How to support a friend who has been admitted to psychiatric hospital

How to support a friend who has been admitted to psychiatric hospital

In the first quarter of 2017 (January-March), there were just under 18,500 psychiatric beds available across England for people in crisis or needing long-term support for their mental illness. This is despite the fact that in every year, 1 in 4 (or over 16 million adults and children) struggle with poor mental health. This means that for every mental health bed across the UK there are roughly 865 people suffering from a mental health condition.

Of course, not every one struggling with a mental health issue needs to be hospitalised, but 865 is still a staggering number. If even 3 in each of these 865 per bed were in crisis, only 1/3 of them would receive the treatment that they needed. It’s a horrifying statistic, and for many people, there’s just no bed available. And if there’s no mental health bed, you can’t even be legally detained under a section.

I guess in a way I have been lucky to have been cared for properly when I was in crisis. If anything, getting admitted to hospital highlights an adequate response to being unwell. I was ‘lucky’ (I sure as hell didn’t feel it at the time) to be recommended for a mental health act assessment and then sectioned in order to keep me in hospital. I was ‘lucky’ to have been transferred to a PICU (the only bed in the country was in Sheffield, a huge relief considering I could have been sent anywhere) instead of being discharged for self-harm that staff just couldn’t cope with.

I have had direct experience of being treated for in a psychiatric hospital. A year of my life has been spent inside the walls of 4 different hospitals. It was the best thing for me each time I was in, but the experience itself was no fun. You can read more about that in my previous blog posts documenting diary entries from when I was inpatient aged 17.

But in this post I wanted to offer some advice on how to help support a friend or family member who has been admitted to hospital. It’s not rare and many people have a mental health crisis at some point in their lives. Here’s how I think you could help:

  1. Don’t push to visit unless you’ve been explicitly asked – getting admitted to a ward can be a very unsettling experience and it can take some time for anyone to get used to the environment. Whilst seeing friends can be a massive comfort, it can also be a little bit too much too soon. Give them some space.
  2. Instead, write to them. Send them post – getting snail mail is really exciting when you’re detained in hospital. Not only is it a reminder that someone actually gives a shit enough to sit down and write an actual letter, but it helps them to stay connected in their own time. Sending photos and little positivity cards is also a good idea.
  3. Remember special holidays – I can tell you now, being in hospital on Christmas Day 2015 was utter shit. It was absolutely miserable. I was lucky that my family were able to come and see me on Christmas Day, and brought presents from all my friends. People from school also sent me cards which was really nice.
  4. Find out what they are and aren’t allowed on the ward – in the open units I’ve been in, patients have been allowed pretty much anything other than the obvious sharps and conventionally dangerous items. However in PICU, the rules can be very strict. The majority of patients aren’t allowed rubbers, socks, anything plastic, more than one teddy, anything that could be ligated with, or anything that could be broken. Don’t send them anything they could use to hurt themselves.
  5. Educate yourself on mental illness – take some time to try to understand your friend or family member without being judgemental. The stigma against mental illness is phenomenal, and honestly it meant so much to me when my friends read up on BPD and were able to talk to me about it and how they could help.
  6. Don’t blame yourself and don’t feel responsible – in a mental health crisis, being on the ward is the safest place anyone can be, when treated properly. Don’t waste time worrying about how you could have done more to prevent this from happening, but instead keep showing this person that they’re loved and cared about and that you will be there for them every step of the way.

There are plenty of services where you can talk about your own struggle with mental health issues, or to vent and help yourselves when coping with someone close to you struggling.

The 24/7 helpline rang by SAMARITANS is 116 123.

 

 

Borderline personality disorder voices

Borderline personality disorder voices

I recently asked sufferers of BPD questions about their perception of the illness, and how they feel they are treated (and failed) by mental health services. Here is a post about the findings.

What is your gender?

98% of those who participated in my survey were female. This does not suggest that borderline personality disorder is a ‘female’ illness, however it makes sense as not only are my platforms possibly more female-supported, but men may also be less willing to discuss their emotions even in an anonymous post due to social conditioning.

How old are you?

56% of those participating were aged between 18 and 21, the most likely period in anyone’s life to be diagnosed with a personality disorder. This is because personalities are thought (sometimes controversially) to be fully formed by the time someone is an adult.

However, a large amount of participants were within the 21 to 25 age range, and 11% were either 15, 16, or 17. No participants diagnosed with borderline personality disorder were below the age of 15. Whilst not impossible to be diagnosed with emerging borderline personality disorder at this age, it’s extremely unlikely for someone who has just gone into adolescence to have a personality disorder label.

How old were you when you first heard about borderline personality disorder?

The biggest minority of participants (42%) were over the age of 18 when they first heard about BPD. This was followed by the 16-17 age group (35%). 24% of participants had heard of borderline personality disorder before the age of 16, including 1% between the age of 10 and 12. No participants reported to have heard of borderline personality disorder before the age of 10.

How did you first hear about borderline personality disorder?

Only 53% of participants actually found out about borderline personality disorder through mental health services. The biggest other factors leading to recognition of the disorder were Google search (15%), the media e.g. films or TV series about it (7%), family history (5%) and the Instagram recovery network (10%).

What did you think about borderline personality disorder when you first heard about it?

  • ‘I was scared’
  • ‘I thought it meant that the person was messed up’
  • ‘That you had multiple personalities at once’
  • ‘I was very confused about it all’ 
  • ‘That it was a bad label to have’ 
  • ‘Sounded like me but very stigmatised and not very well talked about’ 
  • ‘That it was like bipolar disorder’
  • ‘People who have it are unstable or unreliable’ 
  • ‘An illness that was loathed by other people’
  • ‘That the sufferers were scary people’ 
  • ‘It meant that sufferers were violent’ 
  • ‘I didn’t understand it at all’ 

Did you think that you had BPD before you were diagnosed?

This was almost half and half, with 52% saying no, and 48% saying yes.

How old were you when you were diagnosed?

57% of participants had a working or an emerging diagnosis before they were formally diagnosed.

36% of participants were diagnosed before they were 18, but the majority (56%) were diagnosed between the age of 18 and 21.

What was your reaction to your diagnosis?

