Between what and what?

The proposed revisions for DSM-V are available to view on the internet and so I went along and had a read of the revision for Borderline Personality Disorder. I was pleased with the revisions, but this has led me to start thinking a lot more about my illness lately, and I have come to terms with and realised a few things about what it actually means to be Borderline.

So what have I realised? Honestly, what I have realised is that the majority of people who know what BPD is either a) thinks the disorder doesn't actually exist, or b) they fucking hate us. No, really.

Let me elaborate a bit. I have been reading on a lot of forums about people who have been diagnosed with BPD and their experiences in the mental health industry. The consensus seems to be that once they had their diagnosis, professional support was withdrawn and they were treated with disdain. At least nine out of ten people had negative experiences as a direct result of their diagnosis. I used to be that one person in ten that didn't... until I actually started looking back and scrutinising my experiences in the mental health system, and then it became apparent that I never really did receive the support I should have. For example, after I was diagnosed (five days into my seven days stay in hospital for a suicide attempt) the doctors and nurses started telling me I was using a bed that could be used for someone with real needs (in those words), and when I was diagnosed, my doctors gave me only the name of my disorder and a prescription. I was never offered an explanation of what I actually suffered from, and had to learn it for myself from the DSM-IV.

My experience was not bad by any means though obviously it was not as helpful as it could have been. However, it is certainly an example of how the system will treat you differently after a diagnosis of BPD. Other experiences I have read about have been much worse. Someone once mentioned on a forum that while an inpatient a large amount of work was done to organise continuing care and support for when they left the hospital. Once they were diagnosed with BPD, those plans were cancelled and the individual was left with no support once they were discharged from the unit.

I sent my mother a link to the proposed revision of Borderline and made the comment of Borderline's being treated differently by the medical field which prompted her to contact a friend who worked for a long time in the mental health field. Her friend confirmed that doctors and nurses do indeed treat Borderline patients differently. She once asked a doctor why they virtually ignored people with BPD and received the answer that "they can't be helped anyway". I recently also witnessed a mental health worker talking about Borderline patients and her comments were that we are "impossible" to deal with unless medicated, and that we were unpredictable and abusive.

When I was first diagnosed I went looking on the Internet for resources about Borderline to help me. All I found were resources to help the abused partners of Borderlines seeking advice on how to leave a Borderline and divorce advice, as well as sad stories about the children of Borderlines being abused by their parent. This worried and upset me so much that I was afraid to live. I knew what my disease was, finally, and was ready to fight it, but what was the point in knowing my disease when I would just become a husband and child abuser? What was the point in living, in fact? Obviously I did fight my disease, and I am now in a relationship, but every time my irrational and quick anger fights through and I say something nasty to my partner I have this sinking feeling inside me. I mean, not only am I afraid to lose myself to my anger and hurt my loved ones, but I am also afraid of passing on whatever genetic link exists inside me to my children and having to watch them suffer from the same demons that I do.

After that little side-track, I suppose I would like to know why the medical profession despises Borderlines so much. Is it because they view us as manipulators and liars just trying to get attention? This reminds me of the debate about whether or not people who self-injure for attention are worthy of support or help, and my argument has ever been that no matter why they self-injure there is still something wrong and they still deserve help. So with a disorder like Borderline which is characterised by desperate and manipulating attempts to avoid abandonment would a doctor not just see that as part of the disease that needs to be treated? Would a doctor not see irrational anger and abuse to be part of the disease that the individual needs to be helped overcome? Or are Borderlines simply placed in the "Too Hard" basket and left to become the abusive parents they become when left untreated?

Everyone has the right to supportive treatment by the mental health field, no matter what their disorder is or how mild that disorder might be. No one should be left to fend for themselves or go untreated because a doctor feels that they are undeserving of treatment.

So to every Borderline that is reading this, I want you to know that you deserve treatment and support. You can, with treatment, live a healthy life and manage your disorder. You're not destined to be an abusive partner or parent. You're not undeserving, and you're not impossible or untreatable. So next time someone tries to shrug you off, stand up and demand the respect and help that you deserve.

