“You don’t know how much it means that you’re here,” they tell me. I feel like a movie star, and I’m flushed from the attention; in fact, it’s almost as disturbing as being ignored. They want to know everything, so I give them a rundown of my past few years. Their admiration is unflagging, and I feel like I’m in the twilight zone. It turns out that most of them have received BPD education and learned some DBT skills through the program created by NEABPD. Hearing all of this, I comment that I wish that my family would get involved like they have. The parents nod, and one of them replies, “And many of us wish that our children would come here, like you have.”
Across the cafeteria and down a few stairs is the table where my parents and I sat that summer, where I begged them to help me and denounced them for not trying hard enough. Then I think of one of DBT’s many dialectics: Everyone is doing the best they can, yet everyone needs to try harder. I put four of the cookies back as discreetly as possible, and Allison hugs me before I can sneak out the door. I’m overwhelmed by their seemingly unwarranted appreciation, and also warmed, like I used to feel after downing shots of whiskey. An inner ease spreads inside me. Such is the power of acceptance and understanding from other people, the power of validation.
This is such an important word: “validation.” It means recognizing someone else’s feelings, behaviors, and thoughts as legitimate, no matter how problematic or dysfunctional they may appear to be. It’s the opposite of “invalidation,” which Dr. Linehan points to as a key factor in activating BPD symptoms in those of us with the biological vulnerabilities (1993a). Allison gave me a powerful dose of validation just by recognizing that I have the disorder and understanding how difficult it was to show up at that meeting and how painful my life has been. That validation fills up a small hole inside me. I’ve tried doggedly to practice radical acceptance and all the other skills, but when these are self-directed, it’s only a partial comfort, and I still feel like I’m living a double life, keeping the disorder in secrecy and isolation. Receiving validation from someone else about being a borderline has a profound effect.
The trainings now being offered by family organizations teach validation as one of the most critical techniques in helping someone with BPD. We need this help from outside because we don’t know how to do this for ourselves. We start with a deep deficit—a chasm, really—when it comes to understanding and being tolerant of ourselves, and that’s even before we go forth to do battle with the rest of world. As soon as someone judges, criticizes, dismisses, or ignores, the cycle of pain and reactivity ramps up, compounded by shame, remorse, and rejection. The act of validation, simply saying, “I see things from your perspective,” can help short-circuit that emotional detour. In DBT, therapists are encouraged to always see the grain of truth in their clients’ thoughts, feelings, and actions, no matter how challenging, dysfunctional, or dysregulated.
And this is exactly what I’ve been trying to teach Taylor and my family: not only to recognize the causes of my pain as being legitimate, but to find a way to be loving and nonjudgmental when I react in ways they can’t understand. I need them to be aware and present with me in the midst of the storm, not just tell me what to do. The fact that the BPD diagnosis and so much of what we suffer from also isn’t validated, either by our loved ones or by the culture, adds another layer to this fundamental problem. Now it appears to me that invalidation has been an ongoing theme in my life—from my adolescence, when my behaviors and feelings were always pinned on being “difficult” and “attention seeking,” to my family’s continued insistence that there’s nothing seriously wrong with me, especially not a personality disorder. It’s possible that only Ethan has walked the fine line between recognition and dismissal, with his admission that I have the symptoms of BPD coupled with his insistence that I am more than that. Yet I also recognize this: Even if everyone in the world were to accept me and my illness and validate my pain, unless I can abide myself and be compassionate toward my own distress, I will probably always feel alone and neglected by others.
19
Being More Than One Thing
DBT graduation is simple. At the end of my last group, we go around in a circle and say good-bye. If it were my choice, I’d have cake, speeches, and party favors (little key chains with “Use Your Wise Mind!” printed on them). I’m accustomed to AA and NA anniversaries, where we pass cards around the room and sign them, and a sponsor stands up to describe the person’s progress: “When our little Kiera first came around, she constantly wore combat boots and sunglasses! Just look at how she’s grown!”
