All that I am, all that I ever was…

I am more than my mental health. I am more than my homelessness. I am more than any one aspect of me. I am Addy. And this is…


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Update: So what am I doing about it?

Yesterday I outlined some of my current stressors; issues that are triggering my mental health into uncontrollable territory. It was a somewhat whiny, somewhat depressing post, but one that needed to be written. Life is hard for me at the moment, there is no joy, no happiness, no relaxation and no pleasure. I have virtually no energy and my loss of hope is making it difficult for me to keep fighting…but, as I have been for twenty-three years, I keep pushing myself.

First and foremost is my attempt to obtain psychiatric support, something I have been trying to obtain for the last six months. You would think this would be simple, that it would just be a case of contacting the local mental health service and – bam – I have a psychiatrist. But, as with everything in my life, nothing is ever that simple. The simple truth of the matter is Wodonga is a small town with only one public mental health service – and they dismissed me as not needing support in 2012, my first year in this town. The psychiatrist I saw back then treated me like crap, just as the psychiatrist I had seen prior to him treated me like crap. He believed (wrongly) that there was nothing wrong with me and that there was nothing the mental health service could do to assist me. He is the only psychiatrist available on the public health system in Wodonga. And I am not putting myself through another abusive psychiatrist appointment. Period. Thus, the only option I have when it comes to psychiatry, is the private sector.

For the last several months my support worker and I have been looking into this option. There are no psychiatrists in the Wodonga region that could help me, which means I have had to look further afield to Albury in order to obtain this support. And we have identified two potential candidates that may be able to help. Both are women (I am unable to see a male psychiatrist due to the misandry and distrust of men I have developed since my rape) and both have lengthy waiting lists. Also, because of the private nature of their service, I am going to have to pay to see them. But this is something I am willing to do (even if it means not eating for the week!)

Hopefully my six-months-and-counting effort in this aspect of my treatment will pay off soon. Whether I will be taken seriously is another matter. I don’t exactly have the best track record when it comes to psychiatrists (because I am a high functioning bipolar sufferer they tend to believe I have too much insight into my illness and, therefore, am not suffering from anything) but I’m willing (and determined) to give it a go. Whatever the emotional and financial cost!

However, I am not naive enough to believe that a psychiatrist will solve all my problems. The simple fact of the matter is (as my post yesterday attested) I am currently navigating a minefield of triggers and stressors, all of which are negatively impacting on my mental health. And the simple fact of the matter is a whole army of psychiatrists and CPNs are not going to change the stressors I am dealing with.

And my neighbour is a major source of this stress.

The noise that my neighbour makes causes me stress twenty-four hours a day. It is incessant. It is continuous. It is mind-numbing. How am I supposed to fight mental illness when I cannot relax for even a millisecond in my own house? When you’re homeless you learn pretty quickly what a home really is. It is not just a roof over your head. It is a sanctuary; a place where you can feel secure, comfortable and safe. And the simple truth is that my neighbour, courtesy of his endless noise, has made my house an unsafe place to live. Two days ago, whilst my house was under attack from his wall shaking video games, I self harmed for the first time in nearly a year. A year of hard work and determination was undone in a matter of seconds because cutting myself was the only thing I could do to deal with the cacophony of noise that batters my conscience on a daily basis. And in the moment that the blade sliced through my flesh I realised once and for all I can no longer live under these conditions: I have to move; for my own sanity – for my own safety – I need to move.

I am not under the innocent belief that moving will solve all my problems (again, I am not that naive) but it will remove a dangerous trigger from my life that will make fighting my mental illness that much easier.

The same can be said for Wodonga as a whole.

My trip to Melbourne proved one thing: I hate Wodonga. It is a town that is bad for me. It is a town that is amplifying my mental illness and making it impossible to live the life that I want to live. There is nothing to do in this town. There are no distractions. No social options. No opportunities to live and breathe. The longer I live in this town, the worse my mental illness will become. Wodonga is a trigger. Pure and simple.

Now, some people may think I’m being over-the-top, that I’m allowing the relaxation of a holiday to control my feelings in this respect. Of course I was calm in Melbourne, I was on holiday, everyone is calm on holiday, yada yada yada. But consider this: my mental health in Wodonga is worse than when I was homeless in Melbourne. I was more stable living on the street than I have been over the last few years living in this town. Why? Because even though I was homeless, I was homeless somewhere I wanted to be.

And, as with my noisy neighbour, no amount of psychiatric support is going to change this. Even if I do manage to obtain a psychiatrist they will be facing a losing battle as their work will be quickly undone by the triggering nature of Wodonga.