Getting the trust back

I had an experience recently where I perceived a loved one was not trusting me to take responsibility for my own mental health. They asked my partner to keep an eye on me while I was going off my medication without talking to me about it.

Now, I have never particularly enjoyed people discussing my mental health behind my back, perhaps because I view it as everyone else not thinking I could contribute rationally to the discussion. I have always felt like doctors and other people in my life have whispered about my diagnosis and treatment without consulting me at all.

I remember just over three years ago I was in an emergency psychiatric department. I was suddenly ushered down to another room where two men wanted to give me a physical before I went to the other hospital that day. I had heard nothing about this and I lost my shit. I told them that I had been quiet and had not disrupted their ward or bothered them unnecessarily. I told them that the psychiatrist on call had told me I had been doing "bad and wrong things", had refused to discuss anything with my mother (who was interstate) and had wanted to release me into the care of my 21 year old housemate (who, at the time, was not my greatest fan, and we have since parted company completely). The men looked aghast and told me they would find out for me, left and came back a few minutes later to tell me that they found a bed for me at another hospital and I would be transferred there in a few hours. I thanked them very much, but I still felt angry that no one had thought to mention to me that they were transferring me. I had a mental illness and was admitted because of a suicide attempt, not because I was incapable of being treated like an adult or being told anything about my own treatment.

I have constantly felt like this in my mental health journey. I have felt like decisions were being made for me without it even being mentioned to me, like I had no say in the matter. I was never consulted, and more often than not I was treated like a fake by the professionals in the field. In fact, after I was transferred to the next hospital, they checked with me every day if I was ready to be a "good girl" and get my Borderline ass (yes, they'd just diagnosed me) out of their hospital because there were people who actually needed the facility and I was wasting the bed that could be needed by someone else. Oh, I'm sorry, I didn't realise that being a suicidal Borderline wasn't as important as that crazy tart across the hall that screamed all night or my roomie that was admitted after being taken to hospital for an asthma attack. The fuck, man? As a matter of fact, the only person I felt truly supported by in hospital was a male nurse who had the last name of Hammond (I remember this because one of my friends is named Hammond). This nurse was always supportive, always ready to give me a hug or listen to me cry because I was confused about being in hospital. Compare that to the snobby indifference of the psychiatrists and you can guess who I would have preferred to spend time with!

So enough about my misgivings with the snobby psychiatrists who treat you like a piece of dirt, we were meant to be talking about trust. So let us talk about why I think I can be trusted, shall we?

I believe I can be trusted because I have worked hard to conquer my fear of psychiatry and psychology, enough so that I could do successful therapy with a psychologist. I took my medication, stopped self-injuring, recovered in pretty much every way. Now I have made the decision after three years to end my course of medication, tapering the dosage down over 80 days. I have taken no medication for over two weeks now and I feel amazing.

Now, I don't want you to think that this means that I wouldn't accept help again or go back on medication if I found that I was struggling, but that seems to be lost on the people around me. I am very aware of my moods and find myself monitoring my mental health very closely, so of course I would definitely be the first in line to see the doctor if things all went a little pear shaped. I feel that my family and friends don't believe that, and are constantly afraid I will relapse.

Just because I was well when on medication doesn't mean I won't be well off it.

On a similar note, people are always blaming any blip in my mood on my mental illness. Newsflash, peeps, "normal" people have mood swings too. Normal people cry when they fight with their boyfriend or someone says something hurtful to them. Because I cry in those situations does not mean I am losing my fucking shit, okay? Just because I cry when I'm stressed, haven't had much sleep and then my cat gets run over does not mean that I am about to flip out and commit suicide. In the same way that women hate it when men accuse them on menstruating when she is being snarky, I hate it when people think I am being mentally ill every time I feel any mood other than happiness.

