I’ve been thinking & I thought I’d do some writing to get my thoughts out. I was thinking about my medication, quetiapine & how I believe it has made such a massive difference to me at the moment. So that led me to wonder if I actually have a mood disorder. I don’t question my bpd diagnosis cos lets face it I’m quite textbook a lot of the times. But what I wonder is if I have an accompanying mood disorder. I’m not seeking labels & more diagnosis’ & I’m not one of those who loves to have every diagnosis in the DSM but I do seriously wonder if I genuinely have a mood disorder. I have had brief thoughts in the past about the possibility of a mood disorder but have never given it a serious amount of thought. I have experienced highs & lows for many years but it’s whether these are distinct from the highs & lows that accompany bpd. What has sparked these new thoughts of having a possible mood disorder is down to the quetiapine I started a few months ago. Medication isn’t supposed to be effective for bpd alone & indeed the NICE guidelines on bpd state that medication is only supposed to be used in the short term for crisis situations as there is no evidence of its effectiveness in long term use. I’ve been medicated close to 4 years now & until I started this quetiapine, medication was all about sedation especially in hospital where I’d be pumped full of benzodiazepines & heavy sedating anti psychotics. Medication never has really had an effect on the mental side of things if I am honest. After being first hospitalised & then being medicated & seeing everyone else around me being medicated, medication just seemed to be the norm. I took it cos it was supposed to help but I knew it didn’t really have much effect, but in time it became a comfort & I couldn’t Imagine not taking it anymore. But then I started on the quetiapine, an anti psychotic like the others I’d been on but also having mood stabilising properties. I started on the quetiapine in the midst of a prolonged crisis. I was suffering low mood & intense emotions & drinking to deal with those & being triggered into repeated self harm. After a while I came around & things got better, then even more better until I got to a stage where I am in a period of exceptional stability for me & a stability I haven’t had in a very long time. It’s impossible to prove but I strongly believe that the quetiapine has played a large part in this current stability. Personality disorder is a cluster of maladaptive personality traits which can’t be targeted & rectified by medication. What I wonder is that the effectiveness of this quetiapine is due to the fact it is working on a chemical in balance which would be a mood disorder. The mood disorder I think most likely if I were to have one would be cyclothymia or perhaps bipolar II. I’ve never had a manic episode so that rules out bipolar I. I’ve had what I believe are hypomanic episodes occasionally, the longest lasting about a month in which I was constantly on the move, feeling happy & being hyperactive & behaving in a silly ways such as often dancing & singing & also at the time i was hardly getting any sleep. This was followed by a massive crash in which I experienced one of the worst periods of my life. The lows are more often than the highs, I experience periods of depression far more often & these can vary in intensity. The question is though are these highs & lows distinct from those of bpd? Are they the depression & hypomania associated with a mood disorder? I’m starting to think they are distinct from bpd mood instability due to the fact that I believe the medication has made such a difference. The highs & lows of bpd are more likely to have external triggers which medication wouldn’t help with so much while those of a mood disorder are more likely caused internally with a higher chance of medication helping. Since starting the quetiapine things have got so much better for me, I actually feel like a new person. My mood is on such an even keel, I feel happy without being too happy & I haven’t felt low in a long time. I’ve even given up alcohol for 10 weeks now. That is helping the stability but if it wasn’t for the stability in the first place I wouldn’t have managed to do it. It’s surprising how easy giving up drinking has been & that’s because I feel so much better within myself. Is that the result of quetiapine? I personally believe it is. Although a mood disorder is separate to bpd being different illnesses /disorders it does not mean they don’t have an effect on each other. The mood instability caused by a mood disorder if I were to have one, would very much be a major trigger for my more bpd symptoms. If I did have a mood disorder & that was under control by medication then I’d have a much better chance at keeping my bpd under control. It could be that a mood disorder has remained undetected & untreated for many years & that’s why I’m not making any real progress & keep hitting crisis & relapsing. But now, now I’m on a medication that is regulating my mood I seem to be doing so much better. If the mood stabilising properties of the quetiapine are really what is making all this difference I suspect that a mood disorder is quite a strong possibility.


