Suicidal ideation and self harm urges

Warning - this post could be triggering for some people. Helpline numbers are posted at the bottom of the page if you need to talk to someone.

I've really struggled today. Driving home today I had very strong urges to drink (alcohol) and cut myself. When I get like that, that is all I can think about. Those thoughts fill up my brain and I obsess about it. Today I kept telling myself 'this is not how I deal with problems and feelings now' and tried to understand why my brain has presented me with these urges.

A few weeks ago I was dealing with almost constant suicidal ideation. It was painful, indescribably so. How can you tell your support people that almost every waking minute of the day you think about killing yourself? That your head is full of images of you electrocuting yourself in the bath, falling and cracking your head open on concrete, gassing yourself in your car, hanging from the garage rafters, slicing your wrists open, driving your car into a concrete barrier/power pole/traffic, drowning in the sea.... That everywhere you look there is more ways to die. And that you fear that, in a moment of weakness when you are worn out from all the resisting, you will give in to an impulse and do something irreversible. When you spend time with loved ones you feel constant guilt about the thoughts you have about dieing. 

So, I'd been having these thoughts for quite some time, two or three weeks I think, when I began to feel quite desperate. It was really starting to worry me that I might act on an impulse and do something I would regret. I brought it up with my psychologist, which is a lot harder than you might think. Trying to get those words out that I was feeling this way and having those thoughts, the feelings were overwhelming my ability to speak or be coherent in any way. Which is another reason it is so hard to talk to my support people and family about things. When I am unwell I am often so full of thoughts and emotions that I struggle to put together words in a way that makes sense to others.

One other thing that I want to make clear - having these thoughts does not mean rational me wants to die. Rational/wise me knows that I have lots to live for, there are things I enjoy and people I love, and that I just need to hang on for a bit until things get better again. Because they do get better. Unfortunately I do have periods of time where I struggle with suicidal ideation. It's been an ongoing issue for me since my teens. Sometimes it's intense and lasts a day or two, sometimes it's nagging thoughts that are around for months on end. This time the length and strength of what was going on for me was wearing me out.

My psychologist was a massive help. He described my brain as trying to protect me. I have a problem, which is that I was having a depressive episode. This was making me miserable. My brain sees the problem - misery - and provides the solution - death - for me. But what it doesn't understand is that by giving me death as a solution it promotes further misery, as another part of me desperately doesn't want to die. So I have the two sides of me - depression/misery/suicidality, and the love for my family and friends/hope for the future - locked in conflict with each other. The guilt and shame I feel at having these thoughts effectively strengthen them. My negative emotions start to escalate leading to further misery, which causes my brain to further bring forward the 'solution' of death/suicide.

By thinking of my brain as this benevolent force trying to using black and white thinking (ie here's the problem, there's the solution) to help me, I could feel compassion towards myself and it completely changed my perspective on my suicidal thoughts and urges. Now when I get those thoughts I can understand it is my brain just providing me with what it thinks is a good solution to my depression. My brain is trying to help me end my suffering in the most immediate way. And now I have to teach it that life is worth living, even if sometimes it is messy and uncomfortable and it hurts.

In the same way I have worked with my psychologist on my binge drinking and self harming urges. These urges often pop up when I am feeling other negative emotions because over the years my brain has learnt that negative feelings and emotions are intolerable. So it provides self harming behavioural urges as a coping mechanism so I don't have to feel horrible things I don't want to feel. Pretty clever when you think about it. My brain has taught itself that it doesn't like anything negative and that it should get rid of those feelings, emotions and experiences at all costs. Even if that involves harming myself or killing myself.

So today when I was having a rough time with wanting to binge drink and cut, I could tell myself that I must be feeling something I didn't want to feel and that there are healthier ways to deal with my feelings. I'm tuned in to my feelings in that I feel everything x100 - joy, sadness, anger, etc. I know what I'm feeling as I'm usually feeling it incredibly intensely. But I often don't know why, what was it that caused me to feel that way. I find that confusing and alarming in itself, to be confronted by these big feelings and have no idea why.  

Today's feelings were brought to you by..... I don't know. Probably a combination of things. I'm unsettled at the moment as I have been thinking about starting a business. Or studying art. Or tech writing. Or anything else. Or.... And that's the problem. One minute I have an idea and am completely taken with it, researching the hell out of it and obsessed, unable to think of anything else. And the next minute I'm off on another tangent thinking of something else. A million thoughts are going through my head, and while I'm mentally walking through what it would be like to study again, several other concurrent lines of thought are going on - what business would I set up, how much would it cost to fund, could I get a student loan for study, should I give art lessons, how about buying a tripod and making you tube videos..... 

Another thing that's bothering me is something that was said to me about Little G. I agreed for us to take part in a research project being done by a service that supports kids who have parents with mental health and addiction issues. Which is fine, I did my interview, she did hers, all went well. But the psychologist who interviewed Little G made some remarks about how she presents and what her view is on Little G's diagnosis. And I don't quite know what to do with the information she presented me with. It hasn't come from a formal assessment so its an opinion, but it's one that's thrown me into a tail spin as basically it equates to the ASD diagnosis may not be right and there is actually something else going on with her. And that something else should be looked in to.

I'm not sleeping at the moment which is never a good sign. The last week or so, I haven't turned out the light before midnight, and most nights not before 2am. I get up at 7am so it could be worse, but I should really be in bed (light out) by 10.30pm as sleep is such an important part of my self care regime. Problem is that I can't bring myself to follow my self care regime at the moment.....

I'm also bored at work. Which is not good for me either. I need to be mentally occupied and challenged otherwise all the other thinking takes over (effectively what's happened) and my brain goes a million miles an hour in a whole lot of different directions. I have a lot of trouble concentrating when that happens, and I also tend to over think and obsess on things. 

So there's quite a bit swirling around in my brain and I guess maybe the self harm urges are trying to tell me that I am overwhelmed. That I need to try and get some sleep, eat some proper food (not just cereal) and try and stop thinking. Use my meditation and mindfulness techniques to get out of my brain and into my life (got that line from my psychologist lol). The trouble is finding the motivation to do those things when they are the absolute last thing I want to do. I have to just keep telling myself I want to be better so I can be a good Mum, family member and friend. And lead a life worth living.


Suicide - read this first

Coping with suicidal thoughts

If you need to talk to someone:

Free call or text 1737 any time for support from a trained counsellor. 

Lifeline

0800 543 354 or (09) 522 2999

Youthline

0800 376 633

Samaritans

0800 726 666

Family and BPD

My Mum, Dad and sister are doing a course at the moment called Family Connections which is for family of people with BPD. They learn about BPD and they get skills training and support. Dealing with someone like me who has a mental illness is tough and I admire them for being there for me, providing me with support and going along to get further educated, and get some support for themselves.

My family have seen me at my worst. They’ve had to scrape me up off the floor when I am drunk and covered in blood. They have been called the the ER after I’ve self harmed, tried to commit suicide, and taken an overdose. They have visited me when I’ve been in the psych unit. I have called them in tears telling them I am about to harm myself. I’ve turned up on the doorstep so emotional I can’t speak except to cry. They’ve held me as I’ve rocked, and sometimes been beside me as I’ve attempted to communicate with psychiatrists, nurses and the crisis team. They’ve looked after my daughter when I’ve needed help, cleaned my house, done my lawns and helped me get things back on track when I’ve fallen apart. They come over with dinner every Monday night to help me out.

