Self-Esteem

I haven't blogged in months. I would love to tell you that I was too busy living life to talk to a computer screen but the reality is much more mundane and predictable; my depression and mood instability had improved, and I was too afraid to write as a (mostly) mentally competent person. Poor writing and bad grammar can be excused when you are cognitively impaired, but I discovered I lack the mental fortitude/balls to be judged as a functioning human being.

Luckily, for nobody, I am once again cocooned in the familiar blanket of depression; albeit a milder manifestation than its predecessor. So to the keyboard I return, for better or worse.

Over the last year I have done a lot of work with my therapists to address and, in most cases, move past events in my life that have contributed to my being an emotional equivalent of a broken condom. Yet my core belief system remained unchanged. No matter how many 'Mother hates me' sessions I had, I still couldn't look myself in the eye. And then I realised that I was missing something - self-esteem.

Let me be clear, I absolutely do not think that everyone else is walking around full of pride; dignity oozing from their pores like cheese from a perfectly stuffed pizza crust. I believe most of us have some level of insecurity, and if you don't, you're probably the next Ted Bundy. Or Tom Hardy. But I've come to realise that my self-deprecation is yet another maladaptive coping mechanism I lean on. And I have no idea how to overcome it. I looked through every page of my stupid (and useful, whatever) DBT folder and there is nothing on self-esteem.

So I googled self-esteem, and there was one exercise that appeared on nearly every page - List things you like about yourself. Reader, I laughed. I was first asked to list what I like about myself in 2004, during group therapy. I had nothing, I handed up a blank page. During my last admission, in August/September 2015, I was asked the same question; after 9 weeks I had nothing. Yesterday I tried to think of three things I like about myself, I have nothing.

If I tried to think of three things I don't like about myself? No problem. Although I think that's the case for many of us. Not that we can't think of our positive attributes, but that it is much easier to highlight our flaws. Personally, would much rather you ask me for a list of flaws, I'm comfortable and well-acquainted with those. But listing all of my disparaging beliefs would be rather long and boring, so instead I will consider my thoughts over a one hour period.

The purpose of this isn't to elicit sympathy,but rather to acknowledge the impact of low self-esteem and hopefully garner some much needed advice.

I have picked this hour for several reasons; first, it's the present, so my memory isn't required; second, I'm alone, thus removing the possibility of outside interference. Finally, nothing massively life altering or heart breaking has happened today. Yet. There's always time for life to be a dick.

I am constantly amazed and disgusted by how naturally pessimistic my outlook is.

You're an attention seeking whore for posting this.

Your hands are dry. and masculine.

Stop wondering what will happen next, you stupid whore.

Everyone already hates you, this is just adding fuel to the fire.

your thighs are touching, you fat cow.

You're fat now and you still don't have boobs. lol.

Waste of space.

Useless.

Your dogs hate you.

You're fucking ugly.

They literally hate you, they want Alan.

that sigh means Loki hates you.

You type too slow.

seriously stop rubbing your dry claws together.

Your hair is greasy.

You are the ugly friend.

You are a waste of space and money.

Remember money? It's that thing you don't have. Because you're useless.

Genuinely, everyone hates you.

Yes, even them. Remember they didn't reply to you tagging them on a comment on FB? It's because they hate you.

Ooo you're the pity friend! Familiar role for you, loser.

Seriously, your dogs hate you. They won't even cuddle you.

ooo remember how you got fat? That was hilarious right? No? Because you're disgusting now?

They all laugh at you. You know that, right? You don't really fit it, pity invite for one!

Fuck you are pathetic. Can't even afford a cup of coffee.

Also, fat now. FYI.

how's the new career going? Not great? Figures, right?

And nobody wants you there? Because you're fat and ugly maybe?

Remember when you could skip food all day? Willpower eh? None left no?

Oh hey, and you're fucking boring. Go on, discuss the presidential debate, with specifics... No? Global Warming? Property? EINSTEIN?

Literately nothing.

Just visualise your thighs touching off of each other. And your hips getting padded. And your face being plumper.

Good times right? No? Oh fuck... it happens every time. I remember the truth - I'm stuck with this face and brain.


Okay, I gave up after 24 minutes. Mostly because my mind was racing and I couldn't type fast enough.

So that's 24 minutes of me sitting in a chair in my living room, incident free. Just me being me. Fuck I hate me.

A Life Lost

I have written the below with consent from Stephens' mother:

This isn't my first time discussing the mental health services in our country, but sadly today I am not writing on my own behalf.

On Friday the 15th of January Stephen Byrne attended Beaumont A&E to seek medical assistance. He was 20, a devoted father and suicidal. A few days prior, he had attempted to hang himself multiple times while in police custody; at that time he was brought to the Mater but was released. Despite informing staff at Beaumont of his intent to commit suicide, he was discharged. The only help he was offered was that his file would be sent to his clinic in Ballymun.

On Tuesday the 19th of January Stephen went missing; his body was discovered two days later, on his daughter's second birthday. To date, nobody from the Ballymun clinic has made contact with Stephen's family.

As anyone with mental health difficulties knows, asking for help when you are at your lowest is incredibly difficult. It takes unbelievable strength to fight your own mind and reach out. This is especially true for young men, as historically our country has stigmatised those with mental illnesses as weak or failing in some way. Men are statistically less likely to seek treatment for mental health issues, but they are four times more likely to die by suicide then women. Yet, when a young man found the courage to walk into an A&E department he was turned away, with devastating consequences.

I know all too well the pain and desolation of reaching out when all you want to do is die, only to be dismissed and invalidated by the very people who are supposed to offer aid. It might sound histrionic to some, but they might as well help you to step onto the ledge.