I suppose the purposes of this kind of therapy don’t include community building, so you shouldn’t expect to leave with a group of friends. It teaches you the skills to create your own life, each skill a building block inside you. You’re not supposed to cling to the structure, but instead go forth and create your own. There’s just one pestering question: What happens to people after they leave the DBT skills group? As with BPD recovery in general, the future is hazy and incomplete. I keep going back to Marsha Linehan’s texts and the research, but I don’t find any data on stage two, nor do I find an instruction manual for life after skills group.
In an article in Psychiatric Times, I find a quote from Dr. Linehan: “In sum, the orientation of DBT is to first get action under control, then to help the patient feel better, to resolve problems in living and residual disorder, and to find joy and, for some, a sense of transcendence.” Yet she also admits, “All my research is at level one, but you can’t stop treatment there. If you don’t go to the next levels, [patients] will often move back to level one again” (Knowlton 1999, 2).
So the question for those of us with BPD on this path is how to keep moving forward. The stage two work of emotional experiencing that I’m doing with Ethan seems to be helping me stay in my relationship with Taylor despite the numerous triggers, and it also helps me manage the stresses of having a job. But I still confront these inner minefields. I try to step around them as best I can, yet it’s obvious that the deeper into life I go, the more explosives I’ll need to identify and disarm.
Miraculously, the advanced DBT group appears to be the answer to this next level. In my orientation meeting with the group leader, Olivia, she explains that while we’ll still be talking about the DBT skills, this group is specifically designed to help people apply their skills in situations that are connected to past traumas.
“Like what happens with me and Taylor whenever I feel threatened,” I say.
She nods. Part of the exposure practice in this group will involve gaining access to the different parts of ourselves that are shut down or in conflict with each other. The technique is culled from a therapy called Internal Family Systems (IFS), developed by Richard Schwartz (1995) while working with severely bulimic women. His patients referred to the different parts of themselves so often that Schwartz began to understand that inner experiences can be organized into separate components of an internal world. This system operates much like a family, each part having its own identity, goals, and values. IFS can seem freaky at first. It’s based on the premise that all of us—with or without psychiatric disorders—have a multiplicity of selves, and that these selves, or personalities, are always interacting in much the same way as family members behave within a family, having individual histories, roles, alliances, goals, and conflicts. Schwartz also uses the analogy of a tribe to describe this collection of parts, breaking down their roles into three basic types that contribute to the overall functioning of a person: managers, firefighters, and exiles. Ideally, each part should be supportive, not in charge. That role falls to the self. Acting in the capacity of tribal leader, the self ideally works with all parts effectively, checking in with them, listening to them, and acting wisely, taking all of the parts’ needs into consideration.
This concept of parts actually doesn’t surprise me. It’s likely that one of the reasons I’ve resisted healing my “inner child” is because I actually have too many inner entities,
too many shifting aspects of myself. Schwartz makes the distinction between multiple personalities that are in dissociative states (such as with multiple personality disorder) and the more relational and conscious way our inner parts typically operate. For instance, when Taylor seems to be ignoring me, I can go from happy girlfriend to scorned woman to whimpering child in fifteen minutes. I’m aware of these different parts, so while they’re compartmentalized, they aren’t entirely split off from me. I can observe that ManRay Girl comes out when being a good girl no longer works or that Hippie Chick can emerge if I think she can get me laid. This awareness of the differing aspects of myself is one of the reasons why the borderline symptom “unstable sense of self” made so much sense when I first heard the criteria. And I can still witness new aspects of myself emerging, as though my identity is not only constantly changing, but adapting—a psychic evolutionary strategy based on my need to belong and feel loved by others. The multitude of parts within me may be a little more extreme, but Schwartz says that parts are inherent in everyone. The IFS model doesn’t try to get rid of parts; it sees them as natural and useful. It’s only when they’re in conflict, frozen in time, or overly controlling that trouble occurs.