Families get a raw deal. Mental health professionals often put the burden of care back on to families, without giving them any support or explaining the system to them. Families are sometimes limited in the amount of knowledge they are given due to privacy reasons, and they are expected to care for very unwell and sometimes suicidal people. Some of the things they have seen would probably cause PTSD in healthy people. They often exist under chronic levels of stress when the person they love has a mental illness, and I imagine often feel very helpless as well.

BPD itself is a disorder that causes chronic relationship problems. I can be extremely difficult, illogical, irrational, overly emotional and unstable at times. I know my disorder better than most people (I’ve done lots of research), and I still don’t know or understand where it stops and I begin. On top of that I have dysthymia (chronic depression) which means I am basically depressed to a greater or lesser degree all the time. Trying to communicate with me can be like walking on egg shells at the best of times, and I could explode with all of the best intentions from everyone.

This puts intense strain on the family dynamics. I am an adult, and I try so hard to be a complete and competent one. I am in my mid 30’s, I have a child, I have a professional job. But I also need a lot of help and support sometimes, due to my mental illnesses. I get mad about that. I hate asking for help. I try to be grateful that my family are there and that they are willing to help me and do things for me. But I wish that I didn’t have to put this burden on them.

I’m sure that on their side of things they probably feel equally conflicted. How to provide support when I am prickly and difficult, what they are supposed to do with me when I am very unwell and can be incredibly uncooperative, what level of support is appropriate - when to back off and when to help out. How they can have their own lives and be free of some of the stress.

So I admire them for all that they do for me, and especially for committing to 12 weeks of learning more and receiving some support through the Family Connections program.

A couple of helpful links:

Family Guidelines
Helping someone with BPD
For Loved Ones

The last few months part 4

Welcome to part 4...

Trigger warning........there’s quite a bit of cutting at the end of this. Please be safe and don’t read if this could trigger you in any way.

So back to August. I’ve got all this turmoil going on in my life. I’ve had a complete meltdown, discovered I hate myself, am slowly decreasing my dosage of all my drugs, and I’m still pretty bloody miserable.

Work stuff happens. So much work stuff. Stressful things like clients getting mad at me for things that aren’t my fault. Work piles up and I can’t get through it and don’t know what to do about it. I can’t seem to get anything finished and every day someone emails or calls to ask where another piece of work is that I haven’t finished.

Meanwhile, my daughter is having some issues of her own. She’s often very sensitive to my moods and for whatever reason she’s having some emotional issues of her own at the same time. She’s crying a lot, very clingy, wetting the bed constantly (not wholly unusual - she’s not nighttime toilet trained even though she’s 8 but she’s wetting through her pull-up) which is causing me a lot of washing, and she’s basically refusing to do anything she’s told. I know it’s a relationship/connection problem - she’s reacting to my mental unwellness But I can’t seem to get back on track to do anything about it.

Self harm is still calling to me all the time. Suicidal thoughts are constantly with me. I get in the car and think about what it would be like to gas myself in the garage. I drive down the road and notice stuff I could run my car into. I drive by the sea (which is everywhere as my city is a series of peninsulas) and think about drowning. I’m constantly thinking about cutting, drugs, electrocuting myself. It’s tiring, all these thoughts of self harm and death.

Alcohol is my nemesis at this point. My body physically craves a drink, but having one lowers my defences and is a slippery slope to doing something I’m trying so hard not to do. But, after achieving something at work I feel like I could do with a drink to celebrate. I call in to the liquor store on the way home on a Friday night and buy some vodka and e-cigarettes.

I always try to take the appropriate positive actions. This time I read books, had a bath, got someone to take my daughter so I could have some alone time. I tried to go to bed early and get more sleep, and listened to music I enjoy.

On Sunday afternoon my thoughts were all over the place. I would feel momentarily calm and then get worked up and agitated about something. At the time I wrote “I don’t want to be me anymore. All the stress and the constant struggle. I’m trying to do the right thing but it feels like no matter how hard I try I always fall short”.

One beer turned into two. One temazepan became two. I did some cleaning. Didn’t feel tired in the slightest so smoked, drank some vodka and had another temazepan. I was getting manic, cleaning the house and dancing around. This was the opposite of the sleep I was craving, so I took more temazepan and drank more vodka.

That’s when the blades came out. Just so I could get some relief. A bit of cutting, some more vodka and another temazepan or two for the hell of it.

Things get a bit crazy. I dance in the kitchen and the blood running down my arms goes everywhere. I for some reason think this is funny. More cutting, dancing, drinking and taking of drugs ensues. I don’t care about anything anymore. I don’t care anymore. I feel like I can see me from the outside and the absurdity of what is happening but I’m powerless to stop and I don’t want to anyway.

I start drinking vodka straight from the bottle and slashing myself randomly with the blade. Arms, legs and stomach.  Take handfuls of drugs with the vodka. I am still trying to clean up the blood but I keep falling and hitting my head on the cupboards. I suddenly realise I have probably taken too many tamazepan and have a bit of a panic. I won’t be able to wake up for work tomorrow. That’s how screwed my mind is. I don’t want to live, and in fact am deliberately harming myself because I can’t cope, and then the responsible part of my brain is worried I won’t wake up for work. Never mind that if I was dead I wouldn’t make it in...

I rang the crisis team. I didn’t want to but I am started to get weirded out. My thoughts and my body aren’t connected anymore. The ambulance come and take me to hospital. For a while I refuse to let them ring anyone but when I start vomiting I want my Mum. She comes and sits with me. A nurses glue up the worst of the cuts while we wait for the crisis team. About 3 hours later they finally arrive. “There’s no beds so you’ll have to go home”. I feel weird about this. I don’t want to leave the safety of the hospital. Home is where people are, and the means to hurt myself. Mum takes me back to their place, I have the day off work and then back to work on Tuesday. No one from the hospital or mental health calls to see if I’m ok. I don’t know what to do. I still want to die. I feel guilty about what I did but not enough to regret it. Life goes on. Nothing’s changed.

The last few months part 3

So here’s part 3

After the major meltdown I had where I hit people and threw myself into the sea, I was still struggling massively with all these feelings. I worked through some of this stuff with my psychologist and tried to start identifying where it was all coming from and why I’d had such a major reaction.

I knew I did not have a good opinion of myself and that made me very dependent on feedback from other people. He helped me see that I felt that I was a horrible person (my core or true self) and I was unconsciously trying to cover this up all the time. I would try and try and then fail and beat myself up for not being good enough. I was looking for external validation, and when I was rejected it felt like my whole world was collapsing because that was reinforcing my core belief that I was a horrible person who didn’t deserve any better.

I don’t like myself much. I often feel like I am playing a part. Like the facade that I present to everyone is a cardboard cut out and I’m just hiding behind it, hoping no one will notice there’s no substance to the part I am playing.

This also contributes to my issues with identity. If you don’t trust yourself or your own opinions then how do you figure out who you are. I feel like I will put on a personality and try it out, adopting the clothes, music, mannerisms etc and then let it go. Like maybe this is who I am, oh no, maybe I’m like this person over here...

