This blog is part of my recovery, and I would like it to remain a safe place for me to share parts of myself and my life that people close to me may or may not know. As a result, while I'm not going crazy with privacy settings, I do ask that if you find this on your own and suspect you may know me, please respect my privacy by checking with us before reading any further. This obviously doesn't apply if one of us has given you the link!

Monday, March 29, 2010

Mucky Monday: Rejection & Abandonment

I've had a rough couple of days. Then again, sometimes it seems like I bounce from one bad day to the next. First of all, I struggle to be okay with being okay (more on that in another post, I think); and then, of course, life keeps happening, and I struggle with the ability to find my feet there.

When mental health closed my file, I was told to make an appointment with my GP and connect with him. I was told to see him approximately as often as I had been seeing my psychiatrist (I am curious if she ever listened to a word I told her about the extent of my self harm - I see my GP a couple of times a week in regards to that) and check in with him in regard to how I am doing.

Let me preface this by saying that as much as I'm about to use powerful words such as "knew", this is mainly conjecture. To start off this new plan, I had organised an appointment with my GP for today to discuss the letter and make sure he was happy enough with the plan. I knew, as soon as I mentioned it, that he was not happy. We are staying with that plan, for now, but he made comments along the lines of "we will find an alternative if you continue to deteriorate". I am not hopeful that there are any alternatives left; but that is not a bridge to cross today, so I am choosing to leave it. Perhaps if/when it does become relevant, there will be new avenues to take that are not currently open to me. The future, after all, is not set in stone.

As he provided the necessary treatment, my GP mentioned to me that he is planning to leave for a month. He stressed that it is absolutely imperative that I begin to see one of the other GPs in the practice while he is still there. His concern is that if I do not, and I need to see a GP while he is away, the situation will end in my needing hospital. I agree that this is not at all a favourable outcome (and my heart secretly wants to beg him not to leave, thus solving the entire situation).

So, on the heels of mental health closing my file, and my ex husband's new fiancée giving birth to his daughter, the sexual violence counsellor I managed to attain after leaving DBT (unfortunately I was not able to hook back in with my old counsellor, but the new lady is one I am familiar with through various art activities run through the centre) is going to be away through all of my upcoming major trigger dates/events, the nurse that I see for wound dressings was away... and now my GP is also leaving. Is it any wonder my normally high fears of abandonment and rejection are so high they're staring down at the stars, at the moment?

Like most people with Borderline Personality Disorder, I am hypersensitive to abandonment and rejection. Usually to decrease the chances of it happening, I will people please to an extraordinary degree. In this situation, there's very little I can do along those lines. No matter how much I try to be 'good', my GP is still going to take his holiday. My counsellor is still going to be away. Mental health are still finished with me. I feel at a loss, as I fear that everything I have put faith in to be there and sustain me is fast disappearing. Soon all that will really be left is me, myself and I.

Knowing those fears are there, though, doesn't mean I have to bow down and give in to them. I have a choice, now: I can choose to see this as yet more rejection and abandonment, and throw in the towel; or I can choose to see that these events are not necessarily connected. It's a hard path to take, to choose to see that these events may have nothing to do with me or each other; and I imagine I'll fall down a lot along the way, but I much prefer the place to which that path leads.

I am choosing to tell myself that it will be okay, that I can learn from this and grow, that I have the capability to live through this and come out the other side a better person.

Today's thought challenges/cheer-leading statements:
If my GP chooses to take a vacation, that does not mean he is personally rejecting me.
A slip is not a failure. I now have a new chance to try again.
The past does not dictate the future. Just because people have left in the past does not mean that people will always leave me.
I am not a bad person.
If someone is upset by actions I have taken, it does not mean they cannot like or love me anymore.

Take care of yourselves until next time, and may we all find our own small fences along the way.

