Tuesday, 24 March 2020

Coronavirus - Keeping A Head

Was it only the beginning of March that some of us were laughing off this dreadful virus? Lots of jokes were doing the rounds via the internet and most people were carrying on as normal. What a difference a couple of weeks makes. Now it is no laughing matter. There is stockpiling, social distancing, escaping to the country or - unimaginable - being forced into lockdown for an unlimited time. 

Two weeks ago, I was at the cinema watching one film and thinking about seeing another. Days - but a totally different world later - The Times tempted me into an online article entitled “The Truth: Two icons are finally sharing a screen."

I was amazed at the article. “What?”, I thought when I saw it was about Catherine Deneuve and Juliette Binoche, the film I was so looking forward to at my recent cinema visit. “Who cares? How can they pretend this is important?” Life is definitely not going on in the way I’ve always known it.

Good advice
I have some important work to do - important in that it affects my future, not important in world terms - and I cannot be bothered. I am afflicted with this extraordinary malaise. I have very little concentration and I cannot manage more than the odd WhatsApp communication, which usually dampens my mood further.

What is a person to do?

When someone decides s/he would like to explore their inner world through psychotherapy, we, as therapists, will often try to help them get in touch with their hidden feelings, feelings that may have been hidden for many years. It may take time and hard work but when that process ends well - and it often does - it’s very satisfying for both client and therapist. Being in touch with your feelings can be the key to living a healthy and enjoyable life.

Therefore, what I’m going to say here goes completely against what I would usually say as a counsellor. But it has to be said. Here goes... 


Let me explain. Life is frightening at the moment and, when we are frightened, we go into instinctive response mode to dealing with it.

Our reptilian response (led by the amygdala and the one that we needed in order to survive in our prehistoric days) goes into flight, fight or freeze mode. It’s also known as our primal brain and it serves a very useful purpose to protect us when we sense we’re in danger.

I have written about it before when talking about hyper-vigilance. It was appropriate then but we are no longer in “normal times”.

Learn different skills when working from home
In a literal sense, we are in danger. We are in fear of losing our lives or of those we love and that is the greatest fear we can ever have.

But, set against that, we’re not facing a moment-by-moment life-threatening situation where a hungry lion or tiger has appeared in front of us and, in this instance, we have to react at speed and therefore need that primal response. It makes us react fast and unthinkingly and is an instinctive and instant reaction to save us in a split second when we do not have time to think. However, it is not a response to hold on to for any length of time.

We in the West have been lucky in recent years. Unlike other parts of our same world, we have not been caught up in the relentless terror of war or social disruption and we have been given the chance to develop and move on to live in a society where most of us are not in imminent danger. That has allowed us to further develop and advance our way of thinking, allowing us to become the chillaxed, untroubled people we like to believe we are.

Clever as always
Not so now. Unfortunately, Coronavirus/Covid-19, has shown us how quick we are collectively to revert to our primitive selves. We are now in continuous panic mode and that does not help us to make sensible, important decisions. Stocking-piling loo paper, for heaven’s sake. Why? Just because someone else started it does not mean you are doing a clever thing. This is a virus that affects the lungs, not the posterior. Stockpiling loo paper is a bum decision.  

We are told we are at the beginning of this and we are presently in a position where we feel helpless, fearful, unable to trust - because those we vote for have no idea either - and, worst of all, there is nothing we can do about it. No wonder we are scared.

So, may I suggest we each individually learn to avoid the chaos swirling around our minds and instead concentrate on finding way to manage our own scattered thoughts. Personally, I am going to comply with official advice (this is not my time to rebel) while hoping the authorities are doing their best. 

I am working on the rational notion that none of them wants to be in this situation either and, while confined to my little home, I will allow myself to escape this world by reading, listening to music, watching escapist TV and maybe doing the odd stretching exercises. I will also talk to friends, rather than text them and appreciate the value of human contact, even if it is not in person. I will remember how I feel about that now and take it with me afterwards - and there will be an afterwards. 

I am going to be very aware of what is going on for me physically so I can connect my body to allow me and monitor my health. But, as far as my head is concerned, I am going to put on my “thinking” rather than “feeling” hat and use the rational part of my brain to guide me through the over-abundance of information that is out there.

Hopefully, with practice, my brain will settle down to do the job it has evolved to do and that will give my body a chance to calm down and stay strong. I wish you and your loved ones well.