After my last suicide attempt, as soon as I regained consciousness I was discharged from Beaumont A&E without ever speaking to a doctor, let alone a member of the psychiatric team. I know a young woman who just last week attempted suicide inside the hospital grounds, and was simply patched up and sent on her way. I know that there are many people with similar accounts, especially those with a history of self-harm or suicide attempts. This is because certain hospitals, as a result of overcrowding and staff shortages, have a policy whereby patients who present more than a handful of times with self-inflicted injuries, including suicide attempts, are no longer referred to the psychiatric team for assessment. We are seen as a waste of resources.

This is not just a local issue, across the nation there are thousands of people waiting for referrals, many of whom will have to travel for hours for an appointment as a result of hospital closures. In some areas the wait for a psychology referral is two years. In 2014 nearly 3000 children and adolescents were on waiting lists for psychiatric referrals and children are routinely admitted to adult psychiatric units.

As a country we are finally starting to break the draconian cycle of shame and secrecy that surrounds mental illness, but our mental health service remains inadequate, underdeveloped and underfunded. The government and politicians are quick to promise change and reforms, but while we wait for them to turn words into actions more and more lives will be lost. Sadly any improvements will be too late for Stephen, his family and his little girl Ava.

Stephen Byrne asked for help and he was rejected; someone decided he was not important enough for their time, their care or their compassion. At what point does someones life become dispensable? Who are we supposed to turn to if our own healthcare system deems us unworthy? They tell people suffering from mental health difficulties to ‘speak up’; to talk to a professional; to not suffer in silence. They ask for our trust, and then break it. Ask yourself, if you were living in hell; if you were in so much pain that you would take your own life to escape it, would you put your survival in the hands of an institution that will likely make your life even more unbearable?

Treatment Part Two

In January 2015 I entered a private residential facility for treatment of my eating disorder. After a lengthy assessment with the consultant, I was diagnosed with EDNOS - eating disorder not otherwise specified. Another ridiculous sounding disorder, bloody psychiatrists. Basically, I engaged in behaviours attributed to bulimia and anorexia nervosa, but didn't tick enough boxes on either side to fit neatly into one box. Boxes are very important to most mental health professionals; once they can give someone a definitive diagnosis they can use the 'one size fits all' treatment plan that has been recommended for that disorder. I have found this to be particularly true of private psychiatrists; you stop being an individual and are completely defined by your diagnosis. You are no longer Lisa, a 30 year old woman with unique life experiences, beliefs or feelings; you are Borderline Personality Disorder and everything you say or do is because of it. You don't hate the taste of mushrooms, you are anorexic(I'm not exaggerating, I had to have 3 meetings in hospital in order to have 'no mushrooms' written on my chart).

When I entered the facility in January I was terrified, but I also knew that I needed help. For me, there is always a conflict between what I want and what the eating disorder wants. It is not as simple as asking for help and embracing it; my eating disorder had become the one thing I could depend on in my life. When everything around me, and inside me, was spiraling out of control, I would use food and weight to anchor myself to the world. So while I voluntarily agreed to treatment, a part of me wanted to cling to my ED, because I was afraid of what would happen if I gave it up. Better the devil you know...

The first priority in any ED programme is to feed the patient, a starved body and mind is not able to engage in the therapies used to treat the psychological side of the disorder. That first day, it took me an hour and a half to eat my half portion of dinner. With every morsel that passed my lips the ED voice grew louder and louder. The rage, disgust and shame were all consuming; I remember nothing else of my first week there. During the day we would have group sessions - Art therapy, craft groups, CBT based groups, nutritional therapy, interpersonal therapy etc; and in the evenings we had weekly individual therapy sessions. Any free time between groups and meals was spent in a communal living room, hiding away in your room was not permitted. Bathrooms were locked for an hour after meals, condiments and spices were restricted, as was liquid intake. We were weighed twice a week, had our bloods checked daily at first and then twice weekly, and we were not allowed to leave unsupervised until the consultant was satisfied that we were committed to the programme.

My referral to the programme had included a detailed history and description of my diagnoses, and I had discussed my BPD during my initial consultation. However after about two weeks the consultant began to question, and eventually dismiss, the BPD diagnosis. The characteristics and behaviours I exhibit that are attributed to my BPD did not fit into the ED mold. So it was simply ignored, and I was now EDNOS. Unsurprisingly, I repeatedly stepped over this new line; and while my actions and thoughts were ignored in terms of my treatment, they had to be dealt with on a practical level. So for the 40 days I was in the facility, I never left the house unaccompanied or ate so much as a biscuit without a nurse present.

Some of the therapies proved quite beneficial to me and none more so than my individual sessions with a CAT therapist, whom I still work with. I met wonderful people, staff and patients alike. I gained some weight and my health improved. I self-harmed and attempted suicide, and on one occasion absconded. I learned about portion sizes, healthy diet and how to make banana bread. But when I was discharged, I returned home and immediately began to restrict again. Suddenly alone for most of the day, I found I didn't have the willpower, and if I'm honest, the desire, to eat without supervision. We had been taught to weigh everything we ate; on my first day home I dutifully weighed out 40g of porridge and cooked it with water. On my second day, I weighed out 35g. My third, I decided the bowl looked too full and threw several spoonfulls into the bin. And so on and so forth until there was no porridge.

My relapse occurred so quickly, and totally, that my depression worsened. I had let my family and friends down, I was a failure and I was weak. Worse, now I was a fat failure. There was nothing I could do, or was willing to do, to make amends with my family but I could do something about my weight.

Just like that, I was back at the beginning. Within a few weeks my weight was back to where it was before treatment, food and numbers were the sole focus of my life, and my depression pulled me lower and lower. I had been discharged at the end of February, and on the 31st of March I turned 30 and tried(poorly) to cut my wrists in a pub toilet. I had given up on myself and given in to the hunger and darkness.

