“The
only part of an argument that really matters is what we think of the people
arguing.”
Kim
Stanley Robinson
There was a point in my mental health journey – not necessarily the recovery part – where I had this sudden realisation that disputes were becoming so frequent that they were almost natural reactions to anything even slightly worthy of disputing. The development of that automatic response meant that I actually wasn’t even realising or aware that I was doing it half of the time it was happening! Through having Dialectical Behaviour Therapy (DBT) as a psychiatric hospital inpatient, I learnt a lot about properly handling yourself to be the best possible version of yourself during a dispute, as well as learning the whole saying of choosing your battles and these are lessons, I still stand by. I – and my mental health in particular – have benefited a lot from this improved understanding and change in attitude and behaviour so I wanted to spread the new-found knowledge to others…
When & Why Disputes First Came Into
My Life
The
first dispute or argument which I can really remember vividly and which I would
wholeheartedly label as having the largest impact on my life and my mental
health especially, was with my abuser when I was 16. It was April 20th,
2007, and I’d just undergone around six months of sexual abuse and one instance
of rape when this argument finished it…
For
legal reasons, I was told not to reveal any defining qualities of my abuser and
so I obviously don’t want to get in any trouble, but it also makes it
incredibly difficult to talk about things like this because I can’t be as clear
and as transparent as I’d like to be. So, what I will say is that my abuser’s
role in my life massively impacted my education and his job meant that it was
actually quite common for someone in my position to argue with someone in that
role. So, I did wonder whether that played a huge role in people not getting
suspicious as to what was actually happening behind the arguments. But, when
his colleagues were interviewed by the Police, apparently a few stated that
they had ‘always wondered’ if that was happening and a few labelled their
suspicions as being caused by the fact that felt the arguments he and I would
have in public were far too personal to be the ones that were expected or frequent
for the parts we played in each other’s lives. In all honesty, I’d rather they
had just failed in getting suspicious than finding out they were, but actually
just didn’t do anything to help me!
If I
had to sum up our arguments though, I’d say they were ‘petty.’ Just because
every single time we’d argue it would be regarding, or because of, a very small
detail. A detail which, under literally any other circumstances, I would deem
completely unworthy of my time nor the effort that would be required from me to
have any sort of dispute about it. But it was almost as though because it was
him, the rules didn’t apply. I think that was because he was having such a huge
impact on my life that it almost automatically made him more important than if
it was anyone else picking an argument or in the situation with me. And when I
say ‘impact…’ Well, despite my first suicide attempt not being until 2009, that
didn’t mean I had no suicidal thoughts or feelings prior to that. In fact, my
first experience of considering suicide was a month or so after the abuse
started when we were in my abuser’s first-floor office (where the majority of
the abuse took place) and I found myself almost daydreaming about what would happen
if I jumped from the office window. But almost as quick as I realised that was
a daydream it had gone too.
Those
six months of abuse and the arguments, ended on that date in April when we were
in his office, and it was one of the few instances where I actually managed to
fight him off. This time however, when I ran out of the office, he came racing
after me! So we ended up arguing with each other but whilst he was running
after me and we got into this corridor at the bottom of some stairs and I
shouted “think of your wife and children!” and at that moment, my abuser’s
employer came out of his nearby office and yelled at me asking why I thought I
had the right to speak to my abuser in that way. For those six months, despite
there obviously being many reasons why I should have spoken up, there were a
lot more reasons – and they were a lot more overwhelming – for me to not report
it. This meant that when his employer asked me that question, it was a ‘straw
that broke the camel’s back’ type of situation and I ended up telling him
everything. Everything that had been going on right under his nose! And it was honestly
like word vomit; in that the entire thing was just pouring out my mouth with
very little thought, caution, or control.