  • Confusion (60% of participants)

‘I was very confused and didn’t understand how it fit me’ 

  • Relief (47% of participants)

‘I felt relieved because it confirmed what I thought was wrong’  

‘It made me feel like my symptoms were validated’ 

‘I felt like I finally knew what I was tackling’ 

‘It made me feel more aware and understanding of myself’ 

  • Shame (34% of participants)

‘It made me feel insane and that there was something wrong with me’ 

‘It made me feel like a fraud because of the stigma around attention seeking’ 

‘I felt ashamed because of the stigma. I didn’t want other people to know that I was diagnosed with it’ 

‘It made me worry that I was broken’ 

‘I felt like it was a throwaway diagnosis and I was a lost cause’ 

‘It made me feel like a bad person with a bad personality’ 

‘I felt like my life was over’

  • Denial (34% of participants)

‘Anger. I didn’t feel like I met the criteria’ 

‘I didn’t believe it was valid for how much I was struggling’ 

‘I feel like this diagnosis didn’t address the trauma that I have been through’ 

‘I was convinced that there was nothing wrong with me’ 

What is your opinion on your diagnosis now? 

  • ‘I feel like it makes sense now. It gives me relief knowing what’s wrong’ 
  • ‘It makes me angry and upset because of the stigma around it’ 
  • ‘I want the diagnosis removed because of the stigma’ 
  • ‘I feel like it doesn’t fit anymore’ 
  • ‘I feel like it doesn’t affect me as much and I am in recovery’ 
  • ‘I still feel alone’ 
  • ‘Has enabled me to get DBT’ 
  • ‘It’s something that a lot of people deal with and it doesn’t make you any less human’ 
  • ‘I wish I was never diagnosed with it’ 
  • ‘Everything gets blamed on this diagnosis, even when it’s completely irrelevant’ 
  • ‘It’s a relief to know that services have helped me and are taking me seriously’ 
  • ‘I worry about the validity of a personality disorder diagnosis’ 
  • ‘It had prevented me getting the treatment that I need for other illnesses’

What factors do you believe have contributed to your development of borderline personality disorder?

  1. Childhood trauma (75%)
  2. Bullying (64%)
  3. Verbal abuse (53%)
  4. Sexual abuse (50%)
  5. Hereditary factors (40%)
  6. Physical abuse (39%)
  7. Biological factors (39%)
  8. Childhood negligence (34%)

Other factors noted were poor relationships with parents during childhood, invalidation, certain personality traits, other trauma such as a miscarriage, drug abuse, and being a young carer.

Do you understand completely what a personality disorder is?

This can be quite a confusing term. What exactly constitutes your personality, and how can it be disordered? 27% admitted that they didn’t really know.

What symptoms of BPD are affecting you the most at the moment? 

  1. Emotional instability (92%)
  2. Emotional intensity (89%)
  3. Fear of abandonment (88%)
  4. Mood swings (87%)
  5. Urges to self-harm (87%)
  6. Suicidal ideation (85%)
  7. Unclear or unstable self image (83%)
  8. Unstable relationships with others (82%)
  9. Chronic feelings of emptiness (82%)
  10. Disturbing thoughts (77%)
  11. Urges to engage in reckless behaviour (75%)
  12. Explosive anger (61%)
  13. Brief episodes of psychosis (43%)
  14. Prolonged episodes of psychosis (17%)

Other common symptoms reported were promiscuity, dissociative episodes, absence of identity, and intense attachments.

Is borderline personality disorder your primary diagnosis?

70% said yes. Personality disorders are usually considered a ‘primary diagnosis’ or ‘main diagnosis’ because they are thought to drive other illnesses.

The 30% who didn’t have borderline personality disorder as their primary diagnosis were most likely to have bipolar or complex post-traumatic stress disorder as their ‘main’ diagnosis, however it varied across the board. Some people were unsure whether their team had specified a primary diagnosis.

What other mental illnesses do you suffer from?

  1. Anxiety disorder (78%)
  2. Depression (77%)
  3. PTSD (41%)
  4. Eating disorder (24%)
  5. Sleep disorder (20%)
  6. Bipolar (16%)
  7. OCD (15%)
  8. Psychosis (13%)
  9. Autistic spectrum disorder (11%)
  10. Other personality disorder (8%)
  11. Addiction (8%)
  12. ADHD (1%)
  13. Dissociative disorder (1%)
  14. None (1%)

Have you ever been diagnosed incorrectly with a mental illness prior to being diagnosed with BPD?

38% said yes.

What was the name of your incorrect diagnosis?

  1. Mood disorder (45%)
  2. Bipolar disorder (38%)
  3. Autistic spectrum disorder (12%)
  4. Other personality disorder (6%)

Do you feel like it’s possible to self-diagnose borderline personality disorder?

65% said no.

Explain why you can’t self diagnose borderline personality disorder 

  • ‘It’s a complex illness that needs a professional’s view’
  • ‘Because a lot of the symptoms overlap, so it could be another illness’ 
  • ‘You can’t see the whole picture. Professionals diagnose without the internal bias’ 
  • ‘Because most people can fit themselves into the symptoms, but not everyone has the severity of BPD’ 
  • ‘It could be incorrect and potentially damaging’ 
  • ‘You can have an idea, but you should approach a professional with that idea’

Has your perception of the general attitude of professionals changed since being diagnosed with BPD?

71% said yes. 3/4 of these commented that the change in attitude was negative.

Explain how professionals have treated you since your diagnosis of BPD

  • ‘They have given me less support’
  • ‘I sometimes feel like I am being treated as if it is my own fault’ 
  • ‘They have refused to treat me’ 
  • ‘They treat me like an attention seeker’
  • ‘I was told about various ex-patients who had successfully committed suicide’ 
  • ‘Wouldn’t admit me to hospital because of my diagnosis’ 
  • ‘They have stopped me from accessing inpatient services, and taken me off my medication’ 
  • ‘It’s not taken seriously’ 
  • ‘They have become very wary and judgemental of me’ 
  • ‘Psychiatrists who are not personality disorder specialist treat me like a naughty child’ 
  • ‘I was treated so much better with just a depression diagnosis’ 

However…

  • ‘I have been offered more help from a specialist service’
  • ‘They have been more understanding now that I have a diagnosis’ 
  • ‘I have access to the complex needs service’ 
  • ‘They are now treating me with DBT’ 

Under what setting were you diagnosed with borderline personality disorder?

  1. In psychiatric hospital (34%)
  2. General psychiatric assessment in the community (34%)
  3. I didn’t even know until I read it on my notes (19%)
  4. Personality disorder assessment in the community (9%)
  5. During the process of being assessed and diagnosed with another illness (5%)

56% of participants believed they were not adequately explained about their newly diagnosed disorder.