Photo 1 by Nick Fewings on Unsplash
Photos 2 and 4 by John Cameron on Unsplash

Monday, 9 March 2020

A Borderline Problem

How would you feel if someone in a position to know told you that you were “emotionally unstable” or diagnosed you with a “borderline personality disorder (BPD)”?

The first diagnosis might bring on a feeling of indignation … “How dare you! Who are you to judge me so?” while the second - if you’ve heard of it - might be a sense of relief. “Phew, just borderline. That’s all right then.”

Whichever reaction you had, you might be surprised to know that both diagnoses mean one and the same thing.

Emotional instability is a diagnostic term used by European/British clinicians, referring to the World Health Organisation's health classification list, while the more medical-sounding term BPD is given by the DSM, a US manual used by psychiatrists around the world as the standard for mental health diagnoses. 

To understand what it is you would have to live with regardless of its name, I’m going to quote the DSM again.

“Borderline personality disorder: a pattern of instability in personal relationships, intense emotions, poor self-image and impulsivity. A person with borderline personality disorder may go to great lengths to avoid being abandoned, have repeated suicide attempts, display inappropriate intense anger or have ongoing feelings of emptiness.”

The impulsive behaviour category includes risk-taking such as casual sex, binge drink and drug abuse, a tendency to self-harm on a regular basis, all of which tends to bring on a chaotic pattern of behaviour. That, in turn, makes what is already a hard life, seem even harder to live. Sometimes, they cannot bear to continue.

Mood swings may be sudden and extreme
Soon after qualifying, I attended a course on BPD and thought I recognised a lot of the signs in me. I stuck my hand up (old habits die hard!) and said: “I’ve got it!” The psychiatrist laughed and said most people learning about the disorder thought they had at least some of it. It was unlikely.

After that, I began looking into the subject with interest and have subsequently discovered I still seem to be one of the few interested in it, rather than the many.

BPD is a difficult diagnosis. It seems to evoke some kind of dread in the medical world because there is no “cure”. Unlike other mental health issues, there is no evidence of any medication having a significant effect.

If, as a professional, a person feels despairing at the thought of being unable to find a way through a client’s discomfort, imagine how the client feels, being told nothing can be done. In a world where we’re told that everything can be achieved, being unable to “improve” something as fundamental as “oneself” is unimaginable.

To be fair to the medical/therapeutic community, working with people with BPD is not easy. Therapy works best when there is a good relationship between client and therapist and a BPD client can be challenging.

S/he - it affects more women than men - can be easily triggered, quick to imagine an unintended slight or to misinterpret what has been said to them. Their mood in a session can be highly changeable, making it is easy for the therapist to feel off-balance. This is not the BPD client’s fault.

Ideally, toddlers will learn to regulate their emotions
The disorder has developed out of a difficult or traumatic time in childhood, as a result of insecure (disordered) attachment and a BPD client may have retained those strong child-like tendencies of emotional extremes They love quickly with deep passion and can hate, discard and leave with that same passion. You can be their best friend or their worst enemy within a very short time. If it is wearing for the counsellor, imagine how tiring it must be for the client. What is charming in a child is unnerving in an adult.

Now, hopefully, change may be coming. For the first time ever, the Royal College of Psychiatrists has issued its own statement about BPD, saying: “The myth that people with personality disorder cannot be treated is damaging and untrue.” The college is calling for more training in the assessment and diagnosis of personality disorder. It also wants a better deal for sufferers, including access to mainstream services which are currently not available.

While there may not be an actual cure, people with BPD can learn skills to enable them to manage their life in what they might find to be a less tempestuous way.  There is dialectical behaviour therapy, developed by Marsha Linehan, herself a BDP sufferer and, more recently, mentalisation-based therapy, with both therapies aiming to help the client live in a healthier way mentally than they have managed to so far.

I was reminded of BPD last month when I read of the sad death of Caroline Flack. It was a tragic story. I later read a question on a public site, referring to her and, in the same post, asking about BDP. No-one can answer that. 

It’s popular at present to talk about avoiding diagnosis and concentrating only on the patient/client as an individual, not as a collection of symptoms. I understand the compassion behind that line of thought.

However, I wonder how it would be if a person displaying many of the symptoms of a potentially life-threatening disorder presented themselves to a professional and was alerted to what might be going on within their inner world.

It could be a life-saving moment.

Lulu Sinclair

Photo 1 by Jan Kopřiva on Unsplash
Photo 2 by Andre Hunter on Unsplash