But here’s the problem. Knowing this stuff doesn’t make it any easier to live with. And in some ways it only makes things harder because I’m aware of how much work I still have to do. Just because I know I hate myself doesn’t mean I know what to do about it.

As time goes by and my experiences of being rejected get repeated, I build fences around my emotions to protect myself. The more times I’m smacked in the face by how much I hate myself, the more my subconscious does to not have to experience that again. I don’t get close to people. I don’t let people help me. And I certainly do not depend on anyone for anything. I don’t deserve anything from anyone, and other people have only let me down in the past and caused me pain. Better to be by myself.

Yes, I can see what a sad situation this is when I write it down, but it does make logical sense and it certainly makes a lot of sense to my subconscious.

And this is where self harm rears it’s ugly head again. There’s several ways it helps in this situation. I don’t want to feel painful emotions so I do something to cause myself pain. I hate myself, so I punish myself by self harming. And I feel pain emotionally and want to see it physically manifested, and I draw pleasure out of turning emotional pain into physical wounds.

Yes, I realise how unwell this makes me sound. But the drive to self harm is really really strong and this is why. It’s like an addiction. Feel a bad feeling = self harm and it will go away. Hate yourself = punish yourself by cutting and feel a bit better. Cut yourself = get satisfaction from having physical scars instead of pain inside your head.

I’m going to have to write part 4 I think. Still got more to say...

The last few months part 2

I wasn’t going to post this but then thought this might give some perspective on how I was feeling back in August. Here goes:


I know I haven't written much recently, but it's not been because I haven't wanted to. I am currently struggling with an episode and it's hard to know what and how much to share. I started this blog to help people like me, to share my experiences in the hope that it might make at least one person feel less alone in what they are going through. And also to increase understanding and awareness of what it feels like to have a mental illness. Stigma is a very real problem and I hope that if more people have understanding and empathy then the shame around having a mental illness will decrease. But, I do have to be aware of the consequences of baring my soul to the world - on my job, my child, and my family. It is a scary thing to expose my innermost thoughts to scrutiny, and I have to hope that by doing so I don't inadvertantly hurt anyone I love.

So, with that in mind, here goes...

I have been very unstable for about the last six weeks. I'm not sure why, sometimes these things happen, but I suspect in this case it was a build up of a whole bunch of stressors. I have job stuff, family stuff, financial pressure, health issues, my daughter's challenges and some personal things going on, and my breaking point is a lot lower than other people's. 

In addition to all that, my latest psychiatrist decided a while back that I was over medicated, and I've been on a plan for the last 6 months to reduce my medications significantly. I'm down from 1400mg of Epilim to 600mg per day, and 375mg of Venlafaxine to just 150mg. I'm completely off Temazepan and Quetiapine now as well. Whether that makes a difference is hard to tell. My psychiatrist tells me drugs are ineffective for BPD, though I have chronic dysthymia which is why I'm still on an anti-depressant. I personally think the Epilim (a mood stabliser) was actually helping flatten out the ups and downs in my mood, but I am willing to try and decrease dosages and see what happens. One of the side-effects of being on so many drugs at such high doses was the massive weight gain I've experienced, at one point I put on 30kg from Lithium in just 4 months (I was on Lithium before Epilim). I'm hoping that with a decrease in dosage I'll be able to drop some of the extra weight. 

Whatever the cause, I've been very unbalanced in the last couple of months. I struggle to sleep at the best of times, and my sleep had got completely out of sync. 

The last few months

And here I am again writing about how I’m back from my extended break.... I actually wrote a draft post about this about 2 months ago and then never posted it. Things have been....complicated.

It’s hard to write when you are in a down and don’t know how to turn things around. It’s also hard to write when there is a lot that you want to say and you can’t say it for fear of hurting someone’s feelings or making a situation worse. There had been several big things happen in my life that I couldn’t write about and that’s blocked all my other thoughts.

One of those things has been my relationship with my sister and her now husband. I won’t go in to details, but suffice to say there was a breakdown in communication, several arguments with him and things haven’t quite been the same since. I got un-bridesmaided and in-invited from the wedding in Rarotonga....unfortunately I’d already brought tickets at that point. It wasn’t just me, the rest of my family were also tarred with the same brush, and things have been very awkward ever since. We attended the wedding but the relationship between us and my sister/her husband is still very much tentative and none of the issues have actually been addressed. I’m finding that pretty hard as I am normally a ‘hash it out’ type of person, but my sister prefers to brush things under the carpet and pretend they haven’t happened and she’s the one calling the shots here.

One of the big reasons this has triggered me so much is my particular sensitivity to feelings of rejection. Throughout my life I have often done things to upset other people and they have cut me out of their lives, without an explanation as to what I have actually done. Due to my mix of Asperger’s and personality disorder, I genuinely don’t know or understand what has happened to cause this, but I end up terribly hurt and feeling completely rejected. This is a repeating pattern in my life, and the more it repeats the more I am inclined to withdraw from socialising and put up walls to protect myself.

In my family I am known as very independent, but one of the reasons I am so independent is because I feel accute pain if I open up and then am rejected in any way. I find it incredibly difficult to tell other people what is going on in my head or how I feel, and I never ever ask for help. Partly because someone might laugh at me and partly because I need to prove to myself that I don’t need anyone else. If people reject me then who needs them? I can do it myself.

One of the ways this pain manifests itself is obsession with what has happened to cause the rejection. My previous psychologist fired me as a patient more than 2 years ago and I still frequently think and wonder what caused that and what I could have done to prevent it, and what I would say to her if I saw her now. It’s hard to let go because I opened up and told this person my darkest, innermost thoughts and then (for me) out of the blue she said she couldn’t help me anymore and that was it. After over a year of therapy. I ponder over this often. I get out the memories of our last few sessions and see if I can try and make sense of what happened. And I still can’t after all this time. But that doesn’t stop my brain from turning this problem over and over to see what the answer is. Time has dulled the pain slightly, but it still hurts a lot. Every time I think about this I feel a portion of that rejection all over again.

So when my sister, one of the people who is supposed to be there for me, rejected me it hurt an incredible amount. But what hurt the most was my perception that they (mum, dad and my other sister) cared about her much more than me. I’ve been in this position before where I had an argument with both my sisters and they didn’t speak to me for months, one of them even moved to another city in that intervening time and didn’t say goodbye. And no one seemed to miss me or care that much. But all three of them were deeply upset by this situation and pursued resolution with my sister. I felt that this meant they cared for her more than me. Another rejection, by my own family.

This boiled over one night when the four of us were having some conversation about this all and something got said about my behaviour. I know I am often completely erratic, I’m difficult to be around and I fly off the handle a lot (working on that), I know that’s part of my illness but I also know it hurts people and destroys relationships. I completely over reacted, hit my sister several times, punched my Dad, bit him, stomped on his feet. He held me in a head lock and I screamed right in his face. I was screaming and screaming, feeling a complete lack of any control. I just wanted to hurt and be hurt.

Later, I walked off into the night and got in the sea fully clothed (I did take my shoes off). It was the middle of winter and I had jeans and a t-shirt on, no jersey, and I was standing in thigh deep water thinking about drowning myself. A very low point in my life.