Do you have faith in mental health services to help you recover?

76% said no. 73% said that they felt that having this diagnosis made them a low priority in mental health services.

In answer to why sufferers felt like a lost cause:

  • ‘It’s not something that can be willed away or even treated with drugs’ 
  • ‘They don’t care because there is no straight way to treat it’ 
  • ‘They think that we’re attention seeking and we can stop at anytime’ 
  • ‘They won’t admit me even when I’m on my final straw’ 
  • ‘Some of my side effects aren’t nice, and I feel like I am being punished for it’ 
  • ‘Doctors seem to think it is an attention seeking disorder’
  • ‘Suicide attempts are treated like just an impulse to self-harm’ 

Are sufferers of borderline personality disorder attention seekers?

The majority of participants said no. However:

  • ‘Yes, sometimes we do. But we have been neglected by services so when we need help, we have to go to extremes’
  • ‘Every human seeks attention off someone. This isn’t inherent to BPD’ 
  • ‘In a sense. But it’s attention for help’ 
  • ‘Yes, but not in a bad way’ 
  • ‘I can have attention seeking behaviours without being intentionally attention seeking’ 
  • ‘Just like anyone else, we need the attention required to stay alive’ 
  • ‘When we say we want to die, we mean it’ 
  • ‘Extra love and care is needed, especially if it was missed from earlier years of childhood’
  • ‘It should be called reassurance seeking or help seeking’ 
  • ‘Remember, there is a reason behind every behaviour’ 

What are your thoughts on sufferers of BPD being called manipulative?

  • ‘Not intentionally, but I can be at times’ 
  • ‘I can be when I’m really angry, but so can everyone’ 
  • ‘No, I am just so frightened of being left alone. I feel like I have been manipulative to counteract my fear of abandonment’ 
  • ‘Manipulation is deliberate. Sufferers of BPD don’t mean to do it’ 
  • ‘Sufferers of BPD are actually more likely to be manipulated themselves’
  • ‘Manipulation requires planning and thought. BPD makes me act impulsively without fully realising what I am doing’ 

How do you feel when these terms are associated with your illness?

  1. Anger
  2. Annoyed
  3. Upset
  4. Scared
  5. Distressed
  6. Invalidated

What treatment have you received for BPD?

  1. Medication (82%)
  2. Inpatient treatment (48%)
  3. Group therapy (45%)
  4. DBT (44%)
  5. Distress tolerance (26%)
  6. Occupational therapy (22%)
  7. No treatment (14%)
  8. Specialist treatment in a PD unit (4%)
  9. CBT (3%)

Which treatment has been the most beneficial for you?

  1. DBT (dialectal behavioural therapy)
  2. Medication
  3. Inpatient treatment
  4. None so far
  5. Group therapy
  6. Art therapy

What is the next treatment step for you?

The majority of participants said they either didn’t know, or nothing. Some reported accessing therapy such as DBT, completing therapy, move to supported accommodation, or getting a place at a personality disorder specialist service.

Many young sufferers of BPD have been on the ‘Instagram recovery network’. Were you on it/are you on it? What is the general network consensus of BPD?

37% had never had an account. 48% were currently using one, and the remainder had had accounts in the past but were no longer actively updating their online recovery journal.

  • ‘When I was younger, it seemed like the thing to have. Now it seems like psychosis is the thing to have’
  • ‘Anyone and everyone has it. It’s a popular diagnosis’
  • ‘It’s good. There are a lot of people who understand each other very well’
  • ‘Some users personally make BPD look bad’
  • ‘It’s almost an aim for users to get diagnosed with BPD’ 
  • ‘I think it’s realistic and positive’

What are your experiences of stigma within mental health services?

62% said they had directly experienced professional stigma.

  • ‘They told me that I was being dramatic’
  • ‘The paramedic said that I was wasting everyone’s time’
  • ‘Told that if I wanted to kill myself, I would have done it by now’
  • ‘Told that X amount of pills won’t kill me, I would need to take X’
  • ‘The Doctor told a Nurse that I was just a borderline and not to give me any attention’
  • ‘Told by a police offer that I’d either end up as dead or a criminal because of BPD’
  • ‘Symptoms of my other diagnoses were ignored and put down as borderline attention seeking’
  • ‘They wouldn’t support me in a crisis because they wanted me to cope on my own’

Have you ever been sectioned for your mental health?

  1. No (42%)
  2. Yes, I was brought into hospital on section (35%)
  3. Yes, I was sectioned whilst I was in hospital (32%)
  4. Yes, under section 136 (27%)

Have you ever been admitted informally for your mental health?

55% said that they had.

63% of those admitted to hospital with BPD said that they weren’t taken seriously by the professionals in the unit.

84% said that they were discharged before they felt safe.

  • ‘I was discharged with no support whatsoever’ 
  • ‘Discharged due to bed shortage’ 
  • ‘Was discharged despite having daily suicide attempts’
  • ‘Was told that I was too complex for them, so I was discharged’ 
  • ‘I was discharged off my section with no warning’ 
  • ‘I had attempted to take my life a few days before but they let me go regardless’
  • ‘I’m only allowed 72 hour admissions’ 
  • ‘I was extremely suicidal and was admitted again very quickly after being discharged’ 
  • ‘I have been discharged straight off 1:1 treatment’ 
  • ‘After suicide attempts, I was discharged from A and E every time’ 

63% felt like their inpatient psychiatrist did not have an up to date understanding of borderline personality disorder.

51% felt unsafe in hospital because of the treatment plans made for patients with BPD.

Thoughts on positive risk taking for BPD patients

Positive risk taking is when professionals give you the benefit of doubt e.g. they don’t put you on high obs for self-harm or suicidal ideation, usually because they think that this will make you worse.

  • ‘It’s dangerous and it costs lives’
  • ‘It angers me as it often leads to death or serious injury’
  • ‘I think it’s dangerous but I understand why they do it’ 
  • ‘Depends. It worked for me but it doesn’t work for others’
  • ‘I think it has to be done sometimes, but not when someone is in crisis’ 
  • ‘It should be done in small steps’ 
  • ‘If they have a high risk of suicide, this should not be done’ 
  • ‘I’ve seen it go terribly wrong and end in suicide’ 

Have you ever wanted to be admitted to hospital?

63% said yes.

