So, the inspiration
for this post has come from a very recent, disastrous first therapy appointment
and so initially I was just going to concentrate on that experience, but I
found myself thinking of so many more bits about therapy that I want to talk
about too…
When the first Psychologist (as far as I can remember) became
involved in my care/treatment, I was very much in agreement with the us vs them
culture when it came to psychiatric service users and certain professionals (most
often the Police and Crisis Team though).
That mindset mostly stemmed from instances where I had been a
psychiatric inpatient, because I think that it can be incredibly easy to build
relationships with others on the ward and then see them in a number of
different situations that could lead to intense thoughts and feelings towards
the staff. I mean, it could vary from seeing someone being restrained and being
angry that they were being deprived of their freedom and choice, to seeing someone
self-harm or attempt suicide and ending up full of resentment for the staff who
had been ‘useless’ in protecting and helping that person.
So, needless to say, I saw cooperating as a sign of weakness and defeat, and I developed a fear that engaging with professionals would make me more vulnerable. After self-harming, so many people would ask why I hadn’t called for help before doing it and I’d say that I hated the thought of seeking help and then those I’d spoken to, responding in ways I didn’t want or expect. I mean, there were numerous occasions where people – in general – have voiced that someone can’t genuinely be suicidal if they’re asking for help; but then you’d make a suicide attempt, and the first question would be “why didn’t you ring such-and-such?!” And that ironic sense of being unable to do anything ‘right’ no matter what you do, can really add to the frustration and contribute to the us vs them outlook.
But I think that the truth is, besides being dramatically
under-funded; one of the largest challenges mental health services face, is
that sometimes, you can throw all the help and support in the world at a person,
but if they don’t want it, won’t accept it, and refuse to engage with you; they’ll
continue to drift away from any hope or chance of obtaining stability and entering
‘recovery.’ And it’s so much more straightforward – and definitely, often true –
to say that sometimes the help and support actually isn’t anywhere near good
enough; but I think that how cooperative a person is with services should be
viewed as equally important. And sometimes that level of cooperation can be
influenced by the actual state of the person’s mental health, and sometimes it’s
about so much more…
For me, the majority of my disengagement and reluctance to follow
the advice and guidance of the professionals, was about viewing them as the
opposition. Which meant that for me to do a one-eighty on that – to completely
change my thinking and see that they were trying their best to help and that
they were only human, so they got it wrong sometimes – it took coming
incredibly close to killing myself. I mean, waking up from life support in
Intensive Care was terrifying. It, ironically, kind of gave me more hope in
that I questioned whether I was even meant to die yet because surely if I were,
it would have happened by then? And with that realisation came the recognition
that if I didn’t start cooperating with the mental health professionals who
still believed I had the potential to recover (and there weren’t many left by that
point – most have given up on me by then), I wasn’t going to get anywhere. Things
weren’t going to change, and I knew that I couldn’t do it by myself. Having
spent years causing myself harm, it felt as though that was all that I could do.
That was all I was good at. And without help, I couldn’t haul my body out of the
hole I’d dug.
The two years prior to the first Psychologist (that I can remember)
becoming involved in my care/treatment in 2011, were so unsettled, impulsive, and
irrational. I mean, I was constantly in and out of hospitals – both medical and
psychiatric – for self-harm and disassociation, the hallucinations were escalating,
and I had made a few suicide attempts.
As unwell as I was though, I was still becoming more and more
aware of the fact that things were just getting worse and that they would
continue to go downhill unless/until something changed. I guess my Community Psychiatric
Nurse (CPN) also realised this because arranged an appointment (I don’t think
there was any real referral process then or if there was, I don’t know/remember
it!) with a Psychologist.
Over the space of a few months, we did two of the greatest pieces
of therapy work that became absolutely instrumental in my mental health and
safety at that time.
