't aware, those with a mental illness, like myself, have very different brain goings on than a "healthy" person's brain. There are very obvious, chemical and physical differences. Anyway, I digress...

Now, for those familiar with the diagnostic criteria for BPD, outbursts of anger are a thing. Borderline's roller-coaster of amplified emotion can be quite explosive. Personally, I am not one to have outbursts of anger very often. I have learnt over my life, particularly in childhood, to avoid conflict, and also to run in the other direction if I myself felt angry. It has actually been feminism that has really made me connect with my anger and attempt to channel it into more productive avenues (ie. destroying the patriarchy).

It's fucking scary facing up to your own anger. To me it kinda looks like this giant flame with angry red eyes (something like Calcifer but much much worse) and I am just this tiny little human with piddly little arms and squishy bits and how could I possibly fight this thing?

The problem I believe is that we often do try and fight it instead of actually sitting with it and going "so, what the fuck is up with this then?" Obviously difficult to do in the heat of the moment, but getting into the habit of paying attention to your anger, where it is in your body, how it feels and when it happens means taking back control of it rather than fighting it or ignoring it and pushing away (which is a VERY bad idea).

How has feminism helped? I'm glad I asked.


One thing that I've always struggled with in terms of my perception of myself is strength. I tend to view myself as weak, due to firstly being quite a physically small person, female, and also because of my mental illness. It's difficult to feel strong watching people around you doing that whole life thing with apparent ease when you fight a battle every morning to convince yourself it's actually worth getting out of bed today and no, everything is not trying to kill you. When you often get harassed simply because you are a small girl in public.

Feminism came crashing into my brain and told me I was awesome. It told me that I did not have to put up with harassment. It told me that I was a bad ass bitch who was powerful and more than able to stand up for myself and that I had no reason to tolerate bullshit. NONE.

(I must also mention the numerous friends who tell me how strong I am on a regular basis. I love you guys.)

So I go it into my head that instead of running away I would stand up, because I am worth fighting for. 


I may be an angry killjoy some days, but I certainly don't tolerate anything that is not a constructive part of my life, and I do not run away when I'm angry. I channel it. I prove to myself and those around me that my gender, size or illness has anything to do with my ability to fight back.

The more you really look at human emotion, the more obvious it is that we have them for a reason. These reasons are generally related to survival (whether your own or that of current or future offspring).

Anger isn't inherently bad or evil. Anger is a useful emotion that simply needs to be accepted and channelled productively. Talk to it, pay attention to it, accept it as part of yourself and learn how to control it. (I am in the process of getting better at this, so I'm not perfect, but I strongly encourage it none the less!)

Note that I do not see abuse or violence of any kind as productive IN THE SLIGHTEST.