They say you only live once, maybe they’re right, maybe they’re not, so why would you live your life in a town/city that amplifies your mental health and makes living a chore devoid of excitement, happiness and social interaction?

As I’ve said twice now, I’m not naive or innocent enough to believe that moving will fix all my problems, I’m not my sister, but it will help in my battle. So, over the last few weeks, I have been looking for new housing options both in Wodonga (to eradicate the problem of my noisy neighbour) and in Melbourne (to eradicate the problem of my pathological hatred of this town)

The simple fact is something must change in my living arrangements. And I am working hard to make that change a reality.

As for my other current triggers, to be honest, there is little I can do about them at this time. My physical health problems are being monitored by doctors so only time will tell how this aspect of my life will play out. The same can be said for my current anhedonia and death fantasies; neither are going away anytime soon and, as both are intrinsically linked to my mental health, I can only combat them as best I can. Perhaps a psychiatrist will assist in this respect. Perhaps not. But even though I’ve lost all hope for a better future, I have yet to stop fighting.

I am just trying to do the best I can with the little I’ve got.

What else can I reasonably expect to do?


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Borderline personality disorder is a hurtful label for real suffering – time we changed it

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by Jayashri Kulkarni, Monash University

Standing in the cold, dark bathroom, she hacked into her wrist with a razor blade and quietly stared at the blood that flowed from the cut. She told herself she was a bad person and deserved the pain.

A part of her felt reassured by the sight of the blood – it showed she was alive – since she felt so dead and empty inside. As she stared at her image in the bathroom mirror, she thought, “I have no idea who that person is staring back at me.”

Such deliberate self-harm is very common in people diagnosed with borderline personality disorder. It takes many forms, including intentional overdoses of tablets with excessive alcohol, risky sexual behaviour, as well as physical self-punishment.

Other symptoms of the disorder include identity disturbances, feeling “dead” inside, rage responses or difficulty regulating emotional reactions to situations, mood swings, constant anxiety and panic, poor self-esteem, memory blanks, dissociation (“out of body” or feeling “unreal”) experiences, problems with concentration, feeling invalid, and fear of being abandoned.

A bad cycle

Between 2% to 10% of the population have some degree of borderline personality disorder, which puts them at high risk of suicide. While it’s poorly understood, we know that it predominantly impacts women.

There’s no medication that specifically treats borderline personality disorder, and it’s associated with a great deal of stigma among both health-care professionals and the general community. Research shows people seeking treatment for self-inflicted harm, including taking medication overdoses, are often seen as “difficult”, a “nuisance” or just indulging in “bad behaviour”.

Rage or diffuse anger is another symptom of borderline personality disorder that’s poorly tolerated by family and health professionals. If the person with the condition repeats self-harming behaviour, frustration among family, friends and health professionals increases and may lead to decreased care.

Since people with the disorder crave reassurance that they are worthy, valid and deserving of care, this rejection sets up a dangerous spiral of increasingly harmful behaviour that’s intended to attract care.

Origins in trauma

About 80% of people with borderline personality disorder have a history of trauma. They may block out recollections of early life trauma, but the impact of their emotional, physical or sexual abuse as a young person is profound and present for many years afterwards.

More specifically, people who were sexually abused as children often feel – wrongly – that they did something wrong, that they are to blame for being abused and that they’re bad people. At a deep level, they believe they deserve punishment; their self-harm acts out this belief.

The rage of people with borderline personality disorder, which often occurs in response to apparently small issues, may actually be a totally justified – a delayed expression of anger with the perpetrator of their abuse. And their memory blanks and out-of-body responses to stress may be attempts to repress recollections of abuse and to escape from trauma.

Not all traumas stem from physical or sexual abuse. Emotional neglect or deprivation can also be difficult for people to identify and define. They can, nonetheless, leave a mark for years to come. About 10% to 20% of people who have borderline personality disorder have no known history of childhood trauma.

Difficult diagnosis

The biology of this poorly understood condition includes the hypothesis that abused or neglected children produce high levels of stress hormones (cortisol) and remain on “high alert” – watching and waiting for the next abusive episode. These stress hormones impact brain circuits and centres that determine anger or emotional control and higher learning.

Deliberate self-harm is very common in people diagnosed with borderline personality disorder. | Rachel Collins/Flickr, CC BY

Women with this condition can also have cortisol-induced cyclical reproductive changes, leading to menstrual cycle-related depression, obesity, diabetes, high blood pressure, increased facial hair, infertility and ovarian cysts. All these long-lasting mental and physical symptoms appear to have their origins in a history of early life trauma with biological brain changes.

There are effective psychological treatments, such as dialectical behavioural therapy, for borderline personality disorder but health professionals have to recognise and explain the condition before appropriate care can be provided.

