Self-Harm and Buddhism

At work there is a program called Illness Management and Recovery (IMR).  It was developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) and consists of 10 modules on managing mental illness.  I am not trained to teach it, but have been working through the modules myself to learn more.  Most recently, the assignment was to explain a symptom to others.  I wasn’t sure which symptom to cover, until I spent 5 nights back in the inpatient unit last week.  I’ve struggled a lot with suicidal ideation and urges to self-harm over the past three months, and reached a point where it was beyond time to take a breather from life and go somewhere safe where I could focus strictly on taking care of me.

While there, I began reading The Buddha and the Borderline by Kiera Van Gelder.  It is a memoir of her experience of Borderline Personality Disorder and her path to recovery via Dialectical Behavior Therapy (DBT) and later delving into its roots in Buddhism.  Early in the book there were some fairly graphic descriptions of self-harm, which I only felt okay with reading because I was in a safe place.  It turns out, it wasn’t entirely safe.  They do the best they can with keeping dangerous objects out, but those of us who self-harm can get pretty creative.  At one point I found something dangerous that was built into the architecture.  I showed it to a nurse and she said she would report it to the director of the unit and that I should come tell a staff member if I was feeling tempted.  One night I did.  I’d been feeling anxious during visiting hours and when my mom left I called the same nurse over and told her I felt tempted toward the thing I had shown her previously.  I also handed over my statistics folder mom had just brought for me and asked her to please remove the staples from the packets of notes.

The nurse told me to stay put, but it didn’t totally register and after a different staff member handed back my folder without even speaking to me I started to get overwhelmed by the noise in the main commons and moved to a smaller area near my room.  The nurse came rushing in and happened to see some recent scratches on my arm from before my admission, which led her to exclaim, “Did you hurt yourself?  I told you to stay put!”  I explained that the scratches were older, and she told me that they would like me to sleep in the quiet room that night so they could keep an eye on me.  The quiet room?  That’s the nice term for seclusion room, which is the nice term for restraint room.  The only furniture was a bed in the center of the room, with restraints built in.  The lights were controlled from the outside, there were cameras monitoring the room, and there was no handle on the inside of the door.  Now on the bright side, they really just were putting me there for the cameras, and the door was not fully shut.  I was allowed to get up and leave to use the bathroom or go to the water fountain or ask for sleeping medication.  It was still rather intense.

It was also completely warranted.  The dangerous item I had found wouldn’t do serious damage, but it was in a place where no one would see and stop me, and I could have hidden the marks had I acted on my urge.  So why self-harm?  It can be many things.  It can be a punishment.  It can be a release of psychological pain in physical form.  Those are the main two things for me.  If I’m hurting intensely, it’s less painful to transfer that into something physical.  I’m also usually tempted toward it when I feel shame, which unfortunately I feel frequently and for sometimes inexplicable reasons.  The important part to note is that, while many people both self-harm and feel suicidal, the act of self-harm is not a suicide attempt.  Severe acts of self-harm could result in death, but it’s different if death is not the intent.  Self-harm is a coping skill, just not a very healthy one.  Some people come home from a hard day and have a glass of wine or eat a comforting meal or go exercise intensely for an hour, and all those things reduce the pain somewhat.  Self-harm does the same thing for some of us, and therapy (such as DBT) is about replacing that with a healthier way to reach the same end result.

I finished reading The Buddha and the Borderline last night, a couple of days after my release from inpatient, and toward the end the author asked one of her Buddhist teachers if suicide was the same as killing another person.  Likewise, is self-harm the same as attacking another person?  The conclusion was that it is impossible to fully practice loving-kindness toward others if you cannot love yourself.  I can’t say that I will never slip and act on those urges again, as that’s much too simplistic to think a line from a book is going to undo decades of experience, but the book did inspire me to look more into Buddhism.  I am not a spiritual person.  I am even less a religious person.  I have, however, found myself drawn toward Buddhism over and over throughout my adult life, and have benefited immensely from DBT and the elements of Buddhism Marsha Linehan incorporated into it.  So I am steering my upcoming focus on reading toward books on the topic, to discover if it is something I want to explore further.

