Personality disorder an invalid "catch-all" label which damages women, says clinical psychologist

June 7, 2007
by Angela Hussain

Borderline personality disorder is an invalid "catch-all" label which can further damage women who have suffered abuse, a clinical psychologist has written in a new book.

In a far-reaching attack on the validity of the borderline personality disorder (BPD) diagnosis, Gillian Proctor criticises the "growing prevalence of labeling women with BPD"

Proctor, a clinical psychologist with North Bradford Primary Care Trust, argues that the BPD diagnosis, which she says has "no excepted cause", is often made on women who "fail to live up to their gender role because they express anger and aggression, which is unacceptable for women in this society."

Being diagnosed with BPD is a "deeply stigmatising" experience which can damage abused women, Proctor writes in a chapter of the book, Beyond Fear and Control - Working with Young People who Self-Harm.

In her chapter, published by psychminded.co.uk, Proctor cites research finding that 88 per cent of women diagnosed with BPD had experienced abuse, and 77 per cent sexual abuse.

Proctor argues it is often such experiences which lie behind self-injury, which can lead to a diagnosis of BPD.

Proctor, who helped set up a service providing medical treatment for self-harm patients in Bradford GP surgeries, concludes: "We need mental health services to see sexual abuse as an issue that affects the whole of society, and which needs a political and societal response. Diagnosing women with borderline personality disorder achieves none of this."

Read for yourself:
Gillian Proctor's chapter: Disordered Boundaries? A Critique of 'Borderline Personality Disorder' (pdf)

Beyond Fear and Control - Working with Young People who Self-Harm.

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The diagnosis saved me

Comment by: Fenella Lemonsky, expert by experience, the North London Hub, Mental Health Research Network (MHRN), Imperial College, London
Date: June 8, 2007

I have BPD and the diagnosis saved me. It meant I was able to go and get good help. Being under the care of Professor Anthony Bateman, a world expert on personality disorder meant I was able to move from illness to wellness, free myself from self harm, destructive behaviours and from being a damaged human being.I was able to grow and become a nice person whom I respected and others did too. Prior to this mainstream psychiatry rejected me as a manipulative untreatable patient. How wrong they were.

Professor Bateman's much respected evidence-based mentalization based treatment was an effective treatment that worked wonders on me. I no longer use crisis teams, or A&E. Nor am a "complete nightmare" embroiled in a land of despair. I am now working as an expert by experience, developing services for those with BPD.

Sadly however PD care (non forensic) is very patchy in the UK. It is a postcode lottery. In areas where there is no specialist service at all women are suffering as they cannot access specialist trauma and other proven therapies like dialectical behaviour therapy (DBT) - which Dr Janet Feigenbaum, among others in the UK has shown does work - and good back-up support.

I was at a recent MHRN conference and the Newham DBT project reported a 70% reduction in those who self-harmed who managed to reduce their destructive behaviour and hospital admissions,. This treatment that was developed by Marsha Linehan specifically for BPD has an evidence base.

MBT is now growing in popularity in terms of evidence and good clinical practice.

I am not sure how much time Dr Proctor has spent working in a PD specialist unit, but had I not had the Halliwick Unit in Haringey, London, I would have died from multiple overdosing.

I had a very unhappy and difficult as well as dysfunctional childhood. Until I reached the Halliwick Unit no one took me in with compassion, care, respect and understanding and empowered me to achieve better things.

I was encouraged to learn to trust and build healthier ways of coping with very difficult situations when emotionally I felt very unwell - ie dysregulated. The ups and downs were very painful and the hard work in the therapy (partial hospitalisation) was at times scary but I was working with a team of highly skilled and sensitive professionals who never once made me feel bad or mad, but respected my pain. The validation for me was a marker that enabled me to dig deep - work hard at dealing with the torment and then coming out the other side a much better Fenella.

I owe my life to Professor Bateman and his team. Which is why I now work with the North London Hub of the Mental Health Research Network and my local area which is growing in terms of PD specialist work (I live in Barnet, London)

Prof Bateman told me once there will always be professionals who attack the work of him and his PD specialist colleagues for various reasons. What is important, though, is to remember the excellent clinical outcomes, much improved functionality and the economic impact of his approach,

Support groups like Borderline UK provide a lifeline to people who otherwise have been let down badly by the NHS and have little support, as well as for those want more in the middle of the night in torment.

I personally would like to see more skilling up of professionals - including clinical psychologists - in how to work in an effective way with BPD and which is evidence based.

References:
* Psychotherapy for Borderline Personality Disorder: Mentalization based Treatment. Anthony Bateman and Peter Fonagy, Oxford University Press. 2004

* Bateman, A.W. & Fonagy, P. (1999) Effectiveness of partial hospitalisation in the treatment of borderline personality disorder: a randomised controlled trial. American Journal of Psychiatry. 156:1563-1569.

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BPD has been used to invalidate testimonies of childhood abuse

Comment by: Louise Pembroke, mental health activist, London
Date: June 9, 2007

My medical student friend's lectures on self-harm consisted of being told that most people who self-harm have BPD, do it because their boyfriend has left them, and are generally horrible people with no hope. Little wonder why women fear this gender-biased diagnosis because those who get saddled with it are subject to considerable discrimination.

Judith Herman, professor of clinical psychiatry at Harvard University Medical School, says BPD is little more than a "sophisticated insult", and some service users view it as one of the worst diagnoses to receive because it feels like total invalidation.

There is no clear evidence to support a specific clinical intervention for self-harm - pharmacological or psychological - though you wouldn’t think this given the way small dialectical behaviour therapy trials are claimed as 'evidence based'.

Some mental health nurses undertaking training in dialectical behaviour therapy [an alleged treatment of choice for people who self-harm - though I don't see people begging for it] have been told that less self-harm and taking better care of oneself does not constitute progress. The underlying theme here is total cessation of self-harm as the real measure of success. That’s all very well. But if the function of a person's self-harm is to avert suicide, cessation might not be their immediate goal.

Then there's the "regulation" of emotions. What is that? Psychological immodium?! I've yet to meet someone who actually possesses fully-regulated emotions.

BPD has also been used to invalidate testimonies of childhood abuse, with claims of exaggeration, of the seeking out of sexual or physical victimisation. A woman with a BPD label has little credibility by virtue of her diagnosis.

Services are generally dismissive of people labeled as such and can even withdraw services. There's a whole industry emerging around self-harm and it's this; self-harm = BPD = DBT. That's as reductionist as hearing voices = schizophrenia = antipsychotics. BPD and schizophrenia represent the very worst of psychiatric categorisation and treatment. The Campaign to Abolish the Schizophrenia Label is working to get schizophrenia dropped [Japan has dropped it]. I would love to see a campaign to get BPD dropped as a diagnostic category. As an activist who self-harms I'm angry at the overwhelming damage I've seen this label inflict on women's lives. It's nasty, we don't need it and I want to see people free of it.

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Self harm needs addressing with compassion

Comment by: Fenella Lemonsky, expert by experience, the North London Hub, Mental Health Research Network (MHRN), Imperial College, London
Date: June 10, 2007

Thank you Louise. In fact something I forgot to point out in my reply was that in the PD awareness training I run I point out that self harm does not equal BPD nor does BPD equal self harm. Self harm is only one aspect of BPD and it is very important that people don't label women with BPD just because they self harm.

I appreciate your comments -after all, when women and men have had very difficult invalidating experiences of the psychiatric system they will take alternative views. As I said - until I reached a specialist service I was invalidated. I am one of the fortunate few who got very good treatment.

I don't see reduction in self harm as the be-all-and-end-all - as that is just one aspect of someone's difficulties in managing their emotional distress. However, when I stopped self harming I was able to start to think about how may I start moving forwards in my life. Self harm does not equate failure either - I know plenty who self harm and have lots to offer and who do good work in the service user movement.

There's nothing wrong with dysregulation. But when it disrupts day-to-day functioning ongoing in a severe way then it needs addressing in a compassionate way. We all get highs and lows - that is part of life. However, the emotional impact of extreme mood swings on a daily basis is very distressing and I am grateful that I no longer have to experience that - and I don't take medication either!

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Whose "specialist services" are they?

Comment by: Louise Pembroke, mental health activist, London
Date: June 12, 2007

Some medical students are being taught that self-harm equals BPD.This means that many more people will not get compassionate assistance. Fenella, the problem is when people go to a psychiatrist and speak of self-harm, they can end up with an immediate BPD assessment, not a general assessment. The line of questioning is clearly going through 1-9 of the BPD diagnostic criteria. Medical schools is where we need to change hearts and minds. It is the only diagnostic category which marks out self-harm as part of the symptomotology, therefore self-harm becomes its hallmark.

It's a circular argument. I've seen people attract that diagnosis when only truly fitting one criteria - self-harm. This is clinical shoddiness at the very least.

I don't think we need any diagnostic labels. We can describe human distress in plain English. I describe myself as a voice-hearer - that's descriptive, not diagnostic and dictates nothing of an explanatory framework.

I think services should be needs-led, not diagnosis-led which they are, across the board, whatever your tag.

The sorts of things that people say they find helpful haven't changed much over the years. But, when comparing user/survivor wish lists to service wish lists, there isn't much overlap. I'm glad you have received decent support, but the overall reality is 'take this or xxxx off' and not everyone wants what is on offer. That's what really needs addressing. It's all very well service providers building up a 'specialist' service of what they want to offer and view as appropriate to a diagnostic category, but most of these specialist services have not developed out of service users' desires.

P.S. I find the BPD websites by "those who care about someone who has BPD" deeply depressing. If I was given that label and then did an internet search and looked at those sites I would feel suicidal. They regurgitate psychiatric criteria and stereotypes and seem like an exercise in character assassination.

The sites by and for people labeled as such again don't fill me with enthusiasm when compared to other single issue groups which seek to explore all explanations and strategies.

I would love to see a strong survivor movement of people labeled as BPD as we have seen within hearing voices and self-harm. I know the label and services will suit some people and that's fine by me, I'm not suggesting everyone should think my way, but I'm worried about all those for whom it does not.

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Appropriate treatment is liberating

Comment by: Marion Janner, director, Bright mental health charity
Date: June 12, 2007

The discussion between Fenella and Louise partly reflects treatment experiences. Louise’s tenacious, eloquent campaigning makes a vital contribution to national understanding of not just ineffective but punitive and damaging treatment by some mental health professionals and services. Parallel to this, Fenella energetically promotes the possibility and therapeutic value of appropriate treatment for people with BPD.

There are clearly social and medical penalties in ‘being diagnosed’. But there are, or can be, invaluable benefits. Despite being treated in a personality disorder (PD) unit, and because my psychiatrist/therapist didn’t label me, it took me months before I finally twigged that what had felt like an incoherent mess of symptoms and behaviours did add up to a PD.

I was really lucky that it happened in this order, as by then I was able to welcome the discovery, rather than reject it and the treatment that comes with the condition. It meant that I could now find out about what can cause borderline personality disorder, how my treatment (mentalisation-based therapy) works and also start to feel comfortable about identifying as someone with BPD. I can also build relationships with others with BPD, based on a certain amount of shared experience of not just the symptoms but also daily strategies for containing and then reducing these.

Both Louise and Fenella are powerful role models for me. Louise in challenging and reforming the system. And Fenella in harnessing the value in those services which are supportive, non-judgmental and healing. Fenella and I are exceptionally fortunate to be treated in a specialist service for people with BPD. I can’t respond to most of Louise’s points about DBT as I haven’t had this. But she’s certainly right that self-harming doesn’t equal BPD. BPD doesn’t equal DBT, any more than crying doesn’t equal depression and depression doesn’t equal CBT (cognitive behavioural therapy). Mentalisation-based therapy has a much lower profile than it should, as it is an evidence-based treatment whose effectiveness is perfectly illustrated by Fenella’s ability to choose to stop self-harming and to come off medication. (I’m not quite there, but am inspired by what’s possible.)

There’s an important feminist debate about whether the BPD diagnosis is just another way of pathologising women. My view is that the focus needs to be on why it is that women convert our distress into paradoxically self-destructive coping mechanisms. Recognising the causation, cluster of possible symptoms and above all being able to access appropriate treatment are the ‘rewards’ for the diagnosis. And appropriate treatment is liberating, freeing women up to get on with productive, trauma-free (or at least reduced) lives.

Intriguingly, there’s a recent report about transference-focused therapy for BPD. It seems to work for some people, but personally I’d rather spend my weekly therapy session talking about reducing the impact of my BPD on my work and life than plunging into endless exploration of what I think my therapist’s choice of tie means for our relationship.

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The 'unacceptable' costs of the BPD diagnosis

Comment by: Louise Pembroke, mental health activist, London
Date: June 12, 2007

Appropriate treatment? Well both of you refer to one service - one consultant whose work I am aware of. But, I'm sure you are aware that your experiences are not common. People deemed to be PD can often find themselves with little or no service, and with little choice over what they receive. It's only liberating if you want it and if you subscribe to that model, but what about those who don't?

Do the 'rewards' of the label outweigh the penalties? Not if you're being stitched in A&E with no anaesthetic.Not, if anything you say is viewed with suspicion because you're viewed as one of those manipulative 'borderlines'. We have to consider the unacceptable cost to others.

Just as I accept someone saying 'I have schizophrenia and need my Olanzepine and are happy with it', I can't ignore the far greater number of people who seek a different response, wish to find their own explanatory framework and strategies for living and not be sentenced to life on antipsychotics.

There is an important feminist debate here regarding the pathologising of women's distress, and self-harm can be understood socially, environmentally, culturally and politically. It can be understood in terms of life experience, gender expectations, and what are socially-acceptable expressions of distress. Men's self-harm is not pathologised in quite the same way as women's. BPD is inherently sexist just as hysteria was, just as being gay was pathologised, just as psychiatry remains inherently racist.

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Better be 'borderline' and offered talking therapy than 'bipolar' and offered pills.

Comment by: Fenella Lemonsky, expert by experience, the North London Hub, Mental Health Research Network (MHRN), Imperial College, London
Date: June 12, 2007

Thank you Marion and Louise. Yes Marion, we are both fortunate to be treated in a great unit. A good role model......I should say that I have periods where I take antidepressants due to experiencing chronic pain and how that affects me. So I am not medication free. I witness service users who are given frightening amounts of high medication doses for mood swings without any psychological approach and are judged on for self-harming in a very negative fashion.

The other point I need to make to Louise is actually the Halliwick service is unique as it is needs-led rather than professionals deciding everything. Many years ago there was a change of structure to the follow-up programme for service users after leaving the day unit. The new programme was criticised by service users for losing the individual sessions component. This was reinstated. Dr Bateman is always open to suggestions about what works or what doesn't, or where something has been misunderstood.

Diagnosis is more than a tick box. It is a very skilled piece of work. However, sadly, how many service users get an extensive interview with a skilled psychiatrist who is warm, kind and non judgmental and very experienced?

All service users appreciate being offered a choice of approaches, not a one-size-fits-all approach. I don't believe DBT, MBT, CBT etc etc is appropriate for everyone. I believe some may want to work creatively, some dynamically, some in groups, some in individual work. My issue is actually about lack of choice overall. If all those who have BPD as a diagnosis were treated better with decent care, compassion, warmth and respect (and with an engaging of two minds rather than patient versus doctor) in the way that I have been treated then that would be great.

Louise, I think an issue around self harm itself is that the physical healthcare risks are far too great to ignore. Yet how they are approached leaves much to be desired. Women in the mainstream attend more GP appointments than men. I agree wholeheartedly about discrimination in A&E and other units, and I myself made many formal complaints about how I was treated.

The difficulty is that, whatever you call BPD, the distress will manifest in many ways. I would sooner be called borderline and offered a talking therapy than bipolar and offered pills. I am very aware of the lack of good treatment and compassion to most. That is why I work very hard to shift organisational culture that is unhelpful. But heck, it is very hard and as women we have to fight for those less able and abused for the right to be treated as intelligent human beings ..... I would welcome the chance to work with you on the issue of a BPD survivor movement being developed.

This has been a very useful discussion.

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I can not support the validity of BPD

Comment by: Louise Pembroke, mental health activist, London
Date: June 15, 2007

A diagnosis [any] doesn't in itself help us make sense of our experiences nor teach us how to cope.

Making sense and coping occurs as a result of hope, belief in us by others, acceptance, trial and error, many people helping us along our way (friends, family, professionals, charity workers, even strangers), being creative, developing a passion in life, paid/unpaid work, learning. The list is endless.

For those with experience of trauma (in the widest sense of the word), post-traumatic stress might be a better tag, but I don't think this is about which label is better. I want us all to be able to define ourselves and most people don't choose a diagnosis. People are given their diagnosis with typically no negotiation. Now if you're happy with that, fine, but if you're not, then it's a sentence.

I just think we can do better.

Regarding a specific BPD campaign, I could only work towards questioning it in education and would support a CASL (Campaign To Abolish The Schizophrenia Label) type of campaign to get it dropped. I could not work towards supporting the validity of it.

I agree the physical healthcare risks cannot be ignored - that's why some of us have spent a lot of time working on those specific areas such as advocacy in A&E, support and training for healthcare staff, and harm-minimisation and self-management materials. Here, we have common ground.

Survivors/activists and professionals have differences and areas of common ground, and we can always work on the common ground and respect the differences.

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Five treatment choices? In psychiatry this is inconceivable

Comment by: Fenella Lemonsky, expert by experience, the North London Hub, Mental Health Research Network (MHRN), Imperial College, London
Date: June 17, 2007

Louise, you state "friends, family, professionals, charity workers, even strangers". I had no friends or family or professionals I could engage with at all as I had no one I could trust. All my relationships had broken down and I was extremely mistrustful. This is a common BPD scenario that many seem to lack understanding of (professionals, charity workers, family etc). This is why those with the diagnosis do better in specialist services as they are more geared up to sensitivity about social exclusion and isolation and family breakdown (although PD is not unique to family breakdown in mental health)

Many service users in the UK have carers, friends and families around them. Many of those with BPD don't as the relationships with some of their families have broken down for various reasons. One of the most common reasons is conflict and difficult relationships including physical, sexual or emotional abuse. This renders those with BPD so distrustful or fearful that learning to trust anyone again takes hard work and a long time.

Until I reached a specialist service I was so distrustful, had been abandoned and invalidated by not only professionals but by a Jewish charity who treated me as if I had no brain and I was treated inappropriately by well-meaning health professionals and family who had no clue.

This is why those with BPD do better in specialist services as they are geared up to sensitivity and have an in-depth knowledge around working with people who have had early difficult experiences and who find holding a relationship and engaging with anyone so painful and difficult.

Sadly, still in 2007 despite the good work of PD specialists nationally which help those in distress get back into healthier and happier times (The McLean Hospital study by Mary Zanarini MD et al in America over 10 years was very encouraging but had some flaws in it as no single approach was the "star" and it was contentious as it sent the wrong message to commissioners - this being that maybe people didn't need specialist help as they got better anyway.....to the latest paper in the American Journal of Psychiatry showing how useful good-structured CBT can help.........to the other studies showing that MBT helps people manage better and move on......) the rest of the psychiatric profession insists on burying its head in the sand and pretending it is not true and push pills.

So no wonder those given the diagnosis are so damn negative. I would be if all I was offered was some pills and a bit of therapy. However I had a good approach without pills. For me it was therapy, creative work, hope and encouragement to see the world as not such a bad place and not having medication to dull my difficult thoughts. Instead I was encouraged to think how I could manage my thoughts better.

I still have no idea how it is many psychiatrists on £100k a year of precious NHS money can be allowed to get away with how they don't hear what service users need and pretend they do hear......I went to see a gynaecologist and he offered me five choices of treatment. They were all explained all in depth. He said 'go away, take your time, ask questions, and phone me when you have decided or want a chat through things again'. How amazing and open minded. Yet in psychiatry this would be inconceivable. Many women need good therapy of their choice with a woman therapist. How many get it?
I in fact wanted a male therapist as the idea of a woman therapist being a mother figure when I had murderous thoughts towards my mother was inconceivable. This has been respected.

Post-traumatic stress is another contentious label. We need gender-sensitive services with choice - well informed choice from a wide range of sources.

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"Attention seeking" - no laughing matter

Comment from: Cat Perrill, service user and former mental health worker, Manchester
Date: June 18, 2007

As a voluntary sector worker, I once attended a steering group headed by the local mental health trust to discuss the "new and innovative" BPD service they were initiating. Within ten minutes I had been alienated by every single person in the room. I was laughed at when I tried to protest that service users were being referred to as "attention seeking" when discussing their "needs". It was openly discussed that "BPDs" were at the bottom of everyone's list of favourite service users, and jokes were made about the best way to pass someone onto a colleague. There was also the assumption made that this new "service" would negate the need for the (successful) self harm service currently being facilitated by my own agency - the premise being that self harmers would be referred to the BPD service anyway.

"Motivational interviewing" was put in the minutes to cover the time spent laughing about how to "get them off their backsides and do something for themselves for once"...
Need I go on? It's horrific that service providers would discuss people this way - instant dismissal of the person as an individual because they have three little letters in their notes. This was within a trust which, on the whole, is reasonably open-minded and "caring". For example, they offer a wide range of user-led services and complementary therapies, and (usually) work in very close partnership with Mind and Rethink.

While many people refuse to accept BPD as a diagnosis, others find it a relief and comfort to give a name to what they are experiencing. I would always advocate what the individual wanted, but while service providers laugh behind people's backs and put them at the bottom of their lists, what hope have we got for improvement?

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Every trust should run training days in PD awareness

Comment by: Fenella Lemonsky, expert by experience, the North London Hub, Mental Health Research Network (MHRN), Imperial College, London
Date: June 20, 2007

Thank you Cat. Sadly this is a common experience. However still very distressing for you to experience. This is why those service users who are fortunate enough to get access to specialist PD services may well fare better as the staff in the specialist service genuinely care and there is no dishonesty or bad feeling but a genuine commitment to helping people with BPD achieve a better standard of living in terms of quality of life.

It is important to remember that not all borderlines are extremely debilitated by illness - in fact many borderlines have a full life without ever entering the psychiatric system. BPD is treatable.

Those who mock it or have disregard are ignorant and need good clinical supervision and training. They should be getting this as otherwise they are at high risk of a SUI (serious untowards incident), but also fundamentally breaching their duty of care and human rights, under the Human Rights Act ,Article 8.3, whereby people have a right to dignity and respect.

It is those who have BPD where it affects functionality in some way who need good treatment and good attitude.
The key theme is education.

Every mental health trust should be running training days for all clinical staff in each sector in basic PD awareness led by PD specialists or staff skilled up in PD management and providing skilled supervision and support.

As for those who dispute diagnosis - that is their right. However, it will not change their difficulties in terms of how their distress manifests itself.

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I would never refer to someone as 'borderline'

Comment by: Louise Pembroke, mental health activist, London
Date: June 20, 2007

Disputing [any] diagnosis can change how we experience distress and how we manage it - that is clear from the hearing voices movement. Some of those who have rejected their schizophrenia tag have been transformed by that rejection alone. When people view themselves as a mere victim of their biology/brain chemistry I believe it does impact on how distress manifests.

I perceive a similar process in those who have rejected BPD because they stop viewing all emotions/actions as this or that aspect of BPD, and stop pathologising their personality.

As I stated earlier, we can agree to differ and work on the common ground, but specialist PD services and training for health workers has to include all positions and approaches, not just the BPD+DBT et al frame of reference. Otherwise those who don't want it will be failed.

I respect your right to subscribe to being 'borderline' although I view you as a person, as Fenella, before your label. I would never refer to you as 'borderline' as I would never refer to anyone by their diagnostic label. You are a person first

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Again, it's about choice

Comment by: Fenella Lemonsky, expert by experience, the North London Hub, Mental Health Research Network (MHRN), Imperial College, London
Date: June 27, 2007

Louise, actually I hold my hands up and apologise - as I should have written those who are affected by BPD, not "borderlines" as I was writing at a very late hour. However, I agree that I am a person not a label and I view myself as a woman of many parts not just my difficult bits.

The schizophrenia label issue that distresses me the most is how orientated the psychiatry mainstream movement is to medication. Prof Peter Tyrer's new groundbreaking work on changing the environment not the person, Nidotherapy, is proof that if you do that, many may well manage without medication or hospital admission ever again.

The PD training, yes, I agree has to be very broad and not a single factor cures all. The training we, as a strategy group, provide in Barnet introduces generic mental health staff to all aspects of care including crisis management through a humanitarian approach rather than how-the-system-deals-with it approach. So we explain all choices that should be on offer, all types of therapy. However, sadly only a few choices are available. I still would like to see a choice for service users - not just 'you have this or this and tough'. If you live in Haringey you can access a service that will offer you a choice of talking treatments, day service, groups, 1 to 1, different 1 to 1 and creative approaches....this is what every locality should have.

Medication should be an option not shoved at you like you are some criminal and told 'take it or else'. I never had medication thrown at me. In fact, when I wanted anti-depressants I was strongly discouraged from taking them.

I think we each find a way of managing in our own way. If you are interested in finding out more about Nidotherapy then contact Sandra, the Hub co-ordinator at the North London Hub, Imperial College office on 020 7386 1237 and she can send you further information or email her on s.o'sullivan@imperial.ac.uk

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