  • ‘I felt like it would be better for my family’
  • ‘I wanted to feel safe and have the security and care’
  • ‘I just wanted to be out of the way of threats’
  • ‘I wanted to avoid going home to an abusive environment’
  • ‘At times I have not trusted the community to keep me safe’
  • ‘I was scared of myself and what I was capable of’ 
  • ‘I knew I couldn’t stop myself from attempting suicide, but I didn’t want to die’ 

Do you think that being treated as an inpatient for BPD helped you?

63% said yes.

  • ‘If it wasn’t for inpatient treatment, I’d probably be dead’
  • ‘My inpatient stay helped to stabilise me’ 
  • ‘They monitored me whilst I was put on new medication, meaning my mum and dad could get on with their jobs instead of watching me 24/7’
  • ‘It saved my life but in terms of getting better, no. It was a triggering atmosphere and a superficial environment’ 
  • ‘I came out a lot more confident, insightful, and self-aware. But it was also very traumatic and difficult’ 
  • ‘I developed a greater understanding and learnt healthier coping mechanisms’ 
  • ‘It helped when I was in there, but they discharged me before I was ready’ 
  • ‘It only ever stopped the cycle of self-harm for a short time, and once I got home I spiralled again. Staff at the hospital were also very unhelpful and unsupportive’

What negative comments have you heard from professionals about admitting someone with BPD?

  1. They are attention seekers (81%)
  2. BPD patients shouldn’t be in hospital (58%)
  3. BPD sufferers will kill themselves if they really want to, we can’t do anything (58%)
  4. BPD patients can’t get better (57%)
  5. We can’t handle your self-harm, so we have to discharge you (52%)

Talking about BPD and suicide

93% of participants said that they had attempted suicide.

The most common age to have first attempted suicide was age 14 (17%). The youngest was age 10, and only a small number first attempted suicide over 18. This suggests that CAMHS needs to do better early intervention work into personality disorders, rather than pushing this aside as an ‘adult problem’ only to be addressed ‘when you go to adults’.

44% of participants received no psychiatric assessment after first attempting suicide. Only 27% were given even an option for inpatient treatment, yet 56% felt like they needed to be in hospital in order to keep themselves safe.

If you weren’t admitted to hospital following a serious incident, how did you keep yourself safe?

  • ‘My parents had to watch me constantly’ 
  • ‘I was under crisis team and went to a day centre, which was helpful’
  • ‘I went off the rails and was eventually detained’
  • ‘I was too young to be taken seriously or to know anything to do with the mental health system’
  • ‘I didn’t tell anyone what happened’
  • ‘My parents locked everything away and never left me’
  • ‘I had to sleep in the same room as my parents’

68% of participants felt that it was likely that they would lose their life to borderline personality disorder, with 13.6% claiming that it was certain to them that it would happen.

How do A and E services usually react to suicide attempts or serious self-harm?

  1. Make me feel guilty (65%)
  2. Discharge me as soon as I am physically well (60%)
  3. Carry out a short psychiatric assessment (55%)
  4. Make me feel like what I’ve done isn’t good enough and need to try harder (50%)
  5. Don’t take me seriously (48%)
  6. Belittle the severity of what I’ve done (48%)
  7. Stop me from seeing A and E as a safe and helpful place (33%)
  8. Threaten to section me (28%)
  9. Section me (13%)
  10. Carry out a long psychiatric assessment (13%)

Have you had any positive experiences in A and E for your mental health?

  • ‘One nurse actually took the time to make sure that my stitches were neat and left less of a scar, when it didn’t really matter because my arm is full of scars anyway’ 
  • ‘They gave me time to explain how I was feeling and why I had done that’
  • ‘The members of staff that had to stay and watch me treated me with kindness’
  • ‘Some of the staff are very understanding and know me well’ 
  • ‘They gave me a bed and let me sleep whilst I waited for an assessment, despite being physical well. A support worker came and spoke to me for a few hours’
  • ‘They always give me a mental health act assessment and treat me with respect’
  • ‘Reassured me that I wasn’t wasting their time’ 

Under which sector(s) are you currently receiving help for your mental health?

  1. Community Mental Health Team (59%)
  2. GP (34.7%)
  3. No help at the moment (19%)
  4. Private therapy (12%)
  5. Crisis team (12%)
  6. Personality disorder network (8%)
  7. CAMHS care (8%)
  8. Private psychiatrist (6%)
  9. NHS inpatient care (6%)
  10. NHS funded private inpatient care (2%)

What are the most upsetting thing a mental health professional has said to you about BPD?

  • ‘You’re just doing this for a reaction’
  • ‘This isn’t a mental illness’
  • ‘You look okay, so you must be okay’
  • ‘I shouldn’t put it on my records because I’m unlikely to get any help if professionals read it’ 
  • ‘You will never get better and will be in and out of inpatient for life’
  • ‘There’s no point treating you if you’re just going to kill yourself anyway’ 
  • ‘They don’t want to hurt themselves. They just want attention’ 

What’s the kindest or most helpful thing a mental health professional has ever said about BPD?

  • ‘I believe you’
  • ‘It’s not your fault and we’ll help you to get better’
  • ‘Nothing lasts forever and you’ll be supported every step of the way’
  • ‘I can see the potential and the motivation in you to recover’
  • ‘You and a brave and an intelligent individual’ 
  • ‘It’s difficult and it’s horrible, but it’s also beatable’ 

What do you think is the biggest myth surrounding BPD?

  • ‘That they’re attention seekers’
  • ‘That they want to be unwell or that it’s their fault’ 
  • ‘That we are nasty and controlling people in relationships’
  • ‘That we’re manipulative and difficult to love’
  • ‘That we all have daddy issues and have been through major trauma’
  • ‘That it’s an excuse made by dramatic people’
  • ‘That you can’t recover from BPD’ 
  • ‘That we copy other people’ 
  • ‘That we are all female and that it’s a ‘woman’s illness”

What do you wish that people knew about BPD?

  • ‘It’s a constant struggle’
  • ‘The underlying reasons behind engaging in self-destructive behaviours’
  • ‘We are empathetic, suffering and deserving of love and compassion’ 
  • ‘Living with this illness is hard work everyday and not just when I’m in crisis’ 
  • ‘We love very hard and will give you our all, so don’t take advantage of that’
  • ‘We are kind and loving and just feel too much’ 
  • ‘That self-isolating is a defence mechanism and I need them not to give up on me’ 
  • ‘We fight so f*cking hard every day just to stay alive’

What treatment do you feel like you need for BPD?