Chronic Pain

Imagine you are at your best friend’s wedding.  The ceremony has ended and the reception just begun when a trivial matter comes between the two of you.  You end up in an explosive fight, and she is so upset that she rushes out of her own reception.  She drives away, tears impairing her vision, and has a fiery car crash in which she is killed.

Imagine the pain you would be in.  The shame over ruining her wedding day.  The guilt over her death that is seemingly your fault.  The anger that you can’t go back and apologize.  Imagine those images playing over and over in your mind.

Now imagine that you feel this pain, this shame and guilt and anger, every time you think or say or do anything wrong.  Imagine that every minor mistake and every real or perceived criticism triggers gut-wrenching sobs.  You cry so long and so hard that you vomit.  Your nose gets so congested you can’t breathe.  Your heart physically aches.

Imagine being in this much pain on a regular basis for days, months, years, decades.  Imagine that you barely remember the time before this pain.  Sometimes it abates, maybe even for months, but the pain always returns.  It is the one part of life you can always count on.

I wish Sadie could feel this pain just once.  I wish she could know that I would never choose to stay in pain if I could find my way out of it.  No amount of caretaking by others would be worth prolonging such a horrible feeling.

Too Many Thoughts for a Title

Back in October, Sadie had suggested doing a Pros & Cons of Existence, which I opted not to do because it sounded too dangerous.  What would happen when I weighed the evidence and found that it was much more in favor of not existing?  Well, I’m about ready to do that pros & cons list now.

Recently I’ve come to understand how people develop Munchausen’s syndrome, in which they intentionally cause themselves illness or injury in order to get medical attention.  I found myself wanting to cut myself or overdose so that I could be sent someplace safe, where people would take care of me and I wouldn’t have to deal with my life.  As time passed I found myself reacting to every little twinge of pain or discomfort with the hope that it was a serious illness.  Every time mom and I were in the car, I would cross my fingers for us to have an accident.

I got a little taste of being taken care of when I got dizzy while Suffering for a Good Cause, but it wasn’t enough.  In my appointment with Sadie the next day, which I’d scheduled specifically to discuss these thoughts, she asked me if being taken care of was a need or a want.  I said that everyone needs to be taken care of sometimes, but I imagine her point was that I’m capable of taking care of myself at this point.  She said it was a Catch-22, that in order to form relationships with people who will take care of you when you need it, you first have to show confidence in who you are in order to attract those people.

I said I didn’t know who I am (lack of a sense of self is a symptom of Borderline Personality Disorder) and we worked on naming off some of my interests and personality traits.  She asked what I would say if I was writing an author’s bio for my book.  I was going to go with where I was born, where I live now, and that I have cats.  Somehow that didn’t seem like enough to give me an identity.  I said that identifying my values would probably help with this, and then remembered that in reading The Happiness Trap there were exercises about values.  From the website of worksheets to go with the book, there is a Life Values Questionnaire and Bull’s Eye Worksheet that can be used to identify one’s values and how far or close one is to living by them.

I had done the Bull’s Eye Worksheet but the other one looks even more specific by addressing more areas of life.  Sadie and I have to update my ANSA and treatment plan at the next appointment on Wednesday, but I will try to prepare these worksheets in case we have any time leftover.

And the pros & cons list?  Well, over the weekend I was on a spontaneous trip out of town.  Mom had asked me Wednesday evening if I’d like to go, and we made all the plans on Thursday and left at noon on Friday.  Throughout the weekend, I struggled with suicidal thoughts.  I no longer was thinking about the possibility of getting attention.  No, I was thinking about actually wanting to die.  I was crying every time mom was out of sight.

I don’t want to be dead.  The thought of dying makes me sad.  I remember back in December, when I was sure I’d be acting on a plan on January 1st, I would cry every time I did something for what would be the last time.  I saw Jean at a choir performance and tagged along behind her for the whole tour of the historic house it was held in, hoping to be able to hug her goodbye.  She never made a move to hug me, despite having done so the last several times I saw her, and I went home in tears.

