feeling unwell in every way i can

had the flu -the proper flu...where i spent 5 days in hospital...

i was -and still am- floored...i couldn't even lift my head off my pillow some days

my fingers felt heavy, my wrists like lead and my elbows and knees and ankles like stone...


i got a letter from my therapist to say she'll definitely be off for the foreseeable...

haven't set eyes on her since March?May?...anyway...court looms...some sort of thing called an "intermediate diet" in Jan...then court on 14 Feb...

fuck this shit...last Christmas I think...

get better at moving...pack stuff up -less rubbish for folk to deal with...

I really have the overwhelming urge to slit my wrists but that is soooo ridiculously messy for some poor soul -and everything would be ruined

at least a hanging only leaves some poor soul to find me but much less mess...and things can go to someone else...

inability to speak today...

not even to call the GP -and i've only got one reliever inhaler left..

...

getting so frustrated with myself.

...

Been There
Feel Again
© Jeff Bresee
Much time I now spend, watching
Watching as others pass by, living
Living their lives
I watch not for care of wanting to know them
Or even so as to learn from what they do and say
I simply watch…and wonder
Wondering why. Why do I feel this way
Wondering how. How have I come to this point
Wondering when. When can I ever hope to feel again
As I watch, I remember
Remember what it was like…
To feel as they feel
To laugh as they laugh
To cry as they cry
To hope as they hope
To hurt as they hurt
To love, to hate, to long, to fear, to yearn…to rejoice…to live
But such is all that I have…memories
Memories which flow before my mind’s eye
Even as the people flow before my gaze
And I, I sit quietly in the shadow…
And wonder

***

i feel as stuck as ever since first breaking my ankle nearly 4 years ago...my heart is breaking for the folk in the Philippines and yet i'm just as selfish as ever moaning in my own head over and over about 'being stuck'...at least i'm alive -i should be grateful for that, plus i live in a country where i can get financial help whilst unable  to work at the moment....but nooooooooooo...


***


I feel smashed and hammered reading that poem...in a weirdly 'good' (not good) way...in that, I can relate and not feel so...alien...
I...Went to the bin chute -only the one in the landing ...through 4 doors (I'm including my living room and front door...because my heart rate had increased before if even gone through them)...that was about 3 hours ago...I'm now agitated beyond my ability to explain...I hate that that was so big an effort I had beads of sweat everywhere...I hate me right now...

Here are the Different Types of Borderline Personality Disorder:

• Low Functioning Borderline - The “Low Functioning” borderline is what most people think of when they are first introduced to the condition. Low functioning BPDs are a living train wreck. They have intense difficulties taking care of their basic needs, are constantly experiencing mood swings. They also have an extremely hard time managing any sort of relationship with another human being. Low Functioning BPDs are often hospitalized more than other BPD types, for the very reason that they can’t live productively without constant coaching and supervision. These patients are challenging for all but the most experienced psychiatrists. Unless otherwise treated, low functioning borderlines lead self destructive lives and attempt to manipulate those around them with desperate acts, including self harm (cutting, etc.).
• High Functioning Borderline - The High Functioning Borderline Personality shares many core aspects of the low functioning borderline personality, except for the fact that they can manage their lives, appear to be productive, and generally keep their relationships civil (even diplomatic in nature). High Functioning borderlines can appear to be normal, driven people one moment; then moody, inconsolable, and manipulative the next. Somehow, there is a mechanism within the minds of High Functioning Borderlines that allows them to lead somewhat “competent” lives, despite the fact that they are in a constant battle with BPD. High functioning BPDs are no better than low functioning: it’s basically the same face wearing a different mask.
• Extroverted Borderline - Anyone familiar with the Meyer-Briggs personality tests will understand the psychological differences between extroversion and introversion. When these characteristics are mixed with BPD, there are two different results. The Extroverted Borderline pushes all their feelings, fears, manipulation, rage, and moodiness outward to the people around them. In essence, if you are around an extroverted BPD, you feel like you’re living through their emotions while coping with your own at the same time. Further, extroverted BPDs will attempt self abusive acts in plain view of others in order to avoid abandonment or to express their rage. For example, an Extroverted BPD might cut themselves and then immediately share it with family and friends around them, hoping to gain sympathy or attention. In most cases, these types of behaviors frighten non-Borderlines, and they wonder whether or not the Extroverted BPD should be committed to a psych ward.
• Introverted Borderline - Contrary to popular belief, “introverted” doesn’t necessarily describe someone who is a recluse (agoraphobic). Instead, introversion is characterized by experiencing life in a self-reflective, private, and at times distant manner. To others, introverts may appear shy or lacking in people skills. This might be true, however, introverts make up for their lack of social skills with rich inner lives, thoughts, and deep thinking. As a result, the introverted Borderline primarily focuses all their BPD emotions and reactions inward. Instead of having a rage episode in public, they might retreat to their rooms and cry for hours on end, perhaps even cutting themselves for their own amusement or as stress relief. Introverted Borderlines live in an odd world: on one hand, they spend most of their time in personal thought and reflection, looking to fill themselves with a viable sense of self; but on the other, they are conflicted by emptiness and the bottomless emotional pit that BPD produces. Introverted BPDs might be harder to “spot” unless you happen to know one personally, in which case you might notice occasional depressive symptoms and evidence of self harm.
• Transparent Borderline - The Transparent Borderline is a bit of a mix between a high functioning borderline and either extroverted or introverted tendencies. In plain terms, Transparent Borderlines live double lives: on the surface, “in public”, they appear one way, but in private, amongst immediate family and friends, they appear completely different. As a result, they may or may not be high functioning due to this conflicted state of mind. Transparent Borderlines spend most of their emotional energy trying to balance the personality demands of Dr. Jekyll and Mr. Hyde, the both of which experience strong BPD emotions like anyone else with the disease. Like Introverted Borderlines, Transparent Borderlines are harder to spot, and often only confess their true disposition after a harrowing rage, major break up, or other severely traumatic event that brings all their BPD feelings to the fore.