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Posted: June 17, 2013 in Uncategorized

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Stability & happiness

Posted: May 29, 2013 in BPD
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It’s been a while since I last wrote a blog entry. Mainly because I’ve not had anything to write about. No issues have arisen recently & I’ve had nothing interesting to say or moan about. I’ve been pretty stable & boring for a good few weeks so don’t expect this entry to be interesting, it’ll probably be dull & boring. I really just wanted to write a little something to update you on what’s going on with me. As I said I’ve been stable for a good few weeks. It’s been over 6 weeks since my last hospital admission. So that’s definitely progress after being hospitalised nearly every week for a few months. I started off this year not in a good way at all, I hated my life so much & I felt so bad within myself. I was very unstable until mid April hence the repeated self harm & hospitalisations. Since my last hospitalisation things have got much better, my mood has improved, I haven’t self harmed, I’ve quit drinking alcohol & I feel much happier within myself. The way it seems to work for me is that I have a crisis, get hospitalised then have a period of stability for a good while. But this year I needed a good few hospitalisations before I got it out of my system & the admissions provided the relief that I needed. This year it was like one long crisis that lasted a few months & it was harder to find that relief I needed. Back when I was in hospital for those 2 years I had to hit ultimate rock bottom before I managed to get myself together & progress enough for discharge. After that rock bottom I quickly regained stability & I progressed quickly. It seems to be that the worse the crisis the better the stability after it is over. I don’t know if anyone else can relate to that but that’s how it seems to work for me. Like now, that lengthy crisis is over & I feel better within myself than I have done probably since the stability after rock bottom in hospital 2 years ago. Nothing has changed in my life, I’m still in the same situation I was in at the start of the year that caused me to be so desperately unhappy but the important thing is that I’m happy within myself. The happiness I’m feeling within myself is enabling me in sense to push away the external negatives in my life. I guess when you aren’t feeling great within yourself it’s easy to focus on the external negatives & that just exacerbates the inner emotions. You hurt inside so you hate outside & the hate for the outside reinforces the hurt on the inside. At the moment I don’t seem to be focusing on the negatives on the outside, what’s important is how I’m feeling on the inside. Perhaps this happiness is masking all the the crap on the outside. My life situation hasn’t changed from before & despite being happier & more positive I haven’t dealt with any of the things that need to be dealt with. I’m not even thinking about about dealing with things despite being in a better position to do so mentally & emotionally, I’m just enjoying feeling happier within myself for now. It’s not often I feel like this & I know it’s not going to last forever so I need to enjoy it while it lasts & that’s not me being negative, that’s just the conclusion made on evidence based history & the nature of my personality disorder. For once I am allowing myself to be happy too, I haven’t made any attempts at self sabotage nor has the thought of doing so crossed my mind. I often struggle when feeling a bit better in myself, I feel I don’t deserve to feel good & I must make myself feel bad again. That’s where the self sabotage comes in. But I think at the moment this happiness is a bit deeper than it usually gets & that’s enabling me to push away the negativity that usually creeps in with my more superficial happiness. I guess it’s not even a case of pushing away the negativity, at the moment it seems there’s a total mental block on negativity & the happiness is destroying the negativity before it even enters my consciousness. The fact there’s no negativity within me at the moment is a very big rarity. I think the degree of this happiness is reinforcing itself by killing the negativity before it gets to my consciousness. The happiness is reinforcing in other ways too. I haven’t self harmed, not even thought about it which makes me feel better within myself. Perhaps the most surprising thing is that i haven’t had an alcoholic drink in over 6 weeks & perhaps even more surprising is that I haven’t even wanted to. I’ve had no desire to drink in a good while now, I’ve not even been tempted by offers of going to the pub or going on nights out with friends. The total avoidance of alcohol has definitely helped reinforce how I feel within myself. I can even acknowledge the fact I have done well in this. But if I were to bring in a slight negativity it would be that the fact the alcohol avoidance has come so easily & I haven’t had to put in any effort to avoid it that perhaps It’s not down to me but the happiness I feel within myself at the moment. I never thought quitting alcohol could Come so easy & it’s a big surprise to me that it has & a testament to how much better I’m feeling within myself at the moment. Another thing that may or may not have helped, it’s hard to know for sure is medication. I started on the quetiapine in February so now there’s been plenty of time for it to get in my system & work. I’m now on a stable dosage of 600mg XL & although its impossible to know for sure it’s my feelings that it has helped. So I managed to climb out of my crisis & things have been good since. The happiness, the no self harm, the no drinking & the medication are all feeding in to & reinforcing each other & the consequence is I feel better than I have done in a long time. I am stable mentally, emotionally & mood wise. I often find stable quite boring after being used to chaos throughout my life, but because I have stable accompanied by a genuine happiness rather than numbness I’m actually enjoying the stable. So yes I’m stable right now & I’m not finding it boring, I’m very happy & content with it. For once I’m enjoying being normal.