Brent noted back in June last year, when I recently had started my job at the hospital and was desperately overwhelmed by it, that I had very specific suicide plans.  What I have in mind now is even more specific.  I don’t see Brent for another 3 weeks, and I don’t know if I’m going to make it that long.  Everything feels manageable early in the day, but as the hours pass and darkness falls I fall with it, spiraling into a swirl of negative thoughts and tears.  I don’t want to be dead, but I don’t have hope of things ever being better enough for life to be worth living.

Brent and Sadie tell me I could work full-time, that I’m not disabled, which would make it very difficult to actually get approved for disability if they don’t support me.  What I’m coming to realize is that I may not be too disabled to work, but I am too disabled to accomplish what I want out of life and I don’t know how to accept the idea that my dreams are unattainable.  I have some good days, but then I have some really bad ones that, if they continue, would make it impossible to follow long-term plans.

It just feels like it’s not possible to be well consistently.  I was patient in the first year of treatment, knowing that it can take a while to get the right combination of meds and have them take full effect.  Now I’m more than two years into this process and I never feel good for more than a month at a time.  Instead of manic highs alternated with the depths of despair, I have an occasional sense of peace alternated with a lingering malaise just bad enough to hinder progress.

So I’m going to make that pros & cons list.  There are some pretty big pros in favor of suicide, and I don’t know if the cons will seem like enough to balance it.  For example, I don’t really want to live to my next birthday, which is next week, but if I don’t I will never get to use the birthday gift I know I’m getting, which is something I’ve wanted for a really long time.  So I cry about the idea of not using the gift, but then I ask myself why it even matters.  If I’m dead I won’t know that I didn’t use it.

I’m trying to remind myself each evening that the next day, although it may not get me any closer to a life worth living, will possibly be just a little less painful, so I can wait one more day before acting.  If I ever feel that I can’t wait and am feeling compelled to go buy the last ingredient in my suicide recipe, then I know it’s time to call for help.

 

The Joy of Lamictal

I’m writing this on my phone so it will be shorter than usual, but I wanted to share that I’m really glad I went to inpatient last week.  I wish I had done it 6 months ago, although that would have been bad timing with my then-new job.

I started asking Brent for Lamictal over a year ago.  He consistently put it off, trying to fiddle with dosages on my existing meds instead of trying anything new.  When I threw the idea out there in inpatient, I expected to get a similar response from Dr. Bhatia.  Imagine my surprise when he said, “Okay.”  Well, what he actually said was, “Four medications is a lot, but that’s a class you aren’t already on.”

A week and a half later, I feel stable.  I’ve had days here and there in the past that felt okay, even sometimes several days in a row, but this sense that I am calm and can handle stress and everything is going to be okay?  That’s totally new.

For the past few days I’ve been on vacation, staying with my best friend, her husband, and their 5-year-old daughter.  Their daughter is intense, to put it mildly.  She has not calmed down any since my last visit in summer 2014, and has actually been wilder since she’s getting over chicken pox and has been cooped up in the house.  On my last visit I had a very difficult time handling her and had to practice my newly-learned mindfulness skills to survive the week.  This visit is going much smoother for me.  The mindfulness skills are much easier to put into practice now, partially because I’ve been using them longer, but mostly because I’m just not feeling the stress. 

There have been some studies that indicate Lamictal is also helpful for the day-to-day mood swings associated with Borderline Personality Disorder, and it feels like that might be true.  There have been the occasional thoughts of suicide or self-harm popping into my head, but instead of temptation to do it I just think, “Gee, why would I want to do that?”  The real test will come when I am back home and have my first conflict with mom since my release from inpatient. 

A Change in Perspective

When I wrote Hello Kidney, that was my reason to stay alive.  I’d had a rough day at work on Friday, and followed it up by reading a post on a mental illness message board that struck a nerve.  The board discourages discussion of personality disorders, under the premise that medication does not help them (which I disagree with – I believe there are some symptoms involved that medication can alleviate).  There was a poster who I had greatly admired due to his ability to work in an inpatient psych unit despite his own mental illness.  At least I admired him until he expressed his belief that people with Borderline Personality Disorder give themselves papercuts or take a single benzo and then run to the ER crying that they attempted suicide, taking up resources that should be saved for people with real mental illness.

