Stress and mental illness

I think most people believe that stress and mental illness are separate entities. The truth is, they are inextricably linked.

Stress can impact on an already diagnosed condition, or it can also be the ultimate cause of specific mental health conditions.

For example, research on Borderline Personality Disorder (BPD), Dissociative Identity Disorder (DID) and Post Traumatic Stress Disorder (PTSD) states they often result from trauma. DID is the newest name for what used to be called Multiple Personality Disorder, which is where the brain separates, or dissociates, from yourself to protect your brain and body from the pain of trauma (usually severe abuse in this case). Research has found that many people diagnosed with BPD also often have a history of abuse in their childhood. There are some things we just don’t need to remember. And PTSD is obviously labelled PTSD for a reason.

If you’re interested in reading a little more on some of these conditions, check out the articles we published in January when we did a focus on mental health. You’ll find factual articles explaining specific conditions as well as some of our readers sharing their experiences with us. readers, Tegan and Kaye, shared their experiences with BPD. You’ll find them all if you search in the archives for January 2014.

On the other side of the coin, when you already have a diagnosis, such as with depression and anxiety, stress can make the condition harder to treat. It’s much more difficult to manage anxiety when your amygdala is being activated repeatedly. In fact, anxiety comes from this repeated switching on of the stress response. When you worry about stuff there is an element of fear that something will go wrong, which triggers our inbuilt survival mechanism. One of my colleagues also wrote a guest post for us back in January. In it she discussed how anxiety works. Note how Sam talks about the stress response and those pesky saber-toothed tigers.

One of the most important things to note for stress and mental illness is that with the help from your professional support team, it may be possible to manage your condition more effectively by using some simple techniques to down-regulate the response. Check out our previous posts over the last few days on Stress and the Triune Brain, Stress and the Amygdala, Stress and Trauma, and the down-regulation of stress. They will give you a good idea of how this response works and how you can help manage it.

On Saturday we’ll talk about stress and breathing, where a colleague and friend of mine will take you through simple breathing practices that can help.

Please remember that while these exercises can be of benefit, always use the guidance of your professional mental health support team. I’d encourage you to show them this post to give them an idea of what we’ve discussed.

Who cares for the carers?

People with mental illness usually have a support team around them. Psychologists, psychiatrists, mental health nurses, social workers, general practitioners. People in mental health organisations such as the Richmond Fellowship (this link is QLD but you can google other states). People handing out medications and people providing emotional support. For the most part, these people do fabulous work in paving the way to wellness.

But there is a whole other population that often gets overlooked. The family and friends. Husbands, wives, sons, daughters, mothers, fathers. The carers. They are often excluded from treatment due to “confidentiality”. How do carers help monitor medications if they don’t have accurate information about which prescriptions to fill or how many tablets are needed? How do they help regulate moods if they aren’t up to speed on which strategies have been used in therapy? And that also means they are unable to provide feedback to give the professional team a full picture of what is happening for their loved one. While I can’t speak for all carers, I know that the ones I have spoken to genuinely want to help support the road to wellness. And they want to respect personal space and privacy.

During periods of illness, carers are often confronted with some pretty tough stuff. Major mood swings. Irrational demands. Thought processes that aren’t based in reality. An inability to reason. Violence; to self and others. Hospital visits. Self-harm. Suicide attempts. Manipulation. Sometimes even homicidal tendencies. And they are often in the middle of the fray, caught up in the maelstrom of chaos.

Chaos

Watching the people they love most in the world go through these experiences is heartbreaking. You watch your spouse with depression stay in bed day after day, week after week. You know that they are in pain and you try everything you know to help them. Encouragement, tough love, praise, cajoling, bringing friends in. You try talking to the doctors but you don’t get anywhere because they can’t talk back. You take over the running of the household, managing the children, cooking, cleaning. And you listen to your husband or wife talk about their inner pain and how much better off you and the children would be without him or her in it. You feel helpless and scared. What if they kill themselves? You wonder what else you can do to help. You don’t always understand why they can’t get themselves out of bed and rejoin the family. You feel lonely because the partner you knew isn’t there anymore. You feel alone because you don’t have your best friend to bounce things off. And you feel hopeless and helpless because the professional team won’t talk to you and tell you what you can do to help. Not to mention feeling guilty, fearful, resentful (of the illness), and a whole host of other emotions.