Olivia gives me a good amount of reading material to prepare for joining the advanced group, and I also buy Schwartz’s manual, Internal Family Systems Therapy (1995). The first thing I need to get clear about IFS theory is where “I” really am, given there are so many various parts. Is one part simply in charge of the other parts? Schwartz says no. He makes a distinction between the parts and the self. The self is considered a transcendent aspect: the awareness and discerning intelligence that dialectical behavior therapy calls wise mind—the integration of emotion mind and reason mind. In IFS, the self has characteristics such as leadership, compassion, perspective, curiosity, confidence, and acceptance, and it works with all of the parts. Schwartz likens the self to the conductor of a symphony, able to hear each instrument and yet leading all of the players in concert (1995). In this sense, the relationship between the self and the parts is dialectical. You have to view yourself as being many things, and yet also one thing, in the same way that physics describes light as both a particle and a wave.
There are other similarities between IFS and DBT. For instance, in the IFS model, nothing is static. Each part’s existence and movements have an impact on every other part. It’s similar to a mobile; when one piece shifts, all of the other parts will reverberate from the impact and move as well. This is considered a systems model, but it’s also based on the same kind of common sense that dialectics uses to remind us that interdependence and change are constant and unavoidable aspects of reality.
DBT and IFS are also alike in being nonjudgmental. IFS doesn’t judge the various aspects of a person in terms of good or bad, even those that are destructive or harmful. IFS says there are no bad parts, that all inner aspects have a role that serves to protect the self, even if that role is not ultimately effective or helpful. Similarly, in DBT the behaviors and experiences that define the borderline condition are seen as ineffectual ways of trying to accomplish goals. Self-harm, for example, serves the purpose of self-soothing, despite its negative effects. In this way, both therapies use validation, but at the same time recognize that the strategies the person is using may not be helpful.
Joining Olivia’s advanced DBT group is like signing on for inner space exploration. The first thing we do is an exercise called the Conference Table. We have to imagine a conference room with a long table and invite all the different parts of ourselves to sit at it. Olivia says a part can be as clear as a voice from the past reminding you to brush your teeth, or as nebulous as a rush of feelings that overtake you in the middle of the night for no apparent reason. Any of the different voices and perspectives that happen inside you can be parts. Olivia asks us to close our eyes, imagine the table, and invite all the parts to sit down.
So I do. And in no time people start appearing: Kiki, the Goth, the Hippie, the ManRay Chick, the Biker Babe, the Writer, the Freak, the Academic, the Mental Patient, the Supplicant, the Obsessive Organizer, the Failure. Olivia asks us to also invite our younger selves to the table, along with the internalized voices and perspectives of other people. The table grows increasingly crowded. My mother takes a place, and sitting on her shoulder is my grandmother. Sometimes they seem to blend together. My father is there, along with an anonymous man, a sort of “watcher.” But where are my younger selves? Olivia tells us not to force it, that our parts come out when they feel safe, and some of them don’t like to be exposed. But when I look under the table, I immediately find my six-year-old. She’s hiding, half in play and half in fear. And then there’s my twelve-year-old. She’s not playing at all. She’s formulating a way to escape.
I’m not the best visualizer. I tried to heal myself through creative visualization at one point during my hippie years, and I never got past the white light exercise. So it surprises me that all of these images have appeared so clearly—even details of the conference room, with wood panels covering the walls and a series of tall windows shedding faint light along one side of the table. I notice a small door at the back of the room. Of course there’s a secret door. Assuredly it leads to a room where parts of myself are hidden. As we sit with our eyes closed, imagining all of these parts of ourselves, I don’t go near that door.
I tell Ethan about all the parts in our next session. He’s been receiving IFS training as well, so he can move through this journey with me, thank god. I want to know what’s behind door number three, but he explains that there’s a process to working with parts. You don’t just pull them out of hiding or force them in any way. First you simply become aware of them. In time you come to understand exactly what their roles and needs are. You have to allow them to have a voice and speak for themselves.