Saturday, March 27, 2010

Sanguine Saturday

First off, let me just say, I've noticed a few people adding this blog to their 'follow' list. To those of you who weren't already my friends, I'm glad to meet you and look forward to getting to know you. Please feel free to throw in any thoughts at any time - I'm not easily offended and I welcome free discussion. Those of you who already know me should, of course, also feel free to throw in any thoughts they like.

Blog Matters:
I've decided to designate today, and every Saturday, Sanguine Saturday here on Finding The Fence. Regardless of my mood on the day, I intend to post a list of skills based successes from the week and a list of things I am grateful for/about. I hope to keep this one post each week free of any negativity at all.

This week's Success Stories:
I made attempts to DEAR MAN my psychiatrist.
I showed congruency between my emotions & my expression of them (Emotion Regulation).
I have worked on not Avoiding specific situations.
I have practiced allowing myself to feel and to express Emotions (Emotion Regulation).
I have worked hard to make good choices, healthy choices, even when I found it difficult (Turning The Mind).
I have taken time this week to do Pleasant Event Scheduling.
I have worked on my goals, and taken steps to build MASTERY.
I ordered hot chocolate and cake, asking for small changes, then ate them in front of someone I had not previously properly eaten in front of (Face Fear).

Gratitudes List/Things that make me happy:
I have been blessed with many wonderful friends, both on and offline.
I was able to attend the Craft Expo today.
Craft and craft supplies.
Interesting conversations with fascinating people.
Unexpectedly finding a gift that I can send to a friend overseas.
I bought a giraffe tissue box cover and a tiger bin (trash can) today.
I'm grateful that I can walk. Even if my ability is still impaired at the moment, I am better off than a lot of people who have no use of their legs.
Encouragement, validation and recognition.
I am grateful that the world is full of beauty.

Today's cheer-leading statements:
I can cope.
Ruminating about the past or the future is never helpful. I need to concentrate on 'now'.
I am not responsible for the actions, thoughts or feelings of anybody other than myself.

Take care of yourselves until next time, and may we all find our own small fences along the way.

Spreading my wings, but I still stumble

Every day, the whole world over, people are living, dying, breathing, smiling, crying, being. Thousands of lives experiencing tragedies and comedies. There's a very real sense of connection, of camaraderie, in that; you're unique, but you're not alone.

Once again my good intentions fall out the window. I'm still reeling from the sense of abandonment regarding yesterday, and after engaging in my pleasant event scheduling, I came home to find that my ex-husband is now the proud father of a little girl.

I've taken time to sit with my emotions. I've worked on mindfully applying distress tolerance techniques when I think I can't bear the pain another second. I've typed out lyrics as they play (keeps hands and mind busy), I've tidied. I've attempted self soothing. I've taken a small vacation and curled up in bed for a few hours (reading my book, followed by a short nap). I've watched NCIS, attempted craft, played games. I've spent time in mindful exploration of my crystal. I've read positive quotes, worked on my goals (both setting and working towards accomplishing), challenged my thoughts, made plans for tomorrow. I have made efforts to turn my mind towards acceptance.

I've reached out, reached in; opened up, closed up; ricocheted in and out of skills. I believe I am doing all that I can to 'deal' with the situation - the only aspect that is in my control is how I respond to the information, so that is where I am concentrating my efforts.

Still, I am tired inside my bones and my heart aches for what might have been. That's okay, and I am still sober.

As the days go by, I am slowly beginning to shape my vision for this blog. Originally I had planned for the entries to be almost entirely thought based; along the lines of my first couple; expanding of my knowledge on the skills and where I am at (in a positive frame), now I suspect that won't work. I'd like to make sure I'm posting something of real substance along those lines at least once a week; but a more 'real' record of what's going on in my life feels important as well - as long as I make sure to include positive ways I can cope/have been coping with the situation.

Today's thought challenges/cheer-leading statements:
The past does not need to dictate the future.
I can cope.
It's okay to hurt over this.
All I can change about this situation is my response to it.
I will not act in a destructive manner.