(http://shitborderlinesdo.tumblr.com/post/42929897175/someone-asked-if-there-are-different-levels-of-bpd)

...

**Borderline personality disorder is a condition in which people have long-term patterns of unstable or turbulent emotions, such as feelings about themselves and others. These inner experiences often cause them to take impulsive actions and have chaotic relationships. The causes of borderline personality disorder (BPD) are unknown. Genetic, family, and social factors are thought to play roles. Risk factors for BPD include: Abandonment in childhood or adolescence, Disrupted family life, Poor communication in the family, and Sexual abuse. People with BPD are often uncertain about their identity. As a result, their interests and values may change rapidly. People with BPD also tend to see things in terms of extremes, such as either all good or all bad. Their views of other people may change quickly. A person who is looked up to one day may be looked down on the next day. These suddenly shifting feelings often lead to intense and unstable relationships. Some other symptoms include: A fear of being abandoned, feelings of emptiness or boredom, frequent displays of inappropriate anger, impulsiveness with money, substance abuse, binge eating, intolerance of being alone, repeated crises and acts of self-injury. Like other personality disorders, BPD is diagnosed based on a psychological evaluation and the history and severity of the symptoms. Many types of individual talk therapy, such as dialectical behavioral therapy (DBT), can successfully treat BPD. In addition, group therapy can help change self-destructive behaviors. In some cases, medications can help level mood swings and treat depression or other disorders that may occur with this condition. The outlook depends on how severe the condition is and whether the person is willing to accept help. With long-term talk therapy, the person will often gradually improve. Some complications include: depression, drug abuse, suicide threats and attempts, and problems with work, family, and social relationships. Call your health care provider if you feel you have symptoms of borderline personality disorder. It is especially important to seek help right away if you or someone else is having thoughts of suicide.**

Birthday rearing it's ugly head again...

i have ONLY posted replies to things in a closed support group for folk with BPD as of late
...and i have put up a couple of silly pics to get us smiling
...but they've really been to try to get ME TO smile
...i feel like i'm dead inside just now -just an empty shell
...like an Easter Egg that isn't Cadbury or Galaxy or any nice-tasting thing
...i feel down...really down...the kind where words fail me...i...i kind of don't feel real at the same time...i have nobody to talk to to explain these things that will understand and not be upset/worried/offended 
...but i've held back from sharing in the group for fear of triggering or offending or worrying folk THERE
...you know what i'm saying when i say "i feel really really low"
...but for those of us WITH BPD we know it's not a, err, aaargh... i don't even know how to word anything... i don't want reported to facebook if i say flat out what's in my head...

or to have the police show up and take me away if i do the same on the phone to breathing space or the Samaritans...

tomorrow is my birthday -the day that will be a day folk get angry with me when i'm gone because it's by my own hand...so it's the day...it HAS to be...

i feel sick to the pit of my stomach -i have NO IDEA where i hid my rope from myself...

i'm both glad and angry with myself for that...

The Emotional Vulnerability of Borderline Personality Disorder

Imagine you have a cut. The skin around your cut heals. But it heals all wrong. The scarred tissue is extra sensitive. So much so that every time you simply touch the area, it’s like the wound tears open again, and again, and again; and the pain peaks every single time. Now imagine this wound represents your emotional sensitivity and how you deal with the world every day. This is akin to the emotional susceptibility of borderline personality disorder (BPD).
As Shari Y. Manning, Ph.D, writes in her excellent book Loving Someone with Borderline Personality Disorder, “People with BPD have an exquisite vulnerability to emotions.” And this susceptibility is hardwired.
For instance, Manning cites one interesting study where researchers tickled infants on their noses with a feather. Their responses ranged widely: Some infants didn’t react at all, others moved around and still others started crying and it was tough to calm them down. These babies were seen as “sensitive to emotional stimuli.”
Like other disorders, BPD also involves an environmental component. (Not everyone who’s emotionally sensitive goes on to have BPD.) Individuals with BPD aren’t just genetically vulnerable to emotions; they’ve also grown up in an “invalidating environment.” So they might’ve never learned how to regulate their emotions, or their emotions were continuously ignored or dismissed.
What It Means To Be “Emotional”
According to Manning, being emotional isn’t a lack of control; it has more to do with “three separate tendencies that cause emotional arousal in different ways.” These are:

• “Emotional Sensitivity.” Loved ones aren’t the only ones confused when someone with BPD has an emotional reaction seemingly out of nowhere. People with BPD may be unaware of the trigger, too. But they still have a strong reaction. “Emotional sensitivity wires people to react to cues and to react to their reactions.” Manning explains that: “To understand emotional sensitivity, think of the person with BPD as being ‘raw.’ His emotional nerve endings are exposed, and so he is acutely affected by anything emotional.”
• “Emotional Reactivity.” A person with BPD not only reacts with extreme emotion (“what would be sadness in most becomes overwhelming despair. What would be anger becomes rage”), but their behavior also is intense and doesn’t fit the situation. They might sleep for days, scream in public or self-harm. Manning points out that emotional reactivity isn’t self-indulgent or manipulative, which is an unfortunate myth attached to BPD. Instead, research has suggested that people with BPD have a higher emotional baseline. If most people’s emotional baseline is 20 on a 0 to 100 scale, then people with BPD are continuously at 80. What can intensify their reactions are the secondary emotions of shame and guilt because they know “their emotions are out of control,” Manning writes. Let’s say your loved one is angry. “On top of the original anger, these secondary emotions feel intolerable, and their fear of all this emotion, ironically, tends to fire off another series of emotions—perhaps anger that is now shifted to you, for ‘not helping’ your loved one or for some unexpressed reason.”
• “Slow Return to Baseline.” People with BPD also have a hard time calming down and stay upset longer than others without the disorder. And there’s interesting evidence to back this up. “In a person with average emotional intensity, an emotion fires in the brain for around 12 seconds. There is evidence that in people with BPD emotions fire for 20 percent longer.”