So, what I am trying to say is to have a little faith. Have faith that I am being responsible for myself, and that I don't need people spying and reporting back on me. Have faith that I can take care of myself now and that I can take responsibility to seek help if I need it.

Have faith!

So you know someone who self-injures

So you've just found out that your child, your pupil, your grandchild or your friend hurts themselves. I am guessing you feel shocked, upset, guilty or angered by this, which are very natural reactions, but what do you do now that you know? How should you approach them? Should you approach them?

In short, now what?

Firstly, it is important to remember that this is not your fault, they are not crazy, they are not seeking your attention and that they are in some degree of emotional pain or turmoil which has manifested in self-injury. They are still the same person you have always known and loved, they are just coping with a problem in a way that might not appear to be very helpful to you, and it is not your fault!

Now that you've processed this information, you need to know what to do, and what not to do. It might take some trial and error to understand which is right and which is wrong for the individual you are dealing with because we are all individuals, and we all hurt ourselves for different reasons and in different ways. The only way to figure that out is to communicate with the person, but for now here is a list of things to do and things not to do!

• Talk about self-injury with the person, but don't press them for information. Be non-judgemental and let them know that you are there to talk to if they need to discuss this, or anything else, with you. Self-injury is a behaviour that is often very secretive, and the person may feel ashamed about the fact that they hurt themselves, so understandably it might be something that is difficult for them to talk about at first. Just be patient, supportive and do not display any hint of behaviour that may portray you as being judgemental of their self-injury.

• Do not ask the person to stop self-injurying and do not issue ultimatums. They are very distressing to the person because they feel that their self-injury is often the only thing they can do to cope with their own distress. If you force them to stop self-injurying, they will become even more withdrawn and secretive, and often very afraid that if they do not stop self-injuring you will not love them any more.

• Do talk to a counsellor about your own feelings and reactions. It is important for anyone in this situation to receive some kind of "self-care" to look after their own wellbeing and mental health. Do not be afraid to seek help for yourself. Caring for someone who self-injures can be very distressing and emotional, and it is important to take care of yourself. You are number one. Always.

These are only three things that you can do, but there are many more. You can read more about how to support a loved one who self-injurers at this website which is a valuable resource for anyone who is affected by self-injury, and also has a very active forum where you can go to ask advice on any aspect of self-injury. A "real-life" counsellor or therapist will also be able to give you some information about how to approach a situation like this.

It's my self-injury birthday

Today I finally reached three whole years without self-injuring. I had been self-injurying in one way or another since I was around 15 years old. I took the big step to razor blades when I was 16 and it was a downhill spiral ever since. I didn't appreciate or understand the addictive nature of the behaviour until many years later, and by then I suppose it was too late.

I still think about it every day. I still fight the urge to hurt myself every single day of my life. I dream about it, fantasise about it, even make up plans of how to do it and get away with it (completely impossible now that I am living with my partner, by the way). I actually sometimes wonder if people with addictions to drugs or alcohol think about their given up addictions in the same way that I do with self-injury.

I see people at least every day who have harmed themselves. Some are friends, some are strangers. Every time I see a young person with fresh cuts on their arm when their armband slips or their sleeve falls down I feel a pang of worry for them. I worry when I see young people who have cut themselves because I too was once them and what started as a scratches soon developed into so much more. I worry that they don't appreciate the highly addictive nature of the habit, and that some day they will be struggling to give it up like I am.

Self-injury is the act of intentionally causing yourself physical injury by cutting, burning, interfering with wound healing, hair-pulling (trichotillomania), skin-picking (dermatillomania), head or wrist banging... and many, many other ways. The reasons that people self-injure are as wide and varied as the self-injury methods. People self-injury to cope with overwhelming emotions, stop/prevent/induce dissociation, as a physical representation of emotional pain, inducing euphoric feelings, gaining control, self-punishment and many other reasons.
People that self-injure often keep it hidden from family and friends because they are ashamed. You could pass people in the street and never know whether or not they self-harm.