This incident scared me. I was completely out of control. I could see the red behind my eyes and all I wanted was to feel physical pain to match the mental and emotional anguish. I’ll never forget the look of terror in my sister’s eyes though as she cowered in the corner after I punched her and pushed her over. And my father physically restraining me.

I’ll continue this in a follow up post shortly.

BPD and identity

I've always had a lot of trouble figuring out who I am and what I like. In my life I've tried a lot of things but very rarely settled to any one thing for longer than a year or so. I constantly seem to question who I am, what I like, what my values are and what I want out of life. I often feel hopeless and directionless because I can never quite seem to grasp what the purpose of my life is and what I should be doing with it. This is not just about career direction, but hobbies, friends, relationships, goals and values.

This is a fairly common problem for people with BPD. When you oscillate between liking yourself and feeling safe and secure, and hating yourself and shutting yourself off from people, you feel like you can't get a grip on what your opinion of yourself is, never mind anything else. 

I have a very short attention span and get bored incredibly quickly. I am lucky in some ways that I have been able to find a career that is mentally stimulating, and has just enough routine to make me feel secure and quell some of my anxiety while also offering enough variety that I don't get too bored and switch off. I have been at my most depressed and mentally unwell when I have had to work at jobs which were not mentally challenging enough. Strangely though I had no problem being at home on maternity leave, although I'd say that was because my daughter did a very good job of providing variety and challenge for me!!

One of the things I have found very difficult to live with is my inability to figure out what my purpose is in life. I have spent numerous hours devoted to trying to understand why I was put here on this earth. As is my habit I have researched this question in the library, and also spent time trying to understand and define my values, read up on altruism and gratitude, attempted to meditate on it, investigated various religions, and questioned a number of people about what they think the meaning of life is. Logically I understand the answers and points of view presented to me, but none of them spoke to me or felt like they were 'my reason'. This can be incredibly depressing, as my life is often a painful chaotic mess of emotions and their destructive impact on the people I care about. I need to feel like there is some reason for enduring it.

I see other people taking action for things they believe in, making a difference for others, practising their religious beliefs, following their dreams, or doing things they enjoy and I get jealous. I love that people I care about are doing these things. But I wish I had certainty about what I believe in or want, or enjoy. Sometimes I feel like I have a strong opinion, only to feel the opposite two hours later. I enjoy doing something but then never want to do it again. Or like the idea but feel no motivation to follow through. I'm capable of loving something one minute and then hating it an hour later. Or getting bored and abandoning in the process or project two steps in.

In the past I've often felt like I am acting a role, saying and doing what is expected of me. When I had my major depressive episode in 2013/14 I remember saying to my psychologist that I felt like a cardboard cut out. That I was presenting this face to the world but there was nothing behind it, no depth to it. I say things that are certainly true in that circumstance but not necessarily how I feel, because I don't know how I feel. Or how I feel changes like the flick of a switch so I can say something to one person that is the truth but regret what I said or feel like I misrepresented myself later. This can feel to people who don't have BPD that they are being lied to or manipulated. But for me, I certainly don't intend to lie, and at the time I am telling the truth. It's just that I'm erratic and very prone to changing my mind half a dozen times in the following few hours.

The stigma of BPD contributes to identity issues. There is the expectation that you just get on with life when you have a mental illness. You don't own up to it and you certainly don't make other people feel uncomfortable by explaining what is really going on or how you feel. You pretend that everything is fine and you suffer in private. This is seen as the acceptable way of coping with a mental illness. Then there's the argument that you can 'over identify' with your illness. That instead of seeing it as something you have, like a heart condition or diabetes, you see it as who you are. People with BPD often call themselves borderlines, defining themselves by their illness. I know I've done this myself in the past, and I think in part it's because having BPD is about identity, it is a personality disorder after all. Identity is all about who you are and what you believe in. But the danger is that in identifying with the illness that you negate the possibility of recovery. Recovery is possible for some people, and there is a percentage of people who do the therapy programs who will recover enough not to meet the diagnosis criteria anymore.

One of my goals is to not focus too much on who I am and what my purpose is. A little bit of self examination is a good thing, but too much navel-gazing makes me feel adrift in a vast sea of possibility and raises my anxiety level. Enjoyment of the journey is still a worthy accomplishment.

Ka Kite Ano

Distress tolerance and crisis survival

I haven't written much recently as I have been very busy at work and at home, and very stressed. My brain feels like it's been scrambled up and on overload. I've been having a lot of trouble staying regulated and working really hard on my crisis and distress tolerance strategies.

It's the busy season at work and because this coincides with winter (not my best months) and winter sickness, I often end up pretty depressed and off balance during this time of year. For me, the combination of working longer hours, less daylight, colder temperatures, more rain/grey days, and the occasional virus mean I really struggle every winter. This winter started better than most - it's the first one in about 3 years where my daughter and I have stayed in our house all winter by ourselves. Usually I have an episode in May or June which ends up with the two of us spending a month to six weeks staying at my parent's place till I get myself sorted out again. But this winter I was determined to try and head that off before it started, and concentrated on using all my distress tolerance strategies I've learnt in therapy to stay well.

I feel like I am finally making some progress in learning how to tolerate and work through my emotions. I see my primary illness (BPD) in simplified terms as being emotionally immature. Meaning that I have these intense emotions and instead of accepting that everyone has emotions and letting myself feel them, I panic and try to push them away by distracting myself or using other crutches (food, alcohol, etc) so I don't have to feel anything. In the past I have massively over committed myself, or taken on huge projects, trained for endurance sport, over scheduled myself, worked large amounts of overtime etc in order to distract myself from thinking or feeling anything. Whenever something that made me upset or uncomfortable happened I would just fill my life with more stuff to get done so I didn't have to think about it. This worked about as well as trying to hold a beach ball under water. You can only do it for so long and then the ball shoots up, often hitting you in the face as it pops up.

One of the major parts of my therapy has been to admit that I have feelings just like everyone else, and try to tune in to what the physical sensations are in my body, and let them come. At some point in my past I have absorbed the idea that emotion (and showing emotion) is bad and weak and wrong, and have spent so long denying I have emotions I had become unaware of what they felt like. This is not to say I did not know sadness or anger, but that every time I had those emotions I subconsciously told myself there was something wrong with me and I must get rid of them, and did everything I could to do this. With my history of depression stretching back to late childhood, it is easy to see how every sad feeling might cause some panic in case it was a sign the depression was back. And in suppressing my anger I turned it in on myself, told myself I was unlovable and the cause of everything bad and wrong, thus causing myself to become depressed. 

This is an extremely simplified version of some of what probably caused me to become the way I am. A sort of extraordinary response (due to genetics most likely) to things which for most kids would have been water off a duck's back. Like 'harden up' and 'don't be a cry baby' and countless other less than empathetic responses to a variety of situations.

It's taken me years to begin to unlearn my subconscious responses. First I had to start with recognising when I was being triggered. What sorts of things would trigger me. And then my body's physical reaction to being triggered. The problem with this though is that when you start to tune in to what triggers you, you then become hyper aware of when you are triggered. And that's where learning distress tolerance and crisis strategies come in. Once you have been triggered and you want to deal with your emotions instead of stuffing them back down, you've got to try and work out what to do with those emotions. Pages 10 - 30 of this workbook have a comprehensive guide to all the different strategies. There's a huge range of activities and strategies that you can try, and therein lies one of the problems. You've got to try them to see what will and won't work for you.