An Exercise in Understanding
In Loving Someone with Borderline Personality Disorder, Manning also helps readers better understand what it’s like to be emotionally vulnerable. She suggests thinking about an extended period of time when you were very emotional.
For Manning her emotional explosion happened when the company she’d worked for was going bankrupt. Not only was everyone upset and Manning barely sleeping but then her friend passed away. “At that point I felt like every emotion that I had was at the surface of my skin. I physically felt like I would explode with emotion if one more thing happened.” She notes that she was “an emotional sponge.” She didn’t even want sympathy because she felt like this would put her over the edge.
When thinking about your own highly emotional experience, Manning writes:

…Remember what it felt like emotionally and physically. Remember how it felt like emotions were just building on each other. Remember the experience of no one understanding how bad the situation was and how emotional you were. Now tell yourself that this is the experience of your loved one every moment of every day.

How Loved Ones Can Help
Manning shared her insight on how family and friends can help in a two-part interview on Psych Central (Part 1 and Part 2). And loved ones can do a lot, especially when it comes to helping the person when they’re upset.
In her book, Manning provides readers with step-by-step strategies and detailed examples. Below is a brief list of suggestions from her book:

1. Assess: ask what has happened.
2. Listen actively; don’t contradict, judge, or say your loved one is overreacting.
3. Validate: find something in what happened that makes sense and is understandable, that you can relate to; say what that is.
4. Ask if you can help, not to solve the problem but to get through the moment.
5. If your loved one says no, give him or her space and remember the emotions of emotionally vulnerable people last longer.

Also, it’s important to remember that people with BPD do get better and simply need to learn the skills of managing their emotions. While this requires hard work and effort, treatments such as dialectical behaviour therapy (DBT) have been shown to be highly effective.

(By Margarita Tartakovsky, M.S.) [http://psychcentral.com/lib/the-emotional-vulnerability-of-borderline-personality-disorder/0009521]

Still on a downward spiral

Back to the 'I won't make it til then and if I leave leaving to the very last minute it would either be the 25th (my Dad's birthday) or if I go for past midnight it would be my dad who'd find me...either way I'm a complete and utter bitch...why I'm prolonging this hell I just don't know... I hate me so no wonder I have no real life actual friends and people are so full of rubbish -I'm sick of "yeah, I'll come see you" when they don't ... I do nothing, I AM nothing...
aargh i hate this -stupid lawyer was supposed to be today at 1 and my SAMH worker could help me out the house (agoraphobic to the max!), he's male and she'd come in with me...then he called to say the secretary got the wrong diary, he wasn't free -can it be Wed...i have no support til Wed -SAMH come Wed and Fri...crisis team-clearly useless...

plus had body therapy today at 3pm -SAMH worker helped me out of flat (and calmed me down when i went back into gimme-a-rope-mode...she's ace but is only on cover for other person who is on holiday...she's nice too -but when she leaves, my house smells of smoke for ages from her and triggers my asthma...)

....anyhoo....filled in sheet you need to at bodytherapy session (basically, a massage -but i've uncovered my arms a handful of times in the last 13 years...and been told i brought shame on the family...had that well ingrained -PLUS since fracturing ankle i went from a size 10-12....to 26 =' ( stretch marks everywhere...i hate my body)...so therapy helps as i'd be able to show someone, who'd be non-judgemental, my skin and disgrace...

this was due to be my first session -filled in form and they add up scores from answers -but i got citation in the last week so answer to "have you felt angry" was -all/most of the time...so to was the answer for "have you felt overwhelmed" etc...so she said i was too severe to be involved with them now -i broke down...

started talking about everything and how i have the means to not be here -she said she was going to call the police (i wasn't being violent...she meant so i'd be safe) but i now HATE the police-they are liars; they twist things and make me a baddie -they are a bunch of swearwords and a re in on it too...everyone wants me to get me...clearly so to are the folk from today...

in a nutshell...

• the police are COMPLETE liars;
• psychotherapist's off for foreseeable;
• social worker hates me and pretends she doesn't get messages from me;
• A&E roll their eyes and call folk who say "there comes a point where YOU have to be responsible for you" -eh?!!trying!! (that''d be why i ask for help you bunch of sadists!!);
• 'crisis' team suggest tea;
• psychiatry say i'm not 'bad enough' to get help from them;
• lifelink are saying i'm 'too bad' to get help from them;
• a GP flat-out told me what to take to go...

wanna smash my head off a wall 'cause it seems it's what they're doing to me...but still kicking about

*****STUPIDLY MASSIVE TRIGGER WARNING*****

*****TRIGGER WARNING FOR THE SENSITIVE -YOU HAVE BEEN WARNED!*****

Cannot stress the triggering this stupidity will do

And yet you're still reading...

Called breathing space last night/this morning -they said to call crisis team -what they hell?!!...by the way I'd already explained that nobody would put me through to them and that it was like banging my head off a brick wall -the only time they called me back was because the girl who is a cpn but off sick just now had called them to say she was worried about me and thought she'd never see me again because I was going to take my own life...she's off sick with her mental ill health...so I can't tell her my thoughts this time...

...and last time I called out of hours crisis I was asked to get off the phone "so that someone in a real crisis could get through"

...I can think of 4 males who ruined me and frick all came of the one I reported that went on from me being 6 til I was 11...

fuck the system...

...Fuck this Point in it? I do nothing but leach off of everyone around me I can't even to outside alone anymore so, nah, fuck this This is the cherry on this fruitloop's cake Court?! When CCTV must show him going round the one way system incorrectly, his statement says they both got out the car -I never even spoke to the girl -she was to busy doing her hair and make up...then the guy who is over 6 foot says he was scared of me? Nah, fuck this This world is shit
And if taking my own life means I go to hell?
...living there already mate...
I actually no longer care what state the flat's in or anything (like who gets what or who finds me or what happens to the student loan i owe -does it transfer to family, etc? or what would happen to my animals) I won't know so fuck it
Sooner rather than later eh?
...Seriously, you should see this letter -the guy was frightened by me??! Eh!! Aye right...lies upon lies -When CCTV MUST SHOW him going round the one way system incorrectly and coming over to me on my crutches when I got out of my car,
his statement says they both got out the car -I never even spoke to the girl -she was to busy doing her hair and make up...next in the statement the guy -who is well over 6 foot- says he was scared of me?! (I'm exactly 5ft and ON CRUTCHES!!!)