And many health professionals find it difficult to recognise the condition because different symptoms come and go over time. An overall view of the person’s life is needed to correctly make the diagnosis.

Ill-fitting name

As a diagnostic term, borderline personality disorder not only fails to capture any of the underlying issues and mechanisms involved in producing its symptoms, it also denigrates. In contrast, major depressive disorder describes a serious condition with the key feature of depressed mood explicit in the diagnostic term.

The word “borderline” was used in the 1930s by psychoanalysts to describe patients whose symptoms were on the border between psychosis and neurosis. But today the most common interpretation of the word is that the condition “borders” on being a real illness.

In effect, there’s an invalidation of the illness in its name. This mirrors – as well as possibly enhancing – the feeling of invalidation the person with the condition already suffers.

And all this is not helped by the next word either. To suggest there’s something about someone’s personality that’s disordered – especially as personality is, collectively, the intimate and unique qualities that describe a person – is a devastating blow. And it cuts further into the already diminished self-esteem that people with this condition have.

Why it matters

Diagnostic labels carry a great deal of weight. They describe symptoms, attempt to answer the question of “what is wrong” and lead to a treatment plan. A diagnostic label such as borderline personality disorder with its stigma and propensity to invalidate the person’s suffering clearly has many negative impacts.

A name that captures the origins of the condition, such as complex trauma disorder, could shift the focus from seeing the person as “behaving badly” or not having a “real” illness, to recognising them as a survivor of trauma or abuse. Such a change could improve outcomes for them and their families.

Of course, what’s also urgently needed is clinical research that creates better understanding of the condition, and the development of tailored, effective treatments. But ultimately, prevention of early life trauma would make the biggest difference to the development and expression of this disorder.

In the meantime, changing the label borderline personality disorder to something more sympathetic, even if just informally, may start shifting negative attitudes to people with the condition.


Jayashri Kulkarni is Professor of Psychiatry at Monash University.

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This article was originally published on The Conversation.
Read the original article.


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31 Days of Bipolar: Day 16. My best possible treatment strategy

Day 16: If you could plan the best possible treatment strategy for your bipolar self, what would it look like?

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The only treatment strategy that I’ve ever had for my bipolar self is medication. I’ve never had a psychiatrist monitoring my moods. I’ve never had a psychologist offering me sage-like wisdom and I’ve never had a team of nurses keeping an eye on the intricacies of my mental ill-health. For some reason the powers that be decided that I have to deal with bipolar affective disorder all on my lonesome, not that I’m bitter or jealous, it has proven to me countless times how strong (and stubborn) I am. But there are times I wish I didn’t have to go it alone, that I had someone to help me with the roller-coaster moods that make up my life, which is why my best possible treatment strategy would start with a psychiatrist.

Now, after my last appointment with a psychiatrist, I’m not exactly overflowing with warmth and trust for people in this particular profession. In fact, you could go so far as to say I despise anyone who pulls on a white coat and decides that their opinion is going to govern someone’s life, but I can’t hide the fact that I believe I need a psychiatrist. Not just someone to correctly monitor my medication intake, but someone with whom I can discuss the intricacies of my life in the hope of finding answers and insight to all the niggling things that nag at my inner-being. Or maybe I just want a psychiatrist because other people have one, and find their input toward their mental health, to be invaluable. Either way, a psychiatrist that I admire and trust would be the starting point to my best possible treatment strategy.

A best possible treatment strategy that would continue with a support worker with whom I had a valuable and trustworthy relationship. A support worker with whom I could discuss things outside of the psychiatrist’s control. A support worker who could accompany me to appointments, advocate on my behalf and help me fight the demons that plague my soul. A support worker who could assist me with DBT, mindfulness and exposure therapy. If I were designing my ‘perfect’ treatment strategy, I know who this support worker would be, because for a short time in 2013-14 she was my support worker, but a funding cut ripped her out of my life and left me the poorer for it.

The next part of my best possible treatment strategy would be a medication regime that worked; not one that has just been throw together because it has worked for other people. A medication regime that included anti-depressants, anti-psychotics and mood stabilizers. A medication regime similar to the one I was on prior to the mood stabilizers causing acute pancreatitis, a side effect that resulted in them being torn from my life and replaced with nothing.

The fourth part of my best possible treatment strategy would be a series of psychosocial rehabilitation groups. A program of activities that would prevent me from being socially isolated, teach me new coping mechanisms and allow me interaction with other human beings who were facing similar issues to myself. This would be an intrinsic part of my treatment strategy, and one that my support worker would assist me in undertaking should my anxiety prove too strong or uncontrollable.