Take care of yourselves until next time, and may we all find our own small fences along the way.

Friday, March 26, 2010

Even amidst my disappointment, there is growth

Although I had originally intended to follow through on my individual criterion focus this week, in sitting down to actually do it, I discovered that I could not get it to just "flow" quite right. In fact, everything I write tonight sounds either stilted or whiney. I'm scatty and I seem to lack any semblance of an attention span, but I've written and rewritten this entry a dozen times over, and I just cannot find my comfortable Blogging voice.

Today has been a difficult day for me.

After DBT ended, I knew that the plan was for me to be released from Mental Health, but when I spoke to my psychiatrist and let her know my concerns, she said she would talk to the team, and then we would discuss what was to happen at my next session (today). At that session I also made a completely unsuccessful attempt to be placed on a different medication. I resolved that I would work harder to get my point across this time. I did a bit of cursory research and came up with two alternatives that we've not yet tried. I made notes reminding me to use my DEAR MAN skills and to stand my ground. I also included a note and phone number to remind me to have her call my GP, as per his request from the last time I'd seen him. I assumed that once all of that was done, we would finish up and that would close my file, and I surprised myself by finally being more okay with it than I'd expected.

So, when I turned up for my appointment today, I was prepared. I held my folded paper in my hand, a tangible reminder of the work I had done, and the importance of being effective. I shook in my boots as I entered that room, but I worked to Appear confident. (Those of you familiar with DEAR MAN will recognise the A from "MAN" - everyone else, please just be assured I have not decided to begin random capitalisation!)

Before I had a chance to even begin to Describe the situation, my psychiatrist spoke. "I closed your case yesterday and sent a letter to your GP."

I froze; all of my false confidence deserted me. Where was the discussion she'd spoken about last month? I had come to terms, in part, with being transferred solely into my GP's care - but I still wanted discussion. I wanted to discuss the medication issue. I understand that medication won't solve my problems with self harm; I know that medications won't stop me from feeling. On the other hand, I have experienced (briefly) what it is like when the medications are working, and I would like to experience that again. And perhaps most of all, I wanted my GP to air his concerns to the psychiatrist so that she could reassure him, because my reassurances mean very little. I, after all, am the patient who presents regularly with what he terms "severe" self harm; the one who reassures him she's fine, only to turn up with new injuries a couple of days later.

I was humiliated when the next question she asked was "what happened to your face?" I am a skin picker. I don't view it as self harm (although throughout DBT, Sandy tried to tell me it was) and I feel that my reasons behind picking are very different to my reasons behind self harm; it is closer to a compulsion than an urge, and I am even more deeply ashamed of it than I am of self harm.

She spoke to the air for most of the time I was in that room. I nodded occasionally, said "yeah" a few times, and stared at a fixed point. I didn't bother bringing up the medication; without any prompting she launched into a speech about how I know the skills, I'm simply not using them; and another speech about how no medication will help me at all. I did make an attempt to have her call my GP, but she dismissed it, telling me she had written him a letter. Mostly what ran through my head was "don't cry don't cry don't cry don't cry don't cry". I feel dismissed and rejected; I feel abandoned. I feel an extremely strong urge to self-destruct. Those are not emotions. I felt sadness, disappointment, guilt and anger. I feel fear that my GP will not believe that I tried to get her to call him.

I find that, also, I am disappointed that I went to pieces so quickly, disappointed that I didn't make better use of my DEAR MAN skills; and yet even in this I can see signs of change.

I allowed her to see that I was upset. I didn't talk to her about it, but for once, the emotions I displayed were congruent with the things I had been telling them.

I did attempt my DEAR MAN skills. This is growth, many's the time in the past I would let everything slide rather than ask for anything.

I identified and expressed the emotions I'm feeling about the situation.

I didn't listen to my urges to self destruct.

Apologies for the lack of thought on this entry, and the over abundance of whine. Perhaps tomorrow my brain will work better again.