Treatment

I was discharged from hospital at the end of September 2014, after 8 weeks. During my stay, I had discovered the addictive high of starvation, self harmed repeatedly, and attempted suicide. At times my despair reached such devastating levels that I took to hiding in the tiny wardrobe in my room; this happened so often the consultant had to issue a note to the ward staff that I was allowed to use the wardrobe to manage my distress. At one point he suggested I purchase a cape, to offer comfort when I was out of my room; thankfully I had just enough sanity left to decline the recommendation. Sobbing in wardrobes was one thing, creeping around a psychiatric wars in a hooded cape was a bit to Phantom of the Opera for me.

When I was discharged, I was not 'cured'. My depression hadn't lifted and my eating disorder was stronger than ever; but as is often the case with BPD patients, they simply ran out of patience and solutions to my problems. In my experience there are two reasons why this happens. One is that the doctors and nurses begin to suspect you are lying about, or exaggerating your symptoms. The idea that lying is a characteristic of BPD is not universally accepted by professionals, and it is my biggest problem with my diagnosis. I have never exaggerated about my emotional state, thoughts or destructive urges. In fact the only time I have lied about my depression, is when I want to leave A&E and avoid a psychiatry referral. I have lied because I know the nurse sitting opposite me thinks I am a nuisance; or to stay out of hospital. Certainly not to seek attention or acquire a ticket to a mental hospital. Disclaimer: when it comes to my ED, I lie more than a banker at a tribunal. More on that later.

I returned home, back to the very kind and tolerant embrace of my local mental health team. Over the next few months I attended a day hospital as an outpatient, ended up in A&E six times for serious self harm injuries and more suicide attempts. I barely slept, barely ate...time kept moving but I remained rooted in the same painful spot. Large portions of my life during that time are lost to me, perhaps because I didn't have a life to remember, I just existed. Moving reluctantly from one day to the next with no destination. The only thing I had in my life that I could cling to was my new friend, restriction. That's what I remember most from that time, restricting all day until my boyfriend came home, and then throwing up after dinner. I structured my days around what I could eat, what I would purge and perfecting the art of lying so that nobody knew the full extent of the problem. Because it wasn't a problem, it was the only thing that got me through the day. If it wasn't for my eating disorder I would have been dead already. It was the only thing I had that brought me any peace, and I felt fiercely resentful of all attempts to take it from me. As I've said before, it became my best friend.

Sure my new BFF came with some downsides; I was cold all day, everyday. My joints ached, my skin and hair was dry and my gums throbbed from all of the acid. Then my white blood cells started dropping, and dropping and dropping...when it was decided that my immune system was compromised, my doctor took charge. I was once again referred for treatment of my eating disorder, but this time it was to a private residential facility.

Anorexia

In June 2014 I tried to hang myself; the depression, self harm and constant purging had become too much for me to bear. I have written about that attempt before, so I won't go into it again. Eight weeks later I was admitted to a psychiatric hospital, for treatment of depression and an eating disorder. However as I was a danger to myself and at risk of self harm I could not be placed on the ED ward. Instead I was on a general ward, and other than a handful of meetings with the incompetent nurse who rang the ED programme, left to my own devices with regards to what I ate.

Restricted to the ward, with all sharp objects out of reach, I threw myself at the mercy of my eating disorder. The despair had eaten away at me, I was a shell of a person. I felt like I was walking around with a black hole in my chest, that devoured all the light from the world. MY mind was always racing, from one self-abasing thought to the next, faster than I could blink. I would have done anything to stop the pain, even if it was just for a minute. The part of me that belonged to the ED offered up a solution. If you loose weight, you won't be so worthless. Worthless, and fat and repugnant. If you skip that meal, it will be quiet in your head for five minutes. The hunger pains took the edge off my self harm cravings. Skipping meals and secretly vomiting made me feel like I was taking some control nack from the doctors and nurses.

I started to loose weight, but it wasn't enough for that voice. Every time they weighed me it would whisper, 'So close, just a few more and it will stop'. The truth is, that goal weight will always be just out of reach. Because you can always try harder; because you ate that piece of toast on Tuesday; because you just have to look in the mirror to see that you're still fat.

The more weight you loose, the more behaviours you engage in, the stronger the eating disorder gets. It's like a leech, draining your body to feed itself. While you waste away inside, it thrives. I could no longer look directly at myself in the mirror, or look down in the shower. The sight of my stomach or thighs made me want to tear into my flesh, to punish my weakness. I stopped eating altogether for a few days, because I knew that I could. The less I ate and weighed, the more I hated myself. I think most people have been self-critical, more than once, and for some people it could be a regular occurrence. I don't think I've met anyone who thinks they look perfect all the time; I mean rarely anyone looks good swimming underwater, except that Nirvana baby. But for me, I don't even have to be looking at myself to be critical. I just need to be awake, and even then, I regularly dream about how grotesque I am. Right now, as I'm typing, that little voice is whispering to me about how doughy my thighs feel when my legs are crossed. And how rounded my wrists look, and my pudgy fingers. I'll stop there, but you get the point. It never stops, not even when I get so hungry I can barely stand. But it gets quieter, when I do what it says.

I said before that one of the reasons I started restricting was because it gave me a sense of control when I felt so powerless. In reality, the eating disorder had all of the power. It was stronger than me, that little part of me buried under all that shit and hurt, and if I'm honest, I didn't but up much of a fight. Because there was one other reason to give in, the distant hope that if you push it enough, your body will perish.