The thing with distress tolerance strategies is that you can't expect to feel better when you are doing them. You may not feeling better at all. The purpose is just to stop you from doing the self destructive or self harming behaviour you have been using to deal with your emotions up to this point. If you'd normally drink lots of alcohol every single night because you feel like crap, then distress tolerance will give you something else to do instead of drinking, but it doesn't remove the reason why you were drinking in the first place. It took me a long time to figure that out. The strategies that work are the ones that help you deal  with your emotions in a more positive way, not take them away entirely.

For me mindfulness is probably my number one go to strategy. It's too big of a topic to cover right here right now but suffice to say that I find most of the other distress tolerance strategies work ok if I have just had a one off bad day, or have one or two things bothering me, but if things have built up and I'm having a particularly tough few days I need mindfulness first before anything else.

Crisis survival strategies kick in when I am so strongly triggered I want to cut myself, or am thinking about death/suicidal ideation. This for me looks like putting one foot in front of the other, just coping with each moment, each minute, each hour. It's focusing on the big four each day - eating, sleeping, exercise, hydration. If I don't eat healthy food, get enough to drink, get enough sleep or do at least a little exercise then I will feel worse and am more likely to make self destructive decisions. This is pretty hard when I'm unwell, but essential to focus on.

Then I have the things I do when I'm right at the point of doing something really stupid and distress tolerance isn't enough. This is called TIP and for me it's holding ice against my skin, submerging my face in a sink of cold water, intense exercise in the gym (intervals). It's designed to try and change my body chemistry and turn on the survival mechanism in the body by stimulating the "dive reflex" and shutting down functions not essential for survival (more on this here). I'm not a big fan of progressive muscle relaxation (the 'P' of TIP), mostly because I am usually far too agitated when I am in this frame of mind to use it. I seem to be unable to sit down and focus when I'm in this state as I'm often pacing,  crying and muttering to myself. Other people seem to find it helpful though.

Anyway, enough from me for tonight. Ka Kite Ano!

Progress is a series of tiny steps

It's been a while. I was pretty unwell for a while there and really struggling. When I felt ready to write again I had accidentally logged myself out and couldn't figure out my password, and Blogger couldn't verify my identity so I was unable to change my password to get back in. Thankfully I eventually figured out I had been using the wrong email address to try and log in.....

Anyway, that aside, it's nice to be back writing here again. I have written some stuff while I've been off Blogger so it's not like I haven't been writing at all, it just hasn't been quite the same.

The last month or so has been really hard. I've felt very down and things have been struggling along. I went through a period of not being able to get out of bed in the morning which is unusual for me. When I say not being able to get out of bed I mean consistantly running half an hour or more late for work. I set at least 3 alarms and I was turning off one or two of them in my sleep without even registering that they had gone off. Some mornings I'd only manage to wake up 20 minutes before I needed to be out of the house and I was not showering for several days in a row because I didn't have time or the energy.

Little G was quite difficult to deal with towards the end of the school term. Her anxiety levels were high and I was having trouble responding to her from a calm, empathetic place. She can read me like a book and her anxiety often feeds off mine so that wasn't helping, plus she also had some pretty big stuff she was dealing with emotionally. Her Dad was getting remarried and she was scared and unsure about what that was going to mean for her. When her anxiety levels run high she attempts to control all the other things in her life to make her feel safe and secure. I've been there, I get that, but as a parent it's incredibly frustrating to have an 8 year old try to run your life and your household. This leads to a battle of wills over almost everything, including school refusal which she has a long history of doing.

When I'm unwell and I have this child refusing point blank to go to school or do anything she's told, and throwing fits and stomping off every fifteen seconds, I struggle. My emotions are already hightened and so it doesn't take much to throw my system into high alert and it takes a long time to calm down again. I have constant thoughts about how I have ruined her, how it's my fault she struggles with anxiety in the first place, my fault she has the issues she does.I think I should be doing more for her. I worry that she'll turn out like me and have to deal with mental illness throughout her life. My brain tells me I am a terrible parent and a pathetic person and that she would be better off without me.

With these emotions running around in my head constantly, they play havoc with the rest of my system too. My stomach oftent feels like it's cramping or has butterflies, my heart palpitates, I get headaches and pain in my face from clenching my teeth and a stiff back and neck from hunching up, almost as if I am physically trying to protect myself. And let's not even mention the effect of all this stress on my bowels!!

Through all of this, plus work stress (major deadlines to meet for various clients at this time of year) and extended family issues, I've had individual events that each have momentarily pushed me off balance. One of those was an appointment I had with my psychiatrist at the end of June. Historically I don't have a good track record with psychiatrists. I've been under the care of Community Mental Health (CMH)/psychiatric outpatients for about 3.5 years and in that time I've seen something like 8 different psychiatrists. Unfortunately that's the way the system works - you see a registrar and so every 6 months the registrar assigned to that consultant moves on and you get a new one. Sometimes you get that registrar back again after 18 months or so when they have had a number of rotations. I've been under the care of  the consultant for 'red zone' the whole time, but I've only actually been seeing the consultant himself instead of the registrar for about a year. In that time there's been two or three different ones because they change jobs or leave.

(*registrar = trainee psychiatrist with degree and 1-4 years experience, consultant = fully qualified and 'boss' in charge of registrars for a certain area. The region I live in is divided into zones by CMH and I live in red zone).

So the consultant I saw at the end of June I've seen twice before (roughly every 3 months), but neither time went particularly well. I tend to be difficult to deal with as I don't understand what they are asking for or how to answer their questions, and I take offence to some of the things they have to say. For some reason the whole situation upsets me and the appointment often ends with me having said something I shouldn't have or refusing to speak to them at all. When this happens I know I am not behaving well but once I have been triggered I find it incredibly difficult to act rationally as my emotions are fully in the driving seat.

In the middle of all this Little G has been sick, we've had school holidays, we are supposed to be following a plan from the continence nurse for her to try and sort out her bed wetting (not happening - she refuses to follow it), I've had family issues and financial pressure, Little G's Dad got married, two of my colleague resigned - one I worked with particularly closely, and my back problem has flared up again. Not to mention that Little G was away in the school holidays so I was on my own for a week. And then the appointment with the communication and behaviour team that I've been waiting for since Little G was diagnosed with ASD two years ago finally happened, and it wasn't quite what I'd pictured.

Suddenly I again felt all this guilt and doubt about my child and shame about my own mental health affecting her, and scared of what they might suggest. I've hung so many hopes on this appointment and to finally get it and find that I was going to be expected to carry out their plan to change Little G's behaviour was very daunting. I don't know what I thought they would do but I hadn't imagined that I would be such a key part of it. For some reason I had thought it would be more about them working with her directly. And that really threw me. Because what if I wasn't good enough? It would be my fault again if the plan didn't work. I doubted my ability to carry anything out and suport her.