Today's thought challenges/cheer-leading statements:
These feelings are unpleasant, but they will pass.
The urge to self-destruct is just an urge. I do not have to listen to or follow any urge.
I am adjusting. It will get easier. I am doing okay.
I have a good GP. If I explain to him that I asked her to call and she felt she had said everything that needed saying in the letter, then he will understand. If he does not understand, I have the skills to handle that situation.
This is not a sign that I am not worth helping, that I have been thrown away or that I am not good enough. This is a vote of confidence in my ability to manage myself for a while.

Take care of yourselves until next time, and may we all find our own small fences along the way.

Thursday, March 25, 2010

Breaking Down The DSM

After being inspired by someone else, I thought tonight I would take a look at how the DSM criteria fits me - both now, and how it fitted/impacted me pre-DBT. (I'll apologise now, I'm retyping each of these as I go, so you'll need to forgive me for changing the spellings to the accepted Australian equivalent!)

The DSM-IV criteria for Borderline Personality Disorder states that there must be "a pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following". Before I elaborate on the indicators, I'll make a few comments on this. I still don't think the psychiatrists had enough information about me to diagnose me when they did, but I have to admit that it's certainly true that I was exhibiting signs of poor mental health by at least the time I was 3. That, I think, certainly falls under "by early adulthood".

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5.

To me, this depends how much meaning we're attaching to the term "frantic efforts". What does that even mean, anyway? Are we talking physically holding on and begging them not to leave? I've never threatened to do anything drastic because someone was thinking about leaving. I don't recall screaming or pitching a fit to keep someone from leaving. I did, however, cling desperately to my friend's husband's hand when he had to take me to the doctors, and again when he had to take me to the hospital. I've made attempts to reduce the likelihood of abandonment by doing things like not admitting to liking something, or wearing the guilt for something they might have done wrong, or going back on my values, though. That one, I have to admit, is accurate for both now and the past - but I'm pleased to report that, post-DBT, I'm now less likely to resort to these behaviours.

2. A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.

I freely admit, I've always been terribly guilty of placing people upon pedestals that are far too high, and becoming devastated when they eventually tumbled. I'm not sure I would categorise myself as having a pattern of unstable relationships characterised by that, though - some, certainly, but I believe that the majority of my relationships with people were fairly stable pre-DBT, and even more now. One thing I've come to understand is that, pre-DBT, when I idealised someone, it took quite a bit for them to fall. Usually if there was anything that might have knocked them from their perch, I took responsibility for that, and thus kept the other person "pure". Post-DBT, I've become more able to hand responsibility where it belongs, and so people are falling from their pedestals a little more frequently. Interestingly, the pedestals I'm building now also seem to be shorter.

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

All my life I have been a chameleon. Whoever I was with, that's who I became. If someone wanted a certain type of person, I would do my best to fit that mould. My self-image in that time has remained fairly stable, but my sense of who I am has not. Having done a full course of DBT, I'm finding myself a little less unstable in my sense of self - I'm beginning to find a niche for myself that feels right; beginning to get an idea of who this person who goes by [dawni] actually is. Feedback from others still helps make up the basis of what I know about myself, but I'm slowly learning to match that feedback with what others have told me, with what 'feels right'. I have learnt that I like photography a lot, that I am avoidant and that I am a difficult read. I have decided for myself that my favourite colour is blue and my favourite animal is the giraffe; I have given myself permission to choose these things for myself.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behaviour covered in Criterion 5.