Don't Leave Me

I attended the day hospital for six weeks in 2004, attending the same groups and covering the same topics as before. While the day hospital gave structure and routine, I came out feeling just as lost and directionless. I returned to work, took a room with a family my dad knew and attended saw my psychiatrist monthly. The appointments were just 15 minutes long and served only to review my medication, and check the box next to 'No suicidal intent'. Still, I took my pills and tried my best to get on with daily life, fake it 'till you make it. Over the years I have spent long periods pretended to be happy; smiled when I wanted to cry; laughed when I was picturing razors and rivers of blood; kissed when I felt dead inside. I worked so hard at faking it that sometimes I can't take the mask off, sliding it into place is as natural to me as breathing. Not once has faking it improved my mood(despite what countless therapists have said), but it makes other people feel better. If you know me, you've probably only seen my real expression because I've had way too much to drink, or you've had the joy of bringing me to or from A&E. Other than that, what you're seeing is probably an act.

Between 2004 and 2014 I continued to battle depression and self harm. I have no idea how many times I had to go to hospital for stitches over the course of those ten years; how many psychiatrists I saw; how many therapists I spoke to; how many suicide attempts I made. If someone else told me that they couldn't count all the times they tried to end their life, my heart would break for them. But the rules are different for me. On my good days, if I think about it, I chastise myself for being such a nuisance. On my bad days, I berate myself for being so utterly useless, for failing so many times.

I had periods of being 'well', months where I was not self harming or in need of medication. But self harm wasn't the only aspect of my personality that was problematic. I frequently drank until I passed out; I racked up mountains of debt through impulse spending; I hurt people I loved and I allowed others to hurt me. I had no control over my emotions, I could go from one extreme to the other in minutes. Nothing was ever bad, it was terrible; I wasn't just happy, I was delirious. Everything I felt, I felt it with an intensity that never matched the situation. I didn't just love you, I loved you and would die if you left me. And I mean that literally. I don't remember ever saying 'If you go I will kill myself', although it's possible I did, but I know that it was definitely implied on multiple occasions. I know how awful that sounds, and there is no justification for such blatant emotional blackmail. My fear of losing the one person who I couldn't live without far outweighed my morals. That would be yet another characteristic of BPD - tendency to form intense and unstable interpersonal relationships.

If you grow up in an environment where love is not always given, or is expressed in negative ways, the one thing you want most in the world is to be loved unconditionally. All you want is for someone to choose to love you, to fill that need inside to be accepted and wanted. As a child I often felt there was something wrong with me, that when bad things happened it was my fault, always. I remember being 7 or 8, sitting at the top of the stairs one night listening to the noise below, and feeling so very cold and unwanted. Once that feeling takes hold, that shard of icy doubt in your heart, it won't let go. We learn to love by being loved, and if your own parents don't love you, there is no way you can love yourself. To this day, age 30, I still can't name one thing I like about myself, let alone love.

So when someone comes along and loves you, not because they have to, but because they want to, it's terrifying. Yes, terrifying. Imagine yourself balanced on a tight rope, arms outstretched, high above the ground. You're halfway across and the air is still, the only sound is your own heartbeat. You're smiling, you know this is your moment to dazzle the world below. You slowly lift your right leg up and forward, and as you lower it back down there is a sudden gust of wind. You wobble, desperately trying to right yourself. Your arms are stiff, moving up and down to counter the motion of the rope. The rope stills, your arms once again stretched out straight on either side, the terror subsides. You mentally shake it off, maybe laugh at yourself to dispel any lingering fear. You refocus on the rope, on that right leg still poised in the air. Then you notice it. Somehow, during the commotion, you arched your left foot upwards. You are now balancing solely on your toes, your right foot is in the air. If you put the right foot down first you risk pitching forward. Equally, if you put down your left heel first you could fall back. You look down at the ground, down, down, down. The fall will most likely kill you, and if not the pain will make you wish you were dead. You freeze right there in the middle, one false move and it's all over.

Being loved when you don't think you deserve it is like being on that wire. One false move and it will be taken away, the one thing you want more than anything else is the one thing that can destroy you. Everyday you are afraid, of loosing your balance, of loosing love. You let the fear have control, you torment your partner with your insecurities. With baseless accusations. With your insatiable need for reassurance. The more they try to reason with you, to affirm their feelings, the worse it gets. You get smaller and smaller, as the relationship consumes you. You can no longer see yourself outside of the pair; you just want to make them love you every second of the day, even if you drive them crazy in the process.

It took me a long time to figure out who I was on my own, including a small relapse into the land of promiscuity. I still don't like who I am, but I know that I'll still be the same person alone. I know I can be alone, I don't need someone else to survive. Depression does not care what your relationship status is on Facebook, but neither does happiness.

Snickers

Forgive me for the lack of posts recently, I have been struggling over the last two weeks and the keyboard was too daunting to face. Ironically, blogging is one of the coping strategies that help me stay on track when I'm struggling. Keep up the good work brain, god forbid you made sense for even a minute.

I'll stop the self-flagellation there lest I scare you away. If you are even there, perhaps I am just sending my thoughts out into cyber space, to drift unseen as 1s and 0s. Maybe I should throw in some flagged words so some analyst in a bunker somewhere in Idaho has to read my blog... Anthrax are a band I like; I also like to watch The Strain, which is about a scientist from the CDC caught up in an outbreak of an unknown virus which causes strange mutations. Heroin is a narcotic, according to the news it is regularly smuggled out of Mexico by drug cartels. Tijuana is a city in Mexico, I don't think they get much snow or ice there.

Okay I'm done annoying Tim from Homeland Security, sorry Tim.

North Korea.

Sorry, last one, I promise.

But seriously, a ridiculous number of those words are allegedly flagged. I mean have there been viable threats involving ice? Angry Eskimos? Hoards of ice cube wielding Yetis? *Gasp* Is Winter coming?

Back to the matter at hand, me being nuttier than a Snickers. After being kicked out of my college dorm I stayed in a hotel until I ran out of money. Then I slept on a friends couch for a while, trying to make it to the end of the semester before facing my parents. I had no hope of passing any exams so I didn't even bother opening a book. Instead I continued to self medicate with drugs and alcohol and slice my arms and thighs open whenever I could. As you can imagine my memories of that time are hazy, but there is one moment that stands out among all the chaos.

