Tuesday, 9 November 2021

EVERYTHING YOU NEED TO KNOW ABOUT A MENTAL HEALTH RELAPSE

From the start of my blogging career, I’ve been very passionate about being honest and open about mental health and my experiences. But when I had my first ‘relapse,’ I massively struggled to talk about it. I worried that through I’m NOT Disordered, I had become a bit of a ‘poster-child’ for mental health recovery. I mean, I receive messages from readers calling me an inspiration. So to have to say that I’d been so well, but just like that, it was all ‘ruined;’ made me worry that readers would panic and loose hope. Eventually, however, I realised that there’ll be so many people out there going through mental health relapses and being afraid to talk about it; and I don’t like that thought because it means a greater chance of them not getting help and support. So, I thought I’d lead by example…

About a month ago – maybe a bit longer – I began experiencing a few things which were sort of similar to the past, but at the same time very different… They were these thoughts – these very strange thoughts… With them sort of being along the lines of the hallucinations I hadn’t experienced since my medication increase over one year ago, I kept quiet for a week. 

Throughout my mental illness, I’ve come across a number of professionals who – even when they were in the same role and working for the same organisation – have disagreed with one another with regards to the hallucinations. I’ve had some say the voices and visual hallucinations of rabbits were stress-induced – that when I was busy or something upsetting had happened, it made those experiences worse. Then, other professionals (who were in the majority, to be fair) believed it was more genuine and something which I actually needed medication for. And because my medication increase last year led to the hallucinations disappearing completely, those professionals seemed victorious.

This disagreement amongst staff meant that when I began having these similar experiences a month ago, I decided not to tell anyone. I did have a lot going on in my life at that time, so I wouldn’t have been surprised if that had been labelled the cause for the relapse. To ensure that didn’t happen – because I had every conviction that this was more than stress; I thought I’d wait to get help until my commitments had levelled out and they could no longer be used as a – in my opinion – flippant response to my experiences. 

My silence, however, meant that no one knew until it could have very well been ‘too late’ because in a bid to cope, I ended up self-harming in a way which genuinely could have killed me. And whilst I wasn’t exactly suicidal, I still refused help for what I had done… Which meant the Police became involved and when one of the Officers branded a suicide attempt as being ‘silly’ and said I was ‘full of’’ myself; I struggled with the notion that perhaps not speaking up had been a good idea because if I was a going to be honest and be treat like this…?

Thankfully, this thought and belief that I shouldn’t speak up when things seemed to be going backwards, didn’t last too long and I found myself having a helpful conversation with the Psychiatric Liaison Team in my local A&E (after another instance of self-harm that resulted in me needing surgery). I found myself thinking up an analogy to try to explain these strange thoughts to the two staff. I finally decided on it being similar to when you bang your knee or elbow and say ‘ow’ then realise it didn’t actually hurt! That was how quick these thoughts were coming to me, and how sort of… automatic and strange they were. And I felt so relieved and validated when the staff both said “I know what you mean” – even though they really couldn’t possibly… Having used that analogy and them say that, really made me feel more understood and less judged.

With my mental health having been unwell for some time, I‘ve found myself becoming so much more insightful in my thoughts and feelings and so that meant that I had the idea myself to start writing (or typing) these thoughts down when they would come. Firstly, it meant that if I were asked what the thoughts had been, I could easily recall. Secondly, it meant that I didn’t have to experience the embarrassment and sense of stupidity I had when saying these things out loud. Thirdly, simply writing these things out meant I could see just how nonsensical they really were. And this element of it became so helpful when I found – over the course of two or three weeks – that things were changing. For the worse. I was finding that these thoughts were coming more regularly, and were staying for longer which meant they were more challenging to ignore or rationalise. 

I think another hugely helpful tool that contributed to me getting through the relapse, was the skills I’ve learnt through Dialectical Behaviour Therapy (DBT). 

Even though DBT is the recommended treatment for someone with the same diagnosis as me of Borderline Personality Disorder (BPD) and I had been diagnosed for over two years, I only heard of DBT through chance! I had been sectioned down South and a member of staff from the psychiatric hospital I was in mentioned DBT over the phone to my Mum and immediately she questioned why it had not once been mentioned over the previous two years. 

It turned out, psychiatric community services in our area up North were so completely void of anything remotely resembling help and support for people with a Personality Disorder diagnosis! This meant that even after finding out about the therapy’s existence, the only way in which I could go through it, was when I was admitted to a specialist Personality Disorder psychiatric hospital… over 100 miles away from home! And with the therapy being advised to take at least 12 – 18 months to engage in, I ended up being so far from my loved ones for over two years! 

As resentful as I was in the beginning of the Therapy, I grew – and still am – grateful for it and I’m filled with the belief that it was one of a few ‘things’ to be responsible for saving my life. I just honestly didn’t imagine that it would continue to develop and aid in maintaining my stability and recovery over seven years down the line and a few relapses later!  

Mindfulness – This module wasn’t all about taking big breaths and practicing relaxation exercises as you might assume (I know I did too!). The aspects of the module that I have found helpful in a mental health relapse are around observing and describing your emotions without judgment or action and utilising the ‘wise mind’ theory by making decisions based on a combination of your rational and emotional mind (instead of one or the other). 

