I’m sorry I haven’t written much lately, once again.
As you can see, I sort of make a career of making the same blunders and subsequently apologizing for them.
Sorry, my bad, over and over.
Can I just issue the human race some kind of card that contains an infinite number of my assorted apologies and acts of self-immolation? That would take a lot out the gab out of my mouth, and to no small degree.
Where am I?
The depression happened again. The spiral happened again. The BPD meltdown, in all of its emotionally unregulated glory, happened again.
Just like April of 2023—a month that, in retrospect, felt like waking up every day to have boiling water thrown into my emotional face. It was late in the month of that year, April 25, that I called my supervisor and officially took medical leave from work.
I was very much used to being upset, but never so upset that I was literally, clearly, unable to function and do the simplest of tasks to effect or consistency. What should have been a time of healing mostly become isolation, adaption, and the overuse of self-soothing behaviors, such as rocking back in forth in a chair. Sprinkle in some dissociation, which is when your mind rejects reality and essentially dumps itself half outside your brain, and you have a recipe for absolute nothingness, marbleized with distressing and self-defeating emotions.
This time last year was not, I should say, my finest hour as a human being. My pills were not working, I found myself to be in an eternal adjustment period, and my therapist, after I likely terrified her in one session, fired me and suggested that I look into DBT, or dialectical behavior therapy, a treatment considered to be the gold standard for borderline personality disorder.
This treatment did not, after a year of it, net the desired results for me, as I have partially gathered from my descent to the same maladaptive depths for a second April in a row, which has, thus far, has included a series of painful splits, or events in which I essentially think of others in black and white terms and excuse myself from them.
Now, a return to the present:
It is April of 2024. The splitting is real. The therapy has hit the proverbial spinning in the wheels stage. My emotions are high, and I’m trying to avoid buying another ticket on the dissociation express, with mixed results. The presence of mood stabilizers in my diet is the X factor that has kept me from a severe meltdown to a total and complete one. For this I am perhaps one of the few humans on the internet who is grateful for their pills.
I know I am. Amen to pills.
As to things other than pills. Why didn’t DBT stick with me, even after some seemingly early results?
My unscientific hypothesis, to be taken is gospel:
The way that I approach my therapy needs to be a trauma based approach, or at least one that addresses sources of this pain in a little more depth.
Encounters like this are always the ones that I find the most beneficial. When a therapist opens me up in a positive way, and in the deepest way in which I can be opened, it is always through the vulnerability and the trauma work. This is where I, post session, feel exhausted, but also a little more free and a little more clear in my thinking.
And more hopeful. I like the idea of tearing into myself, only to conclude that I still deserve to live.
In my view, and I say this with no disrespect to the many people who have benefited from DBT, that I find it to be little more than microwaved Buddhism with a heavy emphasis on the things that you need to do, do, do, and do.
And I am not allergic to doing things. I have crawled through metaphorical Hell and fire in my mental health journey, going down to depths I never thought I would see. I have done the doing, over and over. I can be accused of many things, but not of avoiding the doing.
For me, DBT doesn’t work because it takes the view away from the source of my pain, putting it almost entirely on my maladaptive, overreactive behaviors. If I lost my temper again, I didn’t use the STOP skill. If I got worked up over something of mild to no significance, I wasn’t checking the facts again. If I was grumpy for too long, I wasn’t accumulating positive things in my life.
All of the things DBT says to do are good things to do, and I can see some of them being a supplement to my therapy diet. But to me, for what I require and how I need to engage in a therapeutic relationship, I need to do more than focus on how well I am putting the lid on my madness.
Putting the cap on something, with no treatment to the source of the pain, is silly, at least as a primary means of working with me.
DBT is at its core, putting the glass cover back on the hot pot. Don’t like what’s going on? Give a half smile. Don’t care for how you have been treated by others? Cheer up, and accumulate some positives already. Feel shameful? Who cares about the source of that shame. Just do the stuff you would do with joy if you were NOT feeling shameful. Opposite action is THAT easy.
I mean I don’t know who needs to hear this in the profession of psychology and whatnot, but it’s very possible to be so upset, so disheveled, so in the dumps, so sick of everyone and yourself, that you really CAN do all of the fun things and not have any fun.
Imagine wanting to leap out of your skin, all the time, no matter what you are doing.
Many patients benefit from DBT, and I think the skills therein could, in some spurts of therapy or another, be useful for me. But DBT alone is not enough. It is largely concerned with the maladaptive Nathan in the present, not the things that created the conditions for the present. When therapy is nothing but DBT, all I feel like is a continuous failure—someone who can learn and digest the skills, and perhaps apply them a little, but never, ever when there is serious moment of crisis.
One can only keep doing the same thing, over and over, spinning the wheels, for so long.
I have been spinning my wheels for more than a minute now. It’s time to get out of this ditch and find another path. It’s been roughly a year since what I could consider to my first full-scale nervous breakdown, where a series of fractured relationships sent me into an official BPD spiral.
As I noted above, for those who are, like me, short on short term memory:
For the 3 months I was on medical leave, hoping to find growth and healing, but I generally found myself self-soothing outside, rocking in a chair in what I always call a “raging depression.”
Again.
This went on for 3 months.
Before I departed for medical leave, I was assigned to teach an experimental course for my employer. The course resembled a direct study, rather than an experience that had closer instruction and harsh deadlines. As part of the requirement, I had to hold a virtual office hour for my students. I set a reminder for this in my phone, for 4PM EST, sharp, Monday through Friday.
When I went on leave, and into the hospital eventually, I did not cancel the reminder in my phone.
And I just haven’t cancelled it today.
I may never cancel it. As I sit here, in a slightly lesser but real borderline spiral, a real reminder of how much I adored April in 2023, I find the ping on my phone, each day, to be a useful sound. It’s like a call that says, “This is where you have been. This is what happened to you. And you had better remember what happened to you.”
I no longer have an office hour, but in a way I do.
I have an office reminder, and I intend to keep it until I’ve healed to the point where I will forget what such a daily annoyance was ever for.
Someday, when I am finally on the other end of this literal madness, I will delete that reminder.
But not now, and not yet.
Until I summit this mountain, my office “hour” is in session.
Yours Mentally,
Nathan
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