Tag: mentalisation

Voids between my mind and others’ minds

I feel so sad and I’m doubting my mind. I clashed with someone I care about. It doesn’t feel right to put the details here much as I want to. Basically I felt we need to make a fact very clear to someone we are working with, a fact that ought to have been made clear from the start. In itself the fact isn’t right or wrong but it does totally change what we are offering the person and what they will expect and it’s absolutely necessary to say it. The person I clashed with thinks there’s no need to say it, it doesn’t change anything, nothing was ever promised. I tried to explain what I believe and he said he would write off working with the person completely.

There’s more to it but that’s all I can say here.

It sounds like a tiny thing but it’s shaken me and got me lost about how I see things and how others see them and the gulf between that. What I see as a clear duty when others don’t. What I expect. How I deal with uncertainty (rather, don’t deal with it). The gap there is between my mind and the people I care about. It’s brought back the ever-near memories of people telling me I expect other people to look after me, or that I didn’t keep my word, my responsibilities, when I was doing all I could to get it right for everyone and hurting myself to punish myself for my failings and still wasn’t good enough.

I’m sad. It probably doesn’t help I’ve been ill physically this weekend.

I know this blog has been too down and negative lately and I need to change that. I’m sorry.

Ginny xxx

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Walking this Borderland #11: ice and lemon?

[Warning: the last 2 paragraphs under the *** contain discussion of self harm]

I know I’ve banged on about this technique elsewhere  in this blog but I just realised it may be a useful tip to add to the collection of coping strategies I’m trying to build up  in this Borderland series. Also, last week I learnt another similar very effective tip which I’d like to share. Thank you for bearing with me through the first two paragraphs if you’ve read my previous posts mentioning this topic.

In Borderline, regulation of emotions is difficult. States of emotional arousal shift quickly. Emotions and the intensity with which they are experienced can change rapidly and yet quickly become all consuming. The instability doesn’t make the emotions less real. Emotions may rise more quickly than they do in people without Borderline PD and stay at the higher level for longer. Equally, those of us with Borderline may suddenly enter emotionally numb or cut off states.

Both extremes can be dangerous, in my experience. Both can quickly tip into dangerous impulsivity, recklessbehaviour and decisions, self harm, suicidal intentions, explosive emotions and higher and higher states of distress. In either state we can’t explore our feelings and thoughts or other people’s feelings and intentions. Most coping strategies or systems of value that keep us strong, or protective factors like caring about other people, or religious faith or other beliefs that give us hope, become inaccessible in these states.

We need something that changes or emotional state so that we are able to reach again for these strengths and beliefs and strategies. One thing that can do this is giving the body a (non harmful) shock or surprise. We can only experience a certain number of sensations at once. A sudden strong physical sensation can serve enough to slightly bring our emotions away from the extreme. Once our emotions are coming away from the extreme, and only then, can we access other thought processes and coping strategies such as self soothing or the rescue box.

My top two ways to create this shift are as follows:

  • Lemon juice: lemon juice is a sharp sour taste. Take a couple of mouthfuls of neat lemon juice. You can even keep a small container of lemon juice in your bag when you’re out (easily available in supermarkets, eg the plastic “Jif” lemons).
  • Instant ice packs: I just discovered these! A really helpful nurse have me one when I was getting panicky in hospital last week after my op. I find this more effective and more practical than holding ice cubes, which is another alternative. Instant ice packs are really small and light, containing little crystals which activate to become cold when you squeeze and shake the packet. The tactile aspect is another helpful distraction too. I’m going to try to get some more. They appear to be available online from about 50p each, though I haven’t tried and tested any sources yet.

It sounds crazy, but the sudden ice and lemon shock does work. (Note to self, don’t follow the ice and lemon with the gin every time 😉 ! Remember to stick to Cola. Joke. No offence intended.)

Other potential ways of achieving the same effect include chewing small pieces of chilli (not too much and make sure you aren’t allergic first!), putting mustard on your tongue, or putting your head under a cold shower. The lemon and the ice are just the ones that work best for me and that I find most practical. I can use them even when I’m out or away from home.

This isn’t intended to be a long term solution but a short term way to keep safe and regain some stability. After you’ve used one of these techniques, you may then find you’re in a position to use other coping strategies once your level of distress is reduced (self soothing or mentalisation, for instance).

****

Incidentally, I wonder if there’s ever a link between why these techniques work and the drive to self harm. I say this with caution because it’s a sensitive and painful thing and what drives someone to self harm will be different for each person. For me, sometimes there’s pain, loss, need, anger, or self hate, or needing to hurt myself so I don’t hurt anyone else, or needing the physical pain to numb and quiet the noise in my head and voices, or to know what the physical pain will almost faithfully be as it stills some of the much more unbearable mental pain for just a little while. For the next person it’ll be different.

