Roots

I’ve never felt at home.

As a two, nearly three, year-old I immigrated to Australia with my mother and father. I remain unsure if this was a wise decision on their part. Despite being so young when we moved I was acutely aware that I was a foreigner in a new land. I spoke differently to my new friends, I had no grandmother, oma, nanna, granny, grandfather, papa or plain old granddad to spoil me, to visit at weekends, for my parents to send me away to so they could have a break. I had no aunts, uncles or cousins to grow up alongside. I had a family of three. Mum, Dad and me. A fourth member tried to join us, but his life only lasted three days. When I was eight a fourth member successfully joined our small family, my brother S. S grew up with a different experience to me. He belonged to this land the rest of us were foreigners in, yet he lacked the extended family his friends enjoyed. His parents spoke funny and, for a while, so did he. Accents get lost when a child starts school, they are spending more time away from the family and become homogenised.

I wasn’t allowed to forget that I was a foreigner. We had frequent trips “home”. Home where I had my nannas, granddad and step-granddad; cousins, aunties and uncles. Home, where the houses had stairs and green grass, where it got cold, but never too hot. Where I didn’t speak funny. But I did. “Ohhh, listen to her cute Australian accent, she’s an real Aussie now.” No, I’m English but I live in Australia.

Over the years I became more of an Australian. Deciding in 1995 that I needed a football (AFL) team to support. I decided to pick whoever won the final that year – Carlton. I don’t think I’ve ever watched a game on television. I went once with a friend and her father, I don’t know who was playing, I don’t know the rules, just that they have to kick a ball through some poles and it’s better if it goes through the two centre poles. My accent diminished further, but I’d still be asked where I was from occasionally. Friends replaced family, but Christmas was always a lonely gathering of four, with the rest of my friends off to see their families around the state / country. I pretended I was a proper Australian and that I loved hot weather and going to the beach, the Sun was great – but not my friend, with delicate English skin.

In 1999 we had a long trip “home?” I was 14 and felt lost. For the first time I was spending a long period with these people related to me by blood, and not just the ties of short lived teenage friendships. I longed to go back to my other home, that is, after all, where I thought I belonged. I was glad to return. Two years later the time came to get Australian citizenship. We were doing this, not out of a desire to be officially Australian, but to get cheaper passports and not need re-entry visas. I was given a choice, but not really. I said no. “I’m not Australian, I’m English!” “But it’s dual citizenship”, said my mother. “You’re both, you just get cheaper passports and have to vote; that’s the only difference.” I did it reluctantly. When I fill in official forms today I tick the Australian citizen box, but then have to fill out the country of birth section, including year, and sometimes exact date of arrival to Australia. So I’m not really Australian if they still care about that.  But I’m not English either.

I’ve thought about moving back, to Scotland where my Aunt and Uncle live, rather than England and it’s not far to travel to see the rest my family. I love Edinburgh. I’m not amazing at making friends and my health is too much of a mess to uproot myself so for now at least I’m staying here.

Beginning Dialectical Behaviour Therapy

I started Dialectical Behaviour Therapy (DBT) properly this week, I say properly because I’ve already done what they call the foundation course. Tuesday was my first individual session and this coming Thursday will be my first group session - they started the individuals the week before the groups. Due to the commencement of DBT I thought I’d write a little about Borderline Personality Disorder (BPD) with which I am diagnosed but only just, enough to warrant treatment. I’ve had a look through my blog to see what I’ve already posted about BPD and DBT, finding that I posted a weighty article about BPD back in June 2013 and not much about DBT. Below is a little excerpt from Spectrum regarding BPD along with the diagnostic criteria. In bold and underlined are the ones I identify with, and just underlined are the ones I only sometimes or partially identify with.

According to the DSM-IV-TR (American Psychiatric Association, 2000), borderline personality disorder is diagnosed when there is a persistent pattern of unstable interpersonal relationships, mood and self-image, as well as distinct impulsive behaviour, beginning by early adulthood and present in a variety of contexts. These difficulties are indicated by five (or more) of the following:

1.      Frantic efforts to avoid real or imagined abandonment.

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

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

4.      Impulsivity in at least two areas that are potentially self-damaging (e.g. spending, sex, substance abuse, reckless driving, binge eating). This does not include suicidal or self-harming behaviour. 

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

6.      Affective instability due to a marked reactivity of mood - intense feelings that can last from a few hours to a few days.

7.      Chronic feelings of emptiness.

8.      Inappropriate intense anger or difficulty controlling anger.

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

Not all people diagnosed with BPD will present in the same way, as there are over 100 combinations of symptoms possible, if someone has five out of the nine criteria.

The diagnosis of BPD is only made when it is clear that these behaviours have been present over time (usually starting in early adulthood) and across a range of situations.