I was angry.  I have never been openly judged for my mental illness, and to have it done by a fellow sufferer AND mental health professional was an extra blow.  Unfortunately, I internalize anger.  Instead of blaming him for making a callous comment, I blamed myself for being unfit for society.  Maybe all those nights I spent in inpatient last year really did mean resources were being wasted on me.  Maybe I’m not worth saving.  I was busy at my second job for a few more hours, but then I headed home, where I picked up a disposable razor and went back out to wander in the night time.

I thought I’d be going somewhere secluded and sitting in my car as I broke open the razor and slit my wrists with the blade.  First, though, I went to Steak ‘n Shake, where I stuffed myself with comfort food and wrote in my journal.  As I wrote, I thought about how I couldn’t die yet, as I still might be able to donate a kidney to mom.  So I planned for that potential surgery and started researching how I could increase my risk of dying from it.

Despite the lack of immediacy to my suicide plan, I knew I should be calling the on-call therapist.  I couldn’t make myself do it.  I can’t be anonymous if calling in the middle of the night, as the therapist has to be contacted and then return the call.  Also, the chances are ever-increasing that the person on-call will turn out to be someone I know.  Finally, I feared being asked to come to the ER for an in-person psych evaluation, and potentially having cops sent after me if I refused.

Instead of calling, I browsed the internet and found Crisis Text Line.  The idea of not having to speak aloud to someone was appealing.  I entered the number into my contacts, but hesitated before sending a text.  Some other customers were creating a spectacle, and watching them distracted and entertained me enough that I was able to safely return home and crawl into my bed.

I held on to the idea of donating a kidney, and on Monday morning I called the transplant center.  I was asked 5 questions in rapid succession before being rejected.  My name, mom’s name, whether I had high blood pressure, whether I was on medication for it, and my age.  I argued with the lady, questioning her about the reasoning and asking if I could get a clearance from my doctor to allow it.  She firmly said no.  I understand why high blood pressure is a problem – it’s a leading cause of kidney damage and they wouldn’t want to take a kidney from someone who might end up needing one later on.  However, it does not make sense to reject me when my blood pressure is normal with medication, and it especially does not make sense that my age would make a difference.  Would she have said yes if I were younger?  Older?

My new thing, apparently, is to throw up when I cry.  I hung up and started sobbing, racing for the bathroom as the force of my tears made me gag.  It would be one thing to have found out I wasn’t a match, as that would still leave the option of arranging a kidney exchange, where I donate to a stranger and their loved one donates to mom.  Being rejected entirely was devastating.

Mom can live on dialysis indefinitely, and at this point has accumulated 27 months of wait time, with it usually taking 3 to 5 years to get a kidney (her first one only took about 8 months).  It’s reasonable to think she’ll get one soon without my intervention, but I couldn’t stand the idea of her being on dialysis any longer than necessary.  My thoughts returned to my original suicide plan, the one that got me sent to inpatient the first time.  I had planned to accompany her to an appointment at the hospital, pin a note to my chest requesting she receive one of my kidneys, and shoot myself in the head.  Maybe that would be the best for all of us after all.

The next day I was sitting in the DBT group that I planned on quitting within the next couple of weeks (as soon as we complete the Emotion Regulation module), and on the break I pulled out my phone and started doing research for my plan.  A few minutes later, in the course of our weekly mindfulness exercise, I had a change of perspective.  The exercise consisted of three questions asking us to consider how we could view situations differently in order to change our feelings about them.  How could we make the best of those situations and hold out hope for the future?  I began writing answers that turned out to be about the kidney transplant and the things I could still do to support mom and the overall cause without being able to directly donate a kidney to her.

I had already notified the group leaders that I was quitting, but when I realized something enlightening had just taken place I questioned my decision.  The group ended and I asked Sierra if she had an opening in the next two days in which I could come speak with her.  We arranged it for 8 am today.  Later in the day I was also able to schedule a brief appointment with Sadie for 10:30 am today.

The alarm on my cellphone was set for 6:30 am, but it was the house phone that woke me, at 10:50 am.  Sadie was concerned because I hadn’t shown up for my appointment, and if I hadn’t answered the phone she’d have been sending the police.  Sierra was also concerned, but wondered if there’d been a miscommunication so she merely sent an e-mail to check in with me.  I was very upset to have missed both of these appointments as I really needed to talk to someone, and Sadie and I agreed that I would show up at CMHC at 2 pm and wait, because both her 2 o’clock and 3 o’clock clients have been flaking on their appointments lately.