Lastly, my best possible treatment strategy, would contain something that has been missing from my life for so long I’ve all but forgotten what it feels like; friendship. I’ve long believed that friends are more potent and powerful than even the strongest medication when it comes to fighting mental illness. Having one person talk to you, spend time with you, show an interest in your life, can re-program your brain chemistry and make everything you battle on a daily basis feel worthwhile. Having that one person care, having that one person show you love, can work miracles.

But like I said, I have been deemed unworthy of having these things. I have been sentenced to battle bipolar affective disorder and other mental illnesses all on my lonesome. So writing about what treatment I would like is painful, it tugs at my very heart and renders me in physical pain, for I know deep down that I will never receive it. Any of it. It’s just the way things are for me.


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31 Days of Bipolar: Days 12 & 13. The good, the bad and the ugly

Day 12. Who was/is your favourite doctor (any kind) and why?
Day 13. Who was your least favourite doctor and why?

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I’ve decided to answer these two prompts together, not because I’m trying to rush through the challenge, but because I like things being in balance. The good with the bad, the yin with the yang, etc. etc. Over the years that I’ve been seeking treatment for my mental health issues (the first doctor I saw about it was in 2001) I’ve had many (many) bad experiences with doctors, in fact, I’ve had far more bad experiences than good. But the chief suspect, the most despicable example of a “doctor” that I’ve ever come across was a psychiatrist I encountered in December 2011.

We got off to a bad start. The first thing he ever said to me was “it’s impossible to suffer from multiple mental illnesses” (referring to my previous diagnosis of bipolar affective disorder, social anxiety and PTSD) and when I questioned him on this, he informed me “how am I supposed to know what to treat?” Now, my sister had received a multiple diagnosis twenty years earlier in the mid-nineties, and I had received a multiple diagnosis on multiple occasions over several years, so I wanted to scream at him “you treat them all you dumb ass!” but I didn’t, as my anxiety prevented it.

Things deteriorated from there. He informed me, very matter of factly, that I should have understood the complexities of my sister’s mental illness upon her initial diagnosis and therefore it was my fault I allowed her illness to affect me the way it had. Now, I was twelve when my sister was diagnosed with anorexia nervosa. No-one explained to me what it was. No-one explained to me what was happening. And no-one explained to me why she was all of a sudden screaming at me for being contagious. But, according to this “psychiatrist” I should have instantaneously understood what anorexia nervosa is (I’ve met adults who don’t understand it), how it affects someone (I know many adults that don’t understand what anorexia nervosa can do) and what can happen as a result (again, I know adults who couldn’t tell you this). So how was I supposed to understand it at the tender age of twelve? According to this “psychiatrist” I should have done, and because I didn’t, he blamed me for the onset of my depression.

If you think things couldn’t get much worse, they did. He went on to inform me that I couldn’t possibly be suffering from bipolar affective disorder because (a) I had never been hospitalised and (b) I didn’t have any children. Yes, you read that right. My “psychiatrist” informed me that I could not possibly be suffering from bipolar affective disorder because I hadn’t fathered any children. A symptom that I have never seen listed in the DSM, but according to this “psychiatrist” exists. Also, his obsession with my lack of hospitalization ran through the entire appointment. According to him if I had bipolar affective disorder I would have been hospitalised at some point. The simple fact that I should have been hospitalised but the health services let me down, escaped him. In fact, I can think of six occasions in 2007 alone that I should have been hospitalised, not including the occasion that I basically begged a mental health team to hospitalize me because I was terrified I was going to kill myself, but they refused because “I wasn’t a danger to other people”. But, this “psychiatrist” ignored all of that.

And when you think things couldn’t get any worse, you’d be wrong, for this “psychiatrist” ended our consultation with the quality line “you’re playacting mental illness in order to escape homelessness”. That’s right. When I was thirteen years old I decided to begin self-harming during a nasty depressive episode because I knew that in fifteen years time I would end up homeless on the other side of the world! This “psychiatrist” didn’t take PTSD into account (at all) despite my abusive relationship, being raped or living on the streets for three years! And given that most people who are homeless are suffering from at least one mental illness (remember, multiple diagnoses are impossible) to state that I was playacting mental illness was grossly ignorant and borderline dangerous.

He ended the consultation by immediately stopping all medication that had been prescribed to me a month earlier by a different psychiatrist. One who had taken my history seriously and medicated accordingly. The primary medication I was taking at the time was lithium, which anyone with any knowledge of this drug will know, is incredibly dangerous to just stop all of a sudden. But that’s exactly what this “psychiatrist” did.