On one occasion none of the hospital staff could agree on whether
I had the capacity to refuse treatment, and, in the end, it took them five
hours to decide; by which time, I was even more poorly. So, the Psychologist recommended
that we write up an ‘Advanced Directive’ which would state and advise what
hospital staff should do if I were to present to A&E due to my mental
health. The most helpful part of it was the recommendation that staff be aware
that when I was feeling well, I wanted to be alive; so, if I was refusing
treatment that could help me, it should be assumed I didn’t have the capacity
to do so. It meant that there were no real arguments between professionals
which helped because usually when they were disagreeing with one another, I was
directly blamed and treat horribly because of that blame.
The second positive step in my work with the Psychologist was when
she created my Schemas document. This was basically about talking through all
the different thoughts and feelings that I felt influenced me to almost become
a different person, and then recording the behaviours and attitude I would
exhibit, and the ways I should be treat depending upon them (you can read more
about the Therapy here).
The Psychologists theory here was that since the abuse happened to me when I
was young, my mind had almost separated off all these different child-like
parts that varied from ‘Vulnerable Child’ to ‘Impulsive Child’ – and everything
in between!
These two pieces of work, were so helpful in leaving me feel that
I had been listened to, validated, and understood; and these were all very
important notions for my mental health. It makes me sad to think that those very
simple qualities – which are arguably completely necessary aspects for any
psychiatric professionals to exhibit – led to my most stable period in the
community. I think it was enlightening for me to see that I actually wasn’t expecting
too much from mental health services and that those very simply things were
enough to leave my thoughts to self-harm or attempt suicide silenced.
Unfortunately, though, the amazing Psychologist did nothing to
help me with the hallucinations and when I began experiencing visual ones, I
was left so scared and hopeless that I made my first most serious suicide attempt.
After being in a psychiatric hospital down South, one of the staff
called my Mum and just, in passing, mentioned Dialectical Behaviour Therapy
(DBT) and when my Mum voiced having never heard of it, they explained that DBT
is actually the recommended treatment for someone with the diagnosis I had held
for two years; Borderline Personality Disorder (BPD). And why hadn’t we heard
of it? Well, regardless of the number of people my local mental health service
was diagnosing with BPD, they still didn’t have any specific help and support
for those people! So, when I returned North, my Mum – being the mama bear that
she is! – fought for me to have DBT, but it became apparent that the only way
to do so would be if I were admitted to a specialist psychiatric hospital miles
away from home!
When the assessment for the private hospital in Bradford revealed
that going there would mean so much more than being just one weekly DBT session
as I had imagined; I refused to go. Initially, this was seen as my decision
that I was both capable and allowed to make, but when the hallucinations worsened
and my third suicide attempt became the most life-threatening, that decision
was taken away from me. Which meant that when I woke up from life support in
Intensive Care, I was told that I’d be going to the Bradford hospital with or
without my consent and cooperation.
So, I agreed to go because as honestly suicidal as I had been when
an Anaesthetist in A&E told me that I was about to be sedated and treat
under the Mental Capacity Act and I said “I hope something goes wrong and I die
anyway;” the entire situation had terrified me. It’s kind of like this episode
in Greys Anatomy(!) where a prisoner on death row is taken to the hospital and
he refuses treatment for his injuries, but when he’s actually about to die; he says
he doesn’t want to and asks for help. One of the Doctors says that death is a
scary thing and he’s allowed to be afraid of it. And I guess that’s sort of
what happened to me… I felt suicidal, but when I actually came close to death, that
seemed to disappear and was replaced by an intense and overwhelming terror.
But that ‘terror’ was so much about dying as it was about living… Months
before my mental health went downhill, I was given too much morphine in a medical
hospital, and I went into respiratory arrest (I stopped breathing). It’s well
over a decade later and I still vividly remember the sense of serenity and the
bright white light that filled my vision and left me inexplicably desperate to
reach where it was at its brightest. I wasn’t afraid of death – in fact, I
quite liked the idea of it… The memories of that blissful, peaceful feeling made
the idea of dying kind of comforting.
The fear during that situation was mostly about the fact that if I
had died, nothing would change. My local NHS Trusts would likely continue to
fail people they were diagnosing with a Disorder they lacked the resources to
treat, and all the professionals who had treat me so horribly, would continue
to do so with others. If I died, I wouldn’t have a voice. I wouldn’t have the
potential to influence change and improvement. And this passion and
determination to change things so that no one else was so failed and mistreat
that they ended up on life support, was really boosted when the staff in
Bradford commented that had I been in their locality, I likely would’ve been
admitted after one suicide attempt. Not three and – as my records state – over SIXTY
hospital admissions.