One CPN I talked to describes the ice pack and lemon type techniques as safe self-harm. It’s a shock, a not pleasant, over powering physical sensation. Personally I don’t see it as similar to self harm or at all a way of self harming safely. Nor do I think it has in itself directly reduced my self harming. I don’t think it’s yet something I could do to avoid self harming once I’m at the point I’m about to self harm, although perhaps it does stop me reaching that point in the first place. However I think perhaps I see some of the point the nurse was making, in that the ice or lemon shock serves to still and control the emotion a little bit. Maybe part of why I started to self harm was needing to control unbearable emotion.

Anyhow.  When life gives you lemons, as the saying goes. …

Ginny xxx

 

Goldilocks and the three bears (with a sore head – or three sore heads I guess)

Goldilocks and the three bears (with a sore head – or three sore heads I guess)

[Artwork is not my own.]

Q “Why are you chasing after a giggling fortune teller with a crystal ball?”

A “Well, my therapist told me that I have to try to reach a happy medium…”

Yeah okay sorry about that one…

In therapy recently we’ve talked about different concepts of an emotional thermometer.

One view could be a bit like a normal thermometer which can read positive and negative temperatures (ie plus and minus zero, not positive and negative in the sense of value). When we reach a very extreme emotional state either side of the middle, it is a bad time for us and we are not able to use coping techniques or mentalise, because of the extreme we are at.

At the high, hot, “red” extreme, where the thermometer has “shot up”, we are experiencing very intense emotions – extreme anxiety, distress, hurt, anger etc. I guess it could also be an extreme of a positive emotion although I wonder if this would make coping as difficult? I probably should think more about that.

At the low, cold, “blue”, frozen extreme, we also aren’t able to manage because we feel so low, cut off from our emotions, maybe as if we are in a numb state.

It might, perhaps, be more possible for us to function in the low extreme than the high extreme – we might be more able to get through the day better than when we are in an extreme of eg distress and crying – but it is not a place we are calm or happy.

In the middle of the two extremes, so a range around the imaginary zero, is a mid-ground where we can have calm and balance and where we are able to mentalise about our thoughts and emotions and be curious and reflective about what we and others are experiencing. So the zero is not a zero in the sense of zero = no emotion, but it represents the mid-ground.

This happy middle ground is the “Goldilocks state”*- where we are not too hot, not too cold but “just right”. (Sadly the term just works with reference to Goldilocks and the porridge part of the story. It is not the emotional state one frequently reaches when finding someone else sitting in your seat on crowded trains and I’m not even going to touch on what happens when you find an unexplained person sleeping in your bed 😉 [joke!]…)**

In order to be able to employ coping strategies, the aim may be to find ways to bring ourselves away from either of the two extremes to this happy “Goldilocks” middle ground. No end of different factors, including our personality, what we have learned about regulating our emotions as children, the role models that we have had, and so on, can affect our ability to return to the middle ground and the extremes we go to in the first place. I guess this something I’m going to find my way through in therapy. Someone said to me that they find the term “emotionally unstable personality disorder” more accurately descriptive than “borderline personality disorder” because it better represents these extremes of emotion.

I think there are lots of ways the thermometer metaphor could be used. Perhaps instead of imagining a plus and minus end of the thermometer, it is more helpful to imagine a thermometer from 0 – 100 degrees and that the happy medium is around the middle of this range, too much is going towards 100, etc.

Personally I can identify with the metaphor that involves the minus temperatures because I definitely feel I slip into a state that’s like sub-zero, when I am so numb and cut off from my emotions (and others’) and can’t engage with anything. Sometimes I can’t even talk to anyone. It is not the heightened emotional arousal of my extreme distress but it is by no means good either. It may allow me to give the impression of functioning for a while, but I feel I am operating in a dream world, not really present. And it is very dangerous because of where it can quickly lead me to, or switch to.

Which brings me on to the thought that for me, as well as the thermometer there is a cyclical path that does not involve going vertically up and down the thermometer, but oscillates straight from one extreme to the other. My “sub-zero” state can very quickly flip straight to the high, hot, red end. My numbness can flick straight to anger, hurt, agitation, even thoughts of violence or fury which I would never normally experience let alone act on. I can flick straight into the compulsive need to self-harm and self-punish to turn the anger and emotional energy on myself. It feels like a frightening loss of control. I can oscillate in the other direction too. Overwhelming sadness and distress can suddenly plunge into numbness and disconnection and dissociation from the world into what feels like one of my other personalities and my memory of what has happened will go very blank. It feels very out of control afterwards.

I don’t know yet how I will start to learn how to some how get off this dangerous oscillating circle to get back to the happy middle ground or how to get control of the extreme emotions, especially managing anger.

Does anyone else switch or spin through emotions like this? I’d be really curious to hear other people’s experiences.

[Note – *and** : as in the children’s story of Goldilocks and the Three Bears, a famous children’s fairytale in the UK / USA. I know some readers are not from the UK so please ask if this reference is puzzling to you!]

Ginny xx