I was there in the waiting room, doing some writing to fill the time, when Sadie came out at 2:10 pm and told me that client hadn’t shown up (and the next one had already called to cancel).  Our conversation looped around through a lot of topics.  She did her usual sneaky assessment of whether I was safe to roam free, and I assured her that I had no intention of killing myself right now.  A couple of days ago I wasn’t sure I could say that.  A part of me really felt like inpatient would be the best option, if only I thought there was anything they could do to make things better.

Sadie told me that mom still needed me, even if I couldn’t help her in the way that I wanted.  She named off all the people I had worked with at CMHC and said that if I killed myself it would impact them all, not to mention all the people I know through work and school and hobbies and family.  I told her this sounded like an argument in favor of not having relationships and she said it was too late, that even people I no longer have contact with, like Wendy, would be impacted.

I had a thought in my mind about a video I watched recently, made by the blogger when she was planning to kill herself.  I had shared it to Facebook, explaining that I’d had many of the same thoughts she expresses.  The only feedback I got was my mom saying, “You never really felt as bad as that girl, right?”  The thought that came up when Sadie was talking was that the impact would just be people thinking there was something they could have done, when they should have thought of that beforehand.  I didn’t get a chance to express this, as the conversation veered in another direction.

Aside from the issue of suicidal thoughts, Sadie and I discussed the rapid fluctuations in my mood.  Despite feeling down and suicidal one day, I can be bouncing off the walls the next.  The past couple of days I worked 3-11:30 pm and found that I could not get myself into bed afterward.  Last night I spent at least half an hour total pacing back and forth in the break room while waiting for work to do.  I was taking the stairs two at a time, and lately I’ve had the non-stop fidgeting of my left-hand that featured so prominently in last year’s manic episode.  I’m driving too fast (60-70 in a 45 mph zone), going out wandering late at night, getting too generous with gifts, and losing my social anxiety.  From the moment I showed up at work yesterday I answered every single phone call that came into the department, despite having a coworker there for the first 5 hours and despite my usual deep aversion to telephones.

On the one hand, Sadie said she was glad I would be seeing Brent next week because it seems like my medication’s not right.  On the other hand, she said she didn’t want me to pathologize everything about myself.  Some of these behaviors can be my personality without being a sign of illness, and the things I was expressing concern about weren’t actually dangerous, with the exception of speeding.  I tried to explain that it’s the combination of all these factors and the fact that it feels like I did before I ended up in inpatient the first time that worries me.  She asked if I had been manic, depressed, or mixed at that point.  I said mixed.  I’ve never directly said that to anyone in the mental health profession.  I know it was the case, but it’s not officially in my records.

She asked if I’m mixed now and I said no, that it’s rapidly switching between the two, which is a little less dangerous.  Mixed states are bad because you feel the despair of depression and the energy of mania simultaneously and are at increased risk of suicide.  We talked about how to describe my symptoms to Brent in a way that he will take seriously.

I fear what he will say when I complain about moods being up.  I had complained before about being down all the time and sleeping too much and he decreased my dose of Latuda, thinking I might be overmedicated.  Well, that’s clearly not a problem anymore.  Maybe what I want is not possible.  I want to have energy and motivation.  I want to not be bouncing off the walls.  I want to sleep 8-9 hours a night and wake up refreshed.  I want to be able to cry over sad things, but not become suicidal over them.  I want to not feel anxious.

What my medication does now:

Wellbutrin – Mostly keeps me out of suicidal despair.  I still have suicidal thoughts, but they get much worse if I go off the Wellbutrin.  Also, it usually prevents me from crying when I’m upset.  My eyes might get a bit watery, but it has to be something really bad (like the rejection from the transplant center) to induce real tears.

BuSpar – Wipes out the cripplingly severe anxiety, but I still have fear that prevents me from doing certain things.  Except, of course, when I get a bit manic and then all bets are off.

Latuda – Slows down reactions to situations.  Makes me sleep more than I’d like.  If I skip it, I’ll be up all night (although the past few days I’ve been wide awake despite taking it).