...this may be all over the place but I hope you can make some sense out of it if you've managed to read any of it...

was feeling sore and rubbish for ages, then felt ok for a few days and as though I could fight again..Then BANG back to earth with a bump -citation in for all the nonsense in Stobhill carpark in September (when, for anyone who doesn't know/remember a crazy guy came round the car park in a hospital car park and into the space that I was indicating to go into...he then gave me the finger, called me a spastic and laughed at me when I asked him to move his car he kept saying "you better not key my car" and after I parked elsewhere I went past his car thinking how weird it was for him to say that. His car was indeed scored. Meantime he'd called the police and said I'd keyed his car and when they arrived I was driven to a police station where I spent 8 hours in a cell with excrement on the wall, it was freezing in there and I asked for my jacket -was told really sternly "No, it has metal buttons!!" (And yet I had my 2 metal crutches in with me!!), I asked to go to the toilet twice and didn't get to go, I asked for a drink of water...yup denied...
I also had to ask for my inhaler twice and only got it the second time because by then the wheeze was audible to the person on the bloody desk!!
-anyway, I've to be in court on 26th August at 9am... I already told the crisis team more than once, and you too ...if it goes to court I will kill myself...well, it IS going to court

 

...WHY WON'T THE CRISIS TEAM BE A FUC£^NG CRISIS TEAM AND HELP ME!!!???

 

...Ack ah guess they were right...sure I had rope but I couldn't use it incase my dad was the one to find me...
or my sister -and she might bring her babies... 

 
Now? I can't call -what if they actually DID help? (My inner voice just laughed at that) it'd mean I'd be here for court.

I won't be.

 

My psychotherapist's assistant sent a letter last week to say a family member of hers had been in a near-fatal accident and that she will be off for the foreseeable...she was the only person I'd be able to get in touch with about any of this...
It's all just too coincidental!!

 

They're ALL IN ON IT -I thought she wasn't...Perhaps I was wrong...and, in that case, i shared too much...that's how they've been able to push my buttons...it all kind of makes sense now...

Besides, even if they WERE a helpful crisis team there would be no point in calling them anyway -you call them if you want help to live...but what kind of life am I living?!
Plus you call them if you want help to not end your life...I don't care anymore...
I actually don't care  

 

***

 

i caved, i called them...their advise??

-she asked if I could make myself a cup of tea and watch a soap...

 

 ***

D'you know...When I overdosed in February I had this ditzy bitch ask me if I was still feeling suicidal I said yes and was discharged less than 4hours later, having been in less than 30hours...why did they bother to ask?...
So I called crisis as soon as I got to the door past the ward... I was made to explain at least twice the situation from start to finish...
Then she said "I don't know what it is you want me to do...you tell me what you want me to do for you" ...I hung up and walked round to A&E -bearing in mind 'walking' for me is painstakingly slow, in an air-walker boot, beyond sore, using a rollator (thing that looks kinda like a zimmer)...plus I was in pyjamas with a hoodie on and it was blinking freezing...
Waited 7hours before crisis cpn team came -spoke with them for less than 5mins during which time one of the women said "there comes a point where you have to take responsibility" at least THREE TIMES...JUST HAD IT ON THE PHONE FROM CRISIS LESS THAN 20mins ago too...must be their 'go to' line...

Was sent home and by this point it was after midnight and I had no money...it took me OVER AN HOUR to walk to the bus stop at the bottom of a long-ass hill as all I had on me was my bus pass...and it was the last bus and only went part-way...I could have cried if I wasn't so frikkin afraid the tears would have frozen on my cheeks...nah, there were no tears left by then

***

So, to sum up:
1. Crisis team won't help
2. Hospital just send me home
3. I have horrendous agoraphobia anyway so wouldn't be able to get to the hospital even if they would help...

***

Back to the 'I won't make it til then and if I leave leaving to the very last minute it would either be the 25th (my Dad's birthday) or if I go for past midnight it would be my dad who'd find me...either way I'm a complete and utter bitch...why I'm prolonging this hell I just don't know... I hate me so no wonder I have no real life actual friends and people are so full of rubbish -I'm sick of "yeah, I'll come see you" when they don't ... I do nothing, I AM nothing...

i have no friends -as it should be...   

Melting down ~MAQ

Had a meltdown in my brain
I asked for help but no-one came
They say to ask when you're in need
But then the laugh  -defeat concede
There's no help coming
There's none to give
They say it's my choice to not want to live

My brain's not right; but it used to be
it used to work now it's just debris
i can't repair the damage done
the game is over and i have not won
too much to fix, too much is broken
i guess nothing can stop the destructive giant that's been woken

it's all my fault and i must be to blame
my world ends soon some might think it's a shame
but then where were they when i needed them most
ha! who am i kidding? i've no friends; i'm a ghost
a shadow, a shell of the person i once was
i couldn't fix it alone -you see there wasn't just one 'coz.

