Buddha and the Borderline

by Kiera Van Gelder

  “Do you have other impulsive behaviors?”

  I don’t want to admit how many men I’ve slept with in the past couple of decades. Or how many credit cards I’ve maxed out. Or the number of times I’ve moved (thirty-four at the last count). “Therapists tell me I need to think more before I act. That I don’t recognize consequences.”

  “But you’ve been able to stay sober.”

  “Yes. I saw that I was pretty much going to end up dead if I didn’t stop. So I guess that consequence made me change.”

  “How do you stay sober now, when you also want to die?”

  I pause here. It’s true, I’d rather jump off a bridge than go back to getting drunk and high. Why? And why am I here in the doctor’s office when a huge part of me is now convinced I should give up?

  Before I can answer, Dr. B says, “Something in you must want to get better.”

  I’m not sure if it’s that, or I’m just here because I’m trying to appease Bennet. Dr. B asks why I haven’t killed myself yet, and I suspect it’s mainly because of my brother. He died when I was nineteen and he was eighteen. We thought it was a drug overdose, but it turned out to be a brain virus. Every time I get to the edge of wanting to kill myself, I see my mother’s face, the way it looked at the hospital when we arrived at the ICU and the doctor opened the door and said “I’m sorry.” It’s like a software program running in the background. When I have the image of me dead, the memory of her devastation—and my father’s—erupts.

  “The reason I haven’t killed myself yet is because of what it would do to my family,” I tell him.

  “So you love your family a lot.”

  “Actually, I hate them a lot.”

  Dr. B nods. “Would you say you’ve have some identity issues, not knowing who you are or changing yourself for other people?”

  Yes, yes, yes again. A teacher at my high school called me the chameleon. Not because I blended in, as I was the resident freak at school, but because I was always changing—every year a different style. I’m still that way, changing depending on who I date, what music I’m obsessed with, my sexuality…

  Dr. B finishes by asking me if I have difficulty with stress. I say the difficulty is so great that I literally go blank and numb when I feel I’m under pressure. “Would you call it dissociation, like leaving your body?” I nod. “How do you see other people when that happens?”

  “I don’t understand…”

  “Does the world seem safe, like you’re able to get help?” This question hits a nerve so raw I start to sob.

  “No one helps me. My family doesn’t understand. Therapy isn’t working. I’ve done everything I can. How can I be thirty and be right back where I was when I was fifteen?”

  Dr. B says it sounds like a nightmare. “You have no idea,” I cry.

  “But I believe I know what your problem is. And it’s actually good news, because it’s treatable,” he says. “It’s a type of illness called ­borderline personality disorder, or BPD. Have you ever heard of it?” I shake my head. “It’s a condition of extreme mood instability. A fear of abandonment. An uncertain sense of self.” He leans forward in his chair. “Does that make any sense to you?” I nod. “A pervading sense of emptiness,” he continues, now ticking off his fingers. “Suicidal behavior. Self-mutilation. Unmanageable anger. Rocky relationships. Impulsivity. In stressful situations, you can get paranoid. Even dissociate and leave your body.”

  “Yes,” I say. “Yes, yes, yes.” I’m a bit stunned. It’s like acing a test you never studied for. How can this diagnosis from someone I’ve only just met so perfectly describe what I’ve been dealing with all this time? The list of symptoms is like a Reader’s Digest version of my diary. Someone has secretly peered into my soul and given it a name.

  “But what does ‘borderline’ mean exactly?”

  Dr. B smoothes out his pants. “Saying you have borderline is just a convenient way of explaining your symptoms. It’s a label, a term, to describe a certain type of distress. You don’t need to pay too much attention to the name.” I nod again. I don’t care what it’s called: chicken head syndrome, broken personality disorder, whatever. I just want to kiss this man’s hand for putting into words this endless cycle of failure and misery. If I have BPD, it means I have something real.