If you are a carer and can relate to this, please understand. You are not alone. There are hundreds of thousands, or even millions of people with mental illness, and each of them very likely has a group of family and friends around them, feeling exactly the same way you do. That is a lot of people feeling like you.

Exhausted. Stressed. Alone. Afraid. Confused. Helpless. Guilty. Isolated.

That is a lot of stress to deal with. And when you feel it for long periods of time, it is really important that you take care of yourself. Some very simple strategies can make a big difference in how you well you bounce back from the stresses and ultimately in the quality of your life.

When you’re looking at specific strategies there is one thing to keep in mind. Given the amount of stress most carers experience, sometimes thinking about doing extra can be overwhelming. So keep things really simple and you’ll be able to incorporate some of them into your normal routine. Try these:

• Take 3-5 long, slow deep breaths. Try to focus on slowing your breaths down and smoothing them out. This will get some oxygen into your brain and help you think more clearly.
• Pamper yourself. Take a bath, paint your nails, get a massage. This helps you relax your muscles and allows those stress hormones to dissipate.
• Surround yourself with nature. Visit a garden, sit under a tree, get your hands dirty with soil. This will help ground you and release the stress.
• Slow your brain down. Meditate, do yoga, or simply sit on your own for a while and breathe.
• Do something you absolutely love.
• Laugh.
• Connect with other people. Often speaking with other carers can help you realise you aren’t in this on your own and give you a chance to pick some brains about strategies that others have used successfully.
• Talk to someone. Sometimes seeing a professional can help you sort out the jumble in your head and give you some direction.

Australia has a network of carers organisations in each state that provide support for carers. They offer a variety of services, including access to support groups, workshops and counselling. They can also link you in with other services you may need. You can find details on each state’s organisation here, or call 1800 242 636 from anywhere in Australia. Some other countries also have carers organisations, including the UK and USA. Other support organisations in Australia include ARAFMI and COPMI (for the kids).

 

Kaye and BPD

Please join Kaye as she shares her story of living with Borderline Personality Disorder and other mental health concerns. Please be aware that her experiences may trigger some emotions for you as you read her story. If you find yourself triggered, please take care of yourself and seek support. If you need to talk with someone please call Lifeline on 13 1114.

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My name is Kaye and I am a 38 year old married mother of 5 beautiful girls. Like most people, I have a story, one that I am not always proud of but it is mine just the same.  Also, like many people, my story involves a long term battle with mental illness, suicidal ideologies and self-injurious behaviours. In the hopes of reaching one person and making them feel that they are not alone, I would like to share my story with you all.

My childhood consisted of a rather insecure family unit, my father died in a tragic accident just after my third birthday and my mother never really recovered from this which left her looking to fill her own void, and in doing so she never really noticed how affected I was by the instability of my family or that I desperately craved her attention and affection. My mother eventually settled down with a man who was wonderful to both her and us kids, however this all changed when they had a baby girl who passed away at six weeks old from SIDS. From then on, my stepdad would beat my mother severely and he would do it in front of us. This continued from the time I was about 7 years old right up until I was about 14 years old. My stepdad decided at that point, that for things to change, he had to leave as my mother would not leave him because she loved him.

I thought that this event would make my life better, but it did not… in fact it got worse. I was constantly feeling hopeless, helpless, worthless and sad to the point that I began to see suicide as my only way out. I also began to burn myself with cigarettes to try and squash the emotional pain and replace it with physical pain.  I pushed away all the friends that I used to enjoy being around, I stopped going out or leaving the house, I couldn’t eat and I slept endlessly but still felt tired when I did get out of bed. I started seeing a psychologist and was given numerous medications by numerous doctors, so I used them alongside alcohol to slip into that beautiful world of carefree serenity, where the pain and the hurt could not intrude.

Naturally it didn’t take long before my first suicide attempt because I found that I needed more and more medication to reach that happy place. It was all just too much. This little venture landed me in a psychiatric unit on a 72 hour court order, for observation and investigation. I hated the hospitalisation but there was also a sense of relief for a while, relief that I was safe from myself and the demons that seemed to be growing stronger inside me every day. I was released two weeks later and continued to see my regular doctors as well as a psychiatrist who prescribed me much more medication! I was having the time of my life slipping in and out of consciousness on the chemical cocktails I was provided with. Eventually after ending up back in the psychiatric unit after another suicide attempt, I was diagnosed with what was called manic depression and borderline personality disorder with dissociative tendencies. I had no idea what this meant and I honestly did not care, all I knew is that I was getting worse and nothing seemed to help me.