LIES ~MAQ

Lies - just tell them what they want to hear
Got to tell them, got to tell them they've nothing to fear

Lies - they need them to get them to sleep
Got to tell them, got to them, secrets? I'll keep

Lies - to help them end the visit or call
Got to tell them, got to them, cannot share it all

Lies - they come out like oxygen now
Got to tell them, got to them, sharing? i'd be a cow

oh! to be 5 again ~MAQ

so shiny, sharp and silver,
bright, glistening, gleaming...

it talks to me all  day long

the silence is filled with it

i miss proper silence -when i could just be bored and not have to fight,

i miss when my skin was smooth -and i didn't have to hide or lie or miss out on things with my nieces and nephews,

i miss the old me -the one who didn't know what 'bad things' were

i really miss the one who never had 'bad things' in her life

i wish i were 5 again

June 2013

was pretty much, well, I'll not use the swearword that's in my head to describe it and nothing else seems to come close...

urgh -having an awful wee spell here - ***TRIGGER WARNING***

I want to hurt me -in any way, punch me, pinch me, burn me, scald me, smack my head off a wall -all of these seem a better idea than talking to yet another out of hours 'trained' CPN -are they really?...my cat is more therapeutic, but then he is a baby and causes me to bleed and remind me i'm alive...maybe that's the trick for me...

As for 'crisis intervention' is it just me, or do they rip the utter pi$$?
frikkin Mental Health team often don't talk back -so many times i've been promised x,y or z.....STILL waiting -same for GP...they're all in on it -they think i don't know and they deny it when i ask...but it's true...

what's the point? i do nothing but leach off of everyone i come into contact with and even some i've never come into with!...


...all i am is a drain on society...

...a fat waste of space...

...who does nothing...

for anyone

what a selfish oxygen thief

 ...but to leave a body behind -is that more selfish than continuing to drain everyone forever?
a poor soul having to cut me down and take me away and do whatever happens next, and my family being inconvenienced, and the people who tried to help...




WHAT'S THE LEAST SELFISH THING......


I WISH SOMEONE COULD TELL ME

a long rant -just because i haven't had one on here for a bIt...

I can't tolerate sounds, mostly normal sounds like people eating, breathing, sniffing, coughing, repetitive noises, certain words etc...pretty much any noise really. its been like this for years but seems to be getting worse just lately, the slightest sound makes me furious, can't control it the anger, and end up hurting myself instead of someone else! it gives me physical pain though, especially chest pain and can't breathe properly...you know like the feeling when you hear nails on chalk board or something? makes me feel so sick...toot toot *Madville* has been reached!

clocks, hairdriers, hoovers, neighbours, drunks outside, my hamster in his ball, my hamster in his pen,when i'm wheezing (that one REALLY annoys me...esp if it lasts more than a few hours even when using meds or is painful becuase i know it means i have to take action...and then THAT means leaving the flat....and i have agoraphobia -badly...then i get lovely new annoying sounds depending on where i end up -sirens on ambulance for example -feelings like my head's going to burst with that one...

***

i have that itchy skin need to hurt me feeling today...brain has shut down, words are failing me and it's taking over....aaargh stupid brainless brain!
Distractions...been going round in circles of distractions for soooooooooooo long and now i'm so tired -in every possible way you can be tired...i wanted to do a wee bit the other day but fought and fought coz i know i'll start a war with my skin again....but this time....aaargh...
i feel numb...that's when i sh -so i can feel anything...
my brain has left my head -i'm just a shell again...a nothing...a ghost of a person...or a person living a half-life...i dunno -because my brain left...
 I WAS driving crazily but had a wee bit of sense enough to pull over and STOP but I didn't think I WAS going to kill someone, but I knew driving like that made me more likely to kind-of-thing...
***

And, just so we're clear, I feel JUST AWFUL for making anyone worry ever in my life...I...yeah...feel just terrible -I know many folk try to help each other but I don't want to be upsetting folk or having them worry unnecessarily. I'm having another 'unseen illness' spell as well whereupon I'm REALLY feeling the pain I (not literally) managed to contain to my left toe yesterday in order to be outside my flat for as long as i was....normally I can't stand up for more than half an hour but I was outside for quite a bit yesterday and now my Complex Regional Pain Syndrome CRPS has taken FULL HOLD -I feel pain EVERYWHERE basically right now and haven't managed to move from the spot I lay down in last night -not even for the loo...on these days I just hold it til I can move...hopefully that'll be soon as I (naughtily) took ONE extra painkiller...but no need to freak it's not an overdose as such...I'd just quite like to go to the toilet...oh, ok it was 2

***

The next GP that asks what my CPN says...well...i can't be held responsible for my actions as my brain will have left my head again...

READ THE F*&kn notes - I DO NOT HAVE ONE - THEY SAY i DON'T NEED ONE...

Had another meeting with a psychiatrist and there was the man from last time who said i didn't need one, sitting in on the meeting...like he's gonna turn round now and say "oh, ok, hands up, my mistake she DOES need one"..that was the last resort and they're having some big 'secret' meeting' if they say I don't need one again like they did last year...aaaargh........argh nothing -they're going to say it -FK this -what's the point....i'm on my own and i'm a ba$tard -what's the point in hanging round with me for company, fk, hardly anyone else can tolerate me for longer than an hour -or they don't at all...whatever....i'm out .... FK this....https://www.youtube.com/watch?
http://www.youtube.com/watch?v=2vFJo8rJqbg
http://www.youtube.com/watch?v=rOHlnV5fcsQ





https://www.facebook.com/groups/520571744640037/permalink/595183120512232/?comment_id=595411980489346&offset=0&total_comments=23

i feel AWFUL i'm so so sorry -words are just words....i am so so sorry....words, are just words....
 i do feel really bad -like i just came along when the rest of the world was having fun 'til i spoiled it....going to shoosh now...

when r u due in court?Can u make an appointment with ur GP today, u can get a letter to state that ur housebound, also ask to be referred to a mental health advocate, explain the stress this is causing u.
Gp is en route -I cannot move and it feels like someone has poured petrol on back and lit it! Yeah I'd get legal aid. No dates no nothing I don't understand what even happened to be honest -I've never been in trouble before that date (nor, may I add have I been asked if is wished a lawyer since!!!)What I mean to say is, it's not like I for into trouble on that date then just went out and started wreaking havoc!!Not been to court -wasn't allowed his statement or anything...
a few folk were worried as to why i went quiet again and were asking what happened...to which i said 
-nothing happened -just a bit of confusion...plus I was a bit (MASSIVELY) impulsive whilst driving ...was a bit...dunno...think I was fighting impulsive thoughts to hurt me and voiced that fact on here which made folk worry...and ...I didn't mean for folk to worry I was just getting that off my chest and I fought it but had tried to stay offline coz I was being triggered (and triggering others too I guess)    = (

***

Was going to buy a book about BPD so i can better understand things and remind myself that i am not alone and that i am not as crazy as i think i am...