A Superficial Happiness

Posted: May 9, 2013 in poetry
Tags: ,

Wrote this poem today. This is how I feel right now. It’s not the best poem I’ve ever written, it’s not even that good really but I just wanted to get some feeling out & in writing

A superficial happiness
May distract me for a while
I can sometimes feel content
& even paint a smile

I can push away the hurt
But not for very long
It rushes back so powerfully
Singing its enticing song

Negativity is me
Badness runs through my core
As months & years go by
The bad gets more & more

A deep emotional pain
Is the essence of my being
It clings to every inch of my soul
& from it there is no fleeing

A self hate so deep
That it skews all my perception
It hurts my heart
To look at my own reflection

A self defeating mentality
My mind seeks to destroy
To break me, to kill me
Is It’s ultimate ploy

Flirting with madnesses
But this is my reality
I know this will never cease
Until it causes my fatality

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Posted: March 12, 2013 in BPD, self harm
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So as I was talking on twitter about my scarring I thought I’d write something about it in more detail & include some of the thoughts I earlier mentioned on twitter. I have scars, lots of scars from years of self harming. They are pretty severe but it’s often like they are just part of me & I don’t really take much notice of them. But then they are the times I do notice them & they evoke lots of thoughts & feelings. My initial feeling is often one of sadness at how I could do this to myself? My arms are pretty much a total mess, damaged beyond repair. I feel sad at knowing I have to live my entire life with them, you only get one body in this life & I’ve totally fucked mine up. If I had a lesser degree of scarring then perhaps I would have more of an incentive to stop self harming, that incentive being to avoid the severe scarring. But now I often think what is the point in stopping? My arms are already so damaged & scarred that does it really matter if I make them worse? I often get angry with myself for letting my arms get in such a state because there’s no going back now, like I said I’m stuck with them forever. One life, one body. I wish I had never started self harming but at the same time I couldn’t imagine life without it, it’s become part of me & what I do. It’s become normalised into my way of life. I was 13 when I started self harming & how I wish I could somehow go back & give my 13 year old self a good talking to but also a hug. But most importantly I wish I could inform my 13 year old self of what would become of this self harm business over 10 years later & the permanent & severe damage it would cause. The scarring was never so bad until I was much older. It’s like as the mental stuff got worse the cuts got deeper & the scarring got worse. The harder things got & the more I self harmed the greater the need for more severe self harm. I guess it’s like a drug in that your body becomes accustomed to it & you need more of that drug to get the same effect. In the moment when I get the self harming thoughts it’s like it’s the only option at the time. The need to punish myself & create a release is overpowering. But it’s like the last couple of lines to my recent self harm poem “the scarred one” that “when the blood has dried & gone, forever I’ll remain the scarred one”. It’s not such much the act of self harm that is the problem, it’s the scars that remain after. Yet for some reason I never seem to ask myself the question of whether its worth it? Maybe I should start doing that but like I said earlier is it too late now? I think I mustn’t have any respect for my body in order to do this to myself, to inflict such hurt & damage onto myself. Or maybe it’s just that all the things that are mentally wrong with me outweigh the respect I have for my body. After all self harm is a mental thing that just happens to have the physical consequences. It’s a given fact that there’s obviously something very mentally wrong with me in order to do this to myself. But mental states aren’t permanent but the consequences of those mental states are. I have been cursed with the disorder they call bpd. It effects me in so many ways & in ways which have caused this self harm. Bpd is the only disorder that includes self harm in the diagnostic criteria & I often wish I had some other disorder that didn’t cause all this physical scarring. One that I could hide & keep in my head & one that didn’t leave any physical evidence. I know that self harm is not exclusive to bpd but the chances are that without the bpd I probably wouldn’t self harm. I often don’t hold much hope of getting better & recovering but at least there is a chance to recover from these psychological issues. However there is no chance to recover from the physical manifestation of the psychological problems. Lets say for a moment I do recover, I begin to lead a more normal life & I stop self harming, I’ll still have all the scars. They’ll be a constant reminder of all the things I’ve been through. There’s no escaping the scarring & how do I integrate that with leading a normal life? I don’t want to have to hide my arms away for the rest of my life & although part of me is not ashamed I do however fear being judged on the physical remainders of what was once mental distress. People’s attitudes to self harm aren’t great & 20 years down the line will I still be getting judged in a negative way for something that happened so long ago? These scars make me fear the future so much more. I fear that these scars will hold me back, even if its just in my own head. The relief of a cut is so temporary but the consequence of that cut is so permanent. I do have to live with these scars forever& that is a scary thought. It’s easy to say I should never have started self harming but I did & there is no going back now. I guess I’ll have to learn to live with them, accept them & attempt to see them in a more positive way. People often say not to look at them as a reminder of the bad times but rather more positively such as “look what I’ve survived”.