Eventually I married and had 2 daughters but the marriage lasted less than a year and I was devastated. Now I was on my own, battling the breakdown of my marriage, my own monsters were rising up to greet me again and on top of that, I was responsible for two little girls. I tried so many things to squash the bad thoughts and desire to self-harm and over medicate. I tried working but I couldn’t get out of bed. I found that socialising was too demanding and extremely tiring; I just wanted to curl up into a ball and die. Then I decided to try study but I couldn’t concentrate and pulled out with only one module left to complete a diploma in counselling (yeah, ironic huh?). No matter what I tried, I found a reason not to follow through with it. My ability to self-sabotage appeared to be endless. Again I fell back into old habits and began to over medicate and self-harm. But I did manage to quell the urge to attempt suicide.

When my girls were 5 and 7, I remarried. I found a man who seemed to be everything I had always wanted in a partner, he was honest, caring, reliable and he had the same values and beliefs around marriage and commitments as I did. The honeymoon didn’t last long though, our relationship became volatile and there was so much fighting, name calling and eventually physical threats. However, I hung in there, determined to make it work because I didn’t want another failed marriage and I desperately loved him. My instability began to show again and the old habits returned in spades, adding to the stress on our marriage. On top of this the 3 daughters I had with my husband all had special needs and one in particular was very difficult to handle. Again I started drinking and over-medicating so it was no surprise when I was admitted to the psychiatric ward again. This time I was determined to make the most of it and sort myself out. Luckily I was being treated by a psychiatrist who really looked at my mental health history and took the time to study what I was doing and what he could do about it. When I was released, he arranged for my medication to be supplied to me on a weekly basis from my chemist and he also kept in close contact with them to make sure that I was picking it up regularly. This man really cared about getting me on track and keeping me there. Things seemed to pick up a little after that. My demons still stirred but I finally had a doctor I trusted and who I believed could help me. I also found that I had a growing support network for my kids’ special needs, which helped all of us to cope.

A few years later I suffered what my psychiatrist said was a psychotic break after my marriage hit the rocks in a big way. I don’t recall what happened or anything that I did, but I ‘came to’ in hospital with both my arms bandaged from wrist to elbow and 2 police officers guarding me. This resulted in almost 3 months in the psychiatric unit and over a dozen doses of ECT. I was well and truly a mess this time and my demons were having a ball. It felt like my mind had split and I was two people fighting with each other inside my own head, one trying to tell me to keep fighting and the other telling me to just succumb to the endless abyss of what I am sure was insanity.  It is difficult to put into words what I felt or thought but the one thing I can say is that I was so close to giving up and letting the darkness swallow me forever. I had nothing left; I was so empty and was in constant pain. I didn’t want to leave the ward, I didn’t want visitors and if the phone rang, I just let it keep ringing. Social interaction was just too much, even having to exchange words with the staff and other patients was exhausting. I think it’s fair to say that that was the lowest and blackest point in my life.

Eventually I returned home to try to resume some semblance of a life, but I wasn’t living, I was simply surviving. It took me a while to realise that surviving for me at that point, was living. If I didn’t focus on surviving I would end up dead, so I just kept surviving from one day to the next. My husband and I continued to try and work through our marriage and we kept going but things were never the same and neither was I. It is now just over 2 years since that breakdown and I am still surviving, one day at a time and sometimes one hour at a time. My demons constantly lurk in the recesses of my mind and I still have the eternal inner battle with myself over living or dying. I continue to take my medication and see my psychiatrist and psychologist regularly. With their firm support and the overwhelming love my family and friends have given me, I have redefined my life and have set myself some goals and a back-up plan for when things get rocky. I am currently studying a university degree in human services and I struggle with it every single day. Not just the workload but with the urge to self-sabotage because I feel that I am not worthy of doing something with my life. Whenever I think about throwing in the towel, I think about why I am doing this. I want to help others like myself who may not be as fortunate as I was in finding a support network that works, or someone that cares. I want to make a difference to them and help them to see that they are worthy and they can be and do whatever they want to do. Everyone deserves that and I intend to tell them so!

Mental health has seeped into every aspect of my life; personal, social, occupational and otherwise. I think the scariest thing about my illness is how my own mind can and has, betrayed me. This demon has twisted my thinking, taken my self-respect, left me powerless and torn me to pieces but it has also given me something. It has given me strength and purpose. No matter how vicious my illness has been, it has not beaten me yet and I am determined not to let it.