The man (I can’t bring myself to call him a doctor) was ignorant, uncaring, arrogant, borderline sociopathic, narcissistic and downright abusive. He caused weeks of untold pain and torment, triggered a suicide attempt and, because of the lack of medication, caused me to become delusional and psychotic. Because of him I refuse to have anything to do with mental health services and psychiatrists in general. Even though I desperately need one. Because of him I do not trust any mental health or medical professional. Because of him my mental health has suffered. Period.

On the flip-side to this “psychiatrist” is my current GP, who is easily one of the best doctors I’ve ever had, as evidenced by the first appointment I had with him. My support worker at the time was in attendance and the topic of hearing voices came up. I explained to him that I heard multiple voices and, although they caused me grief, were not something I was worried too much about as they had been with me since I was a teenager. He didn’t try to medicate them. He didn’t tell me I needed to stop communicating with them. He just accepted that they were a part of who I was. This non-medical approach he took to my voices endeared me to the man almost instantly, and over the last two years, we’ve created a wonderful relationship.

He monitors my medication effectively, constantly informing me of any changes and what side effects I should expect if he introduces a new medication. He keeps up to date with blood tests, treats my illnesses with respect and doesn’t allow them to define who I am as a person. On most occasions that I see him, he remembers what we had been talking about during our last consultation, preventing me from recapping what we had talked about, which is a tremendous relief to my anxiety. He is caring. He is compassionate. He is kind. He is understanding. He is everything that the “psychiatrist” was not.

If it weren’t for this doctor I wouldn’t have the support that I have, and I will be forever thankful for finding him. Having quality support from medical professionals is quintessential to someone’s recovery from mental illness. We all need someone we can trust to talk to about what is happening to us. That “psychiatrist” was not this person. My current GP is. Without him I would be nothing. And I hope everyone suffering from mental ill-health can find someone they can rely on in the way that I rely on him.


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Roadblocks to Recovery: #2. Social Anxiety Disorder

To say that being without hope is a strange feeling would be an understatement. To be without hope makes me feel hollow, that something important is missing from my soul. I feel empty. Lost. A little confused. Being without hope is not something I would recommend. It’s painful, disconcerting and altogether mystifying. Yet it’s one of those things that’s easily lost, yet interminably difficult to replace once it’s disappeared from your life.

In this series of posts I am dissecting what is preventing me from navigating further down the road to recovery; all the things that have created roadblocks and zapped the hope from my being. Hopefully, I will be able to shine a light on what I need to do to rekindle hope, and with it, myself.

Social Anxiety Disorder

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It’s not all bad. Heightened self-consciousness, apartness, an inability to join in, physical shame and self-loathing—they are not all bad. Those devils have been my angels. Without them I would never have disappeared into language, literature, the mind, laughter and all the mad intensities that made and unmade me.
~ Stephen Fry ~

It’s true that social anxiety disorder has provided me with several positives in life. My love of writing, reading and literature. My love of movies, television and the moving image. Even my love of photography, a gloriously intimate act that can be performed quite beautifully in solitude. But for the most part, social anxiety disorder has been the devil that has destroyed me.

Since it’s onset in my teenage years, it has had a profound effect on my ability to make friends and retain relationships, to the point that I now find myself an isolated individual incapable of even talking to people, let alone making friends with them. Social anxiety disorder was also instrumental in destroying my educational career, affecting my A-level choices, ability to cope with examinations and my return to college in 2007 was also hampered by social anxiety, to the point I lost that course within weeks of returning (although glandular fever and abuse also played a large role in the loss of that particular course, it would be plain wrong to suggest social anxiety had nothing to do with it). Even now, as I contemplate returning to university, I find social anxiety rearing its ugly head as it convinces me I would be unable to perform the course or survive around so many other people. Social anxiety disorder plays havoc with the view that I have of my own body, feeding into preexisting body dysmorphic issues that have plagued me my whole life. It also renders simple, day-to-day activities, almost impossible to perform. For example, going to the supermarket has become a strenuous action that shouldn’t be anywhere near as complicated as it is. I have to go at a certain time of the day (early afternoon, when the supermarket isn’t as busy) and I have to go to specific supermarkets, ones which have self-service checkouts, so I don’t have to make ‘small talk’ with the checkout operators as they scan my food.

Everything in my life is controlled around my social anxiety. From walking down the street to the actions I perform whilst there, everything is ordered so as to keep my anxiety as low as possible; no communicating with people, no socializing under any circumstances, no pushing myself into situations that I deem uncomfortable. Activities that I used to enjoy, that I used to garner so much pleasure from, have become no-go areas; for example, I can no longer go to the cinema due to the number of people present, I can no longer attend munches, which in 2013, were one of my few lifelines of social interaction. Even blogging, an activity I used to relish, has become super-difficult for me to perform. I worry continuously over people judging the words I have written, stress endlessly about commenting, even on my own blog, let alone other peoples and find myself censoring myself for the first time in eight years out of pure stress over what people may think of my output.