I freaked out. I think I subconsiously equated her communication and behaviour problems to my own as a child and I don't want her to go through what I have. The pressure of having to be the person to help her when I am so fully aware of the possible consquences of getting it wrong tore me apart. Then I started blaming myself for my poor mental health and the damage I'd already done to her. I know attachment is really important and forming a secure bond with your child sets them up for the best possible outcomes in life. I also know that I have been inconsistent and at times very unwell and that Little G's and my bond is not as secure as I'd like. I'm working on it but I'm always scared I'll screw up.  

I'd already been having suicidal thoughts for weeks. I live with them. Sometimes those thoughts are louder and sometimes quieter but they are almost always there. These are the ones that tell me I want to die, that no one would miss me, that there is no point to life, that people would be better off without me being a burden on them. When I really freak out I start also hallucinating suicide scenarios, which tend to scare me even further. I get in the car in my garage and I can see myself closing the doors, putting the windows down and killing myself with carbon monoxide from the exhaust fumes. I see myself in the bath with blood running down my arms, or head in a noose hanging from a tree. I frequently picture myself walking into the sea with all my clothes on and drowning. When I'm driving I can see myself plowing into power poles or into something solid.

Living with these thoughts and hallucinations is really scary sometimes, particularly when I tend to be impulsive and I'm aware I can't always trust myself when I feel like this. Telling anyone you have this mess in your head is impossible. I still can't quite believe I've written it down because it almost looks worse on the page than it did in my head. How do you tell someone who cares about you that you want to die so much that you vividly picture multiple suicide scenarios daily, sometimes hourly.

And yet, and yet.... if there is one tiny kernel of hope in all of this, it is that I am still here. I am still taking things moment by moment. I mostly remember and follow my crisis survival and distress tolerance strategies. I mostly take care of myself. Any one of these stressful situations would have triggered a full meltdown with alcohol and a lengthy cutting session only a few months ago. Not to say I haven't cut because unfortunately I have. But just a bit and it was the first time in four months which is something I feel proud of. I am ashamed that I have self harmed again, but I do acknowledge the progress I am making. Small steps. Progress is a series of steps, and even if they are tiny I am making them.

One song I am listening to a lot is Let It Be (The Beatles). It fits nicely with the mindset I'm trying to cultivate.

 Kia Kaha

An update to my post on depression

I know I've already posted tonight but I really wanted to write an update to my depression post last week.

I have been having a really hard time in the last couple of weeks, first with stress and anxiety and now feeling depressed and being unwell with some sort of virus. Work has been hard for various reasons, I've had to take my cat to the vet, we have a problem with the hot water at home, my daughter has a virus causing a full body rash, she's wet the bed every night...the list goes on. Shit happens in life, and it happens to all of us.

When I wrote my last post on depression I didn't really think about who would read it or what your actions would be. All I wanted to do was give some insight into what being depressed looks like. That's its not always the sterotype image of someone clutching their head in their hands and crying. I know I have friends out there who also stuggle, and one of my motivations is to make sure they know they are not alone. That no matter how together someone might look from the outside, we all have our own challenges.

I also find it incredibly hard to ask anyone for anything. One of the things that always gets said when there is general talk in the media or on social media about New Zealand's terrible suicide rate (we are world number 1 for youth suicide - 16 young people per 100,000 die by suicide every year), is that we should make sure people know they can ask for help. Yes, by all means make sure they know there is help available, but making that leap to asking for it is something that I am only just begining to learn how to do, and I'm nearly 20 years older than some of those teens going through this.

I don't know what the answer is, all I know is that I am grateful for the wonderful friends and family I have. Friends like Mrs W, who came over with lunch on Monday bearing a box of food, fruit and eggs so it wouldn't matter if I couldn't go to the supermarket. Or like the people who messaged me and asked how I was, and S who invited me on a bike ride. And my amazing Mum who delivered 3 meals worth of soup, plus scones and french bread for me. My Mum and my sister helped me do dishes and sort/fold/put away washing, my Mum tidied Little G's room and my Dad cooked me dinner. One of Little G's friend's Mums has looked after her for me. I didn't expect the help and support I received but I am incredibly grateful to all of you for your thoughtfulness.

Thank you, thank you, arohanui (much love)

Unconscious thought, Freud and me

I have been reading about unconscious bias recently, and the way it reinforces what we already believe in. Unconscious bias makes us tend to like people who think the same way we do, who have similar backgrounds and upbringings, and even look the way we do. This has a number of effects on how we view the world.

Bias shapes our world view because it provides a shortcut for our brains when receiving and reviewing new information. If we immediately disregard anything that doesn't fit with what we already know or what feels familiar to us, then over time we develop a narrower world view. We will get less exposure to ideas, to different ways of life, to different situations. Our ability to have empathy for people diminishes if we can't imagine ourselves in the situations they find themselves in.

I became interested in what my own unconscious biases were when I realised after reading information about the subject, that just declaring you were open and tolerant of others wasn't enough to actually override the effect of bias on your thinking. I could tell myself all I liked that I didn't discriminate against certain groups but that didn't make it true. And in fact, all the reading I was doing was really reinforcing my unconscious bias as I was subconsciously filtering what I chose to read, and the information I was retaining.

Then I asked myself why I really cared about it at all. Why did I need to think about how I was thinking? I got stuck on this concept for a number of days, wondering why I cared about what my unconscious beliefs were. Sometimes when I have an idea that fascinates me I get obsessed with it, research it to death and read everything I can about it. But this one felt just out of my reach, like I couldn't quite grasp something really important about it. I couldn't even begin to narrow down a definition of what was in my head so I could type something in a search engine.

I put it down for a bit, got side tracked in other things as I tend to do. I happened across a blog post about transference which is where "we unconsciously transfer feelings and attitudes from a person of situation in the past on to a person or situation in the present". Basically, when a person or situation reminds you of something else you transfer some of the feelings you have about the original person or situation on to the new one. I was fascinated by this, in part because of the link between these unconscious thoughts and the unconscious bias idea I had been trying to get my head around. In both of these phenomena the mind is taking what we have learnt in the past and applying it to the present, effectively creating a shortcut for thinking. This sets up a situation where we learn something and then potentially perpetually recreate and reinforce it.

I started to get really excited by the idea that all these things could be impacting on the way I see and react with the world and I am not even aware of any of it. I looked up Sigmund Freud who is the founding father of psychoanalysis - a type of therapy in which transference plays an important role in making the unconscious conscious.

One of the first things that came up a picture of Freud's unconscious mind model, in which he used an iceberg to describe the three levels of mind. The tip of the iceberg is shown as the conscious mind, which is all the thoughts and mental processes we are aware of. The pre-conscious is the "working memory" type area of the brain, and then the unconscious mind, the bit of the ice berg well under water, is everything that we are not conscious of that influences thoughts, attitudes, processes, feelings and behaviour. Freud believed that our feelings, motives and decisions are influenced by past experiences and this is stored in the unconscious. While I don't agree with all of Freud's work, I do believe, as he did, that more of behaviour is governed by the unconscious mind that we realise.

And by putting all this together I had my answer. I cared about unconscious bias, and about situations of transference, and my core beliefs, because I am trying to change my pattern of behaviour. BPD is marked by (among other things) patterns of instability in mood, behaviour, self image and functioning. I need to be aware of the unconscious thoughts and beliefs my brain is holding in order to disrupt the pattern and then change it. 