The Realities of BPD

Following the focus this week on Borderline Personality Disorder (BPD), Tegan Churchill has kindly put together her own experiences living with this illness. She explains how it has impacted on her life and now how she copes with a young family. Very brave and resilient woman!

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 I remember the first time I knew that a diagnosis of Borderline Personality Disorder was on the cards. I was sitting in the waiting room of my small town doctor, my chart on my lap because there was no computer system yet. Curiosity got the better of me and I flicked through the pages. Nestled in the back was a letter from the psychologist I was seeing at the time, in bold letters were the words Borderline Personality Disorder. I was confused, on the borderline of what? I committed the term to memory so that I could look it up on the internet when I got home.

I didn’t like what I saw, the checklist of symptoms read like a list of ‘how to suck at life’. I knew that I ticked most of those boxes and I was ashamed. I was 15 at the time but a definite diagnosis was not made until I was 18. Doctors decided that I had, had enough time to grow into my personality and this was how it was going to be for the rest of my life.

I sought out support in online forums, losing myself in an online world. All around me my life was falling to pieces. I dropped out of university, I was living with my grandmother and spending most of my days in bed. My GP told me that I was a 9 year old trapped in an adult’s body. I was horrified at the time, unable to process the comment. Looking back now, it’s true.

I was on a destructive path. A suicide attempt lead to my mother moving with me to a larger center with more mental health services. It didn’t matter, I was hell bent on destroying myself. I was reckless and failed to see the consequences. After ending up in jail for 2 months, my mother moved back to our hometown. I stayed in the city and moved into single’s accommodation for women. I had everything I wanted; I lived in a large town where nobody knew me.

I didn’t know what to do with my thoughts. They were all consuming, every emotion felt like a thousand knives were piercing my skin. I didn’t know how to express my feelings. I lashed out at anyone who tried to help me. I was like a stubborn child. The professionals who were supposed to help me wrote me off as an attention seeker. Therapy was stopped after another suicide attempt and I found myself floating through a system that seemed hell bent on keeping me unwell.

Having Borderline makes making and maintaining relationships difficult. I find myself going between loving a person more than anything and hating them with everything in my being. I often turn people off without a second thought to repair the relationship. I find myself in screaming matches with people who I love, feeling a rage that is so all consuming that I worry that my veins will burst through my skin. I turn into the hulk and it takes me days to calm down.

For years I turned to self-harm to help fight the feelings. I self-harmed to make me feel and to stop feeling too much. Each time I cut it had to be deeper than the last time. I didn’t want to die; I just wanted to destroy myself, to punish myself for the perceived wrongs that I had committed.

Now I have a child to consider. He is counting on me to be there, and he is the reason that I looked into better therapy. I let my moods and my coping skills get a lot worse again before I admitted I needed help. I had put on a mask, hidden behind a wall and didn’t let my feelings out anymore. I was afraid that I would lose my son. The mask was so good that my current psychologist was skeptical that I had Borderline at all.

I have recently completed a course of Dialectal Behavioural Therapy (DBT) and found it immensely helpful. It was a relief to have someone take me seriously, who saw that I was someone worthy of treatment and had the time to spend working on my issues.

I’m a different person to when I first received the diagnosis of Borderline Personality Disorder. I still struggle to express my feelings, and to interpret others’ intentions but I am making progress. I still catch myself wandering down the destructive path, but I know that I have so much more to live for. I still feel like I’m walking around with no skin, taking in every slight, every glance, every word but I am getting better at processing the thoughts.

Borderline may be something that I will always struggle with but I am happy that I am filling my toolbox so the good days begin to outweigh the bad.

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Blurb: Tegan can be found at http://www.musingsofthemisguided.com where she talks about mental illness, parenting and everything in between. She hopes that by sharing her story and knowledge that she can do her part to help rid the world of stigma. Joining her on the journey is her partner Paul, a 4 year old bundle of energy and a puppy with an attitude.

Personality and Disorders – Part 2

In the search for people to write posts on their lived experiences with mental illness, one of the ladies who agreed to share her story is Tegan. She was diagnosed with Borderline Personality Disorder (BPD) and describes the experience as feeling her emotions without her skin on. If you’ve ever had a wound on your arm where the skin has been torn off, you’ll know how tender, raw and painful it feels. Now imagine all of your emotions without their skin. You get hit with everything at once. It’s really intense, and you don’t have any skills to deal with it. You get so many emotions that you can’t even decipher or make sense of them.