For more information about self-injury you can visit Self-Injury: A Struggle, which not only has an excellent FAQ about self-injury (for both people who self-injure and their friends and family) but also a large and tight-knit forum community where you can talk to others and receive support.

Bloodletting

I went to the book store yesterday and found myself at the check out with arms full of the memoirs of people with mental illnesses. The first one I picked up to read as soon as I got home was "Bloodletting" by Victoria Leatham. I suppose I picked it to read first because it was the only one that was even remotely applicable to me. The book is a written record of Victoria's experiences with Bipolar II and her struggle with self-injury.

Victoria struggled with her Bipolar Disorder for approximately 15 years before a doctor finally recommended she try Cognitive Behavioural Therapy (CBT) as well as medication. In the past, doctors and psychiatrists had done seemingly nothing except give her various forms of psychiatric drugs. She had never done any form of psychotherapy except for partaking in some group therapy on the occasions that she was hospitalised.

I want to use this book as an example for explaining my number one psychiatric pet peeve: Drugs do not make you happy.

That last statement may come as some sort of surprise to you, but it is true. There is no magical medication that will make you happy. Antidepressants are mood stabilisers. Meaning that they regulate your mood so that you do not have extreme highs and lows, thus making your mood easier to deal with and handle. They do not make you happy, and they should never be the only form of help you seek for depression issues. If you only ever take medication and never once try psychotherapy, you are likely to relapse because you never changed your behaviour in the first place.

I am not saying, and I never will, that medication is not useful. It certainly is for many people (and then it isn't for other people as well), but medication alone cannot "cure" depression because it is often more than just a chemical imbalance. We have a lot of negative, self-defeating behaviours that are often learned, and unless you unlearn those negative behaviours and thinking patterns, you can take all the medication in the world and relapse.

I definitely believe that doctors in Australia are incredibly script happy when it comes to psychiatric medication. Most GPs will be only too happy to give you a prescription for a psychiatric medication and then send you on your way. Some won't even bother to suggest you see any form of mental health support group, let alone seek an appropriate counsellor. I always wondered why a GP was even allowed to write prescriptions for psychiatric medication when they often have no idea about the medication or how it works.

A doctor I saw once prescribed Fluvoxamine when the medication I was on (Venlafaxine) was making me drowsy and I was experiencing suicidal thoughts. Fluvoxamine (or Luvox as it was branded when I was taking it) has the very common side effect of making you incredibly drowsy. The psychiatrist I saw after everything went a bit pear-shaped on the Luvox front (Lets just say that I was only awake for a few hours before being so exhausted I had to go back to sleep) was aghast that I was prescribed it in the first place considering I was complaining about drowsiness and the fact Fluvoxamine was withdrawn from the American market after a tasty little scandal with a school shooting. It isn't a very popular medication (and a very old one, since it was one of the first SSRIs on the market) and I still wonder why a GP was able to prescribe medication that he had no idea about, and that had the potential to go very wrong, and then of course I wonder why he opted to simply prescribe medication to me (and not recommend I see a psychiatrist) when I told him I was suicidal.

My experience isn't unique, and I wonder if a lot of problems with recovery could be prevented by medication only being prescribed by psychiatrists and used in conjunction with an appropriate psychotherapy (CBT, DBT, etc).

Would Victoria Leatham had to have suffered for so long with mental health issues if she had been told about CBT in the first place? Maybe they could stop a whole lot of people suffering for so long if they could just use psychotherapy and medication as the first response to mental health conditions, and perhaps they should stop letting GPs prescribe psychiatric medication when they have no specific psychiatric training.

So, the moral of the story is that medication won't make you happy, but it can be very useful in the successful treatment of various mental illnesses when used in conjunction with an appropriate and supportive psychotherapy.



Obligatory disclaimer: I am not a medical professional, and my opinions are based on a metric fuckton of personal experience and a whole lot of experience with others who are receiving treatment for