***

Back hardly eased all weekend -it was either 9/10 on the pain scale or beyond 10....it honestly felt like i WAS ON FIRE at points...I usually feel bad for having to have the GP come to me, but I didnt fel bad in the slightest this time -I COULD NOT MOVE...not even to go the toilet...it felt like i was glues to the fiery bed...so i didn't feel bad for the call out this time-but on call outs before, from my old GP practice, when it's been because agoraphobia has kicked in...and i KNOW i have a chest infection or whatever but they still insist on coming out (which i understand) ..i end up in tears coz they'll talk about the wee bed-ridden man they'd just been at or whatever....ach...plus the receptionist will ask more than once "and you've A-B-S-O-L-U-T-E-L-Y  N-O  W-A-Y  O-F  G-E-T-T-I-N-G  H-E-R-E?" as though i'm either stupid,  pretending or both...

***i managed to record a song to try to distract myself as i HAD to sit up for 3 lots of 10-20 mins today = ( ...it was so difficult to get into a sitting position, and felt nigh-on impossible to stay there...so recording really helped to try to take my mind off it. Earlier, when the dr came i couldn't even hold a book to read to distract myself...'twas a LOOOOOOOONG day!!!!!!!!!!!!!!!!!

crisis team asked me to get off the phone

it seems to be only me who is into this page but i'm going to give it a shot...i've got nothing to lose....Christina -you've NO IDEA...you sent me a text when i had just opened a bottle of bleach to drink...i'm typing this, several hours later, and as you probably have guessed i didn't do it...i called the crisis team  yesterday (technically i mean Tuesday) and they were 15mins from swapping to out of hours so said "is it urgent or can you wait?"...i'm SURE you guys know how much it takes to make those calls for help....after a minute or two of silence on my end she said she'd get the duty worker to call me in the morning...i didn't sleep...
i didn't believe they'd call, but they did at half 10...by then, English totally failed me and i couldn't explain things...she said since it was all "long-standing things" they couldn't help..i've started drinking -and setting stuff on fire....and another really bad thing -stealing....utter rubbish, stuff i don't need...just totally impulsive and....i don't know.....i'm scared....and if they find out about the stealing...God help me, another period of time in a cell and i WILL hang myself..............


guys, i'm so so sorry..........


i don't know what to do -and now i'm burdening you and how would you know either -i don't mean that derogatorily ...i just....i don't know.....

i don't feel like me....




i don't know me i don't think anyway -but i DO NOT ;normally' feel like this -something's wrong and crisis aren't listening...

what would happen to any bills etc i have if i died...or debts...

**I called crisis again when i gave my name the woman straight away shut down and was almost like a robot ...she said "i understand it's long-standing things"...didn't even give me a chance to try to explain...then she said how i had a respiratory appointment and i said i knew that and that was freaking me out -the door was making feel PHYSICALLY SICK and i'd already wet myself twice and it was hours before i needed to leave...she said "well, anyway, we need to keep this line clear for people in ACTUAL crisis so if you could get off now and get in touch with *some acronym  i've never heard of" tomorrow ...then she said "will you do that?"
i said no...
she right that's great bye"

...she mentioned in the call how i had a psychiatric appointment in a fortnight and that, that wasn't long...i said it was if you can't sleep and a rope is calling you...





i don't think i'll last a fortnight...

things i wanted to do before i died

(i haven't done too badly on my list really)

*see an Aurora Borealis
*visit Auschwitz
*swim with dolphins
*have a baby at the age of 30 so that there'd be 30 years between my gran and mum, 30 between my mum and me, and 30 between me and my baby
*have twins
*Make another Sacrament
*bungee jump
*return to cantoring/choir
*go to the top of the Eiffel Tower
*go to the top of Blackpool  Tower
*travel to Australia
*take a trip somewhere overnight alone
*ride a horse
*have friends
*get a degree
*paint things for charity
*ask for help when i need it
*stop self harming
*visit New York
*go on a blind date
*donate things to charity
*forgive the people who ...
*be happy being me
*work in another country
*let someone love someone me without worrying if they have ulterior motives
*help someone else in a way they couldn't themselves
*be the cantor a funeral
*be the cantor a wedding
*compose a new Mass setting
*Return to work
*learn guitar properly
*visit Anne Frank's hide-out
*be in a band
*be a DJ
*be a KJ
*Do karaoke again
*help at a homeless shelter

Psychosomatic pain ~Stephen Tyrer

As a psychiatrist working in the field of pain, it is commonly assumed that I devote most of my attention to people who have pain as a result of stress or psychological difficulties. Indeed, 24 years ago when I first started seeing individuals in chronic pain who had been referred to me in a pain clinic because it was thought that organic factors were insufficient to explain the complaint of pain, I looked carefully for psychiatric and psychological explanations. Despite the fact that one-third of people attending our clinic had evidence of psychiatric illness (Tyrer et al, 1989), it has become clear to me from those I see that such psychiatric morbidity is largely a result of chronic pain and is not a forerunner of a painful state. The vast majority of people I see in a multidisciplinary pain clinic have a clear organic cause for pain either in the present or past, and it is rare to have a patient with pain arising purely from emotional causes. There is evidence of environmental and social factors affecting the exhibition of pain. Psychiatric illness is more common in people with pain referred to psychiatric out-patient clinics (Merskey, 1965; Merskey et al, 1987), but in total the evidence for organic factors leading to distress in vulnerable individuals is overwhelming.