Although social anxiety has always played a tremendous role in my life, I’ve found that since my hospitalization earlier this year, it has only become worse. Since coming out of hospital I have been isolating myself more and more, refusing to go out unless I absolutely (unequivocally) need to. I have become, for want of a better word, a recluse. A hermit. Someone who refuses all social interaction due to the worry over panic attack, due to the worry over what other people may think of me, due to the possibility of making a complete and utter fool of myself. I don’t know why being in hospital escalated the symptoms of my abuse. Perhaps it was being forced to share a ward with other individuals. Perhaps it was the control being taken from my life. Perhaps it had nothing to do with hospital, and that’s just become a convenient excuse. All I know is that over the last few months, my social anxiety has been so out of control, so impossible to contend with, that it has become (even more so than it used to be) a serious illness that has a profound (and monumental) debilitating impact on my life.

It is holding me back. It is preventing me from living. It is sucking the hope from my being on a daily basis. It is destroying what belief I have left.

So what can be done? What possible avenues can I explore to try to fix this particular, debilitating aspect of my mental health? Well:

Firstly, there is talk therapy. I have spent very little time in my life talking about social anxiety. Psychiatrists have been uninterested in this aspect of my mental health, preferring to focus on the (perceived) more serious illness that is bipolar affective disorder. Psychologists, equally, have ignored this part of my illness. Instead choosing to focus on my moods and blaming my ineptitude (and lack of effort) for my isolation and inability to communicate and/or make friends. What I need, more than anything, is a psychologist who understands what social anxiety is, how it impacts on someone’s life and the damage that it can cause if left unchecked. I’m hoping that the psychologist I am planning to see will have this understanding, but only time will tell on that.

Secondly, there is exposure therapy. Of all my readings on social anxiety disorder, this form of therapy seems to have a particularly positive effect. For those not in the know, exposure therapy is when someone is slowly exposed to the source of their anxiety and/or trauma in the hope it will lessen the impact and help the individual cope with what is causing the pain. In the sense of my social anxiety, this means exposing myself to situations where other people are present, where I am forced to socialize and communicate with strangers, in the hope it will lessen the control social anxiety has on my life. Perhaps this means attending psychosocial rehabilitation groups again, perhaps it means forcing myself to go to the cinema (under controlled circumstances), perhaps it means just going to the supermarket during the busiest time of the day. Whatever I decide, exposure therapy could work.

Thirdly, there is CBT and DBT, which I’ve heard can work wonders for people with anxiety disorders. As I have attempted to self-teach myself these practices, to little or no effect, I feel that I need to work through these treatments with another individual – perhaps a psychologist – who understands them better than I.

Fourthly, there is simply being more kind to myself. I am immensely hard on myself in all walks and manners of life. In fact, it would be fair to say that I hold everything I do up to intense scrutiny. From the blog posts I publish, through to the meals I cook, and the speed in which I walk, everything is criticized, analyzed and torn apart by my perfection seeking mind. I need to learn to be kinder to myself, to understand that not everything I do needs to be perfect, that nothing anyone does is ever perfect. I need to find a way to look at my body with acceptance rather than revulsion; I need to find a way to blog without tearing myself apart; I need to find a way to act without criticizing myself into oblivion. I need to be kinder to myself; for if you can’t accept yourself, how can you expect anyone else to accept you? If you can’t love yourself, then other people cannot love you. It’s as simple as that.

Fifthly, there is seeking advice from people who are either living with their own battles with social anxiety, or those people who have successfully managed to control the impact it has on their life. But for that I need to get past my own insecurities over commenting and emailing and teach myself, once again, how to communicate with strangers. For the knowledge of other people is often the greatest knowledge of all – or at least, that’s what I’m led to believe.

Sixthly, well, I can’t think of a sixthly at this time, so these five goals will have to suffice for now.

Whatever happens with my attempt to manage social anxiety disorder, I know that I will not be able to live the life I deserve (see, starting to be kind to myself already) until I have learnt to control my anxiety. It is, without question, one of the biggest (and most severe) roadblocks on my recovery journey – and one I need to tackle quickly and definitively.

Previous installments in ‘Roadblocks to Recovery’:


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31 Days of Bipolar: Day 05. Six of the best treatments for bipolar

Day 05: What treatment, therapy etc do you do?