The majority of participants commented that they felt that DBT was the treatment that they needed. Other popular comments were the need for trauma therapy, 1:1 therapy, specialist inpatient treatment, more intensive outpatient treatment and different medication.

64% did not believe that recovery was ever going to be possible for them.

Which name do you prefer BPD to be called?

  1. Borderline personality disorder (64%)
  2. Emotionally unstable personality disorder (24%)
  3. Mood disorder (3%)

Other suggestions included emotional intensity disorder and emotional regulation disorder.

Sum up your life with BPD in one sentence 

  • ‘I hate you, don’t leave me. I’m depressed, I’m ecstatic. I want to die, I’m the happiest’
  • ‘It’s been a rocky road but I can now see smoother sidewalks’ 
  • ‘A frustrating limbo between two sides of my brain that don’t work together’
  • ‘I’m living with emotional burns. Everything hurts’
  • ‘A painful daily battle in order to cope with turbulent thoughts and survive’
  • ‘One big, emotional rollercoaster’
  • ‘It’s like a nightmare I can’t wake up from’
  • ‘Why does everyone keep abandoning me?’

What advice would you give to someone who has just been diagnosed with BPD?

  • ‘Read about it, get some books out, join a support group’
  • ‘Ignore professionals who treat you like shit and keep reaching out for better treatment’ 
  • ‘Don’t let people belittle you’ 
  • ‘Never stop reaching out for help’
  • ‘Don’t take the negative comments on board’
  • ‘You aren’t flawed and you can better from this’ 
  • ‘It doesn’t change you. You are the same person you were before you were diagnosed’
  • ‘This is your life and you have a right to fight for it’ 
  • ‘You will make it to recovery’ 

 

 

 

 

 

 

 

 

 

 

Why I’m glad that I’m still alive

Why I’m glad that I’m still alive

2 years ago to this month, I was admitted to general hospital for a suicide attempt, nearly passed away, and when I was eventually deemed physically stable, was sent to a CAMHS psychiatric unit where I was sectioned and sent to a PICU (mental health intensive care). It was the single worst thing that had ever happened to me, and it was the result of years of struggling. Years of ‘less severe’ suicide attempts, self-harm, self-hatred, anxiety, and instability. Years of inadequate treatment and being turned away by people in my life.

The reason why I went so downhill at first when I went into PICU was because I had reached the point where I had wanted to die, and I was angry that not only was I still alive, but I was being locked up in what felt like hell. It was suffocating to have staff constantly on my back, watching my every move, restraining me to stop hurting myself. Suddenly all my rights as a ‘free’ human being were taken away and I felt stuck. All hope for a bright future promised by my A level grades vanished. I had had enough, big time. I felt done.

I eventually turned a corner whilst inpatient. This was due to the right combination of medication, but also because I was given what felt like a second chance. I was given a lot of support to continue studying for my exams on a ‘casual’ level, and I received 4 university offers, 2 of which were unconditional. When I realised that I had an unconditional offer from the University of Nottingham (the only feasible option for me at that time), I felt immense relief. I felt hope that I could move forward with my life. I honestly feel like if I hadn’t had the prospect of university on the other side of my admission, I would probably still be in hospital now. My assessment changed from low-secure personality disorder treatment (12-36 months), to an acute adult ward step-down from PICU, in which I only stayed for 8 weeks.

It’s scary to look back and to realise that things could have turned out very differently. I could have died in August 2015. I could still be in hospital right now. But I’m not. And as difficult as the past two years have been, I feel so grateful to be alive. My life has changed so much for the better in the past two years, especially in the last year. I spent almost the entirety of my adolescent life feeling I was worthless, that everyone else was better for me, that I didn’t deserve happiness. Comments from people at school would send me into a meltdown. I cared immensely about what other people thought, because I was taught to believe that what other people said about me was a reflection of me, rather than a projection of themselves and their own insecurities.

I always achieved good grades at school. I worked hard and especially at A Level, I loved my subjects. English was always my favourite. I have always loved reading, and I’m not just saying that. I’ve found that often, books can be kinder than people. But, in my English lessons during sixth form, and in seminars in the autumn term of my first year at university, my lack of confidence kept me from being able to contribute. I could write, I could think, I could perceive. But I couldn’t talk. My English teacher tried so hard to convince me that it was alright, that I had no need to lack self-esteem, but it never worked because it didn’t come from me.

So, I’ve learnt to stand up for myself. Being in hospital and in intensive services taught me that. I didn’t have my parents or my friends or anyone on my side when I was arguing with staff on the ward. I had to voice my own opinions, tell them what was wrong, tell them how to help me. In assessments and meetings, I had to often fend my own corner. I couldn’t afford to be quiet anymore. In order to get anything from mental health services, usually you have to push really hard for it.

Other girls walked all over me at school. I was slut-shamed, isolated, and essentially shunned for things that hadn’t happened. I was casually sexually assaulted by boys. Constant comments about my breasts. Hands up my skirt. Told that I was a slag, that I was easy, that my body was ‘fit’, as if that’s really a compliment coming from a horny little boy. People spread rumours about me, stopped talking about me. I once went to meet one of my best friends to walk to school with her, and when I came up to her she straight up ignored me and carried on walking to meet other people. Friends would laugh in the changing rooms and joke ‘It looks like you’ve been self-harming. I heard ‘friends’ saying horrible things about people they thought were ‘crazy’, about students who had come out as LGBTQ, about ‘sluts’ in the year. And when I got really unwell, people didn’t want anything to do with it. Oh, Rosie is attention seeking. Rosie is so dramatic. Rosie is copying behaviours. Rosie probably just wants one of the guys to ask what’s wrong. Why is it always about Rosie? Why is she doing this all the time?

Not anymore. I’m done with being pushed around and belittled, and I’m so much happier for it.

I’ve learnt what I should have learnt when I was 12 years old: the only person who can make you feel shit about yourself is you. People say and do nasty things and it’s painful, but it’s up to you to block off the suffering. It’s not worth giving your time or energy to people who make you feel like a burden. People who are struggling with their own sexuality or relationship troubles so take it out on you. People who are jealous. People who don’t understand how someone their age, just like them, can become mentally unwell. I’m not bothered anymore. Only the people closest to me could ever break my heart like that again, and the reason why they are so close, is because I know that they never won’t. And if I hadn’t of gone through this horrible journey, I would never have experienced this freedom from the snare of toxic people.