For more info: https://dialecticalbehaviortherapy.com/mindfulness/

Distress Tolerance – Skills I learnt in this module which have proved helpful in a relapse, have been around using grounding techniques to maintain your presence in the moment rather than considering the past or being overwhelmed by thoughts of the future, discovering distraction and self-soothing activities, and practicing radical acceptance to recognise your reality without judging it.

For more info: https://dialecticalbehaviortherapy.com/distress-tolerance/

Emotion Regulation – The part of this module that has helped me the most through mental health relapses has been self-validation by accepting, acknowledging, and allowing your emotions.

For more info: https://dialecticalbehaviortherapy.com/emotion-regulation/

Interpersonal Effectiveness – I found learning about assertiveness and being able to use those skills, the part of this module most helpful in a mental health relapse. 

For more info:  https://dialecticalbehaviortherapy.com/interpersonal-effectiveness/



So, in all honesty, these five stages have been in my head a lot recently because it’s coming up to the first Christmas without my bunny; Pixie. So, I wondered if I was just trying to make them fit somewhere random where they didn’t really belong, but the more I thought on it and started writing about it, I saw that they really do fit as different stages you might experience with a mental health relapse. So, here’s the order I think I’ve experienced them in with my most recent relapse:



1.    Denial

There have been so many times where someone has suggested or even just checked whether my mental health was deteriorating again and I’ve shrugged them off with “no, of course it’s not!” Sometimes, this has been a genuine absence of awareness; but on most occasions it’s been about denying that fact in the hope that either it suddenly won’t be true or that acknowledging it – giving it that ‘relapse’ label – will be what makes it into one! 

Advice: Know that it’s ok if establishing a name for your experience is important to you, but also know that this name doesn’t have to define or guide how you feel and what you do. 

2.    Bargaining

Typically, bargaining in terms of grief where there has been a death, is about considering ‘what if’ scenarios and struggling with senses of guilt or responsibility. And this is much the same with a mental health relapse in that you can become so desperate to turn back the time to a point where you could change something that you may deem to be the cause of the relapse. 

Advice: Recognise the elements that are in your control and those which are not.

3.    Anger

Sometimes, I wonder if ‘frustration’ is a better word for this stage… but then that somehow sounds more insignificant than ‘anger.’ As though they’re on some sort of scale and there’s a big difference in their level of severity! I think that the anger around a relapse is mostly about experiencing the sensation that something has gone ‘wrong’ somewhere.

Advice: Don’t assume you need to stomp down your anger – it can be used as motivation and passion in a productive way that could lead to the end of the relapse.

4.    Depression

This is probably the most obvious stage you may experience in a mental health relapse – I mean often, it’s the definition of the actual relapse; but it can also be a response to it. A response which may – very likely – exacerbate your relapse and leave you feeling completely overwhelmed. 

Advice: Always seek immediate help if you find yourself feeling unsafe/suicidal.

5.    Acceptance

Ironically, I think that acceptance could actually be the cause of a lot of the previous stages discussed. I mean, surely accepting and acknowledging your mental health has relapsed will cause a certain amount of upset and anger? Alternatively, the acceptance could be a response to all of those stages – like, you’re accepting the ‘depression’ and that you’ve been in ‘denial.’ 

Advice: Recognising the relapse for what it is – and what it could become – can be essential in maintaining your safety and getting the right help and support. 



Finally, my GP spoke with a Psychiatrist and agreed to increase my antipsychotic medication, so that within one week, the thoughts were coming a whole lot less often. And now – just over two weeks later – they have completely gone! 

Even though I had every faith that the medication would work; I feel very lucky and grateful that it has. I mean, if those other professionals had been right and it’d been stress-induced; it would’ve been a lot harder to ‘fix.’ Whereas taking one extra pill at night time? Well, in comparison, that’s incredibly straightforward! 

Since the last incident, I had a few stitches to be taken out and there were some queries that they could have been infected, and then one of them was buried under the skin a bit so they had to cut around it to remove it… And the whole thing just reminded me of the fact that you can do something in the moment and then later – when you’re no longer feeling that way – you’re faced with the consequences of what you have done. 

Fortunately, there was no infection and they did get that stitch out, but I’ve found that I have reduced sensation around the area and that points to it likely being permanent nerve damage. So, yet another injury that I may have to deal with for years to come… 

To cope with this, I’ve found reminding myself that when I did what I did, I was poorly and I was convinced that was the only way to feel any better. So, whilst it’s important that you recognise the turmoil you were going through if you have acted upon a thought or feeling in your relapse, it’s equally essential that you don’t let that put you back into that place. 

Having now experienced a handful of relapses in my mental health recovery, I’ve become less and less disappointed… I mean, with each one I’m still terrified and concerned because I’ve seen just how close to death I’ve put myself; but I’m no longer that much taken aback when they’ve happened. I panic less at the thought that it’s never going to get better again. I rarely lose hope or believe that there’s no point making any effort to come out of the relapse knowing that I’ll likely fall back into one at some point. It’s probably ironic because you might think that the more relapses, the less hope I’d have for a future. 

So, I guess I’d like people to know that no matter how many relapses they have, that will never put them back to square one. It shouldn’t leave them with little faith in the encouragement that recovery is possible – or in any false promises professionals make about recovery being linear. It is not. And that doesn’t mean there’s been some sort of failure on your part.