Reference:

http://www.spectrumbpd.com.au/pages/about-borderline-personality-disorder-bpd/formal-diagnostic-criteria-for-bpd.php

As you can see I identify strongly with three of the nine traits and partially with four of them, meaning I don’t quite fit the diagnosis. I should strongly identify with five of the traits. Because of this I’m unsure whether I should be pursuing DBT. I don’t know if there are people more deserving of my place, if I’m going to be sitting in the group not being able to identify with the topics because we’re talking about one of the traits I don’t suffer at all, or just sometimes or a little bit. I also have a lot of trouble with my memory and concentration. The group sessions go from 3:45 – 8:30, there are two breaks but that’s still a really long time it’s helped by being interactive but I get fidgety and restless and just don’t take anything in.

Below is the entire description of Dialectical Behaviour Therapy from the PsychCentral site. I don’t know how reputable that website is but having read through everything posted below I can tell you it’s right. I don’t have a good enough understanding of this to write it in my own words, but I know enough to be able to say this is right.

Dialectical behavior therapy (DBT) is a specific type of cognitive-behavioral psychotherapy developed in the late 1980s by psychologist Marsha M. Linehan to help better treat borderline personality disorder. Since its development, it has also been used for the treatment of other kinds of mental health disorders.

What is DBT?

Dialectical behaviour therapy (DBT) treatment is a cognitive-behavioural approach that emphasizes the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. DBT theory suggests that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels.

People who are sometimes diagnosed with borderline personality disorder experience extreme swings in their emotions, see the world in black-and-white shades, and seem to always be jumping from one crisis to another. Because few people understand such reactions — most of all their own family and a childhood that emphasized invalidation — they don’t have any methods for coping with these sudden, intense surges of emotion. DBT is a method for teaching skills that will help in this task.

Characteristics of DBT

• Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life.
• Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: “I have to be perfect at everything.” “If I get angry, I’m a terrible person” & helps people to learn different ways of thinking that will make life more bearable: “I don’t need to be perfect at things for people to care about me”, “Everyone gets angry, it’s a normal emotion.
• Collaborative: It requires constant attention to relationships between clients and staff. In DBT people are encouraged to work out problems in their relationships with their therapist and the therapists to do the same with them. DBT asks people to complete homework assignments, to role-play new ways of interacting with others, and to practice skills such as soothing yourself when upset. These skills, a crucial part of DBT, are taught in weekly lectures, reviewed in weekly homework groups, and referred to in nearly every group. The individual therapist helps the person to learn, apply and master the DBT skills.

Generally, dialectical behaviour therapy (DBT) may be seen as having two main components:

1. Individual weekly psychotherapy sessions that emphasize problem-solving behaviour for the past week’s issues and troubles that arose in the person’s life. Self-injurious and suicidal behaviours take first priority, followed by behaviours that may interfere with the therapy process. Quality of life issues and working toward improving life in general may also be discussed. Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person’s life) and helping enhance their own self-respect and self-image.

Both between and during sessions, the therapist actively teaches and reinforces adaptive behaviours, especially as they occur within the therapeutic relationship. . . The emphasis is on teaching patients how to manage emotional trauma rather than reducing or taking them out of crises. . . . Telephone contact with the individual therapist between sessions is part of DBT procedures.
(Linehan, 1993)

During individual therapy sessions, the therapist and client work toward learning and improving many basic social skills.

2. Weekly group therapy sessions, generally 2 1/2 hours a session and led by a trained DBT therapist, where people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills are taught.

The Four Modules of Dialectical Behaviour Therapy

1. Mindfulness

The essential part of all skills taught in skills group are the core mindfulness skills.

Observe, Describe, and Participate are the core mindfulness “what” skills. They answer the question, “What do I do to practice core mindfulness skills?”

Non-judgmentally, One-mindfully, and Effectively are the “how” skills and answer the question, “How do I practice core mindfulness skills?”

2. Interpersonal Effectiveness

Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict.

Borderline individuals frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. An individual may be able to describe effective behavioural sequences when discussing another person encountering a problematic situation, but may be completely incapable of generating or carrying out a similar behavioural sequence when analysing her own situation.

This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person’s goals in a specific situation will be met, while at the same time not damaging either the relationship or the person’s self-respect.

3. Distress Tolerance

Most approaches to mental health treatment focus on changing distressing events and circumstances. They have paid little attention to accepting, finding meaning for, and tolerating distress. This task has generally been tackled by religious and spiritual communities and leaders. Dialectical behaviour therapy emphasizes learning to bear pain skilfully.

Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality.

Distress tolerance behaviours are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, and thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus wilfulness.

4. Emotion Regulation

Borderline and suicidal individuals are emotionally intense and labile – frequently angry, intensely frustrated, depressed, and anxious. This suggests that borderline clients might benefit from help in learning to regulate their emotions. Dialectical behaviour therapy skills for emotion regulation include:

• Identifying and labelling emotions
• Identifying obstacles to changing emotions
• Reducing vulnerability to “emotion mind”
• Increasing positive emotional events
• Increasing mindfulness to current emotions
• Taking opposite action
• Applying distress tolerance techniques

Reference:

http://psychcentral.com/lib/an-overview-of-dialectical-behavior-therapy/?all=1

I went through the assessments to do DBT a while ago, I think it’s been a couple of years now, but my doctor decided against having me do it because he worried I could be triggered by the struggles the others in the group are going through. I still worry about that because I am easily influenced by the suffering of others; I only have to see an ambulance to think of all the times I’ve been in them and what I could do to bring on one of those situations (that’s quite embarrassing to admit publicly).