One of
the largest reasons for not reporting the rape and abuse immediately, was the
knowledge and conviction that I wouldn’t be believed because I knew he would
deny it, and no one would believe me over him. So, I wasn’t too surprised when,
after the word vomit(!), my abuser’s employer called me a ‘manipulative liar’
and banned me from setting foot back in the building! On waiting for my Mum to
pick me up – after having told her a hugely elaborate lie because why on earth
would I tell her after the response I’d just received?! – I heard laughter and
looking down a nearby corridor, I saw my abuser and his employer shaking hands
and laughing. And all of a sudden, everything was so pointless. All the
arguments. They were rendered null because they had literally gotten me nowhere.
I had benefited in absolutely no way. It had all been an incredibly colossal
waste of my time!
My First Mental Health-Related Dispute
Similarly
to the argument with my abuser and the fact we’d had a ton prior to the one
which stands out the most – the one I just talked about – the dispute I’m going
to talk about regarding mental health, wasn’t really the first one in that
realm. It’s just the earliest one which stands out the most – but actually not
even for being the more memorable(!) because I was so poorly (mentally and
physically) that I actually struggle to remember a lot of the details from it! I
still chose it though, because I feel it was the earliest one to be the most dramatic
and the most influential in a ton of ways!
After
my first suicide attempt, I was sectioned under the 1983 Mental Health Act and
because, as an inpatient, I disclosed that I’d begun experiencing auditory
hallucinations ten days before the attempt, the inpatient Psychiatrist thought
that I had made progress to a degree that I was discharged. Despite knowing
nothing had changed in my head and having confidence in the idea that I would
likely make another attempt, I didn’t speak up or question the decision.
Within
a matter of months, I had made another attempt and by chance, the Crisis Team
found out and then my Mum did, and I remember being in my bedroom at her home
(where I lived at the time) and I was refusing to go to hospital for the
medical treatment. Mum said, “what am I supposed to do?” and I – very rudely – told
her: “ring the Crisis Team; you’re in a crisis.” I’d like to think that a lot
of people who only know me recently, would be surprised to hear that I’d been
so rude and abrupt – especially with my Mum! But that’s the person I used to be.
That’s how I used to think and how I used to feel. And that’s how those things
came out of me.
I have
vague memories of the Crisis Team coming and me still refusing to go to the
medical hospital and I remember being in my bedroom and hearing a lot of hushed
voices and not knowing if they were real or just more hallucinations. But I was
too scared to find out. Then I remembering talking to two people and a bit
later, one was on the phone giving directors to the house. It turned out, you
need an Approved Mental Health
Practitioner (AMHP)
and two Psychiatrists to section someone, and I’d only seen the AMHP and one
Psychiatrist and so they were directing the second Psychiatrist to the house.
I was
in my bedroom when I heard a man’s voice leaving the sitting room downstairs
and saying, “I’ll see what she says, but get the papers ready.” And then the
Psychiatrist who had actually been my inpatient Psychiatrist turned up in my
bedroom(!) and he looked so out of place in my bright pink room that I almost
laughed at a few points just from the sheer hilarity of his appearance, presence
in my bedroom, and the surreal-ness of the entire situation. I don’t remember a
great deal about our conversation, except at the end when he said, “I think
it’s going to be a good idea to bring you to my hospital and see if medication
will help that voice.” And I remember questioning his use of ‘my’ hospital by
making a joke about the name of the psychiatric hospital being St Nicholas and
not St Stewart (his first name). And he just gave a very condescending smile
that was full of concern.
I
followed him downstairs and watched as everyone signed and filled in all these
pink papers (I later found out that’s the colour of section papers!) and I
remember someone knocking at the door and a lady going to answer and I heard a
gruff voice saying, “do you need us or not?” and she told him “we probably do,
let us section her first!” A little while later and I was on the settee in the
sitting room and everyone was telling me I had to go to A&E and that they
could force me to now, but I wasn’t backing down and the next thing I saw were
all these shiny, black boots storming in! They belonged to Police. The Officers
handcuffed me and strapped velcro leg restraints around my calves and my thighs
and then carried me out of the house like a parcel!