A few months ago, I had shared a few medication options with Brent and he said, “#6 is Not An Option“.  That was the point at which he reduced the Latuda.  In looking back over the options I provided, there should have been a #7 and #8.  I didn’t bring up the possibility of lithium, probably because the idea of the frequent blood tests intimidates me, and I didn’t account for the fact that the solution might involve more than one of those changes.  Brent and I need to have a serious conversation next week, because I am just not okay with the way things are right now.

This is why a small part of me wants to go hide in inpatient, because I know something needs changed, and I’m a little scared of doing that with minimal supervision.  I’ve reached the point that I haven’t experienced serious side effects from my medication in a long time, and the idea of new side effects hitting me as I try to make it through my work days is daunting.

My First, My Last, My DBT

Apologies in advance that this is a very negative post.  I know I should be giving things a fair chance, but sometimes a situation just sucks so much that it’s hard to set aside the frustration and try it again.  This morning I went to my first DBT group meeting.  I also may have gone to my last.

Going into the meeting, I was anxious.  It started hitting me about 45 minutes before the meeting time, when I was trying to figure out exactly what time to leave to be not-early and not-late.  I was anxious about figuring out how to pay – who to pay, what payment types would be accepted, and even whether or not I should pay, given that it will just be tacked onto my ever-growing bill if I don’t.  I was anxious about being in a group in general, and especially about joining a group of people who had all been attending for years and already knew each other.  I was anxious about which section of skills they might be working on, and how well that would line up with what I’d already done in individual therapy.  I was so anxious, in fact, that I drove right past the place and had to turn around in a parking lot to come back.

I did pay, in cash, to some confused receptionists who weren’t used to a client who doesn’t have Medicaid.  I entered the group meeting room and found two women sitting there.  When they introduced themselves, I thought they were the group leaders, but it turned out they were both just members with thick binders of all their accumulated handouts.  We were soon joined by two additional members (one of whom was male), and one of the two therapists who lead the group.  The other therapist and several members had called to say they could not attend today.

The meeting began with each of the other members describing which skills they had used during the previous week.  Two people did this in a succinct way, that avoided too much backstory.  Two others rambled on and on about all the situations they were in when using these skills, which I had been told in the orientation was not the appropriate way to use group time.  However, the therapist made no effort to reign them in.  To be honest, I was sitting there thinking that I don’t give a shit about these people or what they have to say.  It was mindnumbingly boring to listen to everyone whine about what all had gone wrong that week and then brag about how they handled it so well.

Then we moved on to actually discussing skills.  They had recently started the Interpersonal Effectiveness section, which is exactly where I hoped they wouldn’t be starting.  I’ve done Distress Tolerance and part of Mindfulness with my individual therapist, so starting with one of those, or even in the Emotion Regulation skills would have been fine.  The therapist went back to the first page of the handouts and reviewed, partially because people missed group so much over the holidays and partially, I think, to catch me up.  Yes, review of the previous week is built into each meeting, but we spent the entire second hour on review and never got to the point where they teach new skills.  In fact, the review didn’t exactly contain any skills either.

One member of the group would not stop running her mouth long enough for the therapist to get a whole sentence out, and also used a profanity for every third word she said.  The others could manage to wait their turn, but never seemed to be on the right track as far as what we were discussing.  I was asked at the end of the meeting whether I thought this was going to be helpful.  I said, “Not in the slightest.”  This earned me a lengthy speech from the member with diarrhea of the mouth, telling me all about how much DBT has helped her in the FIVE YEARS she has attended the group.  Five years.  You complete the whole set of skills in 6 months, so she has been through it all 10 times.  I cannot even remotely count that as helping, if she still feels the need to attend the group and be retaught these skills over and over again.

At the break in the middle of the meeting, the therapist went and made photocopies of the Interpersonal Effectiveness handouts and put them in a binder for me, along with a few copies of the weekly diary card.  I nearly left the binder on the table when I walked out.  I was already 95% sure I would not be returning next week, and 100% sure that I would not complete the entire program, so it’s hardly fair of me to come back and lead them on.  By the end of the meeting, I wasn’t anxious anymore.  I was just annoyed and frustrated, and felt that I had just wasted 2 hours and $12 on complete drivel.  I’m giving my therapist one chance to talk me into returning, at our appointment later this week.