I was outside with a group of 1st year students I knew. If I'm honest, part of the reason I had initially befriended them was because most of my existing friends had come to a point where coursework was given priority over the more hedonistic aspects of college life. This approach did not fit in with my self-destructive lifestyle, so I needed new playmates. As a happy coincidence they were all interesting, smart and funny people.

So we were outside one day, sitting under a tree on campus. Everyone was laughing, joking, making plans for the weekend and I was sitting slightly back from them, enjoying the speed I had just sucked up my nostrils. As I looked at them I was struck by this overwhelming sense of loss, there was a sudden wrenching in the pit of my stomach and I had to close my eyes to hold back the tears. I realised that I was looking at something I would never have. This group in front of me represented everything that was lost to me - the future, possibilities, happiness. That was the first time I really believed that my suicide was a foregone conclusion. That it wasn't something that might happen, something to dream about when my thoughts grew to heavy. It was my destiny, the only mystery was when. It's a strange thing to accept your own death as fact, terrifying and liberating at the same time. After that day I no longer needed others to give me an excuse to misbehave, I threw myself head first into being as stupid as possible. It was a wonder I had any friends left, so many of them had to carry me, hold my hair or patch me up. Or just generally be in my obnoxious presence.

Luckily (or unluckily depending on how I'm feeling) I hit a speed bump on my way out of life. I had taken to smashing pint glasses and self harming in toilets on nights out. One night, unsatisfied with my attempts to cut my wrist, I decided to stab myself in the stomach. I won't go into the gory details, but it was pretty disgusting. At this point I was self harming nearly every day, I knew what I was doing. But every so often, you make a mistake. You press too deep, or whatever you're using was too sharp or you just got a bit too enthusiastic. Whatever the cause, there's a split second where you realise you've messed up and time actually stops. Everything freezes. And then it happens, before you can even blink its like the elevator doors opening in The Shining. If anyone reading this has ever self harmed, you'll most likely know exactly what I'm talking about. Well this was one of those times, I knew immediately I had gone too far. I was drunk, in a dingy pub on a night out and there were at least two hours of drinking left. So I did what any rational person would do, i wrapped toilet roll around myself and pulled back down my top and wandered off into the night. I lasted about 5 minutes before the toilet paper failed and I was rumbled.

I eventually allowed myself to be brought to A&E the next morning, where I was stitched up and referred for a psych evaluation. My mother was called, and after she spoke to the psychiatrist she told me that if I didn't sign myself into the nearest psychiatric hospital I would be sectioned. This was a lie, but one told with good intentions (I've only come to terms with that lie in the last year, it was a serious point of contention for many years. When we arrived at the hospital I was put on the closed ward, intended for acutely ill patients, including those who are a danger to themselves or others. As I was considered a suicide risk I stayed on the ward for five nights for assessment. My first time as an inpatient was both frightening, and enlightening. Fortunately my doctor decided to release me and refer me back to the day hospital programme I had attended the previous summer. It felt like I had come full circle and was back at the beginning, or the end.

Mirror, Mirror

I'm stepping out of the past for this post and bringing you into the present, something I had never intended to do when I began this blog. It has always been my intention to share my story chronologically, in the hopes it might help others who have had similar experiences. I will return to that, but today I need to help myself with my blog, so forgive me for the inconsistency. I need to release some of the words buzzing incessantly inside my head, before they drive me down paths I don't want to travel.

I have been out of hospital for six weeks now, following nine weeks as an inpatient on an eating disorder unit. This was my second time in an ED programme, having spent six weeks in a private residential facility in January of this year. The first one didn't work out, obviously. When I entered the hospital in May I was just 1kg above my lowest weight, and had attempted suicide two days before. I was a voluntary patient; the combination of my ED and year long depressive episode had physically and mentally exhausted me to the point that I knew I had to get help, or die.

The programme on the ED unit had two objectives: weight gain(or loss if needed) and to help you take back control from the ED, on a psychological level. The later was done through group work on self esteem, nutrition, cognitive behavioural therapy etc. The weight gain was achieved through that revolutionary concept called eating. Each individual was given a meal plan, depending on their admitting weight and physical health, and if necessary this meal plan would be changed. Anyone who was underweight would, when physically safe to do so, be put on a plan that had an expected weight gain of 0.8-1kg a week. We were weighed twice a week, and if the average had not increased week to week, you would be moved up a meal plan. The higher the meal plan, the higher the calorie intake. We had three main meals, and three snacks a day - the size of your meal or snack depended on your meal plan, but all meals and snacks were eaten under nurse supervision and they were not optional. I remember the first desert I had to eat, a chocolate muffin covered in chocolate sauce. You think you can't get any lower, and then you find yourself sobbing over a cake. If you don't have an eating disorder I imagine that sounds completely ridiculous, but if have or had one, you understand how much I hated that brown blob.

So you had to eat what they gave you. Even if you really hated eggs, unless you had an egg allergy approved by the dietitian, you were eating those eggs. Bathrooms were locked after meals and snacks; fluid intake was monitored; all condiments were rationed; fruit intake was restricted; high calorie milkshakes were used if needed. In short, they had the weight gain process down.

So I gained weight, about eight kilos. I was still slightly underweight, but no longer in danger of my body eating my organs. Objective one completed. Objective two was a whole different story.

I have always hated my appearance. I honestly don't remember ever liking what I saw in the mirror, even as a child. They used to say in the hospital that if you stared at your finger for long enough you would find something wrong with it. I didn't need to stare at it, I could list three things wrong with it without even thinking. The part I hate the most is my face, I've spent countless hours daydreaming about plastic surgery. I used to cry at those television shows were they gave people who felt ugly new faces. I would have done anything for a new face. But, until I win the lottery, there isn't much I can do about my face. Other than use layers of make up to try and detract from the worst of its flaws.