So, here it is. Reasons why I, Rosie Wildman, am glad that I have spent the last two years alive, when I could have completed a suicide attempt.

  1. I would never have met my best friend, Victoria. I can’t even imagine what life would be like without her. With some people you just click, and she’s one of them. She has taught me more about life than most other people I know put together, she’s brave, and she’s strong. She also doesn’t put up with any of my shit. She tells me how it is. She reminds me of how far I’ve become. That I’m different from the people I compare myself to. That you can live a relatively happy life with borderline personality disorder.
  2. I would never have seen my family grow. My sisters are now 16 and 17 and they are intelligent and beautiful young women. I was never close to my sisters when I was a bit younger, and I’m happy to say that I now am. Over time, things patched over and I can always rely on a hug and a chat with Joni or Poppy. I have also been able to see my brother go to big school (secondary school) and continue showing everyone what a kind little soul he is, even if he gets angry at me sometimes.
  3. I’ve read so many books, especially over the last year. When I was feeling really depressed I couldn’t concentrate properly on the words, but thankfully I have been speeding through books at the moment and I love it. It’s such a great distraction when I’m feeling shit, and it maintains my good mood when I’m feeling happy. It makes me feel pretty sweet that there will always be another good book for me to sink my teeth into. All these stories change me slightly. They give you insight into different worlds, different literary dimensions.
  4. I would never have been so self-confident in myself and my appearance. I am not just a pair of boobs. I have soft shoulders. I have sparkly eyes. My whole face lights up when I smile. I have dimples in both of my cheeks. I can run pretty quickly and I dance like nobody’s watching (usually in a club, embarrassing myself) and my brain is brilliant. I’m aware of my imperfections, but they don’t define me. I’m not some heinous beast. I’m just me. I’m excited and friendly and energetic, when I’m not struggling. I can make other people happy. When I glow, it feels like all the other people around me are glowing.
  5. I would have never have become so independent. Although I am probably less independent than most people at my university, as my family live pretty near to the campus and my Dad actually works there, it’s been a massive step from being on 1:1 in psychiatric hospital. I’m not scared to be in an empty house anymore, I can go to sleep without worrying that I’m going to be attacked, I can make myself meals. I look after my surroundings and I look after myself.
  6. Finally, I would never have connected with so many people who have been through the horrible and draining ordeals of mental illness that I’ve been through. The friends I had on the inpatient ward: late night conversations sat at our doorways, sneaking into each other’s rooms, playing XBOX in the quiet room with the lights off so we could pretend we were somewhere else, group leave. And, the friends I’ve made through the recovery network. My beautiful Lauren. Rhianne. Cora. Emma. Megan. Shauna. Sophie.

 

Life isn’t perfect and it would be pretty futile to claim that I’m ‘recovered’ by any stretch of the imagination. But I am moving forward and I have come a long way. I am not a victim of mental illness anymore. I am a fighter and I’ll continue to fight for as long as I’m still here. This chance to live has shown me why the world is so beautiful and it has made me fall in love with it all over again. I’ve grown, and I’m still growing.

 

Oh shit, I don’t think my brain is functioning properly

Oh shit, I don’t think my brain is functioning properly

 

Today is just one of those days. One of those days where getting out of bed feels like an overwhelming effort. One of those days where my thoughts are lagging, all excitement gone. One of those days where it feels like I’m always going to be like this.

It isn’t an unsafe day. In fact, the days when I am at the highest risk of serious self-harm or suicidal ideation are days when I’m manic for longer than a few hours, or when my mood is swinging rapidly. Today is just a shit day with nothing to show for. If I can’t find the energy to drag my sorry butt out of bed, I certainly don’t have the energy to do much else, including hurt myself.

Contrary to common belief, self-harm takes a lot of bravery. It hurts and despite how crap I might be feeling, it does scare me. You go too far. You begin to worry about the pain. Doubts kick in. Everything crumbles. I’m not brave today. I’m weak and I’m vulnerable.

On days like this, all I want to do is be asleep. It’s the easiest thing. When I’m asleep, I’m safe. I’m out of it, in a little dream world where things can be scary, but not in the way that I know with my mental illness. I can’t remember ever having a dream in which I self-harmed or killed myself.

Today, my head hurts. It’s pounding. Everything is too loud. I think about how loud it is, and I start spacing out. Am I a real person? Is anyone else real? Was my brain always going to be like this, or did something happen? I am slipping.

Today, my stomach is sinking. I have no hope for the future. I can’t even see tomorrow ahead of me. It’s just a black hole. I have nothing in the future. I am stuck in the present, with these thoughts lagging around me. It makes it hard to breathe.

Today, everything is grating on my nerves. A harsh word, an accident, and everything is fizzing. I have this dull anger which is directed at nobody apart from myself. It feels like I’m trying to scream, but I can’t, so it just comes out as a whisper.

These days don’t last forever. For all I know, I could feel better in a few hours. The sinking feeling is temporary, despite how permanent it feels in the moment. I am not drowning. I can breathe and I can live, despite what my brain is telling me.

Writing these feelings doesn’t make me feel significantly happier but breaking out from the nothingness of this cage my brain has made does evoke a small sense of release. This might be a bad day, but I am not a bad person and I will continue to fight as hard as I can to stop my illness from doing bad things to me.

emotions running high 3

A personal update

A personal update

It feels strange that I’ve been away from university study for over two months now, with my final exam having finished at the end of May. Not only this, but I’ve been three months out of a hospital admission under section, over three months since my last general hospital requiring incident, and weeks free of self-harm. Sounds pretty lame, but I’m kind of bossing life at the moment. It’s going good. So here’s what’s been going on with me.

Preparation for next year at university

As well as readings lots of books at my own leisure, I have been cracking on with some Class A Amazing books (as well as some less thrilling ones) for some of my modules next year. My favourites so far have been Moll Flanders by Daniel Defoe (for my Romanticism module) and The Power by Naomi Alderman, which is for my Spring Popular Culture module. Because I found myself last year having to skim read chunky texts in short periods of time, I’ve decided to read all of the core texts before the term starts, to save myself some stress.

In preparation for going back to university in September, I have also been re-allocated a mental health advisor. I’m meeting up with her before term starts and hopefully the service will be able to help me more this year.