What do I hate so much about it?  Well, aside from everything mentioned above, it’s repetitive.  The skills are just the same things said over and over in different ways.  I’m not an idiot who needs to hear things a hundred times in order to understand them.  In fact, I’m just plain not an idiot.  We went over a page about challenging myths about interpersonal effectiveness.  After just one of them, I said, “So in other words you just add a negative to the sentence.”  The therapist looked at me as though shocked that anyone would pick up on that on the first try.

I also hate that, in looking over the list of skills on the diary card, I once again find that the skills are not the same skills my therapist has been giving me.  The same happened with a DBT workbook I bought.  Oh sure, some of them are the same, and some of them are clearly just different wording.  But there are entire skills that are missing from this list.  How can DBT be some proven program if it’s not even the same skills when different people teach it?

I hate that the skills are not things I need to be taught.  We went over and over the idea that Interpersonal Effectiveness is about asking for help when you need it and being able to say no when you need to.  I don’t inherently have a problem with these things.  I have a problem with these things because I experience social anxiety, but I don’t need to be taught how to do them.  When my anxiety is under control, there’s no problem, and when it’s not, there’s no skill in the world that is going to help.

Most importantly, I hate that I’m not doing this because I want to do it, or think it will help me.  I’m doing it because it’s what my therapist wants me to be doing, and I feel that if I tell her I’ve had enough of the DBT and that I’m not going to the group or letting her teach me the skills anymore, then even if she can work with that there will always be a tension between us.

I don’t even really believe my BPD diagnosis is correct.  I don’t have most of the stereotypical symptoms, and the ones I do have can be easily attributed to bipolar.  I don’t always use self-injury to cope or think about suicide, only when I’m depressed.  I don’t always drive too fast or overspend, only when manic.  If the diagnosis is wrong, and the therapy is not what I need either way, then why the hell am I doing it?

Low-Functioning, High-Insight

Today Lauren Hayley posted Day 28: Do you consider yourself high-functioning or low-functioning?  The question is in terms of Borderline Personality Disorder, and she includes a description from BPD Central of the traits of these two levels of functioning.  As a general summary, low-functioning BPD sufferers are those who direct their pain inward with self-destructive actions, and are seeking help.  High-functioning BPD sufferers are those who lash out at others, destroying relationships, and are in denial that they have a problem.

I find these definitions weird.  I don’t see how seeking help makes a person low-functioning, or why being high-functioning requires fitting the negative stereotype of BPD sufferers being abusive toward friends and family.  By these standards I would have to describe myself as low-functioning.  Externally, I’m one of the nicest people you’ll ever meet.  I take things out on myself.  I also am seeking help.

In my latest therapy session, my therapist and I discussed the fact that I often don’t list many skills used on each day of my diary card.  One of our theories was that I’m actually using more skills than I write down, but don’t think of them consciously when it’s time to fill in the diary card.  In some cases, I’m using skills I haven’t been taught yet, so of course I don’t know to write them down.  One skill that has been referenced occasionally but not yet taught is “Opposite to Emotion Action”, which is what I used today.

I recently complained about Dialectical Behavior Therapy in I’m a person, not a diagnosis.  I hate DBT.  I’m joining a DBT group on Monday.  In the orientation session I went to today, when I was asked if I wanted to join the group, my mind was screaming at me that it sounded like torture from hell.  I wanted to say no and run from the room as fast as I could.  Instead I agreed to join.

The woman who did the orientation said that they don’t like to do “process therapy” with people who haven’t yet learned these skills, because there is a risk of triggering negative reactions that the person can’t yet handle.  This gave me a new perspective on my struggle with doing DBT in individual therapy.  It’s true that when we discuss negative experiences from my past I often leave therapy feeling terrible, crying, and having urges to harm myself as a result.  I need to recognize that I’m in therapy for the long haul – as much as I want it to, it’s not going to magically “fix” me in a few months.  I need to have patience with the DBT now, knowing that there’s time for other approaches later, when I’m better prepared to handle them.