A sizeable number of people in distress from chronic pain do not have enough signs of illness to persuade doctors that organic factors are sufficient to explain their symptoms. These individuals usually show intense conviction of disease, strong adherence to mechanistic explanations of their illness and considerable functional disability arising from the painful complaint. They are undoubtedly in distress and they score highly on symptoms of depression and, to a lesser extent, other psychiatric illnesses. Why these people present in the way they do cannot be deduced solely through application of the medical model.

***

PAIN AND MIND-BODY DUALISM

 

The word pain comes from the Latin poena, which means punishment or penalty, after the Roman goddess of punishment. The term was originally used for the punishment of an offence against the law. Over time the word was increasingly used to denote suffering, particularly if this had resulted from a blameworthy act. 

Early writers equated emotional suffering with pain and the words were used interchangeably. This psychological dimension to the experience of pain was largely forgotten following Descartes' observations illustrating pain as a signal of physical pathology:

 

‘quand je ressens de la douleur au pied, la physique m'apprend que ce sentiment se communique par le moyen des nerfs dispersés dans le pied, le pied, qui se trouvant tendus comme des cordes depuis là jusqu'au cerveau, lorsqu'ils sont tiré dans le pied, tirent aussi en même temps l'endroitdu cerveau d'ou ils viennent et auquel ils aboutissent, et y excitent un certain mouvementque la nature a institué pour faire sentir de la douleur à l'esprit, comme si cette douleur était dans le pied’ (Descartes, 1647).

Although not anatomically precise this work convinced scientists of the relationship between the integrity of sensory nerve conduction and the experience of pain. The experimental work then conducted supported the views of doctors that pain was due to tissue damage, so in those complaining of pain there must be a source of injury. The concept of non-organic pain was not considered important at this time. It was not until Breuer & Freud (edition 1957), in detailed case histories originally published in their studies on hysteria in 1895, suggested that pain could be a manifestation of a psychological problem, that the contribution of psychological factors to pain was reconsidered. The profound influence of Freud shaped the belief in psychological and psychiatric circles that persistent pain associated with emotional distress in the absence of organic findings is primarily due to a psychiatric illness. This was not generally acknowledged by physicians although a number of pain specialists have realised the importance of psychosocial factors in the presentation of patients with chronic pain (Fields & Price, 1994; Livingston, 1998). Dr Livingston, a surgeon writing in the middle of the past century, disagreed with the concept supported by many doctors at the time that pain, without physical findings, is hysterical or due to malingering.  

***

PSYCHIATRISTS AND PAIN

The concept of ‘emotional pain’ occupied a select group of British psychiatrists in the 1960s and Erwin Stengel proposed a variety of mechanisms to explain this phenomenon. Stengel was born in Vienna as an identical twin and came to England in 1938 following the occupation of Austria by Hitler. He was intrigued by those who seem to be impervious to pain and described case studies of this phenomenon. More than most, he understood that mechanistic models were inadequate to explain the gamut of experiences described by people with pain. The controversy between Stengel and Eliot Slater about this issue, published in the British Journal of Psychiatry 40 years ago (Stengel, 1965), neatly encapsulates the mind-body dualism that was adopted by most practitioners in a more convergent explanation of the origin of pain (Slater, 1966).

Stengel's work in this area led to a sprouting of interest in Sheffield, where he was the first head of the university's Department of Psychiatry at this time. Three junior psychiatrists in his Department have since become prominent researchers in this area - Harold Merskey, Izzy Pilowsky and Sir Michael Bond. All have contributed massively to the contribution of psychiatric and physical features to the perception of pain, an area into which, sadly, psychiatrists in the UK nowadays rarely venture.

At the same time that Stengel was articulating his views in England, psychiatrists in the USA developed psychological theories to assist in the management of pain in the New World. The established physician and truncated phonemic associate George Engel believed that, although pain may originally develop from an external source, it often becomes a psychological phenomenon (Engel, 1959). He described risk factors for developing chronic pain, including a history of defeat, significant guilt, unsatisfied aggressive impulses and a history of real or imagined loss. Later, Blumer & Heilbronn (1982) described a group of patients who developed chronic pain who had a strong work ethic and were preoccupied with their pain. As these individuals later developed many of the vegetative symptoms of depression, these authors unwisely generalised that chronic pain in such people is a manifestation of depression. 

***

EFFECTS OF PAIN ON PERSONALITY

Although Engel (1959) and Blumer & Heilbronn (1982) correctly described factors predisposing to the genesis of chronic painful syndromes in a selected group of patients, the generalisations they made dissuaded colleagues working in this field that the biopsychosocial model espoused by these psychiatrists was necessarily relevant (Engel, 1977). Later studies showed that the development of psychiatric illness more usually follows the development of the chronic painful condition, and ‘pain-proneness’ is not demonstrable in most patients (Gamsa, 1990). The reason why most people in pain complain of distressing symptoms is because of the debilitating and demoralising effects of the pain itself. This contention was supported by an intriguing study carried out 20 years ago. At that time the Minnesota Multiphasic Personality Inventory (MMPI) was a widely used tool in the investigation of those with chronic pain. The typical profile of an individual who had developed chronic pain and had the psychological disposition to do so was a component of high scores on the neurotic triad, the depression, hypochondriasis and hysteria sub-scales, of this instrument. This picture was found in a large proportion of a group of patients being assessed for backpain surgery. By chance, a number of the individuals concerned had previously been tested with this instrument in an earlier epidemiological study. In these people it was found that their premorbid profiles were within normal limits, strongly suggesting that the painful condition from which they were suffering was responsible for the apparent change in the personality picture (Hagedorn et al, 1985). Love & Peck (1987) later showed that this particular MMPI profile found in patients with chronic pain did not represent previous personality functioning but was a consequence of disability.