Looking after my own mental health

Although incidents wise my mental health has been pretty amazing, that doesn’t mean that I haven’t been struggling. My mood at the moment seems to be alright most at the time (with some catastrophic declines), but anxiety is the real Bummer. This is something that has happened every summer for the past few years where I sort of isolate myself and thus feel very strange and anxious about getting out and about and doing things, but I’ve been trying really hard and also accepting that some days aren’t going to be as great as others.

Changing up my look

My best friend dyed my hair for me way back in March and there was definitely still a red/pink tint, but this week it’s been topped up and I’m feeling FABULOUS. My hair is naturally a bit of a dull brown so I like adding a bit of cherry pink colour to it to make it more exciting. I don’t really bother with make up during the holidays (probably because my anxiety means I don’t see people very often. Also, effort) so having my hair dyed kind of tricks me into thinking that I’m making an ‘effort’ (which is important when you’re bed-ridden depressed) all the time. Woo.

Planning for my student house

In three weeks I’m moving into my new student house with my course mates. It’s especially exciting because I’ve spent the last year in catered accommodation (would not recommend), but obviously this year I’ll be cooking all my own food and sort of looking after myself a little bit more.

I am a little bit worried because there are going to be times when I’m in the house on my own (only recently have I been actually coping being in my own house at home on my own), and also on the other hand, times when I’m going to have to interact with my friends even when I’m not feeling up to it. However, this nervousness is largely overridden by my excitement at the prospect of decorating my new room and turning it into a self-care and comfort (and studying, meh) den.

Watching Celebrity Big Brother

OK so Big Brother is utter trash, but it gives me something to add to my routine and I’m not going to lie, I get pretty into it. I like all that Psychology and analysis shit, but at the heart of it, it’s just easy TV with (some) likeable personalities. Indulging myself in a bit of reality TV is a really good distraction, despite how heated up I get into housemate arguments and controversies. It also gives me some time to chill out and watch television with my Mum, which is really nice.

Travelling to Birmingham

Like I said, my house-binding anxiety has been pretty catastrophic at the moment, but I have managed (twice!) to get down to Birmingham to see my best friend, Victoria, and her super cute puppy, Harlyn. This is a big deal because I find train journeys really draining and stressful.

I’ve just got back from Birmingham today and I’ve had a great week. It started off a bit stressful – I decided to walk from the train station to Tori’s house with all my luggage (in a strange, unknown area), because I was too scared to call a taxi. It only took me just over an hour but I strained my back and I was convinced I was lost right up until I got into her house.

Typical of me, the trip consisted of some tears, some annoying sarcastic banter on my part, occasional strops, non-stop tweeting, a multitude of selfies, make overs, minor arguments and plenty of dog cuddles.

 

 

To my beautiful friend Sophie

To my beautiful friend Sophie

I was just 15 when I experienced my first mental health crisis. Despite the fact that I had been struggling with bouts of anxiety and self-harming behaviours for years leading up to that, the summer of 2013 was the first time in my life where I thought it would never get better, and I therefore reasoned that it would be better, and less painful, to end it now.

It was around this time that I joined the Instagram recovery network. For those of you who don’t know, it’s a whole little sub-section of the Instagram world in which (mostly) young people struggling with mental illness, create a sort of update diary on how they are and what’s happening in terms of their wellbeing. It can be very comforting to have other people messaging, supported, and relating to you.

The recovery network was toxic to me for numerous reasons. I subconsciously picked things up by reading them, I got upset when I read that my friends, the people who I had grown to know and love, were in a shitty place themselves. It did trigger me at times, but in those years when my mental health was neglected not only by mental health services but by basically everyone around me, it was solace. It was a private place where I could open up and let it all out.

Sophie Payne was one of the first people who I became friends with on the Instagram recovery network. We then went on to have each other as friends on other social media sites. She texted me when she was upset. She gave me advice about inpatient life and the general struggles of having BPD. I read her poems for her and sometimes gave her feedback (which was always, always positive. She was super talented). She was beautiful, brave, extremely talented, and above all, she was kind. She was kind to everyone who knew her.

Sophie was let down by mental health services. She had been inpatient many times and had sometimes been discharged before she was safe. In her last admission, she was waiting for a personality disorder unit bed (she was excited and hopeful to finally be able to recover properly), when she sadly passed away. In the unit that she was in, Queen Mary’s Roehampton, other people had died on the ward since 2010. It’s negligence. This could have been prevented.

Sophie was passionate and always voiced her opinions on problems with mental health services. Part of her really wanted to get better, and she wanted to help other people. She was really bright. She was insightful. When I was diagnosed with borderline personality disorder, she talked to me about it. She helped me understand.

It’s such a shock to lose a friend like this. When someone you know is sent back to inpatient, it’s distressing to know they are in a crisis, but you feel comfort. You feel like in the unit, your friend or family member will be kept safe. That they will be looked after. That they will be able to come out of the process much happier and healthier. You expect them back. Nobody should be able to take their own life inside the walls of a psychiatric unit. This is supposed to be the one place where psychiatric patients are indefinitely safe. This is the second time year that I’ve sadly been proven wrong.

Sophie Payne will remain to me always as a beacon of kindness and immense bravery. She fought (and won) many battles, and was always there to help support her friends. She was a fundamental part of the recovery community and someone who will be missed by all of us who were lucky enough to know her. You gave me hope Soph, and I’m so sorry the world couldn’t give you more.

Love always,

Rosie x

SAMARITANS UK 24/7 LINE – 116 123

 

 

Admission to a CAMHS psychiatric hospital: Transferral to PICU

Admission to a CAMHS psychiatric hospital: Transferral to PICU

TRIGGER WARNING – this blog post may be upsetting to those who are triggered by discussion of inpatient services, restraints and self-harm. 

Thursday

After two weeks of being on an open unit, I have now been transferred, which I am very upset about. Despite the fact that I’ve been doing alright over the last few days, a Nurse took me into the Low Stimulus Area and told me that I was about to be moved to a PICU, which obviously made me very angry and upset. I had to stay in the LSA and wasn’t allowed to say goodbye to anyone before they took me out the back doors to a van. It’s made me really sad because I have actually been making small progress and I didn’t want staff touching my belongings.

On the way to the new unit I did some word puzzles with a Nurse from the open unit, but once we were at the PICU she had to leave me there and I was escorted into a meeting, which was horrendous. I ended up being restrained onto the ward, having my physical observations checked when I was calmed down, and then being taken into a ‘Quiet Room’. Everything has escalated so quickly and this is a horrible place.