Therapy has allowed me to look at this by working backwards - from the action such as impulsive or suicidal behaviour, back to the thought patterns and then back further to the trigger for those thoughts. But by also trying to uncover the unconscious core thoughts and beliefs held by my brain I should be able to work on changing them before I am triggered.

So I have decided to see if I can discover what my unconscious thoughts and biases are. Hopefully this will help me discover more about my patterns and how I can change them to bring more stability to my life.

Ka Kite Ano

Depression

This is the not the post I expected or even wanted to be writing tonight. In fact, I am halfway through writing on a completely different topic, which I had intentions of finishing tonight.

But here I am. And that's because I'm struggling with my depression again. I knew it was coming. I could feel it in me waters (as Kath from 'Kath and Kim' used to say). It has a pattern which I can recognise now. Not necessarily do anything about, but recognise.

Over the last few weeks my anxiety has built up. Every time I feel my anxiety getting worse I wonder what brings it on and this time has been no exception. There are always events in my personal life, little and bigger things which seem to have a larger impact on me than they would on other people. That's part of my BPD - limited ability to deal with the stressors of everyday life. I feel everything at 1000% so something that's small to someone else is magnified for me. And those events buffet me back and forth like the strong wind toying with a small sailboat.

This time, as with all the other times, I started trying to shore myself up. Increasing the exercise, making sure I had books to read and an art project or two to keep myself occupied. I joined the gym because one of my theories was that high intensity exercise would help manage my need for endorphins, which is what was driving my cutting behaviour. 

My stress at work increased and my insomnia returned. I know what's coming, I can feel it, I can almost see the black cloud about to engulf me. I can't shake off the overwhelming, crushing, defeated feeling I have when I am not making head way with my work. I have so much on that I can't prioritise effectively, and I know I'm not spending my energy in the right places. I should be able to handle things, I know what needs to be done and I've no urgent deadlines so no need to stress. But my anxiety is making me feel sick every time I think about meeting a client or picking up a file. I want to double check myself every time I make a decision but I am aware of time pressure - the more time something takes the more cost on the client's bill. So I force myself to go with my instincts. I force myself to walk into each meeting with a smile on my face and pretend the confidence I wish I had.

Things get worse though. I know how important sleep is to my wellness. My basic wellness plan for when things are starting to get bad is eat good food, drink water, get exercise and get enough sleep. When these things start to fall that's when I know the darkness is creeping over my last line of defence.

I go to bed on time. I cook nutritious dinners (though I do eat chocolate afterwards...). I make it to the gym four times a week. I am completely exhausted. But when I go to bed at night I lie there wide awake. Not thinking anything in particular, but not sleeping either. When I do fall asleep I roll around restlessly all night long, unable to get into a deep sleep. 

The less sleep I get the more cranky and depressive I am. Everything makes me want to yell and hit and stomp around, or put the covers back over my head. Sometimes both.
Slow driver? Cue road rage from me. Child not picking anything up or putting it away? Cue yelling from me about irresponsibility and how I should throw it all away. Someone makes a mistake? More rage from me about imbeciles who can't engage their brains. I park too close to one side of the garage or the other? I'm an idiot who can't get anything right. 

I went to the gym after work yesterday hoping the endorphins would kick in and I would feel slightly better, or at least tired enough for a deep sleep. All that happened was that I was too tired to go and get milk and bread, so we had nothing for breakfast this morning. 

The cupboards are bare because I haven't done any grocery shopping. My child is a chronic bed wetter and there are piles of washed laundry on the floor in the lounge as they have fallen from the chair they were on. There is washing hanging on a clothes airer in the lounge and washing on another line in the garage. There's more washing to be washed in a pile by the washing machine, and in a pile in the corner of the bedroom (just to be clear - everything with pee on it is washed every day - it's the other stuff that piles up around it). My kitchen bench is full of dishes, the bin is full, the bathroom needs cleaning, the vacuuming needs doing and paperwork for the last two months is spilling out of the mail rack.

I am hiding from everyone and everything and all I wanted to do this morning was put the covers over my head and close my eyes. I have no desire to do anything. TV doesn't interest me. I can't be bothered reading or drawing. I don't want to go to the gym or talk to anyone. Every day I get up and pretend to be a person. I slap on the face I show to the world which says "I'm doing ok" and I go to work.  

Then at night, when I am tired and my defences are down, thoughts like why bother and I'm no use to anyone creep in. Don't get me wrong, I'm not suicidal. The depression is just asking me what the point in trying is. When I'm like this and life seems so endless and grey and hopeless, I can't remember the feeling of happiness. Intellectually I know that I was, and it was only a few short weeks ago. But the memory of what that feels like is gone.

So one of the ways I try and remind myself is singing. When I am feeling happier I sing along to my favourite songs. I know it sounds odd, corny even. But my most reliable measure of depression is whether I am singing in the car. If my favourite songs come on and I don't hum along or sing then I know I'm in deep. But I can remind myself what being happy is like by remembering when I have sung. Turning up the music and connecting to it by singing releases something in me.

This is another thing I have stumbled on to by accident but it is apparently used with dementia patients as our brains are hard wired to connect music with long term memory and deep emotional recall. You can read more about this here.

So, I wanted to share this with you all so you can get a sense of what depression can look like. And for those of you with depression, who are also struggling, you are not alone. 

The good thing about knowing this was coming was knowing that it will end. After the stress and the anxiety comes the depression, and then it will pass. That doesn't make it any easier, or suck any less, but it will pass. Hold on till it does.

Kia Kaha

Self harm and me

Trigger alert - today's post talks about self harm and it's causes. If self harm is a problem for you please get help from a professional. This post describes my experiences and is in no way designed to encourage anyone else to self harm. 

Just as an added note, I wrote the following post last weekend. I debated all week about whether to post it because the issue of self harm carries a huge amount of stigma. Many people know I have this problem because the scars are hard to hide, but no one (with the exception of my family and one other person) has ever raised the subject with me. 

The shame and stigma attached to self harm are overwhelming at times and it is perhaps one of the hardest aspects of mental illness to discuss. Many people can not understand why you would want to harm yourself, particularly using the method I do which is cutting. The following post describes what leads to this behaviour and the biological reasons why.

(Sunday)

Today....today was unfortunately one of those days that is so common for me as a person with BPD. A day where my moods changed with speed of the wind outside, sweeping away all traces of what I felt previously and hammering me again and again with intense emotion.

This morning I woke feeling motivated. Little G went off to her father's early, and then I got on with the washing and ate breakfast. I had decided to spend another hour or so in bed as it had been a long week and I was trying to take things easy so as not to get sick.

All morning my brain fought me. It was sunny outside and there was a war raging inside my head. One side telling me how lazy I was, and that I was wasting sunshine and time laying in bed reading. And the other side telling me I needed the rest, to give my body a chance to recharge and get ready for the next week. I recently found an article about boring self care and her drawings were the main reason I managed to stick to my guns this morning and try not to berate myself too much for resting and reading. She does cute little cartoons about the little things we can do to take care of ourselves, and today I knew that rest was what I needed. Didn't stop my brain from trying to take over with my normal pattern of non stop activity to fill a long day by myself though.

