Mourning?

Today is a hard day, it's my Dad's 62nd birthday - well at least it would be if he was still alive. I thought I'd be fine, but I cried over my breakfast and then managed to bite my lip for a few hours to stop a repeat. I allowed myself to shed a few more tears when I got home from my psychology session. He was briefly mentioned, but I felt like there were more pressing issues to discuss. It's hard knowing what to feel right now. I guess the answer is whatever you are feeling is right. It's just so confusing. My psychologist and I were talking about emotions taking on a whole new life when they are attached to trauma, they're stronger and harder to dismiss or even accept.

I've been in therapy for nine years now and we've all agreed that I have depression, which is biological and even if I was brought up in the ideal family it would have reared its ugly head. It is worse due to what I've been through though. On top of the depression, I also have anxiety and Borderline Personality Disorder. I can't be bothered searching this blog to find out what I've already told you, so I'm sorry if you've heard it a hundred times. The trauma in my life is from growing up with the emotional abuse from my Dad's alcoholism. I'll make it clear, he didn't hit us, but I was still terrified nearly every night of what was going to (eventually) walk through the door. Often it was late and he'd wake me up with his shouting and very loud music, one time he threw a heap of crockery across the kitchen, smashing plates and bowls on the floor and walls. I hid from him pretty well when I knew he'd be yelling at me. I'm not going to type every incident from the 21 years I lived with him in here, but let's just settle on the fact that I was scared of him.

Mum was and still remains a stone. If that woman has an emotion it's hidden underneath a mountain. I couldn't share my fears and shame with her. I attended a Christian school where everyone came from a perfect church- attending family, of course not true, but it felt like I was the only one with this dirty secret that my family wasn't perfect. It was made worse by the church when I started attending of my own accord when I was in year 9. There the families were on a higher level of perfection and I just felt that I was somehow tainting the place. I told no one except the one girl who invited me to the church. (she probably told her dad, who was/is the pastor, so I'm sure more people than I thought knew). Not having anyone to talk to has made the emotional abuse so much worse, I didn't have extended family as we moved to Australia from England when I was 3. My Grandma was a great support on our most recent trip. I think about how much better things would have been had I been able to talk to her whilst growing up, and for Mum to have some support if she wanted to get a divorce.

Mum says I blame Dad too much for where I'm at now, but my doctor puts a lot of blame on him, and her for failing to be emotionally available and for tearing me away from my extended family. (If you're reading this Mum, I know you thought you were doing the best thing). You can't raise a healthy child in an environment where it doesn't know what to expect each night, where it has to keep secrets and has no support.

An aside. In year 10 my Dad was getting home late most nights and playing music very loudly whilst shouting at Mum. I think it's understandable that most mornings were slow. I got to school late most mornings and my bastard of a homeroom teacher, instead of taking me aside and asking how things were at home just kept giving me demerits and detentions.

So today on his birthday, I'm lost. He was a drinker right to the end. I remember one apology, he was trashed on my birthday and the next day went and bought me a beautiful pearl necklace, which I still wear on occasions. I am similar to him in that way, I show my love through gifts. He loved me and showed it in his own way, but that doesn't wipe out the damage he caused.

If my Mum reads this I'll be in so much trouble for telling all of you this. I don't let Mum see the links but I think she snoops around sometimes.

I'd like to add that since leaving the church of my youth I've been open about Dad and I'm not a dirty stain on the church, I'm part of a body of believers who love and help each other.

I have nothing else to say.

Happy Birthday Dad

Welcoming V

We’re getting a new housemate, as our relatively new J - who will be greatly missed - is off to get married very soon.

I’m not long home from a session with my psychiatrist; we talked about an admission at the end of next week, just as a respite, but I refused because I don’t want our new housemate, V’s first impression of the house to be “Oh, one of them is in a psychiatric hospital, well that’s just great!” She knows I have depression and spend time in hospital, as we all agreed she should know something about what to expect from me, but I didn’t mention the BPD and anxiety. It’ll come up in conversation, but not until I’m ready. BPD’s a crappy diagnosis with so much stigma attached to it; and because I have the co-morbid conditions of depression and anxiety I can’t really separate symptoms to adequately describe the experience. I can give you this: Right now my mood is about a 4/10, but largely I’m numb, urge to cut 7/10, urge to OD 8/10, but strength to refuse urges: 8/10 for OD and 7/10 for cutting, so it’s unlikely I’ll be doing either of those things today. I have things on this weekend I’d like to be conscious for, but I could get away with some cuts.

I just worked out that by the date I feel it’ll be acceptable, with the new housemate in mind, for me to go back in I will have been out of hospital for 12 weeks, that’s a very long time for me. I’ve had the one night in Short-Stay after the Seroquel overdose, but we’re not counting that. I may not last till 12 weeks, but I don’t want to scare V away. Really I should have gone in a couple of weeks ago when I was very low and used that time as a respite as well as a safety net. I’m a little scared that by postponing the admission I’m going to have a meltdown and destroy things with V more than my absence would have. Choices.

A Few Words on Trust

Yesterday I awoke feeling like I needed to die. I wasn’t upset about anything, everything just felt wrong.

I argued with myself for a while before giving in and going to a pharmacy to grab a huge box of Seroquel. That box took my collection up to 4. I can get two more off that same script but they have to be 21 days apart.

Knowing that I might have had enough for suicide but only borderline, I instead decided to use just under half a box (40 pills) to make myself unconscious. I’ve taken that exact amount of pills 4 years ago and it had me unconscious for 20 hours in the Emergency Department; this time I went straight there after taking them. I was attended to quickly. Sadly because I got there so fast they were able to give me activated charcoal – awful stuff. They monitored my heart all night as it shot up to 157bpm at one stage. My Lithium levels came back a little low too, so I’ll be talking with my psychiatrist on Friday about that – and also what the hell made me do this –

I appreciate my housemates, they care for me and I should do better for them than a single half-baked message saying, “I’m in ED due to another OD, might be a night or two.” I didn’t even try to soothe her worries, I’m not sure though how I could have at that moment as I could hardly move to pick my phone up. I’d prefer not to tell anyone about these single night trips as they’re always after an OD and it worries people. I want my friends to enjoy my company and not to sigh when they see my name popping up on their phones. I don’t know how to ask for help before doing something stupid. People have jobs, jobs and kids or study. This makes them hard to contact last minute when I may be distressed.

As I just said, I appreciate my housemates, and I trust them enough to tell them when I've done something stupid. But I’ve overdosed 3-4 times while I’ve been living with them and it makes them worry. I don’t know if I can be as blunt as to say “Don’t worry, if I ever do kill my self it will be at xxxxx, you won’t be the ones finding the body." I do wonder if they fear finding me dead, so I want to allay those fears. I will die somewhere quiet with lots of trees and maybe a lake. I have a good place in mind.

My other housemates know of my situation and are not happy – more scared than angry – and I don’t know what to do; a few years ago my two housemates left because if it. I don’t want to get kicked out of here or asked not to join them in the new house. I think we just need to have a frank discussion.

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.