Tag: borderline personality disorder

Internalised Stigma

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I touched on internalised stigma in The Middle. I was not expecting it to rear its ugly head in more recent times, since I have taken quite a few steps in terms of acknowledging my mental illnesses, including coming out to family and friends on Facebook last August. But, following a call to a mental health helpline last week, I must admit the battle in my head in terms of fully accepting – rather than merely acknowledging – my mental illness still continues.

Last week, I quit my job, and asked that the statutory period of notice – which is rather long in my profession – be waived for health reasons. I agonised over this decision for weeks, cried most days out of guilt and was paralysed by crippling anxiety over what to do. But, for quite possibly the first time in my life, I prioritised my mental health over my career.

What, then, was the ensuing problem? Surely, the fact that my GP had signed me off sick with low mood and anxiety would be enough to put my mind at ease for a little while as regards the guilt of leaving my profession without sufficient notice. But no, internalised stigma came knocking once again.

‘How do I explain myself to my boss?’ I asked the mental health advisor, clutching my phone to my ear in between trembling fingers.

‘You don’t need to – the medical certificate is enough.’

‘But – ‘

‘Think about it this way. If a colleague broke both arms in a terrible accident – let’s say it involved a bus – would you expect them to give x weeks of notice? Would you expect them to go over the accident in excruciating detail?’

Of course not, I answered. There is no difference in either case – both are illnesses, both strike without warning, and in both cases, the person directly affected is not at fault.

Logically speaking then, why was I stigmatising myself over my illness?

It is a complex issue, and one which I continue to wrestle with time and again. Perhaps it connects to the invisibility of mental illness. From a cursory glance at me, you would be none the wiser of my diagnoses.  But if I had a cast, or crutches, it would be immediately apparent that I was undergoing treatment. Sometimes, even I forget that just because you can’t see my illness, that doesn’t mean that it doesn’t exist.

Internalised stigma also links to the fallacy that mental illness, being so inextricably bound to one’s state of mind, is not as such a ‘real’ problem. Rather, it is one that one should just be able to magically ‘get over,’ through exerting the sheer power of one’s will. This fallacy is premised on the idea of control – that someone always has agency over their illness.

But, long-term mental illnesses, like a trespasser at a birthday party, do not ask for permission before they materialise on your doorstep. It takes time and effort to keep them at bay. And sometimes they can even insidiously find their way into your house. They may have already helped themselves to a martini in the kitchen, used your bathroom and switched your meticulously crafted playlist for their own before you notice their presence.  

Early Warning Signs

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I was at a party, one of my closest friend’s birthday parties to be exact. Like the fizzy drink in a bottle that has been shaken vigorously, my anger was about to burst beyond the flimsy lid that had been feebly containing it until now. A man I did not know grabbed my waist as I waited for a drink at the bar and swung me around to face him and that led to the lid rocketing off into space. ‘What the f*** do you think you’re doing?’ I more or less screamed. Cue a further round of expletives from yours truly. Cue aforementioned man looking very confused, stepping back in bewilderment. Cue my friend looking at me with a concerned expression on her face.

This was very out-of-character behaviour for me. I think I attempted to start about three fights that night, verbally, and swore a great deal – I would have given Gordon Ramsay a run for his money. The same thing happened at another party a few weeks later.

My friends were really worried about me, and suspected I had some form of illness because I had been acting like a completely different person. I was completely oblivious to all of this, of course. I saw myself as undertaking some sort of crusade against men (one of my many delusions). This was September 2017, two months after I graduated but around a month and a half before I was hospitalised.

Let’s pause for a second here. What I was experiencing here were early warning signs of a psychotic episode. Generally speaking, they include:

  • A worrisome drop in grades or job performance
  • Trouble thinking clearly or concentrating
  • Suspiciousness or uneasiness with others
  • A decline in self-care or personal hygiene
  • Spending a lot more time alone than usual
  • Strong, inappropriate emotions or having no feelings at all

At these parties, I had no doubt illustrated points (3) and (6). The others I also manifested at various different stages in the run-up to my first full-blown psychotic episode. The explosive anger also correlates with the traits of emotionally unstable personality disorder (also known as borderline personality disorder) that I have, specifically, with emotional dysregulation – trouble with managing strong emotions and regulating or controlling these emotions.

The key distinguisher is that, when some of these factors are taken together, they are indicative signs that a psychotic break might be imminent.

Back to the party. I was called a ‘psycho’ (the first and only time someone has said this to my face) by another guest. Now, if I ever met that woman again, I would probably explain to her that this term is loaded with stigma and therefore should be avoided (I’m looking at you, Ava Max). But that’s a gripe for another time.

A Meditation on Recovery

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Recovery, I have found, is quite a lot like Dr Kevin C. Snyder’s conception of success. It does not follow a straight diagonal line upwards to a particular zenith. Rather, the line is wiggly, convoluted, and ties itself up in knots along the way. You may take a fair few steps backwards for every step forward that you take; you may fall flat on your face (several times, and painfully) but the key is to – as clichéd as it sounds – keep getting back up. The scars may still be fresh, and you may well be picking at your scabs long after they have begun to heal. But the fact that those scabs have formed in the first place is the important thing.

My steepest fall on the path to recovery was the relapse in psychotic symptoms that I experienced around six months ago, during England’s first lockdown in response to COVID-19. Due to the fact that I had been ‘well’ for just over two years, my psychiatrist had proposed in April 2020 that I might embark on a trial period without antipsychotic medication. The conversation when this was agreed lasted no more than five minutes over the phone, which I find ridiculous in hindsight for such a momentous decision. Although I was briefly informed of the risk of relapse, the pros and cons of the change to my medication were not fully explained to me. This disastrous decision – combined with upheaval in my personal life and the effect of the pandemic, which was seismically shaking the world through restrictions in every area of life – led to the very outcome I had feared the most: being sectioned for a second time.

I’ll cover sectioning – which is when an individual is compulsorily detained in hospital for treatment under the Mental Health Act 1983 – another time. For now, I am still treading the path to recovery (both in relation to the trauma suffered through the psychotic relapse and my EUPD traits) with all the elegance of a giraffe masquerading as an amateur tightrope-artist. Gingerly, awkwardly and not at all with the poise and perfection that I would have hoped. But recovery is a process. I’ve come to terms with the possibility that it’s not necessarily true that one day I will wake up and think: yes! I’ve fully recovered, I’m cured and everything from here on out is going to be ok. Life is always going to throw crap at you when you least expect it.

But along the way, if you learn to get a bit quicker – a bit better – at putting yourself back together again each time you fall, that’s something to be proud of. And that’s what I’m starting to learn.