Lucy-Therapist

Most people who I’ve spoken to that are afflicted with bipolar have a psychiatrist monitoring their progress, medication and moods. In fact, I would go so far as to say that having a psychiatrist is pretty much a prerequisite for someone suffering from an illness as serious as bipolar. However, as the last appointment I had with a psychiatrist went so badly, I no longer have any trust for people in this particular profession. Thus, I am left to navigate the ups and downs of bipolar all on my lonesome.

But that doesn’t mean I don’t undertake treatment, I do, and here are six examples to prove it:

Medication

First and foremost, there is medication, something that pretty much everyone who is diagnosed with bipolar has to contend with. I say contend with because some of the side effects of psychiatric medication can be pretty brutal, as I discovered this year, but regardless of these side effects, medication is quintessential for dealing with bipolar.

At this point in my life my medication regime is: an antidepressant (Fluoxetine, 40mg/daily), an anti-psychotic (Solian, 100mg/daily) and a second anti-psychotic (Abilify, 10mg/daily).  For those who have some knowledge of bipolar, or medication in general, you will notice something pretty obvious is missing from this chemical cocktail…and that is a mood stabiliser.

I had been taking Sodium Valproate (aka Epilim) at 1000mg/daily, but this was immediately cessated in January 2015 after it caused a particularly nasty bout of acute pancreatitis that saw me hospitalised for two and a half weeks. Since then, I have had numerous conversations with my GP about starting an alternative mood stabiliser, as my mood as been rather unstable over the last three months. He ruminated over starting me on Lithium, a drug that works exceptionally well for me, but because it negatively interacts with the Fluoxetine he decided against it. Whether or not I will ever be back on a mood stabiliser is beyond my control. Personally, I would be happy to stop the Fluoxetine in favour of Lithium, but my opinion is neither here nor there. All I do know is that without a mood stabiliser, my moods will continue to fluctuate wildly, and it’s doubtful I will be able to stabilise myself, regardless of how many anti-psychotics I’m taking.

Support Worker

My only form of real-world contact comes from the weekly appointments I have with my support worker. In all honesty we don’t do all that much, mainly because my anxiety prevents me from opening up to her. So our appointments are basically her battling to get me to say anything whilst occasionally recommending a particular course of action for me to take.

This is yet another example of how my anxiety impacts on my life. It would be wonderful to have an open and honest relationship with my support worker, but no matter how much effort I put in toward achieving this, anxiety rears its ugly head and prevents me from saying anything. It’s frustrating. It’s annoying. It’s all manner of badness. In fact, more than anything, it’s gloriously ironic. Here’s a person who could potentially help me manage my anxiety, but I can’t talk to them because of my anxiety. Grrrr!

Talking Therapy

Okay, I’m being a little cheeky here. As I write this I’m not technically undertaking any form of talking therapy. I don’t have a counselor. I don’t have a therapist. I certainly don’t have a psychiatrist. But I am hoping that I will soon have a psychologist with whom to examine the intricacies of my life.

During my last visit to my GP I informed him of how difficult it is to deal with my anxiety, to deal with my PTSD and to deal with the fluctuations of mood that bipolar causes. He suggested I see a psychologist (it’s been several years since I last saw one) and dutifully referred me to someone.

I’m still waiting to hear from them about my first appointment (if I haven’t heard by tomorrow, I’ll be calling them next week) so will keep you abreast of developments in this area of treatment.

CBT and DBT

Without someone to help me with these forms of therapy, I am left to navigate them all on my lonesome. This may sound difficult, and it is, but I have a number of books on both subjects that have helped me understand the basics of each form of therapy and allowed me to partake in them as and when I’ve been focused enough to do so.

I have to be honest, I am hoping that the psychologist I’ve been referred to will be a practitioner of DBT, as I believe it would be of tremendous value to have someone assist me in working through this particular form of treatment. Fingers crossed!

Acceptance and Commitment Therapy

This is something I’ve been practicing since I first learned of its existence in 2013. Back in that heady year of mayhem, busyness and fun I undertook an ACT based psychosocial rehabilitation group and learnt  many of the exercises and metaphors that populate this method of treatment.

Some posts I’ve written on Acceptance and Commitment Therapy (in case you were interested!):

Writing Therapy

Although my blogging isn’t as prolific as it was in 2012-2013, it is still one of the primary methods of therapy that I undertake. There is something gloriously cathartic about writing about your life, feelings, emotions, moods and thoughts before sharing them with the world. Even if no-one reads, likes or comments on a post, I am still proud of myself for having the courage to put it out there in the first place, especially as my anxiety often interferes with my blogging and works to prevent me from posting anything at all.


