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
Sunday, 20 August 2017
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!
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!
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