Coming in a close second for most hated part of me, is my body. The entire thing, from my chin to the top of my toes. I could fill the screen up listing all of its flaws, but that's not going to be fun for anyone. But trust me, there is not one part of it that I like. Or tolerate. But unlike my face, I can change my body. Or at least the size of it. So that's what I did. If I had to be ugly, I could at least be thin and ugly. That way I could blend into the background, the smaller I was the less people would notice me. And if they didn't notice me, they wouldn't see all of my defects. So I became bulimic (there's more to it than that, but that's for another post), and then anorexic. Then eventually it was 'eating disorder not otherwise specified'. Which basically means I was a bit anorexic and a bit bulimic. Or, in my head, I wasn't disciplined enough to even have a real eating disorder.

So my weight dropped, stabilised, dropped, stabilised...and then went all the way down. Other people would tell me I was too thin, or that I was underweight, or my BMI was too low. I knew they were all lying, all I had to do was look in the mirror and I could see how fat I still was. Most people don't believe me when I say that, they don't understand it when I tell them I am still overweight. I don't understand how they can look at me and not see that I still need to loose weight. At my lowest weight, I knew I still had so much weight to loose. When I admitted myself to hospital, I did so knowing I would come out grossly overweight. But I had to make a choice between gaining weight and dying, and in that moment I picked gaining weight.

Since I have left hospital I spend 90% of my time in jeans, tracksuit bottoms and baggy tops. Everything must be loose to hide my chubby thighs, thick waist and protruding stomach. I have worn make up and put on dresses on three occasions, and each time I wanted to claw my skin off because I felt so self conscious. I have not looked at myself fully in a mirror in months. I can't look down at myself in the shower, I can only focus on one body part at a time or the pain inside threatens to swallow me whole. I have to accompany my boyfriend to a work event this weekend and I have already started to panic about what to wear - tracksuit bottoms are not an option. I didn't even own tracksuit bottoms until I was in hospital, now they are my favourite thing in the world other than pajamas. I am embarrassed when I see people I know, because somehow I know all of these gorgeous women, who always manage to look amazing on nights out. That's how I see them anyway, I'm not one to assume to know how they view themselves.

So here I am, I can eat food now. But getting dressed makes me cry. If someone else told me they couldn't think of one thing they liked about their body, I would want to hug them and I would hurt for them. But it doesn't work on myself. I'm not sure I will ever complete objective two, but maybe someday soon I can think of one thing I like about that finger.

Therapy

After my suicide attempt I was released from hospital and sent home with my parents(well my mother, my father living separately of course). We went to meet with my psychiatrist in college and it was recommended I be referred to the nearest psychiatric hospital. I had no health insurance, so all of my dealings with mental health services would be through the public health system.

I was assessed by the hospital, although I have no memory of it, and I was registered as a day patient. This meant that I would attend the hospital Monday to Friday, participating in group therapy sessions. I was also linked in with a new psychiatrist in the local mental health clinic. I would remain a patient of this clinic for a number of years, but as it was a public service, the doctors would change every six months. This constant change, coupled with my intense fear of abandonment, meant I never fully trusted any of the psychiatrists I met. It also meant that despite records being kept of my visits, I had to repeat my history for each new face I saw. The years I spent under the clinic were like being stuck in a perpetual time loop, always being dragged back to the past.

The Day Hospital was terrifying at first; I was incredibly self-conscious and shy, which left me feeling awkward and uncomfortable at all times. I had also never spent time with other people who suffered with mental health issues. As there was only one day programme all of the patients in the group struggled with different difficulties, and were at different stages of their recovery. I freely admit that I was slightly apprehensive on my first day, fearing that the bi-polar patients and the young man with schizophrenia might erupt at any point. I quickly realised that my per-conceived notions of psychiatric illnesses were entirely incorrect, and that the people in my group were no different than anyone else. In fact, in some ways, they were better because they understood what it was to have your own mind turn against you. There was also a sense of camaraderie - we were all there because we were suffering, and we were all there trying to get help. That is not to say we all believed the programme would work, I certainly didn't, but we were willing to try.

I spent six weeks in the day hospital; talking, painting, writing, sculpting, talking some more. I did not come out 'better'. There is no better with mental illnesses and disorders, and even if I could have been fixed, a few weeks of splashing paint across a page wasn't going to do it. But my time there gave me an anchor while my medications were being tweaked, and a safe place to go as my suicidal urges slowly receded.

Throughout this time my relationship with my father had been strained; he did not believe there was anything wrong with me that hard work or a walk couldn't fix, and he was vehemently opposed to me taking medication. When I was discharged, my parents assumed I had put all of my nonsense behind me and I was expected to get my life firmly back on track. I re-took and passed my first year exams, allowing me to begin the second year of my degree that September. My dad found me a job working in a friends pharmacy, as I had left my data entry job in a bank after my suicide attempt. College, job - as far as everyone was concerned I was back to being a normal, sane person.

But the thing my parents forgot, or rather didn't know, was that I had not been 'normal' for a long time. They believed my suicide attempt was a result of stress, that I had become overwhelmed in college and this had caused my depression. I know the college psychiatrist told them my diagnosis, but it was forgotten the moment it was heard. For my part, I did nothing to alert them to my continuing problems. Primarily because I wanted to avoid any more confrontations with them, but also because I hadn't stopped self harming and I wasn't willing to give it up. I was still struggling with intense and frequent mood swings, anxiety and depression. The medication and therapy had done nothing to change the thoughts and emotions that thundered inside my skull, so self harming was the only effective tool in my arsenal. So I kept quiet, plastered a smile on my face, and waited. Waited for that black wave to pull me under again; death was coming, I just had to wait.

