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Mental Health

Operating Instructions

How your loved ones can be your safety net

Daphnée

"Blips and Dips in the Recovery Journey" issue of Visions Journal, 2019, 15 (2), pp. 11-13

Stock image: Woman speaking to a counselor

I crush the instant ice pack as hard as I can, then press the cold pack against my eyes and forehead. My heart rate drops, my anxiety decreasing at a fast speed. I need to calm down, and feeling as if my face is submerged in cold water helps me stay grounded.

I carry ice packs in my backpack at the suggestion of my therapist, so I can self-soothe anywhere I go. This is particularly helpful when I find myself hyperventilating right before an exam. As a student, I am familiar with the stressors that come with having to write midterms and academic papers. I’ve experienced mental health challenges since early adolescence, and transitioning to adulthood has exacerbated my symptoms.

My recovery journey

Self-soothing is a skill I learned through dialectical behaviour therapy (DBT). I completed the 15-month program eight months ago. After seven years of active symptoms, a dozen medications, three hospitalizations and a course of electroconvulsive therapy, I figured that I had exhausted all my other options.

The main goal of DBT is to build a life worth living, and I feel grateful I’ve been well for some time now, because recovery is a privilege denied to many. Part of me is terrified of getting sick again and believes that I will never be able to survive another depressive or hypomanic episode. Then I wonder, “What if the past few years have just been a test run, and there are much bigger challenges ahead?”

One of the biggest challenges for me in my recovery process has been learning how to recognize what “illness” looks like and what “wellness” or “recovery” looks like. Illness and wellness look different for different people. I’ve learned what each one looks like for me, and I’ve learned that there are some things that I just need to do in order to stay well. For me, this includes eating well and taking medication.

For me, wellness is being able to walk along the beach in the evening, enjoying the beautiful pink and orange ribbons in the sky. On those summer days, I wear cute polka dot dresses instead of wearing sweatpants and fleece hoodies—practically my uniform when I’m not feeling well—and spending most of my days in bed. I work at BC Children’s Hospital and I need to stay healthy, so my eating practices have changed—I’ve started to cook my own meals instead of ordering pizza late at night.

When I wake up in the morning now, my bed sheets are not soaked in sweat from my nightmares, which is a symptom of post-traumatic stress. I still experience intrusive thoughts and mood swings, but I can cope with them better than I did before. It took me eight years to accept the fact that psychiatric medications reduce my symptoms. After stopping my medication abruptly and experiencing withdrawal effects, I learned my lesson and gave up my resistance. Nowadays, I take my medications as prescribed.

The recovery process isn’t all about positive experience, though. Recovery also looks like grief. When I sit in my therapist’s office and begin to speak, my raw emotions spilling out, I confess how angry I am, and I contemplate the number of days I’ve lost to an illness I never chose to have. I whine at the unfairness of it all and curse my friends with their seemingly perfect lives. Underneath the anger, there is a profound sadness.

Mindfulness, or accepting reality as it is, has been a key part of my recovery. When my thoughts spin out of control with worry about the future or I find myself judging others, I try to simply notice these thoughts and then let them go. I imagine them as giant soap bubbles that I release and let float upwards to burst in the air.

Creating a relapse prevention plan

For me, having a relapse prevention plan has been a useful tool. My relapse prevention plan is a document that I wrote exclusively for myself. It includes my emergency contacts’ information, a list of coping skills that have worked for me in the past and a series of concrete steps that I should take when I experience a crisis. I’ve brainstormed calming activities I can engage in when I’m distressed and I’ve listed positive affirmations I can tell myself.

Here’s the thing, though: even the best plans are not bulletproof because nothing in life really is. You can have titles in boldface and subheadings in italics, a colour-coded cheat sheet with self-care activities, a list of early warning signs and late warning signs, but all that information can become useless when you fall ill. There is no user manual for life, and sometimes a relapse is inevitable. Sometimes, despite my best efforts, I miss my warning signs or get triggered unexpectedly.