I was first hospitalised just over a week after my 22nd birthday. Since then in the last 3 & a bit years I’ve had 8 hospitalisations, 1 of which was for 2 years. The 1st one was after I severely self harmed, severely enough to warrant being admitted to the plastic surgery unit. It was a voluntary admission & I was admitted to the assessment ward where I was discharged after 3 days. I was incredibly unwell at the time & upon discharge I didn’t know what to do so I walked straight to the bridge where I was arrested under section 136 & ended up being detained under section 2 of the mental health act within a few hours of discharge. I was incredibly shocked at being sectioned & never thought it would happen to me. But it did happen & from there I ended up being detained for the next 2 years. Since discharge after those 2 years in November 2011 I’ve been hospitalised a further 6 times. Twice under a section, once partly sectioned partly informal & the 3 recent informal admissions. So does hospital help? Is it necessary? What are my experiences? Good? Bad? Those are some difficult questions to answer but I will try answer them as honestly as I can. My 1st admission was like a brief introductory to inpatient treatment. I felt relief at being admitted as myself & my life was one big chaotic mess & I was severely unstable at the time. However the relief was short lived as I was discharged after 3 days. I’m not sure why I was discharged after only 3 days because it was quite clear I was very unwell. The only thoughts I have on the issue is because of my diagnosis of bpd & the fact they do not generally like to admit people with bpd except for short “crisis admissions” of 72 hours. It was a bad experience really because I felt secure on the ward & then it felt like they just chucked me out to all the shit without anything being changed at all. In fact things were worse cos they told me at my discharge meeting that my cpn had been taken away from me. I remember being so angry & storming off the ward, I was incredibly desperate & walked straight to the bridge because I saw no other option than to end my life. Luckily I was intercepted by the police & from there detained for the 1st time under the mental health act. I was admitted back to the assessment unit but this time they decided to keep me in & I was sent to the treatment unit. I was there for only 4 days & then because of a couple of incidents was sent to the low secure psychiatric intensive care unit (PICU). Little did I know at the time I would spend the next 2 years in secure units. Indeed I was told the admission to PICU was for a short assessment. Within a few days of admission to the PICU I was placed on anti psychotic medication despite never having a period of psychosis in my life. It just seems that anti psychotic medication is a catch all treatment for anyone detained in hospital. It’s more about sedation than anything else & attempting to keep you quiet. I was a very angry person while on the PICU & often flipped out smashing windows, breaking doors & furniture. I was constantly being restrained, IM’d & secluded. For that reason I definitely think it was necessary to be in hospital & in a PICU. I was very unstable at the time & couldn’t have imagined being at any other place during that time. I guess there was no other option than being there but at the same time I guess it was a bit unhelpful because the staff were very attentive & I became so used to that & dependant on it. I guess that was the start of the slight institutionalisation I’ve developed. After a few months on the ward & my consistently unstable behaviour it was decided that I would be sent somewhere for treatment long term. Obviously they couldn’t discharge me given my mental state & behaviour nor could they keep me on the PICU long term. Funding was granted & I was to be sent onto a low secure specialist personality disorder unit. However in the month or so before I was transferred I did calm down significantly & I feel the right thing to do would of been to keep me on the PICU a while longer & be discharged into the community. However their minds had been made up & I was sent on to the personality disorder unit regardless. I’d been detained for 6 months on the PICU when I was transferred & I was desperate to get out of there despite it not being such a bad place to be looking back. At the time I was quite looking forward to going to the PD unit knowing it was private & thinking I’d get good quality care & treatment to help me get better, how wrong was I! It was a horrible place, strict, confined, incompetent & disorganised. I hated it so very much & from the moment I got there all I fixated on was getting out of the hell hole. Of cause I hated being there the whole 18 months I was there but at the start it was particularly difficult, I didn’t know how I was going to cope & make it through each day there. Of cause over time I got used to the place & it became more bearable but I still hated the place so much the entire time I was there. It was a forensic secure unit & as a consequence there was many rules & regulations which I found difficult to cope with, it felt like a prison at times. In the end, after 6 months of being there it took its toll & I got significantly unwell again after being quite stable for quite a few months. It was a very low point in my life, I was probably the most unwell I’d ever been & it was caused by being in a place that was meant to be making me better. It lasted about a month & in that time I was frequently placed on 2:1 observations. After being at my lowest the only way was up & I got better quite quickly. I progressed through all the things required of me to be discharged & eventually was after 18 months of being there. Being there was a bad experience & I don’t think I should have ever been sent