Before I started my second year of college, my mother, step-father and sister moved to South Africa. They certainly(and understandably) weren't going to give the crazy 18 year old free reign in their house, so my dad paid for me to move into on-campus accommodation. If you asked me to list the most significant moments in my life, their departure would definitely be included. On a rational level, since my step-father had retired they wanted a change of scenery, an adventure somewhere warm. I was starting my second year of college so going with them was impossible, and I had no interest in living in South Africa. Oh if only rational thought reigned supreme in my mind. To me, emotional mind running rampant of course, this was yet another rejection. My father had left me as a child, my step-father had openly rejected me and now my mother was abandoning me. To me, this was her way of telling me she didn't want me. This led to my next conclusion; I was living on campus because my dad didn't want me in his house. I had always known I was unwanted and unloved and now I had proof.

My first night in my new dorm I cried my eyes out. I cried from loneliness. I cried from fear. I cried because I couldn't stand my own company, but I was all I had.

And then second year started, and it all went downhill from there. More downhill. I actually dug a hole at the bottom of the hill and just kept digging.

Killing the Thing on the Outside

In 2003, when I was 18 years old, I attempted suicide for the second time. I was home alone, with bandaged wrists from my first attempt the previous night. When I woke that day the numbness that had set in the night before remained, I felt no emotions and my mind was blissfully silent.

I ate breakfast, showered, dressed and had every intention of going about my day as if nothing had happened. But as time moved forward, as it tends to do, the silence began to recede. Sorrow came calling first, I cried because I had come so close to dying and then I cried because I was still alive. Guilt was the next arrival - if I had succeeded my mother would have had to discovered the body of her eldest child; my sister would have been heartbroken; my parents might have blamed themselves as they buried me. I was ashamed of how selfish and uncaring I was. Regret filled me.

Sorrow, guilt, and shame - I felt these things every day, and as they washed over me it was as though a switch was flicked in my brain. I suddenly remembered who I was, what I was. I was a terrible daughter, I had disappointed my parents time and time again with my inadequacies, and I was once again letting them down with the mess I had made of college. I knew I had no hope of passing my course, I was too stupid, too incompetent. My sister didn't need me, I was a black mark in her otherwise perfect existence. I was not a daughter and sister that would be missed, I was an embarrassment. I brought them nothing but misery, and they would be better of without me. They would be happier without me, removing myself from their lives was the best gift I could give them.

I was broken inside, that was clear to me now. Fundamentally flawed, without talent, without intellect and with nothing to offer the world. My outside was as hideous as my inside, I looked in the mirror and saw the ugly truth in front of me. I looked and looked, my revulsion growing with each passing second. What an eyesore I was, what a waste of flesh and bone. I was a failure; defective; repugnant. A lifetime of mistakes played in my head, the fiasco of the night before just another scene to tack on at the end. I remembered how lonely I was, always feeling like an outsider looking in. An unwanted intruder in other peoples lives.

Then the pain returned. It felt like my chest had been ripped open from the inside, and all the light in my world was sucked into the darkness. The hole pulled and pulled, swallowing all of me, leaving nothing behind but despair and misery. This pain had been a part of my life since I was a child, but in recent months it was my constant companion. It never stopped, not even in sleep could I escape it, dreams had been replaced with nightmares. As the day went on I sank lower into the abyss, unable to escape the thoughts that tormented me or the agony of being me.

I had tried counseling, I had taken the pills, I had tried. I couldn't bear the thought of living one more day with such ceaseless suffering. So the decision was made, killing myself was the only option.

As soon as I made the decision a sense of calm washed over me and I knew I was making the right choice. Everyone, including me, would be so much better off after I was gone. I felt almost giddy with relief; dying didn't scare me, living did. I poured myself a beer, gathered up my months supply of medications and any paracetamol I could find, and sat in front of the television. I wanted to watch something good, maybe even a comedy so I could leave with a smile on my face. I took the first handful of pills and started flicking between the channels. Much to my dismay there was nothing on but news and soaps, so I chose the latter and swallowed some more tablets. I topped up my beer and another handful went down. Then another, and another. As I waited for the inevitable I grew restless. Dying was taking longer than I thought it would and I couldn't bear anymore dreadful soap operas. It suddenly struck me that talking to someone would be the best way to kill some time. I checked the computer and nobody was online. My head was starting to feel heavy now, and balancing became something of an issue. I tumbled to the floor and laughed, was this what insanity looked like? Laughing as you slowly died?

I felt drunk, the xanax probably, and my restlessness turned into a sort of mania. This was it, I was finally going to destroy the body that shackled me to my pain. I wouldn't have to hurt anymore, it wouldn't matter that nobody loved me or wanted me. It would be silent in my head forever. Wait, I hadn't written a letter and my hands weren't working enough to write one now. I had to talk to someone, someone who couldn't foil my plan but could perhaps get a message to my parents. Yes, I needed the phone.

Dialing the number for The Samaritans was challenging, as my vision swam in and out of focus. From this point on my memories are almost completely gone. I remember I spoke to a woman, and told her cheerfully how I had taken all the pills and I would be dead soon. She tried to engage me in conversation but my ears were full of cotton wool and I couldn't remember why I was on the phone. She very gently asked me to do her a favour and please hang up and dial 999. I was on the floor at this point, my body limp and my head heavy. I didn't want to upset her, she had been so patient when I explained how much I hated soaps. I ended the call and with great difficulty rang 999.

"Ambulance, Police or Fire?" (Or something to that effect)
"Eh, I took some pills and the woman said to ring"

She asked for my address, I started to drift off and she shouted down the phone. Why do I have to open the front door? Stop shouting. I rolled down the stairs and managed to pull the door open. Oh good, now she can stop shouting...then everything went black.