Friday

Possibly the only good thing about this unit is that the beds are comfy – I didn’t want to get up this morning. It’s ridiculous – I’m allowed absolutely nothing in my room, so I had to go to the Nurse’s station and ask for a toothbrush and toothpaste (what the hell would I do with that) and have someone pick out an outfit, and then give my smelly pyjamas back in. It’s ridiculous. 

My hair is greasy as hell and I probably really smell but I have no energy to get in the shower and there’s no time in the morning, plus I really value my time in my bedroom. I’m becoming really anxious about the onset of my period and being on 1:1, but at least here I’m on line of sight for the toilet, rather than someone being fully there. 

The staff here are really firm, there is barely any furniture and all the walls are blank. The manager is especially strict, she came and lectured me about the need to cooperate with staff. I really don’t like it here and I want to convince my tribunal that a different unit might be better for me. 

The physical health lady came back and examined my bruised head and basically said that I need to go to hospital because there’s too much fluid on my head. I was taken to minor injuries first, but then we were sent to A and E where I had a CT scan. My eyes are really blurry and everything hurts.

Saturday

Today has been a tricky one. I woke up early to get in the shower, which was awkward because I got naked into the shower, only to realise that it wasn’t working, so I had to tell my 1:1 (fully naked) that the shower wasn’t working, so then had to put my clothes on, and walk down the corridor to have a shower in a spare bedroom. It was worth it because now I don’t feel so disgusting and my hair is no longer greasy as hell.

I had an incident after breakfast so I was taken back into my room for a bit. My face is actually looking slightly better this morning, although I have been getting some blurriness and some double vision. 

They let me have my colouring books and pens for a bit but I ended up having a massive lapse because my 1:1 left me alone in the bathroom. I’m fighting so hard but the opportunities are too much to resist, so I’m angry I guess, but also happy. I then demanded to talk to Mum, smashed my head in the phone booth, was taken out of the booth to ‘calm down’, before being finally allowed to talk to Mum and tell her how shit everything is here. This place is making me ill – the level of support is just stupid. I feel like I am absolutely losing it.

I also had no lunch and no dinner today as I didn’t even see the menu, so nothing was given to me. I then asked if I could call my Mum (to complain about not being fed) and they were like ‘no phone calls at meal times. You can’t rely on your Mum all the time’. 

Mum and Dad came to see me this evening and they were not very happy about my treatment, and were adamant to see a Nurse. One came and basically told them that I need to cooperate and communicate more with staff, which I am going to try really hard to do. 

Sunday

My head is BANGING. From the top of my hairline to the middle of my skull, it feels like it’s being compressed by a heavy weight. I don’t know. At least its numbing everything else. 

I’ve been pacing up and down all morning and I’m quite scared because when I saw my reflection in the big bathroom mirror I looked pretty vile. 

Some patients have been playing JustDance on the Wii, but others were playing basketball IN THE LIVING ROOM which was really quite irritating because the constant banging kept jolting me. Eventually everyone got so worked up that two patients broke down the door to the seclusion and office corridor, and had to be restrained back. 

I’m really tired and my head really hurts.

Monday

I went down to Education this morning and it was actually alright. The teacher dude said he was going to get in contact with school and get them to tell me what extra work I can be doing. It’s going to be hard continuing my A levels because we only have 2 hours of Education per day. One teacher was moaning that he was being made redundant because they needed a qualified maths teacher. 

I refused to go to Community Meaning because I was really upset and everyone was shouting really loudly. However, in the afternoon I went to Occupational Therapy group. 

I haven’t cooperated very well today and I’ve had two major incidents which involved being fully restrained. Another patient was dragged to seclusion with about 10 staff, and one patient threatened to beat up another because there was an argument about a missing stress ball. 

Tuesday

I hate every fucking thing about this stupid place. I want to die and really do not give a shit anymore. I absolutely do not care about myself and the only thing that is making me slightly rational, is the thought of my Mum. Why is this place like a prison? 

Staff aren’t even nice most of the time. I don’t need to be here. I don’t want any of these people laying their hands on me.

I stayed in bed for ages this morning because a man was on my obs and it was really awkward. I find it so creepy that they just watch me sleeping. I eventually got up to go to Cooking Group, where I was faced with the challenge of cutting up a potato with a plastic knife. I had an incident and had to be taken back onto the ward.

Mum and Dad came for ward round, but I wasn’t allowed to attend which makes no sense. So I went back to the lounge and kept going to the toilet because even on 1:1 if you bang your head quickly whilst the toilet is flushing then they won’t notice because of the noise. Plus, my 1:1s aren’t very reliable and sometimes just let me go to the toilet on my own, forgetting that they are meant to watch me. 

I’m really unhappy because it’s difficult for me to write to people now because all my contacts have to be ‘approved’ by the social worker. I WANT MY MAIL FOR FUCKS SAKE. 

Other patients are shouting and hurling chairs around, finding bits of glass and swearing. 

I don’t like who is on my 1:1 so I’m going to go to sleep now. 

Wednesday

I am so annoyed. My period started last night so I asked a Nurse discreetly for a sanitary towel, and she started off on some ‘risk assessment’ bullshit. WHAT THE HELL. After contacting the on-call Doctor (for fucks sake), she eventually gave me one thin towel. MATE. What an absolute cow.

I woke up again this morning and could barely see because my eyes had puffed up so much. However, I still went down to Education and then was taken down for a gym assessment. This involved a 20 minute interval session on the watt bike, crunches, sit ups, planks, squats and activities involving the exercise ball. It was tiring and pretty difficult to do sports activities without a bra on (risk assessment, again). 

I was asked to sign my care plan, but it was a load of bullshit and had no input or consideration for what I had said, so I refused. My head is hurting so much that I’m actually crying from the pain. 

I saw Mum this evening and she passed on messages from my friends, and asked if I wanted to write to them.She also cried because she said that the best day of her life was the day I was born. 

Everything kicked off at dinner time, so the rest of us had to go and sit in the middle lounge with our dinners. We were in there for so long that some of the patients fell asleep. 

Also, I’ve finally spoken to some of the patients properly. Everyone is shocked that I am 17 because they presumed that I was 13 or 14. They seem really nice, but everyone here is really unwell. 

This documents my first week on a psychiatric intensive care unit. This again was a very difficult time, and thankfully it all goes up from here. I hope you found this article interesting and insightful.