  “A personality disorder, unfortunately, cannot be cured with a pill,” he explains. “Getting better is going to take a lot of time. There’s a therapy I recommend you do, specifically designed for BPD. It’s called dialectical behavior therapy.” He takes a white business card from the pile stacked at his elbow and writes down a number. “There’s a program here. Call and set up an intake appointment. I’d also like to try you on lithium, since your emotions are so of control.”

  This is the first time since we’ve sat down that I feel worried and mistrustful. Lithium is for manic depression, or bipolar disorder, as it’s known these days. Is that another thing I have?

  Dr. B says that I might and instructs me on how to wean myself off my regimen of antidepressants over the next couple of weeks. “Don’t worry,” he says as we stand up. “You are a woman of great passion. You’ll learn to channel your energy, to control it, rather than the other way around. You will learn equanimity, and when you do,” he smiles, “there will be no need for a diagnosis.” He gives me a prescription and we make an appointment for next month.

  Out in the winter air, I feel a relief probably similar to what cancer patients feel if they’re told the tumor is contained and operable. I’ve never heard of this strange disorder, and I didn’t even know there were personality disorders, but if it means I have a real illness rather than just being a terminal failure, I’m willing to try it on for size. Nothing else has been able to describe the self-destruction, the desperate clinging, the obsession with suicide, and the shifting moods, identities, and perspectives. I have BPD, I tell myself. I’m not a total fuck-up.

  Before I reach my car, I call Laura to share the good news. Laura has known me for many years. In fact, she’s one of the few people still in my life. We share similar histories: Like me, she became addicted to drugs and alcohol, dropped out of high school, and ran away from home. We both ended up in institutions and eventually landed in 12-step programs, where we met. Now in our early thirties and with a few years of recovery under our belts, it would make sense if our lives continued to parallel each other, but that hasn’t been the case.

  While Laura got married, bought a house, and is now having a baby, I’ve been stuck in an endless round of lost jobs and failed relationships. I keep falling apart, while her life grows steadily more settled and secure. I haven’t talked to Laura since I called her this summer to gush about my new man, but now I feel like she’s the right person to tell.

  “The psychiatrist says I have borderline personality disorder!” I exclaim. “And it makes perfect sense!” There’s a pause at the other end as she takes in the news. She majored in psychology as an undergraduate, and since Dr. B didn’t give me an informational pamphlet on BPD, I’m hoping she might be able to tell me more.

  I hear the TV in the background, and then Laura shrieks, “There is no fucking way you are borderline!”

  I pull the phone away from my ear. “Why not?”

  “Listen, borderline is Glenn Close in that movie Fatal Attraction. Think stalking, knives, psychobitch from hell. That is not you!”

  “But I have all the symptoms!” I plead.

  “No, seriously. People with BPD are really, really, really disturbed. Listen… I know you’ve had some problems. The twelve steps don’t cure everything. But seriously, get a second opinion. You don’t want to have BPD on a medical record. You don’t want to have it at all.”

  I don’t want to have BPD? Do I have a choice in the matter?

  Accepting a psychiatric diagnosis is like a religious conversion. It’s an adjustment in cosmology, with all its accompanying high priests, sacred texts, and stories of origin. And I am, for better or worse, an instant convert. I
n time, I might even be accused of being a fundamentalist. Despite Laura’s words of warning, I am convinced, simply from Dr. B’s list of symptoms, that this is the problem that’s been plaguing me all along. I head over to the hospital’s resource center to see if they have any information on this mysterious disorder. A spectacled woman gives me a stack of articles on BPD and a copy of the diagnostic criteria. I ask if there are any books specifically for people with BPD or written by someone in recovery from it, and the librarian shakes her head.

  “Oh no, wait,” she corrects herself. “There’s one you can probably find in a bookstore. It’s called I Hate You, Don’t Leave Me.”

  Great. I hate you; don’t leave me. That’s exactly what I feel with Bennet most of the time. Though more precisely it’s “I hate you, why don’t you leave your fucking ex-girlfriend?” I take the materials and head back to Bennet and Alexis’s. They’re making dinner when I come in, and Bancha is sitting on Bennet’s shoulder.