Impulsive? For a long time, that seemed more like something that would apply to my ex husband than to something that applies to me. In general, I'm not a particularly sexual person and I don't drive at all, so I think we can safely leave those two aside for now.
I am quite impulsive with my spending, probably more now than pre-DBT, but I've never spent so wildly that I've put myself in serious financial hardship.
My eating has been pretty shocking for years. Particularly in the lead up to my diagnosis, I occasionally binged, but more often starved myself. Admission to hospital set me back on the path of eating, but this time I moved back into binge eating. Post-DBT, my eating disgusts me. Despite knowing that it is a choice, I seem to have little control over my binging, and I am mortified at the amount of weight I have gained. This, too, is a side effect of my medication: extreme cravings, particularly for carbohydrates and food binges - one of the reasons it is described by those who've taken it as "legal marijuana".
As for substance abuse, I suppose it's time I admitted it. I was well on the way to becoming a drunk, pre-DBT. I'm ashamed to admit that I probably turned up at work still slightly drunk on more than one occasion; ashamed to realise how many times I went with what would have been a hangover, if I got them. During DBT I got this one, at least, under control. I went from several times a week drunk to drinking only once every month, or couple of months. Unfortunately, when DBT ended, the first thing I did, was to go back to drinking heavily. (I'm pleased to note, though, that in 8 hours, I will have been alcohol free for 9 days. It may not sound like a lot, but it's something, and that counts.)

5. Recurrent suicidal behaviour, gestures, or threats, or self-mutilating behaviour.

This one rings true both pre and post DBT, but the suicidal thoughts  and attempts have lessened. In the six months before I began DBT, I had about a dozen hospital stays of varying length either after a suicide attempt, or to circumvent suicide urges. Post DBT, the hospitalisations have lessened (in fact, I've only had a few one or two nighters in the entire 13 months since DBT began). One thing that does both fascinate and frighten me, however, is that although at this point, my self harm has decreased slightly in frequency, there has been a marked increase in the severity of incidences. (And I'm pleased to note that although I have had one possible slip [that I am choosing not to count], and three minor wound interferences, I am coming up on 9 days since my last incident of "real" self harm.)

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).

Ah, finally, one that actually doesn't apply to me, either pre or post DBT. One of the reasons I fought the BPD label so long was that I lack the short term see-saw of emotions I feel this describes. My moods don't up/down that way, for the most part, and I don't really believe they ever have. When I experience an emotion, it tends to stick around for a long time - and here I'm talking more like weeks than hours. That said, I do struggle with emotion identification, so it's possible I may be way off base saying this one doesn't now, and never has, applied to me.

7. Chronic feelings of emptiness.

I denied this one, in the past, but I'm starting to wonder if it may have fitted after all. How do you define or describe a feeling of emptiness? I currently link it, in my mind, to that unstable sense of self: but is that accurate? Is it that search for self, that search for something that will complete you? Because if that's what they mean by feelings of emptiness, I'm already on board that train.

8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

Difficulty with anger is certainly something that I struggle with, but in my case, it takes the opposite form: I struggle to allow myself to feel or express anger at all. Pre- or post- DBT, I think this is another one I can just cross off the books.

9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

I've heard 'psychotic' symptoms included in this box, as well, so I'm going to include that in my response. Dissociation is certainly applicable, both now and pre-DBT, though, again, the dissociation has lessened since DBT. I do suffer a small amount of paranoid ideation, and minor 'psychotic' symptoms such as hallucinations and 'voices' during times of particular stress; all of which has lessened since doing DBT.

In all, I can see from this that DBT has made a difference. It's hard to see, with just the criteria looked at in this way, how huge the changes have been for me, because the biggest ones have been in areas that aren't really covered by the DSM criteria. Things like learning how to ask for things, and building confidence. Things like being able to look someone in the face, or tell someone, "I feel angry today"; they don't show on the DSM criteria.

I'm considering making this my focus for the next week and going back over each criterion a day at a time, in order to highlight what I am doing, and what I can do, in order to continue minimising the effects of each on my life. I'll sleep on it and see how I go tomorrow.

In the meantime, I welcome those of you who knew me prior to DBT, and those of you who know me now, to share thoughts on what I have written, or what you may or may not have seen change in me regarding these criteria.