I woke up the following day in hospital, my worried and understandably angry parents on either side of me. This time I couldn't lie my way out of the hospital. Instead I had guaranteed my place in a different kind of hospital.

I want to tell you I felt fortunate to be alive that morning. I wish I could tell you I never attempted suicide again. I wish I could tell you that my life got a little bit better everyday after that, and that now I am a paragon of mental health. But obviously I am still here, so my while there would be more pain in my life, my story hasn't ended.

Frustration

I have been warned time and again to always be careful not to get too comfortable during inpatient treatment. That people can learn to love being in hospital, and either lengthen their stay unnecessarily or constantly seek to return to one; by either consciously or unconsciously sabotaging their mental health or not putting in the work needed to get better. I can see that for some people, having little or no responsibility for yourself could be appealing. Or perhaps the hospital environment is simply more pleasant or less distressing than their home environment.

This is not the case for me. I am a control freak, textbook BPD with co-morbid eating disorder. Ask my boyfriend, I'm a pain in the ass, and when I am depressed it gets even worse - I try and counter my out of control emotional state by micro managing everything else I possibly can, spontaneous does not exist in my little bubble. But in hospital, I am bound by the rules and timetables of the ward. When I eat, wash, walk, talk - it's all controlled by someone else. Hell, I can't even have a cup of coffee outside of the designated warm beverage times. And let me tell you, it is a long wait from 5am to 8.30am when you can finally clasp a hot cup of roasted bean glory. But, there is a reason I am here, I recognise this. The systems they have in place here are likely tried and tested and are for the benefit of the patients.

Knowing this makes it no less irritating to one such as myself. This post probably seems entirely pointless at this point, stop withering on about it Lisa. But right now, and for the last 60 minutes, I should be doing some work in order to get into a particular mindset for the impending unpleasantness that is breakfast. But I can't. Because I have run out of plastic pockets to put my worksheets into as I read them. And I have only a handful of pages left in my journal, which I have taken to clutching to my chest at all times, like some sort of scribble safety blanket. As I am confined to the ward, I cannot get to the coffee shop and buy and new journal; let alone somewhere for plastic pockets. I can ask my boyfriend to procure these items and bring them to me on Wednesday but by then there will be multiple pages needed to be sheathed and I'll be left with loose A4 pages to write on. Which is wrong, the pages of a journal must be bound together in one notebook. They must be sequential, not loose and fool hardy; likely at any moment to slip from between the pages that hold it.

So I decided to stop staring at the nearly full diary and four remaining plastic pockets, and blog instead. Hoping to pull my mind back from the spiralling abyss and refocus. At least for long enough to get through breakfast. All these words are here, in cyber space, just so that I can step away from a ludacris stationary conundrum and cry over a bowl of muesli.

I might not like hospitals, and the loss of freedom that goes with them, but it's possible I might need them.

Admission

My assessment with the eating disorder clinic took place yesterday. On Monday I was both surprised to have made it to the previously unreachable date, and filled with fear and anxiety. My distress levels reached so high that I slept for only two hours that night, two hours filled with nightmares and terrifying delusions. My meeting with the consultant is mostly gone from my memory, but I felt, and still feel, that I failed to express myself accurately. I had to fight to get each word out, and the voices in my head were buzzing so loudly, forming those words into comprehensive sentences was all but impossible. At one point I was so lost for words I was one more silence filled second from channeling Princess Leia

Help me Obi-Wan Kenobi. You're my only hope

Nevertheless it was decided I did indeed need admission to hospital for my depression and I was told I would be contacted once a bed became available. Victory! That's what you're all probably thinking. Finally I would be getting the help I needed and had waited so long for. Surely a sense of relief and even happiness filled me as I left the appointment. Step forward Ms.Borderline Personality Disorder. Happiness is not an emotion I feel at present, or indeed for some time now. So no, I did not feel happy. This is not unusual given the aforementioned depression. Probably more confusing for you, is that what actually filled me was anger and hate, with some more fear thrown in for good measure.

Who or what was this hate directed at? Why all of you, of course. It burned under my skin for hours, roared in my head ceaselessly, until I could do no more than hide myself away in bed and try and wait for the waves of emotion to calm. I hate you, all of you, because you helped me to get to that assessment, thereby helped me get approved for admission to hospital and, here we come to the crux of the matter, helped me to stay alive. Every part of me raged against the idea that admission might mean a continued existence. We want out, we are tired, we have suffered enough. Yes, millions have suffered far worse than me, are suffering at this very moment. But we have had enough of our pain. We do not want to try anymore, how dare you all be so selfish, and cruel, to make me feel this anguish for one more day. I can stand outside of myself and see the basic wrongness of these feelings but that doesn't make them any less true for me. I suppose it is the nature of my personality disorder to want to fight against help, because it doesn't want to get better. Its goal has always been that final, blissful quiet. To embrace the dying of the light, not rage against it and fight on. I'm not sure if someone who has never wanted to die can understand such thoughts, but they are what they are.

Today the hate is gone, but the fear remains as strong as ever. Fear of the unknown, fear of finally facing the full force of the feelings I have to hold back everyday, fear at the hard work that lies ahead. A fighter would probably take that fear, and use it, spit in its eye and forge ahead. There is no fight in me today, so I hide away in my fortress and move through the day like a shadow, here but not present. Certainly not 'living in the moment'. Tut, tut, my DBT instructors would be most displeased; I am failing Mindfulness 101.

Now all that is left to do it play the waiting game, again. I suppose those who care for me will be hoping one becomes available quickly, so that I can be somewhere safe and they can worry just a little less. There is no hope in me, just the same question repeating over and over - 'Is there any point to this?'.

Only time will tell.