  Bennet kisses my cheek and congratulates me on going to see the new doctor. His fingers are covered in garlic juice and bits of red chile peppers.

  “The doctor says I have borderline personality disorder.”

  “Borderline to what?” Alexis asks.

  “Good question.” I hold up the stack of articles. “Time to find out.”

  3

  The Diagnosis That Dares Not Speak Its Name

  There’s no question that the diagnosis fits. I have all the symptoms: I have chronic feelings of emptiness and an unstable sense of self. I’m suicidal and self-harming, and I frantically avoid abandonment and rejection no matter what the cost. My relationships are stormy and intense, and my perceptions can shift between black and white at the drop of a hat. My emotions are out of control, I freak out when stressed, and others often find my anger inappropriate. The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the bible of psychiatry put out by the American Psychiatric Association, says this disorder develops in early adulthood, but it seems to me that this isn’t true. As I look back, I see that I’ve had these symptoms, in varying degrees, since I was eleven years old. To say that BPD starts in early adulthood is ridiculous. No one wakes up at age eighteen and is suddenly borderline.

  To those looking from the outside, it might seem this illness took possession one day out of the blue, as signaled by some specific behavior: Kiera’s cutting herself; Kiera’s doing drugs; Kiera’s shaving her head. But that’s part of the whole problem—no one saw, knew, or understood how long I was suffering and sick. Even my mother thinks it started later, when I went to the private school and began cutting and burning myself. But I disagree. As soon as I read the symptoms, I realize the seed was there all along, watered by pain, secrets, and inattention, and by my own desperate need for relief.

  The day after I get the diagnosis from Dr. B, I have my weekly appointment with Anna. I haven’t told her about this new consult, so she’s understandably surprised when I pull out the list of BPD symptoms and declare that I have borderline personality disorder.

  Immediately she declares, “No, that’s wrong. You can’t have borderline.”

  “Why not?”

  “Because you’re not one of those.”

  “Those what? Can you explain to me what that is?”

  “It’s hard to explain,” Anna says.

  I suspect she’s referring to what Laura mentioned. “You mean I’m not someone who stalks people with knives?”

  “That’s one way of putting it.”

  Anna is a kind, motherly woman and we’ve done a lot of work together, though it’s never any different from the work I’ve done with so many other therapists. We dismantle my childhood, my upbringing, and my issues. Every three months we diligently fill out a treatment goals chart. Sometimes we target anxiety reduction; other times, finding a job or improving my self-esteem. All the while, there’s a psychiatrist in the background, in a different town, prescribing me medications once a month after I check in with him for fifteen minutes. Anna’s been my lifeline through many crises over the past couple of years, and also a font of optimism regarding my potential for growth, but ever since I quit the teaching position and was sucked into the Bennet and Alexis vortex, the tone of our appointments has changed. Now I cry a lot and she gives me Kleenex. Now we discuss things like how I can get out of bed in the morning and how I can avoid dwelling on my desire to kill myself.

  I urge her to look at the list of symptoms. “Tell me if this doesn’t sound like my life: ‘a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity.’”

  Anna peers at the page. As a counselor who mainly coaches people in 12-step recovery, she doesn’t trust clinician-speak. “That could mean a lot of things,” she finally says.

  “I’m the very definition of unstable.”

  “You’re an artist,” Anna counters. “It comes with the territory.”

  “So what about all the other symptoms?”

  “I’m sure there are other ways of looking at them.” She reads off the first of the criteria: “Frantic efforts to avoid real or imagined abandonment…” She pauses for a few seconds, trying to choose her words carefully. “Well, of course you’re sensitive to that. Your parents divorced when you were young. You never knew when your dad was going to show up, or when your mom was going to pay attention to you. We’ve discussed how they weren’t there for you in the ways you needed. Anyone with your upbringing would have some abandonment issues.”