I’ve become a bit lost in writing this. I don’t have a clear point to make, maybe just that I’m worried and reluctant about DBT starting this week. I don’t know how it’s going to fit in with my very frequent hospital admissions because you only have to miss two sessions to be kicked out and made to start that module from the beginning. Unless of course you elect to quit, something I’d probably choose over going over the same content from the start.

That’s this blog post done. Sorry it was long and didn’t really make a point.

Anxiety Demon

I took my night meds about an hour ago so I may drift off whilst writing this…

I was triggered to write because I thought, “maybe there’s some sort of creature / demon who is actually getting his belly filled up from eating all my anxious thoughts.”

Just now I was lying in bed thinking about our living situation, and really it’s all gone wrong too fast. The landlord is moving back in in January or February, there are three of us wanting to stay together, one maybe and one no because he’s getting married (good enough excuse).  So I was lying in bed worrying about that and also where I will live long term. I love the Eastern suburbs, I love the trees, the lake around the corner from my house and the birds – we get Rosellas hopping along our balcony ledge every day. They make me smile. The health care is better in the East too. The public mental health service is rotten in the West and they treat you like a criminal; when you go to see your case manager you have to talk to the receptionist through a tiny crack in the window separating her from the potentially murderous patients, the chairs are all plastic and the floors hard. I was never offered anything like I have over here, my mental health support worker who comes to see me once a week, though we often go out for coffee and casually talk about my goals and how she and her organisation can help me achieve them. I greatly value the support I’ve had through my support worker and the agency. I’m taking up pottery through them soon. No such thing exists in the West. Unprompted my doctor said on Wednesday that my move to the East has been very good for me. From the nature point of view, services and being closer to my friends and church. I’ve been in two of my local public psychiatric hospitals – public is never fun, but they’re both much less terrifying than the one I’ve been to in the West.

I’m scared of moving back West, which could happen due to us housemates all needing to find somewhere – maybe I’ll fail and end up back with Mum, maybe in the future I’ll choose to live there for other reasons. But with no support, very few friends, no hills, very few trees and a truly scary local hospital if I have to go public it will be challenging. I think the solution is a LA style risen road network of 30 lane roads (with 150kph speeds) going everywhere so there’s never any traffic and you could get from East to West in 20mins. Just the little pollution and ugliness issues to manage.

Here Again

This is the first time I’ve written since November, and as usual I’m writing from hospital. The most exciting thing to have happened since my last post is that I moved house again. I’m now living with four people, two from my church and two from a church that everyone seems to know someone from. I love the house; there’s always someone home at night, we cook for each other and there’s just a general sense of kindness and care. I wasn’t doing well at the old house; I was alone too much and had no motivation to cook for myself. I resorted to eating very little and when my stomach hurt using those powdered shakes to line my stomach. Being in hospital again has nothing to do with my living arrangements, I really couldn’t be happier there.

I was in here for six weeks recently with the plan of getting me off Lithium. My doctor decided to do it as an inpatient because he knows how sensitive I am to medication changes. He halved my dose and for a while it seemed to be going well, but then I became very depressed and agitated. It improved very quickly once the dose was increased again. My mood was still too low to send me home though so I had a round of ECT. I have no fear of ECT and I like the feeling of the anesthetic kicking in so there’s a kind of good side to it. It works very well for me and two days after the course ended I was sent home feeling great.

The positive feeling persisted for two weeks and then I started planning my suicide, a method I have access to and so could do very easily. I sat with the feeling for two days and then called my doctor. As usual there’s some protective element inside me because rather than follow through with it I called him, he suggested taking some Seroquel and having an early night and that we’d speak the following day. The following day came and I was more bent on dying and very reluctant to go into hospital, but he insisted. I only have accompanied leave, so I feel caged up. I’ve been here since Saturday and I’ve had my Mum visit on Tuesday and my outreach worker today, so that’s twice I’ve been outside in almost a week. Two friends might come tonight and another on Sunday.

I’m very disappointed in myself for being here this time. I was only home for two and a half weeks between admissions and I feel like I’m letting the household down because I’m not there to do my share of the cooking and shopping, but they’re a good bunch and I know they’re not going to resent me for being sick. I would like to explain to them what it’s like for me, that even though I can appear completely fine I can be in great turmoil. I’d like to have the kind of relationship with all of them where I can honestly talk about all this shit. I don’t even have that with my Mum. I wasn’t raised in a very emotionally open environment. I suppose when your husband is a nasty alcoholic you’re trained to answer “fine thanks” each time you’re asked how you are. I would have picked up on that.

I decided this afternoon that I was going to stop eating as a form of self-harm and control, it’s easy to feel like others have power over you in here. God is good. I decided this in art therapy and when I got back I had a message from a friend asking me to dinner tonight. I’m not going to go out for dinner with someone and not eat. So I’ll start that tomorrow if I still feel that way, it may be that I’ve changed my mind by then.