Defying death - bring it on

Ouch. Someone hit me where it hurts, metaphorically, this week. All this prevention stuff you do, does it really work? Getting a hobby is not going to stop you from feeling like you want to die. Erm, no it’s not and the really honest answer is, I can't answer that. Yes, that’s right, I don’t have all the answers. And I had another great blog post all ready to go, but this feels important. Okay, so this challenge is somewhat over-simplified and it would take more than 140 characters in twitter to answer. In fact, more than this blog post, as part of the answer can be found in the culmination of thousands of research papers and the work of many passionate, dedicated organisations and individuals.

Can we count how many people didn’t die by suicide? Can we count how many people didn’t die of anything? Any prevention effort for mental or physical health is targeted, based on statistics and demographics and research, but you cannot with absolute certainty say that one particular thing prevented someone from doing something. Starkly, the answer to whether or not something works in suicide prevention is a matter of life and death. The person is either still alive or they are not.

Think of all the factors that lead to someone thinking about suicide. It is never just one thing, so it is unlikely that just one thing will help. Although there is a tipping point in both, and it’s on that precipice while the scales are still tipping back and forward that one small, tiny thing can change the tipping direction. It could be a kind word or smile – someone actually noticed me today. It could be a moment of revelation in therapy – suddenly I have clarity. It could be someone showed compassion – I am worth something. Anything that helps someone to believe that they are a worthwhile human being in the midst of their descent into the black hole of suicidal thinking, could be the lifeline that they need.

It is my hunch, from many conversations about suicide, that it is the big things in life that make people want to die. No one ever comes to the decision to take their life lightly and without thought and turmoil and pain. Big things like devastating loss, overwhelming sadness, paralysing fear, life-changing events. And it is the smallest things that make it possible to keep living. No matter how small and fragile that life force is, it has more power than death can ever have. Even in the blackest darkness a tiny pinprick of light has an impact and becomes a magnet for our attention and for our hope.

"Hope is the thing with feathers, that perches in the soul. And sings the tune without the words, and never stops - at all"      Emily Dickinson

So, if you ask me what makes a difference, I am inclined to say – something, anything – anything except nothing. If we do not reach out, people will die. Of course we have fantastic evidence-based interventions. Let’s have some more of that please. And also, no matter how difficult and uncomfortable and scary it can be, let’s keep talking about suicide. This is literally death-defying work.

If you’ve noticed that I have steered clear of statistics and quoting research papers, well done. It’s deliberate. That is not what this blog is about – there are many others out there doing exactly that, and doing it incredibly well. This blog is simply what I think, which has been influenced by too many people, books and academic papers to list. What comes out this end is my own process in making sense of it all.

Dr Murphy – signing off. Maybe something lighter next time…like shame, maybe?

Crossing the borderline - it’s all about the stories

These are not the kind of stories that begin with, once upon a time, and end with happily ever after. They do not always unfold in a logical manner with a clear plot line and character background. They are often the drip-feed between a description of symptoms and sometimes unfathomable behaviours. I am talking about – that which must not be named. I am talking about the backdrop for people who are given the label of borderline personality disorder.

I am often torn between the value of diagnosis in targeting the kind of help a person needs and the stories that accompany labels. In any kind of diagnosis – mental or physical health – there is a set of criteria that must be met in order to place someone within a specific category. For some people, they might wear it like a badge, look, I’ve got this. For some it is a relief that what they are experiencing is actually written down in a diagnostic manual. For others, it increases the shame which has already permeated every chapter of their own life story.

Personality disorder basically means the way a person has developed according to their childhood and life experiences and most probably trauma. Think about this for a moment. Their personality has had to adapt in such a way as to be able to survive as a person. What must these circumstances be to facilitate someone to have disordered emotional development? It is certainly not a story of being valued, accepted, nurtured, understood, cared for, protected, enabled. It is not a story of mutually nourishing relationships. People with this label struggle with relationships more than anything else. They struggle with relationships with their family, partners, friendships and with health professionals. We expect them to behave just like us and are surprised when they don’t.

I am not surprised. What does often surprise me is the creativity and ingenuity for survival. That someone can find a way to navigate life without most of the tools and psychological clothing or even skin that most of us have. That’s right, they feel naked and raw most of the time. They might self-harm as a way to find some caring either from themselves or someone else. They might attempt suicide because the pain of being in a raw state is unbearable. They might become over-attached and have inappropriate boundaries with anyone who shows them interest and caring. Ironically in their craving for connection, their behavior disconnects them from others.

Unmet needs are at the heart of their experience. So how do we even begin to meet those needs? If damaged relationships are at the root, then we know that healthy relationships are part of the healing. So how can we be in relationship with those who don’t know how? How can we help someone to work with their vulnerability when they feel so raw most of the time? I would venture to say, and I’m sure there will be some disagreement, that it might be vital for us to show some vulnerability too. To truly be my authentic self in that or any other relationship, I must be prepared to give careful, thoughtful, respectful and specific feedback about how it feels to be me in that relationship.

"You know nothing about Hope, that immortal, delicious maiden forever courted forever propitious, whom fools have called deceitful, as if it were Hope that carried the cup of disappointment, whereas it is her deadly enemy, Certainty, whom she only escapes by transformation."  George Eliot

These I have found are the powerful moments of transformation. The very fact that I have let down my own armour of theories and models to simply be human, to be real, is what creates space for a shift. Like any practitioner, I have invested vast amounts of time and energy in my learning – so to suspend that in mid-air, while I just be me, with the other – makes me feel vulnerable, exposed, maybe a little naked. I have no doubt, for I have felt it in those intense moments of connection, that these authentic relational moments of courage make change possible.

Of course, this goes hand-in-hand with the solid base on which our psychological theories and models of therapy are based. We are not swimming about in the deep ocean here without some buoyancy aids. I have my life-jacket and believe me, it’s tied on tight – anyone I am working with would expect nothing less. But we both have to remember to kick our own legs – helping and being helped can never be a passive encounter.

So let’s not let this story be about a dialogue which continues to contain phrases like “borderlines”, revolving door patients, problem clients, attention-seekers, para-suicidal, self-harmers, lost causes, here we go again, draining. My hope is not just for more understanding and compassion, but actually for excitement, drive and enthusiasm to being part of making a difference in someone’s life, to being a witness to true transformation.

I would like to be a witness to the transformation of how mainstream services view and treat borderline personality disorder.

Dr Murphy – signing off