there. Everybody else were under court hospital orders for committing crimes or had spent years being “revolving door patients”. The other patients often said they couldn’t believe I’d been sent there on my first detention under the mental health act & that I was incredibly unlucky. I remember my very first CPA meeting there my case manager said that the outcome of the PD pathways assessment I’d had while in the PICU concluded that the best treatment pathway for me would be a community based one but that the level of care I needed was unavailable in that area so the only option was hospital. It angered me so much when I found that out because how can they jump from community being better for me to placing me in a secure unit? It wasn’t the treatment I received that made me better enough for discharge either, rather the horrible experience of being there & the overwhelming desire to get out. If I’m honest I played the game, you had to if you wanted to get out. Of cause I pissed about & had a laugh pushing boundaries & being mischievous as that’s what made the place more bearable, having a sense of humour. But when it came to serious stuff I did what was required of me although mostly I faked engagement. We were pretty much forced to do DBT which I genuinely hated so much because of the circumstances in which I did it. I never had individual psychology sessions either until the nearing of my discharge cos of an incident that happened. The occupational therapist actually told me that there wasn’t enough therapy sessions to go around & cos I had no history of abuse I wasn’t priority. I could write so much about this place but I would be here for hours doing so. So in the end I was finally discharged. I thought I was better & so did they but I think the stable environment lead me into a false sense if security within myself. I fell apart pretty quickly after discharge & started self harming again. I really don’t think I got any benefit from being in that place. I think the admission to PICU was necessary but it should have ended there. That 2 year hospitalisation in some ways made me better but it many ways it has made me worse. It has destroyed my confidence so much, I didn’t have much confidence before but it totally shattered the tiny bit I did have. I am obviously a different person due to the experience but not necessarily for the good. I feel much weaker & less able to handle even the smallest of things. Of cause there’s the slight institutionalisation I developed while being in there too & this need for a high level of care & dependency I feel unable to be able to escape from. If I could go back I’d do anything I could to make me more stable while I was in PICU so I didn’t get sent to that place. As I said when I got out I went back to being unwell & it only took 4 months until I was hospitalised again. Firstly it was a short admission of about 5 days in march 2012 which was half informal half under a section 5(2). I don’t really remember much about that to be honest. About a week after that I ended up back in hospital under a section once more. I ended up on a PICU again but a different one as I was now back in my hometown whereas before I was away at university. The PICU in this area isn’t a secure unit however, just a locked unit. I spent 3 & a half weeks there before winning my tribunal & being discharged. I spent the first 2 weeks of that admission on 1:1 observations & frequently being restrained & IM’d before I settled down. I think that admission as much as I hated it was necessary as I was unwell again at the time. I also think it was helpful as it provided some relief & stability which lasted quite a few months until my next admission in October 2012. I was totally out of it at the time after putting my head through a window & attempting to jump in the river. I was sectioned again. I was sent to the normal acute unit for my town which is the most horrible unit. I hate the place & even professionals have agreed its not a nice place. I spent 5 days there before being sent on home leave with a view to come back in 5 days in order to be discharged. It was too soon though & I was still unstable & after a few days at home I ended up being recalled back to hospital but this time sent to the PICU again. I spent a week on the PICU before being discharged. I was better by this time & managed to stay out for a few months until my recent informal admissions to ward 18. I don’t think these 3 recent informal admissions have helped one bit. I think the first one was necessary but the last 2 were not. The first 2 were positive experiences but the third one spoiled that after I felt they chucked me out & went against what I thought was the plan of a longer admission to get me sorted. So overall it’s hard to say if hospital is helpful. Sometimes it’s definitely not helpful & indeed counterproductive. Sometimes it is useful & serves its purpose though. Sometimes as much as I hate it it is necessary too. I think it’s hard to know until after if an admission is the right thing to do. I do feel that because I’ve Been admitted & sectioned in the past they more readily admit you or section you. I guess hospital is never an ideal place to be & should be avoided if possible. They say they avoid it if they can all the time but it doesn’t always seem to be the case. Anyway I hope to avoid future admissions to acute units, PICUs & secure units as often they do more damage than good. In general my experiences of hospitals have been pretty negative & the positive experiences I have had are very much overshadowed by the really awful experiences. All in all I think hospital admissions aren’t good because even when they are being useful they are being damaging at the same time. The issue of hospital is a very complex & there are so many levels to it being bad & good