I just
remember looking to the side and seeing the AMHP hugging my crying Mum and I
began screaming and wriggling even more because I furious with all of them.
Because I didn’t used to take responsibility for my actions, I felt that all
these professionals were to blame for my Mum going through this entire
situation. I didn’t stop to consider that my role in the scenario had actually
caused all of these other people to be involved and I had really caused them
all to make the decisions they had. I think that my lack of taking
responsibility though, was actually a self-preservation method because I was
already suicidal and I was afraid that if I started blaming myself and
recognising all the hardship, I was causing others, those thoughts and feelings
would, very likely, dangerously multiply. And if I was already acting so
unsafely on what I was currently thinking and feeling, how would I respond if
that was all added to?!
When I
arrived at A&E with the Police, I was taken straight to a cubicle and the
Psychiatrist appeared again and he asked me: “how many staff do you think I
need to have kept you here?” By that point, I was so drained – physically from
the fighting back and mentally from answering questions and trying to stay
adamant and stand by the hallucination – that I just got a bit flippant,
sarcastic, and cheeky, and I remember saying: “how many Police did it take?” He
told me; “six and apparently there’s only eight in your entire town… So maybe
I’ll get four staff?” Within half an hour, the Police were leaving and were
being replaced by four support workers from the local psychiatric hospital.
A
little bit later, I stood up off the bed in the cubicle and the staff jumped up
too and I said I just wanted to go and give my Mum a hug because she was sat on
the other side of the A&E department. This is the bit where I feel worst
about – but at the time; I gave little regard to how horrible and manipulative
this was! I hugged my Mum and then made a run for it because she was right next
to the exit to the waiting room. But the support workers were faster and
basically rugby tackled me to the ground in the middle of the waiting room!
They took me back to the cubicle where the hospital staff injected me with a
sedative. Then, I remember them taking me on the bed to the ward and they were
struggling to align the two beds, so I offered to get up and walk the short
distance between them, and I remember this Nurse saying; “I don’t want your
feet touching the floor!”
After
that, I made a further two attempts to run away whilst on the medical treatment
I needed to counteract my attempt, but both times the staff flattened me and
administered a sedative injection. Then, I was transferred to a psychiatric
hospital, and I’d sum that specific dispute as having ended at that point. For
me, the entirety of it had been about me being so suicidal that I wouldn’t
listen to anyone nor agree to do anything they said which could, in even the vaguest
of ways, counteract those thoughts and feelings by saving my life. Having this
intention and facing all these professionals who wouldn’t let it happen, really
initiated a very long-standing and over-powering sense of a us vs them
mindset/notion. One that was so debilitating because it had such a negative influence
on my levels of cooperation and engagement with professionals, therapy, and
medication.
How It Feels When Professionals Are Arguing
With Each Other
There
has been a number of instances where I have felt in between two sets of
professionals or organisations disagreeing with each other, but there are two
which really stand out:
The
first was actually the instance I was just talking about when I was sectioned
in my Mum’s house and the Police carried me out of it. Well, I missed this bit
out because I wanted to save it for its relevance here… I think that on that
night, there were a lot of professionals involved in this one instance and that
it was perhaps one of those ‘too many cooks’ scenario where it meant having so
many people made it harder to stay organised and to communicate efficiently and
effectively. So, I really shouldn’t have been too surprised when I ended up in
the middle of a huge misunderstanding between everyone.
I’d
overheard the AMHP telling a Police Officer to take me to the local A&E
because I had to have medical treatment before I could be accepted to a
psychiatric ward. I guess perhaps she said this to an Officer who wasn’t
driving the van I was in and that the Officer clearly didn’t even at least pass
that information onto those who were with me. Despite being in the cage in the
back of the van (not a riot van, the smaller ones!) I could still see through
the windscreen, and I watched as they missed the turn-off for A&E, but I
kept quiet because I wasn’t 100% sure that the plan hadn’t changed and I didn’t
want to look like I was telling them how to do their job.