***

SOMATOFORM DISORDERS

 

A minority of patients with chronic pain do fulfil the criteria for the diagnosis of a somatoform disorder. In such conditions there is continued presentation of physical symptoms together with persistent requests for medical investigations despite negative findings of organic illness and reassurance by doctors that the symptoms have no physical basis. The diagnosis par excellence of a somatoform disorder is somatisation disorder, where pain is just one of many symptoms exhibited by the (usually) female patient. This diagnosis is not common, ranging from 0.2% of patients referred to a liaison psychiatry service (Smith et al, 2000) to 5% of medical patients (Fink et al, 2004). This figure is higher than the previous figure of Smith et al (2000) because Fink et al (2004) used ICD-10 criteria. The ICD-10 diagnosis of persistent somatoform pain disorder was 1.5% in this same population (Fink et al, 2004). This low figure is not too surprising, as the latter diagnosis can be made only if the pain described by the patient ‘ occurs in association with emotional conflict or psychosocial problems that are sufficient to allow the conclusion that they are the main causative influences’ (World Health Organization, 1992: p. 168). Contrast this with the diagnosis of pain disorder listed in the somatoform disorders section in DSM-IV (American Psychiatric Association, 1994). For this diagnosis to be made, ‘psychological factors are judged to have an important role in the onset, severity, exacerbation, or maintenance of the pain’ (p. 461). Although cases largely due to physical illness are excluded, as also are cases where the pain is ‘better accounted for by a mood, anxiety or psychotic disorder’, more cases with pain and emotional sequelae achieve this level of diagnosis on the DSM-IV schedule than on ICD-10.

The differentiation of the somatoform disorders has been questioned (Wessely et al, 1999). The problem with the diagnosis of somatoform disorders in general and of somatoform pain disorders in particular is the judgement required that the symptoms manifest are due to psychological factors. It is not easy to determine this objectively and most psychiatrists working in the area are aware that physical and psychological factors both contribute significantly to the presentation (Mayou, 1991; Merskey, 2000). The evidence of psychological causation cannot be assumed from a history of previous risk factors. The reporting of unexplained pain symptoms as due to previously experienced psychological trauma has been found to be an artefact of retrospective self-report rather than a consequence of actual events (Raphael et al, 2001). This being said, there is evidence that some non-organic pains arising in adolescence have a psychogenic basis (Hotopf et al, 1999).

The value of the present classifications of these syndromes has been brought into question because of the imprecise categorisation of such disorders and the fact that many patients fall into the category of undifferentiated somatoform disorder, a watered-down version of somatisation disorder (Bass et al, 2001; Sharpe & Mayou, 2004). Dimensional assessment of pain on the axes of nociception, evaluation of pain, mood consequences of the pain and pain behaviour (Karoly & Jensen, 1987; James, 1992) may be of greater clinical relevance.

***

BOOKS ON PSYCHOSOMATIC PAIN

Edward Shorter, the prominent medical historian, has shown how the symptoms of psychosomatic illness have changed over the years. He believes that these symptoms are presented according to the prevailing culture. In the early 1800s, for example, a current concept to explain back pain was spinal irritation, caused by pressure at specific spinal tender spots, leading to nerve and muscle pains. Shorter's contention is that psychosomatic symptoms are selected carefully from a culturally determined symptom pool to give the impression of origin from an underlying organic disease, thus avoiding ridicule (Shorter, 1992). This assumption is supported by the changing terminology of diagnostic labels such as hysteria and neurasthenia.

A recently published book argues that fear of pain explains the high prevalence of psychological distress in patients with chronic pain (Asmundson et al, 2004). There are two schools of thought to explain why a minority of people behaves in this way; these are interrelated. One claims that a catastrophic meaning is placed on the experience of pain because of the fear of injury or re-injury. The other suggests that fear of pain is due to fear of anxiety-related sensations associated with painful episodes. This hypothesis has led to treatment by graded exposure to such situations to enable individuals to learn to manage both anxiety and pain together (Vlaeyen et al, 2002). For more general reading on psychosomatic disorders, books by Chris Bass (1990) and Peter Manu (2004) are recommended.

As is usually the case with a medical condition that is imperfectly understood and has no established cure, there is a plethora of books for sufferers from pain. One that has received considerable plaudits from patients is The Mindbody Prescription, on treatment for back pain (Sarno, 1998). Dr John Sarno believes that tension is the underlying cause of many back problems. He states ‘ Pain serves to smother the emotions so they don't break through to the conscious mind. The brain produces these symptoms as... a distraction to make sure your internal rage does not come out’ (p. 39). Although treated with scepticism by his medical colleagues Dr Sarno is clearly appreciated by many pain sufferers in North America. A useful part of the therapy process is educational, in the form of a lecture presentation in which the temporal relationship between emotional feelings and pain is recognised. 

***

THE FUTURE

The specialty of pain has grown considerably over the past 25 years and the influence of the psyche on painful symptoms and vice versa has become much more widely recognised. The difficulty in disentangling the mechanisms involved in this relationship will be clear to those who have read to the end of this piece. Those wishing to obtain more information are recommended to contact the International Association for the Study of Pain (IASP; http://www.iasp-pain.org).

It is in many ways paradoxical that in the UK the vast majority of doctors working in the pain field are anaesthetists, with only a scattering of pharmacologists, neurologists, orthopaedic surgeons and psychiatrists. The value of psychological assistance is more widely recognised. The IASP recommends that all first-class pain clinics should have at least four healthcare professionals on the staff. This is a rare situation in Britain. Until the field of chronic pain is recognised in liaison psychiatry job plans, there is unlikely to be major input from psychiatrists in the UK into chronic painful conditions. If a Faculty of Pain Medicine or similar organisation were to be designated, this might change.

• © 2006 Royal College of Psychiatrists

***

References

all found here:

http://m.bjp.rcpsych.org/content/188/1/91.full

***Psychosomatic pain by Stephen Tyrer***Department of Psychiatry, University of Newcastle upon Tyne, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP,UK. E-mail: s.p.tyrer@ncl.ac.uk
(EDITED BY SIDNEY CROWN, FEMI OYEBODE and ROSALIND RAMSAY)