In my last post, I was writing while in the midst of a highly dangerous BPD trigger episode that took me fearfully close to attempting suicide again. Before I go any further, I should make it clear that I am no expert in mental illness except when it comes to describing my own experience of it. There may be times when I use terminology that feels absolutely right in doing so, but which those who are experts may well apply more knowledgably. I’m glad to say that I’m feeling a lot better since then, although I’m still angry that I didn’t get the care I needed, and indeed am still not getting. I did, however, manage to get one session in with my psychotherapist, and as predicted she helped me to identify the trigger for this severe episode.
A few weeks before the uncontrollable tearfulness and panic attacks that signal an episode began, I had been out to dinner with a relative. During the course of the evening, I heard for the first time about an incident of utterly savage abuse that had occurred within our family. I don’t feel comfortable going into any further detail about it here, but I mention it only to illustrate how in my case, childhood abuse can directly contribute to and exacerbate mental illness. At the dinner, when I was having this conversation, I reacted by doing little more than gritting my teeth hard for a moment and then saying, “Well that doesn’t fucking surprise me.” I didn’t really think more about it at all over the days and weeks that followed. But I did start to become withdrawn. I found the commute to work extremely hard. I felt massively unsafe and had to take some time off. I then started finding it difficult to take a simple walk to the shops to get food for myself, and this quickly became worse to the point where I couldn’t even bear to walk down to the kitchen to cook for fear of being around other people. I knew that I had entered a big danger zone, so I started to practice every single coping mechanism I knew, and I revisited every resource I had that had helped me in the past. And it worked, to a point. I could feel my mood start to lift and I felt the peaceful elation that comes with knowing that I had pulled through again. But something was different this time. Each time I felt myself coming up, a small incident would occur that triggered me afresh. Martial arts training, usually invaluable in helping me manage my moods, became a non-option. An online article about assault had me burying myself under the covers in floods of tears. A misogynistic comment about violence against women from an ignorant colleague at work was what sent me home on the day I came close to ending things. It wasn’t until I saw my therapist that I connected the dots and really addressed what I had been told at dinner that night. Suddenly everything made sense – no wonder my coping techniques hadn’t been working – my mind was trying to comprehend how someone whose job it was to protect me and care for me could do something so chilling and barbaric. And no wonder I felt so bad when I wasn’t even consciously acknowledging the struggle I was going through!
There is a continual debate about the causes of mental illness, mostly centering on whether it’s down to nature or nurture. There are some who will rightfully express indignance at the myth that mental illness can be resolved solely through talking therapy, because that is simply not true. But to deny that childhood abuse may contribute to or even cause mental illness is also incorrect, and presents an incomplete picture. Psychotherapy has most definitely helped me manage both my conditions (bipolar disorder type II and borderline personality disorder), to the point where the length of my episodes has shortened drastically through ever-increasing knowledge of how my illness manifests in my life.
So is it nature or is it nurture? I say it can be both – the spectrum of mental illness, in terms of specific diagnoses, as well as intensity and combination of symptoms, varies as widely as the individuals who experience it. This debate will continue to fascinate me, as does the research unfolding in the science of epigenetics, which challenges our assumption that what makes us who we are is a result of either nature or nurture. Instead, we are now challenged to think about how nurture affects nature. The video below has the simplest explanation of epigenetics that I could understand, although a doctor colleague of mine says that the research has moved on drastically from work with mice. Enjoy.