Eventually,
we pulled up in the carpark near one of the psychiatric wards in the local
mental health hospital and I watched the two Officers get out and knock on the
door to the ward, then two staff appeared and the following argument ensued:
Psych
staff: “Has she had the treatment already?”
Police:
“What treatment?”
Psych
staff: “We got told she isn’t medically fit yet so we can’t have her on the
ward until she is.”
Police:
“Why can’t she just have the treatment here?”
Psych
staff: “Are you serious?”
Police:
“Excuse me?”
Psych
staff: "No, she can’t have it here.”
Police:
"Then you need to get her to the hospital. She’s sectioned so it’s on you,
not us!”
Psych
staff: “She isn’t sectioned to our ward yet, so she isn’t our responsibility,
she’s yours!”
Police:
“Like hell are we responsible for her! This is on all of you!”
Then I
heard a car pull up alongside the van and they all turned to look to it, I
heard the doors shut and then the AMHP’s voice:
“Why
have you brought her here? We said A&E first!”
Police:
“But she’s sectioned!”
Psych staff
to AMHP: “We tried explaining to them she isn’t sectioned to the ward yet but
they’re being so difficult about it.”
Police:
“We’re being difficult?! We’ve sat outside her house for hours, waiting for you
all to get yourselves sorted and now we’re getting the blame and having to do
all the grunt work!”
AMHP: “There’s
no need to be like that. We’re telling you that you need to take her to
A&E. I’ll drive behind and you can go once she’s there.”
Police:
“F**k this!”
And I
watched as the Officers stormed back towards the van, threw their doors open,
got in, slammed the doors shut and then I heard a window go down and the female
Officer shouted out of it to the psychiatric staff and AMHP who were still
standing at the ward doors looking shocked; “we’re going on lights and sirens so
that you don’t waste any more of our time!” And with that, I saw her press a
button on the console where a radio is in a normal car and the siren started
blaring and I could see a flashing blue light up the sky as we pulled away and
sped off. When we’d almost reached A&E, the female Officer turned in her
seat to face me and said: “don’t you dare kick off when we get you there! You’ve
f****d everyone around all night so you better start behaving!”
When we
pulled up at the entrance to A&E, I breathed a huge sigh of relief that I
was finally able to get out of the same car as them, but I was terrified of having
to face them when I got out of the van and was convinced, they were going to
just drag me into the hospital. Fortunately, though, when I got out, the AMHP
was there too so I felt reassured that they couldn’t be too mean to me with her
there. The Officers each took hold of the tops of my arms with one on each side
and the AMHP walked alongside us into A&E and as we got into the waiting
room, a Sister in dark blue came and said, “is this the sectioned girl? You can
bring her straight through.” Once we got into a cubicle, the Police unlocked
the handcuffs, and the female muttered to the AMHP: “don’t you dare let her run
off and call us!”
Then
the Psychiatrist turned up and said about how many staff did he need to have
sit with me and the rest I talked about earlier.
That
instance with the Police was so saddening because I’d actually had such a
helpful experience with them when I ran away from hospital after my first
suicide attempt. I think it was so difficult because I’m a huge fan of continuity
and especially appreciate this from organisations and professionals, and so
them failing to do that… Well, it meant I was thinking: ‘if I ever need them
again, how are they going to treat me?’ And I hated having to wonder that.
Like, for me, especially in mental health related situations, a person should
never be worried as to how services and professionals will treat them. You
should be able to be confident that you’ll receive help, support, respect,
equality, and validation. There should never be a concern and thought, like; ‘I
hope I don’t get that person again!’ It shouldn’t matter which member of staff
or professional you interact with; it should just be a given that everyone from
that organisation will treat you well.