So, when I finally went to the specialist hospital in Bradford in the
summer of 2012, I was told that you actually don’t just immediately start DBT
once you’re admitted. No, instead, you have to complete a lengthy (in my
opinion anyway!) period of stability first. I guess that the thinking behind
that is that if DBT makes anything ‘worse,’ chances are you’ll be in a better
position to cope with that than you would if you started the therapy whilst at
your absolute lowest. And I suppose that actually makes sense. (It’s probably
also worth noting that even some therapies in the community require a period of
stability before beginning.)
I think that finding the correct timing for you starting therapy is
also not only about how you cope with it if things get tough, but also how you
engage with it in general. I mean, sometimes a person (not just someone with a
mental illness)’s level of cooperation and engagement are dependant upon their mental
state. I mean, if you’re struggling with thoughts to self-harm or suicidal
feelings, how are you meant to sit in a room and focus on completing worksheets
and reading through your DBT diary? If you’re experiencing hallucinations, how
are you supposed to stop them from taking over absolutely all of your attention
long enough to sit through a few hours of teaching of even just one DBT skill?!
Those months it took to stabilise my mental health – mostly through
medication – were also really important in influencing my opinions of the Bradford
staff. I mean, I don’t think I was even there for twenty-four hours when I
tried to escape and was promptly sectioned under the 1983 Mental Health Act! And
of course, that filled me with anger and resentment towards the staff who – in my
opinion at the time – were only prolonging my suffering by stopping me from
killing myself. I wasn’t at all grateful to be saved. I wasn’t excited to start
DBT. I didn’t see the admission as the one that would change everything. To be
honest, a huge part of my motivation to go to Bradford was that I’d be further
away from the people who knew me the best and that could heighten the potential
for me to be able to attempt suicide again.
Ironically, though, it had the opposite impact because being surrounded
by staff who didn’t know me very well turned out to mean that they always aired
on the side of caution – in the most (in my opinion) drastic ways! But equally
ironically, this stopped making me hate them! I mean, when the professionals
back North would make decisions like the Bradford staff, it always felt like a
misunderstood punishment. As if they were desperate to stop dealing with me and
sectioned or sedated and restrained me, out of frustration and not care or
concern. Whereas the Bradford staff seemed to be a whole lot more kind,
thoughtful, and better motivated. And I think that developing this trust and appreciation
in the staff was really influential when the time came to start DBT.
I used to really frequently feel sad at the thought of how bad my
mental health got before I got the right help and it started to get better; but
not anymore. I’ve learnt to deal with that frustration and sadness by using the
mind set that perhaps all those years and hospital admissions before Bradford,
just weren’t the right moments for it. I mean my Nana and my Mum always talk
about everything happening for a reason and perhaps I just had to get to the
point I did in order for me to develop the passion and dedication to claw my way
back.
Mindfulness: I like to utilise this when engaging in a distraction activity (found
in the Distress Tolerance module) that is helping to make any unsafe thoughts
and feelings bearable:
Mindfulness
: DBT (dialecticalbehaviortherapy.com)
Distress Tolerance: I like to use the radical acceptance skill in this module when I’m
feeling completely powerless or resentful around a situation, and the grounding
skills when the hallucinations are overwhelming or disassociation is creeping
in:
Distress
Tolerance : DBT (dialecticalbehaviortherapy.com)
Emotion Regulation: I’ve found the self-validation skill in this module really
useful when I’m feeling dismissed, ignored, and patronised by the people I’ve
looked to for help and support:
Emotion
Regulation : DBT (dialecticalbehaviortherapy.com)
Interpersonal Effectiveness: I typically like to use, the FAST
skill when I’m feeling overly critical of myself, experiencing low self-esteem,
and falling back into old thoughts that I was deserving of hardship and
destined to die:
Interpersonal
Effectiveness : DBT (dialecticalbehaviortherapy.com)