So how do you cope?

I would imagine that your survival instincts (remember that Neanderthal man who Sam talked about in the anxiety posts) would kick in. Your brain would narrow your focus to one simple thing. Survival. All those emotions at once would be really overwhelming. You’d probably panic. And then do anything that you could possibly think of to stop it all. You’d feel so overwhelmed and panicked that you’d choose the first thing to enter your head, whatever that may be.

As I mentioned in the last post, it is very common for people with personality disorders to have had a history of trauma or abuse. So it is very likely that you would feel really crappy about yourself. You might even hate yourself so much that you feel like you need to be punished. So the strategies you’re likely to turn to will be things like hurting yourself. It could be with food or it could be with alcohol. Or even with drugs, cigarettes or razor blades (burning or cutting yourself). Anything to relieve the pain you feel inside. Even suicide.

And when people try to help, you reject their advances because you feel like you need to push them away before they abandon you (which is what you feel you deserve). And this confirms your belief so you push people away even more, by using any means necessary. You argue with people, yell, scream, insult, push, shove, steal. And so on.

And then you feel even worse about yourself because you know that kind of behaviour isn’t what you should be doing. So you increase your efforts to punish yourself. You would be unlikely to recognise much good in your life. You might meet someone and marry, but because of how you feel about yourself, the relationship is likely to be full of arguments and bad feelings. Parenting would also be a huge challenge. As would your work relationships.

If you’re lucky though, you will reach a point, like Tegan, where you acknowledge that you can no longer live that way. And so, after many false starts, you begin a very long, slow journey to make changes in your life. You seek professional support from a psychiatrist and psychologist skilled in working with BPD.

Stay tuned to hear from two very brave women, Tegan and Kaye, about what it is like to really live with BPD.

Personality and disorders – Part 1

We all have a personality. We might call some people loving or caring. Introverted or extraverted. Angry or aggressive. Anxious or self-centred. Or a whole host of other things. But what does that really mean? I found a website that provides a definition of personality. It says

personality is made up of the characteristic patterns of thoughts, feelings and behaviors that make a person unique. In addition to this, personality arises from within the individual and remains fairly consistent throughout life.

Our personality is an internal aspect of our experience and includes thoughts, feelings and behaviours. The way we think, feel and act. These quirks and characteristics remain pretty stable throughout our life and are unique to each of us. And yet for the majority, the differences between one person and the next is not that huge. I’m sure that we could all look around a room full of people and note that every single person conforms to a set of socially acceptable behaviours. And when we discuss our thoughts and feelings we would find that we have a lot in common.

But there are a group of people who possess quirks that are outside this “norm”. This is very different to simply finding people who have different ways of thinking. We all have unique thoughts and feelings, but there is always a sense of commonality underlying that uniqueness. The difference between “normal” and “not normal” can sometimes be quite subtle, but it can also be very clear. The American Psychological Association says,

Personality disorders are seen by professionals and researchers as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it. These patterns are inflexible and pervasive across many situations. The onset of the pattern can be traced back at least to the beginning of adulthood. To be diagnosed as a personality disorder, a behavioral pattern must cause significant distress or impairment in personal, social, and/or occupational situations.

Wow, what a mouthful! More simply, differences are mostly noticeable with social interactions. There is inflexibility in thinking and a very narrow set of beliefs. So when interacting with others, a person with a personality disorder always has to be right and will go out of their way to prove it. They will have difficulties making or keeping relationships, getting on with friends, family or colleagues, staying out of trouble and controlling their feelings and behaviour. This website has a simpler explanation than the more technical one above and also briefly looks at some of the treatments available.

Causes

There is some debate about what causes a personality disorder and there are no definite answers. Some say genetics (family genes) play a part. Childhood trauma and abuse has also been looked at, which studies suggest are particularly relevant for Borderline Personality Disorder. This website briefly looks at some of the research. The behaviours and habits of people with personality disorders are usually seen early in their lives, sometimes in childhood, and are commonly diagnosed between about 18 and 36.

I’m not too sure exactly how it works, how or where things go haywire. I believe there are still a lot of researchers arguing about it. If you would like to read some more, technical information you can go here. You’ll notice the list of all the different types, one of which is Borderline Personality Disorder (BPD). We are going to focus on this one as an example because we don’t have the time or space to get through all of them.

In the next post we will look at BPD and the experience of living with it.