The
second instance of dispute between professionals was in around 2011. After a
huge argument with my Mum, I left home and went to move into my Dad’s home down
South. At first, it was amazing and felt like a really relieving fresh start, I
got a job, I enrolled in a College… But my mental illness caught up with me and
after being treat horrifically by my Dad and Step Mum, I came home to my Mum
(and I couldn’t be more grateful and apologetic for that instance). When I got
back however, I could still remember that really good period of time when I
first got there and so I kept wondering whether I would experience that again
if I went somewhere else. So, I began running away. And, on one instance when I
ran, I self-harmed and was found by the Police who detained me under the 136
section of the 1983 Mental Health Act and took me to their local medical hospital.
It
turned out that I needed this treatment on a drip where it takes around twenty
hours to go through and so the Police where technically obligated to stay with
me until I was medically fit and could be assessed under the Act. After around
ten hours though, the Officers with me started going backwards and forwards out
into the corridor on their radios and then this very tall, older Officer came
and introduced himself as the Inspector. He asked me what I would do if the
Police left me in the hospital and I said I would stay and have the treatment.
He asked if I meant that because if they left and I ran away, I’d be considered
a high-risk missing person, and the entire Force would be tasked with finding
me. I told him I wouldn’t put them through that and that if I was struggling
with thoughts to run off, I would tell the Nurses.
So, he
went off into the corridor which I could not only hear what was said in, but I
could also see into it. I watched as two Nurses joined the Inspector and the
two Officers who had been sat with me and the dispute began:
Nurses:
“You’re responsible because you’re the ones you brought her here.”
Police:
“For you to take over.”
Nurses:
“Isn’t it the actual law that you can’t leave them after detaining someone
under 136?”
Police:
“It just says we have to take them to a place of safety. This is that place.”
Nurses:
“And what if she runs away?”
Police:
“She says she won’t but – “
Nurses:
“You’re leaving her because she said that?! You can’t trust someone like that!”
Police:
“If she runs away, you use the usual protocol and call us.”
Nurses:
“Be honest, you’re doing this because there’s a match on and you’re needed
there too.”
Police:
“We’re doing this because if we don’t need to be here, then we can be helping
people elsewhere.”
Nurses:
“It’s the match.”
Police:
“This is so unprofessional. You realise you’re burning bridges here? Why would
we stay now if you’re going to speak to us like this?!”
The
Police ended up leaving and when the Officer I’d gotten on well with came up to
tell me they were leaving, I apologised and said that I felt like the entire
situation was my fault. That I’d put them in the situation they were arguing
over. That they wouldn’t have been arguing if I hadn’t provided them the reason
to have to. The Officer told me that yes, we were all there because of my
actions, but the way their interaction had panned out, was on her colleagues
and the hospital staff. They were responsible for their communication with each
other. And she said it might end up actually being helpful because it gave them
reason to make changes to processes so that they didn’t end up in that situation
again. And I just thought ‘why did I have to be the one to have taught them
that?!’
DBT Skills From Each Module That Have
Affected Disputes in My Life
In 2012,
I made another suicide attempt, but after refusing treatment for it, I was deemed
as lacking capacity and so under the 2005 Capacity Act I was sedated, put on
life support, and given the treatment. When I was woken, I was admitted to a
psychiatric hospital which specialised in my diagnosis of the time of
Borderline Personality Disorder (BPD). Unfortunately, my local mental health
NHS Trust didn’t have any services for someone with a PD diagnosis, even though
it was incredibly obvious and recognisable that someone with such a Disorder
required specific help and support. The lack of these services meant that the
hospital I was admitted to was actually over 100 miles away from home and from
my loved ones.
The
recommended treatment for someone with a PD is Dialectical Behaviour Therapy
(DBT) and so the hospital facilitated that but not immediately after being
admitted; you had to be ‘stable’ before you could begin the sessions. Their
thought process for this was that if you were still really poorly, delving into
your thoughts, feelings, and experiences – as DBT does – could actually worsen your
mental health. The difficulty with this though, was that in admitting me, they
robbed me of my coping skills of self-harm and running away and so that
actually exacerbated my mental illness and it was confusing and frustrating
because DBT was intended to provide you with positive and productive coping
skills. So, in my opinion, they should have introduced that straight away so
that I could develop some sort of replacement for the unsafe methods I’d been
using.