  The topic of neglect is a reoccurring one in our therapy—and in all of my therapies. How much love and attention could a single mother have provided for two young children? How destructive was it to have an absentee, alcoholic father? I know I haven’t gotten everything I needed from my parents, but in the Hierarchy of Parental Horrors, my parents were Bob and Carol Brady compared to some of the other stories I’ve heard.

  Plus, I’m more than just a “little sensitive” to abandonment. I used to write letters in blood to boys who rejected me! Anna says that was a long time ago. She says, “You have some codependency issues, but we’re working through them.”

  That doesn’t seem to suffice. I’ve already read Women Who Love Too Much and Codependent No More, to minimal effect. I’ve gone to Adult Children of Alcoholics meetings and Al-Anon meetings. None of it has stopped me from throwing myself into the arms of random men and feeling like my life depends on their attention, and then falling to pieces when they look away.

  Anna glances at the list again. “I’m not saying your symptoms aren’t real, only that they can be explained by things other than BPD.”

  “So these relationship problems I have…”

  “You never had good role models. Didn’t your parents stop speaking to each other when you were six? How were you supposed to learn about love? Communication? Emotional security?”

  I’m not up for this game of deflection. I know what I see, or at least I think I do. Or maybe I don’t know. She passes the list of symptoms back to me. We both look weary.

  “Why do you want to pathologize yourself, Kiera? Haven’t we worked together long enough for you to realize you can get through these things?” Anna presses her hands to her heart and looks like she might cry. “Can’t you see that you’re a survivor? You don’t need another diagnosis. You just have to start believing in yourself.”

  Once again, I don’t know what to believe about who I am or what I’m dealing with. And that’s been part of the problem all along.

  I spend Christmas and New Year’s waiting—waiting for a disability determination, waiting for a spot to open up in the dialectal behavior therapy (DBT) group. At my second meeting with Dr. B, he insists DBT will get me out of this hole I’m in. So for the time being, I focus on staying alive and learning everything I can about BPD. Learning about BPD might seem like a straightforward process. After all, the American Psychiatric Association first officially recognized BPD over two decades ago. And while mental illness isn’t
exactly easy dinner conversation, most disorders are considered treatable. There are ads on TV for depression, complete with bouncing happy and sad faces, talking about all the ways you can get help and treatment. In my research, however, the first thing I discover is that it’s almost impossible to get good information on BPD, and even more impossible to find people who claim to have it or recover from it.

  I plow through the clinical articles from the hospital resource center, read I Hate You, Don’t Leave Me from cover to cover, and, like everyone else I’ve since met who’s been diagnosed with BPD, I go online to find help and support, with the hope of being understood and accepted. However, the first sites I come across aren’t run by doctors or people with the disorder, but by those in relationships with borderlines. They call themselves “nons” (as in, “non-BPD”), and they are pissed. I come across a blog written by a mother who says her adult daughter has BPD. She describes her daughter as a chronic liar who abuses her verbally and lacks even a shred of empathy. The daughter rages, manipulates, destroys furniture, and wrecks dinner parties, and if she doesn’t get her way, she threatens to kill herself. The mother is at her wit’s end, in a constant battle to control her daughter, who refuses therapy and claims that she’s not the crazy one—her mother is.

  I follow a link on the mother’s page to an online community of nons, with seemingly thousands of members. On the website’s bulletin boards, they write heartbreaking messages about how they suffer in relationships with people they say have BPD. Words like “cruel,” “indifferent,” and “incapable of empathy” swarm on the screen. Seen through the eyes of these people, BPD looks nightmarish in ways I can barely fathom.

  I am mortified at what I read. How much of what they describe is actually the BPD I have? Am I like what these people describe? Do others see me as a monster—even more than I see myself as one? Now I don’t want to have the disorder either. And I understand why Anna and Laura are shouting from the sidelines, “Don’t call yourself a psycho!”