Setting up a safety net

That’s when other human beings need to step in. At some point, I have no other choice but to rely on my support system or, as I lovingly refer to them, my safety net. The concept of a safety net was introduced to me by my DBT therapist, when I told her that having a relapse prevention plan and “coping ahead” is very different from actually being able to act on the plan when things are going wrong. I have a tendency to pretend that everything is fine when it’s not; my biggest struggles are recognizing when I need to put a plan into action and then actually doing it.

I know my symptoms by heart. I know myself so well that I can predict which self-destructive behaviours I will engage in when I become overwhelmed at school, find myself in conflict with my boyfriend or have difficulty getting up in the morning. When I experience intense painful emotions, I will do whatever it takes to avoid them, even if it means taking action in an unhealthy way.

On a logical level, I understand that to maximize my chances of wellness, I need to keep my stress level low, engage in daily self-care and not isolate myself. Yet when I lose my insight, having a safety net prevents me from falling through the cracks as my loved ones can intervene before things get worse. My therapist said that when I can’t count on my brain anymore, when I’m at home unable to get out of bed, I need someone to “come over and stand beside me while I put some clothes on.”

I call my loved ones my safety net because they are friends who also have lived experience, and they know me better than anyone else. I created and shared a document outlining instructions so they can better support me when I fall ill. I often feel like a burden to those around me, but I have found that giving guidelines to my peers lessens the guilt I feel. It brings relief to my loved ones because now they are more confident in their ability to help me during difficult times. It gives them concrete tools and protocols to follow and tells them exactly what my future self will need from them. For example, I have given them permission to contact my psychiatrist or call my parents in the case of an emergency.

My safety plan acts like a template, providing guidance. It has statements such as “If I tell you I’ve stopped taking my medications, this is a bad sign. Remind me that last time, I ended up in the hospital due to withdrawal symptoms. Call me out and say, ‘What would your wise mind tell you?’” And “If I start to obsess over academic papers, this is a really bad sign. Check in with me immediately. It means I am depressed and something is going on.” And “If I appear high and can’t stop talking, this is a dangerous sign. Gently assess whether I am having suicidal thoughts, and ask me if I can keep myself safe. If you suggest I might be hypomanic, I will most likely snap at you. Please forgive me.”

Giving up control and having faith in the future

So, I relinquish power and let others hold space for me until I can hold space for myself. When I’m sick at home or in the hospital, and my loved ones tell me that it will pass, I don’t believe them. But they hold my hand even when I resist, stick with me regardless and never let me go. And I try my best to do the same for them.

Even though it requires an incredible amount of trust and vulnerability, if there’s one thing that has helped me, it’s interdependence. It’s acknowledging that we can’t do everything on our own. The bonus is that when my friends are struggling, I am willing to do the very things for them that I can’t do for myself. In the end, it benefits everyone involved.

Ultimately, what motivates me to stay well is my desire to model recovery, to foster hope by sharing my story, and to help children and families as well as my peers navigate the mental health system. I want to give to others what I needed the most back then but never had, in the hopes that they will be able to access resources and get the help they desperately need and deserve.

Once, after a particular difficult setback, I felt hopeless, convinced that I would never get better. Despite her reassurances, my therapist could tell I was still upset, so she grabbed an erasable marker and turned to the whiteboard in her office. She drew a graph of my progress: a jagged line moving upwards to the right. Even though I had experienced a relapse, I was still heading in the right direction.

She stepped away from the board and considered her work. After a moment, she erased and re-drew the line of progress, softening the angles and adding elegant curves and loops, her marker like a plane in aerobatic flight.

She turned back to me and half-smiled.

“Just trust the process,” she said.

 
About the author

Daphnée studies English Literature and counselling psychology at the University of British Columbia. She works at BC Children’s Hospital, enjoys volunteering with inner-city kids and tries not to take life too seriously

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