In undergoing
DBT, we had both group sessions and 1:1, so that it didn’t matter if you
benefited or learned in different ways (in terms of being taught alone or
learning with others) because you were given the opportunity to use both methods.
In all honesty, I wasn’t the greatest ‘student’ in the beginning, for a number
of reasons:
1.
I
was resentful that I was having to rely on others to teach me how to cope with
my own memories and that felt like admitting defeat and made me feel utterly
useless.
2.
I
felt embarrassed that these were actually incredibly ‘simple’ skills which I
felt I should have been able to think up of trying myself.
3.
I
had a huge misunderstanding of Mindfulness and assumed it was all about breathing
exercises but actually, you could do an activity mindfully.
For
this part of the blog post, I’ve utilised the website dialecticalbehaviourtherapy.com
and so, each skill is coupled with a link to its section on that website. I
chose this website because in addition to explaining the Modules and each skill
within those, it also provides worksheets and features a lot of useful coaching
for helpful and productive exercises which can be used to better understand
each Module/skill as well as establishing how you can apply it to your own life
and use it as beneficial for your mental health.
ü
Describe Your Emotions: This skill helped me to
establish exactly what I’m feeling in an instance and in doing so, I’ve found
that I’m better able to describe and voice it to others in disputes in a way
which aids me in illustrating the impact a cause for dispute has had on me.
This tends to render my perspective in the dispute more effective.
ü
Letting
Go of Judgments: In DBT, this skill is used in partnership with another named
‘Negative Judgments’ and there’s a focus on ‘repetitive judgments’ with an
exercise around establishing how it makes you feel and what life would look
like without it.
ü
RESISTT
Technique: This anagram is all about helping you to deal with overwhelming
emotions and it stands for – Reframing the situation, Engaging in
a distracting activity, Someone else, Intense sensations, Shut
it out, Thoughts, and Take A Break
ü
Radical
Acceptance: This concept refers to fully acknowledging and embracing the
present moment – even including any discomforts or difficulties. It also covers
accepting your reality and letting go of bitterness (a common emotion in
disputes).
ü
Being
Effective: This skill refers to being proactive in doing what is necessary
in order to achieve a goal – both short and long-term – because it recognises
that in meeting your goals, you experience positive emotions.
ü
Self-Validation:
This part of DBT focuses on accepting the emotions you’re experiencing, and it
promotes utilising three steps to do this: acknowledge, allow, and understand. It prevents a person from being overly
critical of themselves and their reaction to situations.
ü
Assertiveness
Skills: In the website, this is divided into two parts, part
one focuses on knowing your priorities, asking for what you want, and
negotiation. Part
two then focuses on saying no and always acting in accordance with your
values.
ü
Resistance
and Conflict: The most obviously relevant part of DBT to the topic of
disputes; this skill talks about validating another person’s view, repeating
your own, and utilising asking specifics e.g. “what did I do to upset you?” to
establish contributing influences on the dispute.
How I ‘Choose’ My ‘Battles’
1.
How
will my relationship with the person I’m in a dispute with be affected?
2.
What
is my goal from engaging in the dispute?
3.
What
will the dispute cost me (in terms of emotionally and practically)?
4.
What
do those whose opinion I trust think of the situation?
5.
What
lengths/processes will I have to go to in order to ‘succeed’ in the dispute?
Know Your Rights: Helpful Links
Mind’s
information and details on your rights under Section 136 of the 1983 Mental
Health Act:
Sections 135 and 136 - legal
information - Mind
Patient
information leaflets for the 1983 Mental Health Act from gov.uk:
Mental Health Act 1983: patient
information leaflets - GOV.UK
NHS
information on all sections of the 1983 Mental Health Act:
The Mental
Health Act legislation page from gov.uk:
Mental
Health Law article on Section 2:
Section 2: admission for
assessment - Mental Health Law Online
Information
and details on Mental Health Act assessments and your rights during them: