From Both Sides of the Couch

A therapist reflects on her time with patients, and her time as a patient.

Borderline Personality Disorder: The Power of Recovery

Those of us with BPD really do get better.
Margalis Fjelstad, Ph.D., LMFT
This post is a response to If BPD is Biologically Based, What Then? by Margalis Fjelstad, Ph.D., LMFT

 

I found some of the assumptions that Dr. Fjelstad makes about people who have been diagnosed with BPD — and I take exception to the use of the term “Borderline” to describe us because the diagnosis is not our identity — outrageous and insulting.

Dr. Fjelstad acknowledges that we can get better in the areas of “reduced suicide attempts, reduced cutting, reduced psychiatric hospitalizations and reduced anger and depression.”

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Then she asks “Will this person function emotionally, socially and in a reciprocally positive way as a spouse or a parent?” She then goes on to predict a lifelong handicap and condemn us to a lack of intimate relationships.

Dr.  Fjelstad, let me tell you a little about my personal journey.

I was diagnosed with borderline personality disorder following a suicide attempt in 1990 by overdosing on Prozac. I had to wait six weeks on an acute psychiatric ward in Manhattan following the attempt at taking my life, then I was unceremoniously shipped off to a long-term unit at a prestigious psychiatric hospital in a suburb of New York City. I was considered such a danger to myself – although I begged to be released to the care of my mother, the psychiatrist was sure I would try to kill myself again — that they wouldn’t discharge me until a bed at the private hospital was available.

I was on the long-term unit for nine and one-half months and then my insurance ran out. It seemed endless in one way but in another way I felt safe for the first time in a long while. I had become part of a community of mostly women who understood, where no one before me had, the cavernous void that tugged at my gut, how unsafe and constantly self-destructive I felt.

When the psychiatrist told me I had to leave, he took me into a small room off of the main living room to deliver the news. I broke down and sobbed for a long time. I knew I wasn’t ready to re-enter the world. The staff knew I was being discharged much too early but there was nothing they could do. I was far from well and I clung to what calmed me — cutting and starving —for a long time after I left Seven South.

Living with just a few of the features of BPD on a constant basis was like being violently tossed about from wall to wall in a small room with no doors or windows. My feelings took over and I felt compelled to act out, despite how irrational and horror-filled my behaviors may have seemed to others.

In a space as short as a few hours, my emotions ran the gamut, from feeling like I didn’t exist to feeling as though I was pure evil. I was a nasty storm tearing a ravaged path through myself. Leaving total devastation in my wake; a trail of destruction ran through mind, body and spirit. Moods fluctuated repeatedly during a twenty-four hour period, almost every day. Days, weeks, months ran together like small streams spilling into the mother river. The intensity of the experience often overwhelmed me and I was consumed with urges to act out self-destructively. When I was feeling as though I was being pulled along in the rapids and was drowning, the suicidal planning and fantasizing began. How could I end my life? I walked around asking myself.

Healthy relationships eluded me. Not just romantic relationships with men, but friendships as well. I was unable to disagree with anyone for fear of angering them. I went to great lengths to avoid the feeling that someone might abandon me if I was too much trouble.

Staring at myself in the mirror at the gym, I walked on the treadmill as fast as I could, arms pumping, breathing hard, first thing every morning, a compulsion fueled by years of anorexia. I focused on my ravaged face that appeared older than its age with the deep lines etched around my mouth and the numerous age spots on my forehead. My dark brown hair was going gray again at the roots and the temples as the semi-permanent color began to fade and I wondered if it was too early for me to let it just grow out. I was already tired of the routine of coloring it every two months. My eyes were tired and haunted with the beginnings of bags underneath them. My line of vision narrowed to the chai (the Jewish symbol of life) that I wore around my neck. I gazed at it as if the simple act of wearing it over the last twenty years could reaffirm my commitment to my life, something that years of therapy and medication had not been able to do. My time completed, I wearily stepped off, not sure if I had what was needed to face another day.

Time passed slowly when there were few commitments in my life with the exception of therapy and a random writing class here or there. The feeling of chronic emptiness that plagued me each day was echoed by the monotonous schedule of nothingness on the outside as well. It was one thing to not have a job; it was another to know I was not capable of performing at one. My thought process, my concentration, my stamina to work for eight hours a day were all limited.

I fondly remembered my marketing days when I worked for a company that made margarine. I wore the corporate uniform which consisted of a grey or navy suit with skirts and jackets, but I absolutely refused to wear a floppy bow tie. I longed to be productive again, scurrying from meeting to meeting, being what I perceived as creative and analytical, switching from right brain to left brain at a moment’s notice.

Instead the colors of black and white dominated my thinking. Are black and white truly colors? There was no room for any other shades on the spectrum. Life was rigid, life was all or nothing. People were either saints or pure evil; they were either friends or enemies.

I ran frantically from person to person; I had only a few acquaintances because I was frightened. I was loathe to risk the feeling of vulnerability that comes with emotional intimacy. I ran from activity to activity, from knitting class to writing class, hoping for some sense of fulfillment, but the truth was that contentment needed to come from within. This was the nugget of wisdom that has been hammered into me by each of my therapists. I didn’t know how to achieve relief from the turmoil because I was not capable.

I laid curled up on my bed, choking and gasping because I was hurting and I could not cry. The tears would not come. I began the ritual of cutting myself. The drops of blood were a substitute for the tears and as I washed and bandaged the cuts, I was taking care of myself. A ritual full of perverse contradictions; the self-destructive behavior followed by the gentle, healing rite.

I was a child on a swing, flying from front to back. She pumps her legs to go faster and harder and then screams with fear as she reaches a new pinnacle and wants to slow down. But she is out of control and has to wait for the momentum to slow her because she can’t do it herself.

I made heartfelt attempts at working, but my efforts were thwarted by my illness. Twice I obtained good jobs, not just a job but a position that had the potential to develop into a career, and then I would find myself so ill that I would have to be admitted into the hospital. My supervisors would have no choice but to let me go, or I would quit out of shame and humiliation. I put all I had into these careers, arriving early, working late, working through lunch so when I would lose these positions it was a major blow, an enormous failure. Each time I felt I could never get back to being a functioning, productive person again.

Hard work. Perseverance. Tumult. Turmoil. I made considerable progress in areas I thought I would never touch. I fought hard, clawing and scratching my way back up the ladder of humanity. The shriveled crevices of my brain and of my body opened up again; I felt free to explore facets of myself that remained hidden for so long. I became aware of my emerging sexuality which had lain dormant for so long and I finally let myself experience the pleasure I had been denying myself.

Having discovered my passion for writing, creating something from nothing, finding a rhythm and flow for my words and my sentences, I started to write about topics that weren’t able to pass forth from my lips. It was easier to tap the keys on my computer than to speak the forbidden words because when spoken they hung in the air like kites flying in the wind and I was unable to take them back.

When I was ill, to win, to be victorious meant living well, living a life full of meaning, hope and desire. Living a life that included people and relationships, being willing to take risks for the reward of intimacy. Living a life full of peaceful grace and leaving behind the turbulent surf that tossed me about for so long. Being able to sit with myself, with my feelings and no longer having the sense that I am being so violently tossed about. To win I needed to be curious about the wonders of life and no longer think about having been critically ill, and the possibility that I could relapse.

I learned to depend on myself. I felt as though I was still learning to walk, taking my first steps, stumbling into the world. I continued to rely on Dr. Adena and when she went away on vacation I found myself feeling concerned that she wouldn’t return and that I would be abandoned. I had to keep reminding myself that baby steps were okay — I had survived a week without her, and she did return — but at the same time I felt as though I was out of step with everyone else. Other people seemed to manage when their therapists went on vacation. To achieve my independence I broke down the anarchy that existed inside my body and mind to some semblance of order. Instead of being all over the place all the time, I found a way to function that denoted linearity. The war that was constantly inside my head between self-destruction and health had to cease and it was essential that I chose health. But most importantly, I wanted to believe that I was capable of making a conscious choice to succeed.

To have gotten where I am at this point in my fight I treated therapy as a full-time job. I labored for more than the two forty-five sessions per week, examining, exploring what Dr. Adena and I had discussed in her office during the rest of the week. Speaking spontaneously was extremely difficult for me as I tended to censor what came out of my mouth for the sake of appearances. I made a conscious effort to say the first words that came to my mind as I learned the value of an unconstrained string of words. I had a fear that what would come out of my mouth would be unintelligible, reminiscent of the days when I was psychotic. Dr. Adena reassured me that would not happen. With reservation, I trusted her and she turned out to be right.

Medication has contributed to my improvement. I have learned to take my medications as I need to — not to self-prescribe — and endure the side effects. Despite all the different medications I have been on, we have finally found a combination at the optimum dosages that are working in conjunction with therapy.

Misery, chaos, and illness were once my familiar companions; these confidantes were always there and were always beckoning. I could have easily retreated back into the fantasy world of self-destruction and psychosis and lived my life there, going in and out of hospitals, just passing the time.

Fighting hard to part the clouds, I saw the cerulean sky and stepped in. I took a leap of faith in myself and returned to graduate school to obtain my master’s degree in social work. When I graduated in 2000 I was 40 years old. I obtained a position at an outpatient clinic near my home. My boss was a kind and gentle man who taught me well.

Today I am thriving. The progress I’ve made has come with hard work. There have been major revelations and breakthroughs that have left me retching in the hall bathroom that Dr. Adena shares with her colleagues. I once spoke to her while standing in front of my hairdresser’s salon with a black smock plastered to my body and my hair slicked back with dye, wailing I need to take it back. I’m going crazy. But of course I couldn’t take back the words I had uttered in our session the day before.

Each time I thought I was done with the revelations and there could be no more, another one, more difficult to handle would come along and take me on a journey about myself, teaching me something that I didn’t know. There were setbacks and relapses but I no longer wanted to die. This was the process of therapy.

In 2007 I began to formally study memoir, writing about my experiences with mental illness and publishing my essays in literary journals and anthologies. The writer identity has replaced my patient identity. A staff member at one hospital called me a “professional patient.” That remark hurt and I have never forgotten it.

I work at a different clinic now that I did when I got out of school. I drive an hour each way and search for parking every day on the street. I have a much more challenging position and my work is split between clinical work and administrative work for the Executive Director. She singled me out because of my penchant and facility for detail work. I have found my niche.

I have a close circle of family and friends ─ and one special man whom I enjoy spending time with — and an active social live, something that I sorely lacked before. I was isolated, spending most of time with my mother in her home. She passed away twelve years ago from pancreatic cancer. My mother was diagnosed and given six months to live. As she was making her arrangements, she purchased her plot and bought a plot for me next to her. Two years ago a friend of hers told me that she lived in fear that I would kill myself. I like to think that she is looking down on me filled with joy and happy that her prediction didn’t come true.

I thought that for me BPD would be a lifelong condition; manageable but not altogether able to be obliterated from my psyche. When I was feeling well, I was able to see a door cracked open, an opportunity for growth and change. When I was caught in the depths of it, I saw my life as coming to a standstill and the only place to go was backwards, sliding down into the haunting world of madness. Thankfully my prediction didn’t come true.

I have reclaimed my life. I am alive, grateful for each day. Waking up early because I am most productive in the mornings, I write before I head off to work, watch the oranges and yellows of the sunrise streak across the sky — I can see the entire spectrum of colors now — and I welcome another day.

 

Dr. Fjelstad, although your portrait of the person with BPD described in your post may have been me early in my illness, it is certainly not me now.

I function at a highly stressful job at my clinic, often putting in 10 hour days, 45- 50 hour weeks. I could not be successful there if my emotional reactivity was that of a child. My job and my life are definitely not predictable, nor there is a set routine as our clinic is open 12 hours a day, six days a week. Despite this job, I make time for my writing, not only this blog, but I publish in anthologies and literary journals as well. And I have a family and friends with whom I get together frequently.

I hope this post will change your seemingly one-sided view of those who are diagnosed with borderline personality disorder and also change how you speak to their families.

 

Gerri Luce is a licensed clinical social worker who publishes under a pseudonym.

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