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Anorexia is an illness – not something we can simply blame on the media

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Catwalk size doesn’t affect anorexia as much as you think. (Republic of Korea, CC BY-SA)

France has joined Italy and Israel in passing laws banning the promotion of extreme thinness in the fashion industry. The health reforms, which include fining agencies employing models with a BMI under 18 and criminalising pro-anorexia web content, have now passed through the upper house of parliament.

An analysis of the reforms by Sarah Jackson on The Conversation suggested that censoring images of ultra-thin models may ease their adverse effects on young women, such as concerns about body image and behaviours such as unhealthy eating.

But while some have been hailing the legislation as a “crackdown on anorexia”, the laws may be unlikely to have any such effect.

Not a lifestyle choice

In western Europe, around 0.5% of adults are thought to be affected by anorexia nervosa. In around 10% of these cases, the sufferers are men. These figures, however, are likely to be an underestimation. It has the highest mortality rate of any psychiatric illness, mostly due to organ failure and suicide.

Yet, the illness is often mistaken by many as a lifestyle choice with an external cause. Despite accounts of the disorder pre-dating the fashion industry, the view that anorexia is caused by comparing oneself to a catwalk model remains popular. Likewise, while pro-ana websites insist that anorexia is a commitment, not an illness, they are highly exclusive online communities, created by and for those already showing signs of the illness. The merely curious are not welcome.

Instead, the link between media endorsement of extreme thinness and the development of anorexia is neither simple nor clear. Research mentioned by Jackson did find that women evaluated their bodies more negatively after viewing images of thin models. However, this effect was small and mostly determined by women’s pre-existing opinions of their figures – women who were already dissatisfied with their body were most affected.

Pre-existing opinions matter. (Joana Coccarelli, CC BY)

As this effect was only measured at one point in time, the effects of prolonged exposure are not known, but when more images were used there was a tendency for the effect to be smaller. Perhaps, as the authors suggested, these images activated, rather than cultivated, beauty ideals.

Whether the effects of media exposure on body dissatisfaction leads to changes in eating behaviour is also unclear. Another study, also cited by Jackson, looked for a link between a person’s real-life media exposure and eating disorder symptoms. The results were fairly inconsistent, with some factors – such as body dissatisfaction – only corresponding to some types of media, and others – such as self-worth – showing no relationship.

More importantly, the research showed correlation, not causation – it is just as plausible that women already unhappy with their bodies seek out thinness-promoting media more often. After all, if such a simple causal relationship did exist, the pervasiveness of these images in our culture raises the question of why the majority of our population is overweight, rather than underweight.

Model bans but no support

Most researchers currently view the cultural value placed on thinness as a “background risk factor”. Meanwhile, several psychological and biological factors are implicated.

High levels of perfectionism, a need for organisation and a focus on details are often observed in those with anorexia. Recent research suggests there is a lower reward response to food in the brain, even after recovery. Some of these factors seem to be influenced by genetic inheritance. Stressful experiences may then influence whether these existing factors then lead to developing the disorder. More than one risk factor will be necessary.

So the legislation is likely to have little effect on the prevalence of anorexia in the general population, but it also offers no support to the models themselves. The law requires a medical certificate proving that a model has a BMI of at least 18. This is still underweight, according to the World Health Organisation. Regular weigh-ins have been only vaguely suggested and there’s been no mention of an obligation to offer support to a model who fails a weigh-in.

A BMI of at least 18 is still underweight. (Fervent-adepte-de-la-mode, CC BY)

While there is some debate over whether models are at a higher risk of developing eating disorders, this career certainly encourages unhealthy behaviour. Thinness of this degree has hugely damaging effects on the internal organs, bones and brain. It can cause obsessiveness and social withdrawal even in psychologically healthy people. France has already lost a high-profile model to anorexia – yet the new laws almost encourage agencies to wash their hands of models who fall ill.

In the same way, while pro-ana content is undoubtedly harmful, the new laws punish those who are in need of help. This exclusively punitive approach is likely to drive these sites further undergound.

If the measures are enforced – if spot checks continue, weigh-ins aren’t cheated and other countries are supportive – they may be a positive move. They may be a first step towards a culture that prioritises health over aesthetics – whether that means a dangerously small or unhealthily large body. Nonetheless, this will mostly benefit the worried well – those who, regrettably, are unhappy with their bodies, but are otherwise unlikely to develop anorexia nervosa. Claiming that these laws address one of the most treatment-resistant mental illnesses is far too optimistic.

This article was written by Rachel Cole-Fletcher, Durham University
This article was co-written by Lexie Thorpe, an MSc in Developmental Cognitive Neuroscience at Durham University

The Conversationconversation-full-logo-1070aea8b0feb9a5f470ed093ecef06e

This article was originally published on The Conversation.
Read the original article.