The parts that are most inaccessible and fearful are known as exiles. These frozen and traumatized parts of ourselves hide and feel the need to be protected at all costs. And at least one of mine is behind that small door. Managers try to protect the exiles by managing emotions and developing survival strategies. When the exiles get loose and run through screaming and on fire with past pain, the firefighters emerge and attempt to douse the flames. Despite their good intentions, firefighters aren’t helpful; they’re the out-of-control behaviors that DBT helps us rein in. And like DBT, IFS understands that those behaviors may be self-destructive, but that they’re also survival tactics for dealing with unacceptable pain. My addict part is a firefighter. My cutter part is a firefighter.
“What is my six-year-old?” I ask Ethan. “Is she the girl who was molested? And why is there a twelve-year-old seemingly connected to her?”
Oh my god is this complicated! Of course, I read the entire IFS book before my next group, and have even started making diagrams of all my parts. I’m ready to wow everyone with my in-depth knowledge, but there’s no opportunity. The way the group is, each week just one person provides an example of a problem behavior, and for the next hour and a half we do a behavioral analysis, identifying the parts involved and the skills that could be used. There are currently five women in our group, and it’s going to be more than month before it’s my turn. So I take a backseat and let my perfect student part, who is always trying to manage information and people’s perceptions of me, take a break.
A couple of months after I connect with the family organization, they ask me to be part of a discussion panel about living with BPD. Until now, I’ve told only the people closest to me about my BPD diagnosis. The idea of such public exposure scares me, and at the same time it seems the next logical step in my process. I don’t want to spend my entire life hiding because of an unspeakable illness. I also don’t want to be so vulnerable that I leave myself open to the judgment and hatred I’ve seen unleashed on people with the diagnosis. The dialectic of exposure and protection is surfacing again, both required when outing yourself. It takes trust to go forward, and in this case I decide to trust them.
A roomful of parents and spouses who, thus far, have applauded my confessions of being fucked up can be extremely reinforcing—especially if you like applause.
So one spring evening I and two other people with BPD take turns addressing a hushed room packed with parents, spouses, clinicians, and even some fellow borderlines who lurk in the back rows. I explain that I’ve had the symptoms of BPD since I was quite young, and that only now am I getting the right treatment and learning how to live with it. I don’t emphasize the gory details; it’s the inner pain that I want people to understand—the hopelessness and shame of being who I’ve been and not having anyone who understands. I’ve grown up with an ethic, call it a part, that insists I hide my pain at all costs. As I talk, I feel this pain leaking out—not just the core symptom of BPD, but all the years of being blamed or ignored for my condition, and all the years I’ve blamed others for how I am. It’s the pain of being told I was too needy even as I could never get the help I needed. When my eyes start to tear up, I see that the eyes of the crowd reflect mine. That’s a mirror I’ve never looked into because I’ve been so isolated and ashamed. And in that moment an image comes to me: a million bodies, curled and sobbing in the corners of rooms, hiding under covers, dragging razors along their skin, raging, screaming, and unseen. How many of us are there?
It reminds me of the part in The Wizard of Oz when Dorothy stands trembling before the projection of the great wizard. She has traveled so far to petition this powerful figure for a way home, but when Toto pulls back the curtain, she discovers that he’s only an old man with a microphone. All of the power and control she thought he had evaporates as she realizes that he’s only human. I feel like Dorothy. I’ve pulled back the curtain to find all of these people, full of fear and not knowing what to do. I think of my mother, a frightened witness to her daughter’s transformation from gregarious child into self-hating, angry, and unreachable stranger. I see a long line of doctors who kept giving me more pills because nothing seemed to work. And most of all, I see my own kind, the borderlines, each hiding alone in an echo chamber of judgment and helplessness.
Buddha and the Borderline Page 18
