I usually fiercely deny that I am a perfectionist about anything, because my self-expectations are often much lower than people assume, however I’ve recently realised how much pressure I was putting on myself to have the perfect recovery.
‘Recovery’ is a pretty contentious term, and I suppose one that I hadn’t given sufficient thought to. I suspect it’s something that each person will have their own definition of, from a life totally free of symptoms, to something more akin to a life that allows a satisfactory level of function for that person. As for what I thought, and perhaps what I now think, well, that’s the purpose of this blog post.
When I completed my time at a therapeutic community (TC) I was very worried about my ability to keep on making the level of progress I had made over the preceding twelve months. I was scared that without the high level of support a TC provides that I wouldn’t be able to cope with difficult emotions without using self-harm or an eating disorder to manage. I also believed that if I slipped at any way at all I wouldn’t be able to get back up. However, as I’ve discussed in previous blog posts , having meaningful occupations to engage with was central to my continued recovery and my progress actually continued quite quickly to a point where I felt I was ‘recovered’. It had been months since I could have been diagnosed with Borderline Personality Disorder (BPD), and while I still had some ‘symptoms’ (I had problems with dissociation and a poor sleep pattern) I was managing a very different life and one I was very happy with – in fact I felt I’d achieved the oft quoted ‘life worth living’ that Dialectical Behavioural Therapy aims to facilitate. I also felt very sure that that could be maintained with a life full of occupations that fulfilled and empowered me, as well as providing challenge, fun and restoration.
When I commenced my training to become an occupational therapist just over two years ago I know I felt I had something to prove. While my university have never been anything other than supportive and accommodating, I had a huge internal motivation to complete my course without any adjustments or help. I felt I needed to be perfect, not in terms of academic achievements, but in terms of health. During my second year I realised I wasn’t superhuman and had to accept some support to allow me to complete my placements in a way that allowed for a continuing poor sleep pattern and to attend ongoing therapy, but still I was determined that so long as all my assignments were completed without extensions then I was still doing ‘OK’. Did I still feel ‘recovered’ at this time. Yes, I think so.
In the Autumn third year began. After a long summer and my time in Moldova I had changed quite a lot and I initially struggled to adjust back to university life. But soon I was enjoying the work and the opportunity to have much more autonomy and independence in my studies, rather than completing the heavily structured modules we had in the first two years. And then I crashed. My mood dipped and I found it very difficult to engage in any of the occupations that kept me healthy and functioning. Apparent competence meant that I put on a reasonable ‘show’ of being ok to those around me, but I wasn’t. I ended up taking a few weeks off university and am now just returning to my studies. I now will be breaking my own ‘no extensions’ rule, and surprisingly it feels OK. This happened because I began to understand that I didn’t have to have a perfect recovery. I had felt that my history of BPD meant I had to prove I was 100% ‘fixed’ (this was an entirely internal feeling and not imposed by anyone else) but with the support (and most importantly acceptance) received from university tutors I suddenly realised that it was ‘OK’ to ‘not be OK’, and in doing so I began to get back towards feeling recovered.
So, for me, what is recovery? I seem to have a definition that doesn’t relate to being free of symptoms (for me some symptoms are acceptable – poor sleep or trauma-related problems, while eating-disordered behaviour, persistent low mood or self-harm would not be), but rather one that involves the level to which I can participate in the occupations I wish to. My ‘norm’ is being tired and having variable emotions related to past experiences, but so long as I can motivate myself to row, attend university and complete necessary work, look after my flat and my own self-care then I feel things are fine. When I can’t manage those things I don’t feel recovered.
I suppose this understanding is unsurprising from someone who studies the value of occupation in improving health but I’m not sure I’d been aware of how much I used occupation as a marker of health before. I had previously believed I needed to have a perfect recovery, but now understand it’s OK if it’s not always a straight path. I used to feel terrified of ‘losing’ valued occupations through low mood, lack of enjoyment or motivation but now realise that my ‘occupational health’ may dip and it can also be restored.