Today's thought challenges/cheer-leading statements:
I am not drowning. I am adjusting, and I am doing fine. I will be okay.
I am not a bad person.
My husband and I had some good times, and we had some bad times, and that's okay. Those times are over now and that's okay. That's how life works.
I am not responsible for someone else's emotions or choices. I am only responsible for mine.
It's okay to feel whatever I'm feeling. No emotion is wrong or bad.

Take care of yourselves until next time and may we all find our fence eventually.

Wednesday, March 24, 2010

Mixed Messages: How Are You?

Today I got to thinking about my relationship with my emotions. It’s not something I usually avoid thinking about, but it’s also not something I am particularly constructive with, either, most of the time.

Several hours ago, I was logged in when a friend signed on and asked a question that sent my anxiety levels through the roof. Did she ask what to do if a prowler is in your home? What to do about some sort of medical emergency? No, it was nothing like that; nothing that big or important. In fact, all it took were a few simple words: “how are you?”

Some days, I just don’t know. Even after a year of DBT, my emotions are a relative stranger to me. I still label them incorrectly; I still struggle to see them at all; I’m incongruent; and I definitely still try to deny and hide them. I hide my emotions so well, in fact, that our DBT coordinator commented on it. “[dawni] is hard to read, yes. She’s a very good cloaker. I think, actually, she’s the best cloaker I’ve ever met.” There was a lot of power in that; I could fool a therapist I respected a lot, without even trying. Of course, the flip side of that was that, without even meaning to, I was treading on my own toes - how could anyone help me get better if they didn't have a clue what was going on?

And that is what brings me to why, today, “how are you?” set off my nerves.

If I know what I’m feeling, I’ll try my damnedest to hide it from you. Hell, I’ll try my damnedest to hide it from myself. On the other hand, I don’t like to lie. If you ask me how I am, I will feel compelled to answer you honestly – while at the same time I will feel compelled to not reveal what’s going on. If I’m lucky, I’ll have something physically going on I can hide behind. “I’m a bit tired” is probably my ‘favourite’, but “my knee hurts” gets a pretty good workout as well, these days. When my physical health isn’t an issue, though, there’s not much I can do except answer or avoid. And as much as I know that simply avoiding the question, especially after the second or third time you’ve asked, is its own answer, I am often too caught between the two answers to give a decent answer. And buried in there, underneath it all is the little thing that sparks it – fear.

I always vaguely suspect that people don’t believe me when I tell them how I am; what makes this so frustrating is that the thought is strengthened by the very behaviours it causes. Of course you’ll have trouble knowing what to believe if my words say “I hurt” and my face and body say “everything is fine”. It gets worse when, as a protective coating, out comes my humour. Now my body’s saying “I’m fine”, my face is saying “I’m fine” and my words are saying, “I’m not fine, but let’s all laugh it off”.  Talk about mixed messages! But doing otherwise, allowing my body to tell its share of the tale? That leaves me vulnerable – not just to you, but to the one thing that frightens me most of all-- myself.

If I admit, honestly, to you what is going on here in my head, I have to admit it to myself. I’m not so good at that. I seem to believe, down in my core, that if I can’t see it, it’ll go away and I’ll feel nothing. For years now, I have been on a quest to simply cease feeling. I am, if you’ll pardon the Star Trek reference, the anti-Data. He spent years trying to attain the ability to feel – I spend them trying to avoid it.

The first step, I’ve heard, is recognising the problem. If the second is to find the why, then I’m well on the way. It’s pretty easy to figure out, this one: the answer is fear.  Are you picking up on a common thread, yet? I’ll probably talk a lot about fear in here – it’s one of my big hurdles.

What does fear have to do with my relationship to my emotions? Everything! I'm afraid of my emotions - including my fear of them. Maybe even especially that one. It seems that I have a few core beliefs about emotions and/or expressing them, that still need challenging.

It is okay to feel. Whatever I feel.
It doesn't matter what lengths I go to, I will continue to feel things.
It is sometimes okay to tell others what's going on for me.