After lunch I stopped feeling like I should do something, and started feeling like I didn't want to do anything. This was particularly bad timing as this is when I'd actually planned to get moving and do chores and buy groceries. It took me several hours to force myself to have a shower and get lunch, put on shoes and go outside for a walk. My brain kept distracting me and I was having trouble focusing on what I should be doing. I wasn't actually doing anything during this time except wandering around pausing and looking at all the stuff I should have been doing. The thoughts in my head about me being useless and lazy were pretty loud, and were drowning out anything much else at that point.

I finally got outside and did about half an hour's walk. This week's goal is to be consistent with my exercise, and try and do 20-30 minutes on 5 or more days. I walked yesterday and today so was reasonably pleased by the time I got home. Off to the supermarket and for some inexplicable reason, the person in front of me drove at 35 km/h the whole way (speed limit is 50 km/h, I normally do more like 60!). The frustration and anger that overtook me was incredible, I was imagining setting up a punching bag and slamming my fists in to it over and over. After 5 minutes I was in full blown rage mode, though my rational/logical mind kept trying to tell me I wasn't in any hurry and that I should calm down.

Pull in to the supermarket car park and park the car in the far corner away from anyone else so I can have some deep breaths and calm down. Then on into the supermarket. After only a few minutes inside I start feeling really upset, then a sad song comes and I have tears in my eyes while I am picking out apples. After telling myself that I'm being ridiculous and have no reason for crying, I manage to pull myself together enough to continue with the shopping.

In the supermarket environment I'm overwhelmed by the number of people, the bright lights, tiredness and the music. My physical senses are often in overload in settings like that due to my autism.

My emotions have run the gauntlet from motivated to hyped up, to depressed, then to confused and distracted, happy after my walk, then tired, angry, full of rage, then to sad (complete with tears). I feel so overwhelmed by the large swings in my mood that my brain keeps trying to default to its standard method of taking the emotional pain away. 

All I can think about is drinking alcohol and cutting myself. I'm severely triggered walking past the wine and beer aisles. The craving for a drink is so strong that I can't stop myself from choosing a bottle of wine to take home, all the while knowing it is the first step on a disastrous path that only has one end.

I'm well aware of how destructive the drinking is, and how once I start drinking then what little control I have over my self harm urges subsides. This usually leaves me sitting in a pool of blood with a razor blade in my hand at some point.

I have to walk past the utility knives, don't need those as my house is littered with them, and anyway they don't provide the deep cuts that give me the relief. They have long since been replaced with razor blades.

I'm not buying blades today. My hands are shaking on the trolley as I walk past but I try and tell myself that if I don't buy them then all I'll do is drink. Unfortunately, this has not proved true in the past. I know full well how to take a razor apart when I'm drunk and in the grip of my compulsion. 

In situations like this in the past I've gone straight home after the supermarket, opened the bottle, sat down and cried about what I'm about to do. I'm normally a spirits girl and a shot is all it takes to release the flood gates. That is when the blades come out and I promise myself it will just be one or two cuts. That I'll see the blood and feel a bit better and then I'll stop. However, it usually takes 8 - 10 shots with small chasers of coke before I've cut myself enough to be able to control it enough to stop.

It's hard to describe the relief the cutting provides, and it can be different depending on the circumstances at the time I have the urge to self harm. For me, self harm is a compulsion. I've used it so many times in the past that my brain is wired up to want to complete acts of self harm to relieve my emotional pain. 

Part of the reason for this is because at some stage I accidentally tapped into the brain's ability to use it's natural painkiller, endorphins, to relieve my emotional pain. Our human brains are wired up to sense both physical and emotional pain using the same two areas: the anterior insula and anterior cingulate cortex. When you get hurt physically, your brain registers the pain in these two areas and prompts the production of endorphins, which is the brain's own natural morphine. Wikipedia says "The principal function of endorphins is to inhibit the transmission of pain signals; they may also produce a feeling of euphoria very similar to that produced by other opioids.^[3]   

Basically this means that if you cause yourself physical pain, the body produces endorphins which then act on your emotional pain as well. In terms of self harm, this is why it can be so addictive - create enough physical pain and your emotional pain will be relieved with endorphins your body has produced to get rid of physical pain. Unfortunately there is no way to stimulate an endorphin response to emotional pain without causing yourself physical pain. And it seems (though more research is being done on this) that you can not relieve emotional pain with painkillers made for physical pain.

The upshot of all this is that every time I create physical pain in response to my emotional pain, I force my body to produce endorphins which relieves both types of pain. This creates a feedback loop - emotional pain leads to physical pain which causes endorphins which relieves the pain. And every single time I use that response to my emotions, the feedback loop is reinforced, making that connection stronger and stronger. This makes the urge to harm myself become a compulsion when faced with situations that trigger overwhelming emotions.

This is not the only reason people self harm. Sometimes for me it is about punishing myself, causing myself pain because I believe I deserve it. Sometimes it is more about the scars and pain on the outside matching the black deadness you have on the inside. Often it is a combination of things - a triggering event may cause the compulsion but may also cause me shame because I'm not living up to my own expectations. I can spiral down as thoughts about what a terrible person and waste of space I am go around and around in my head. 

The therapy I'm doing, which is a combination of acceptance and commitment therapy and dialectical behavioural therapy with a few other things thrown in, is teaching me to recognise my triggers, to try and prevent them, and what to do when I am in this situation. In order to remove my self harm behaviour I have to have something to replace it with.  Not only do I need to recognise when I'm having thoughts that lead to overwhelm, I have to self care skills, triggers, be able to tune in to myself and my surroundings (mindfulness), and a range of coping skills to suit all sorts of situations.

So, last Sunday, despite the fact that I brought the wine, I came home and I did not drink it. I put it away at the back of the cupboard, then I ate dinner. I had forgotten to eat much during the day and it wasn't until I did some mindfulness on the way home from the supermarket I realised I was hungry. I switched on Netflix and watched a funny movie, with my soft sensory blanket on my knee and the cat on my lap. Then I got on here and wrote about my day. I did some other writing which was a bit of homework for my therapist and finally sat down to read. Crisis averted, till next time.

You might think, reading what I did to cope with that overwhelming urge to self harm, that the things I did were nothing special so how could they possibly have helped if I was really that bad. The answer to that is two fold. One, the whole time I did the things I outlined above my body was craving endorphins. The thoughts don't leave my mind, I just try and distract myself from acting on them. Two, it's taken a lot (a lot a lot) of hard work over the last two years to get this far. I have crisis strategies like holding cubes of ice (either in my hands or against my arms), submerging my face in cold water, intense exercise (like short sprints), and paced breathing. But first I try distraction and soothing my senses with things I know work for me (a really good link explaining this is here.

Things are slowly getting better but sometimes I fail, and sometimes I fall. I am always going to have to be mindful not to fall back in to old patterns. At times the amount of work I need to do to get and remain mentally healthy looks like an enormous burden. But I have learnt that there is a time to look at the big picture and a time to look only a little way in front of you. Sometimes it's best to try and deal with today and plan just for tomorrow rather than get too tangled up in what the future might hold. 

Ka kite ano