Buddha and the Borderline

by Kiera Van Gelder

  I think I do. “That Mom’s way of coping turned into a giant form of invalidation. She dealt with everything by ignoring it, because that’s what worked for her.”

  “Exactly, but it didn’t work for you.” That’s certainly true. I need people to understand and validate what I feel almost constantly, even when I’m in a good space.

  “I never meant to ignore or dismiss you,” my mom says. “I always focused on how strong and talented you were. Especially when you felt at your worst and didn’t believe in yourself.”

  “But why can’t you take my mental illnesses seriously? I feel like I’ve been set up, over and over. Like I’m a cripple without a wheelchair, and everyone keeps signing me up for marathons, then shaming me for not winning the race.”

  “I just can’t see you as mentally ill.”

  I feel the rage returning. We’re back at the beginning. “How can you say that after all I’ve been through?”

  Janna turns to my mother. “This is a very serious issue. And I don’t think it’s in anyone’s interest to disregard it.”

  “But you’re doing so much better,” my mother says to me. “How can you still say you’re ill?”

  I look at Janna pleadingly. I’d called her earlier, to see how capable she was of helping my mom understand BPD. She assured me she’d do her best. Now the moment has arrived. I wait.

  “Beth,” Janna says, “I’m not sure how much you know about borderline…”

  “I read that book Kiera gave me!” she interjects. (Ah yes, I Hate You, Don’t Leave Me. She also never mentioned it again.)

  “Do you understand that, given Kiera’s numerous diagnoses combined with BPD, she’s very lucky to be alive?” My mom shakes her head. “One in ten people with BPD die by suicide. Factor a drug addiction into the equation and it’s higher. Add depression and all the other issues, and the chances of survival are even less.”

  “Kiera is definitely a survivor,” my mom declares.

  “True. But you need to see how much she struggles—every day, sometimes every minute—and often with things that wouldn’t affect you. Those of us without the disorder generally don’t understand, but it’s critical, I could say even lifesaving, that you recognize her different reality—her sensitivities and the kind of pain she has.”

  There’s a long pause as my mom takes this in.

  She nods hesitantly. “I just can’t reconcile…how amazing Kiera is—the abilities she has—and this other thing. I don’t see how she can be both.”

  “Think of it as being on the borderline,” I quip.

  “She’s fragile in ways you might not be,” Janna says, then turns to me. “But Kiera, your expectation that your mom be like you is also counterproductive. If you impose your own coping skills on her and don’t recognize that she needs to escape or compartmentalize or do whatever she needs to do to take care of herself, then you’re doing exactly what you accuse your mother of.”

  “Then it’s like a mutual invalidation fest…”

  “Fodder for another session.” Janna smiles. I look at my mom. She’s completely wiped out. Charged therapy sessions are hardly new to me, but I can already understand, based on this idea of different coping strategies, that sitting down and being this intensely vulnerable has drained the life out of her.

  Out on the sidewalk, the shifting leaves dapple light over our faces. “This is so fucking heavy,” I say. We take each other’s hands. “Can we use your coping style now, Mom?”

  “What would that be?” she asks.

  “Let’s go for some Thai food, see a movie, and not mention anything about our relationship for the rest of the night.”

  “Deal,” she grins.

  22

  The Tipping Point

  These days I always come back to the DBT stages and goals. They continue to be the closest thing to a road map I have for understanding what I’m going through and where I am. Ethan tells me that the road to recovery is always under construction, and it’s obvious the stages generally don’t occur in a neat, linear fashion. Sometimes several stages are occurring simultaneously, or you might skip over one for a while. It’s not like a train that delivers you at a destination, though admittedly you do have to get on somewhere, and in that sense stage one is crucial, because it involves keeping yourself alive. Dr. Linehan says that establishing behavioral control and learning the DBT skills can take a year or more, and in general should be done prior to the stage two work of processing trauma and experiencing emotions (1993a). She also mentions that sometimes it’s necessary to enter a different type of therapy at stage two, and she doesn’t see a problem with that.

  The recovery process itself is ever-changing and dialectical, bringing together opposing experiences and catalyzing new levels of growth even as it sometimes throws you back on your ass. I think I’m firmly in stage three now: I’m identifying and working on life goals, developing an enduring and loving relationship, creating meaningful work, and establishing a home that’s not just an expensive suitcase (pending Taylor’s help). And I’m also starting to feel the pull of stage four in terms of wanting more than just a life. I want an amazing life that isn’t constantly tied to fear and need. I want to be free of the cognitive filters that insist the world is hostile and I am unlovable and alone.

  I’ve come far enough to understand that my reality is deeply affected by these inner states, and I’m doing a much better job of managing how I respond to and make sense of my experience. So in some sense, I’ve crossed the borderline. Isn’t this what people want? To be loved, to have a secure and supportive job, to feel like you belong somewhere? I suspect that, at this point, some people with BPD decide that therapy is over. Their goals have been met, and a semblance of normalcy and stability have been achieved. But I’m not in that camp. Inside me, the parts pull me in numerous directions. I still don’t know who I am, really, or where I belong without reference to Taylor. My six-year-old still can’t climb out of the adult’s bed. And I crave something, but what? Maybe it’s the transcendence suggested by the fourth stage, or a sense of wholeness. Whatever it is, Ethan is the person who travels with me in the journey, and I’m not going to give him up just because I’m in better shape. In the three years we’ve been together, our sessions have decreased to once a week, but those fifty minutes are a precious respite where I’m able to breathe deeply and readjust my focus. More than anyone else, he has witnessed and is able to hold all of the pieces of me with an unconditional regard I only wish I could bottle and swig from all day long.

  Recently Ethan has been teaching me the art of irreverence. I continue to get intensely caught up in perceived slights and annoyances, especially when I’m trying to do good things for people. Ethan suggests that when I get too embroiled in other people’s behaviors, I just take a deep breath and say, “What the fuck.”

  “What the fuck”: It works like magic for me. I’ve always found it so hard to let go in the face of perceived opposition. Now that I’m beginning to make forays into the “consumer” community of mental health, where other people with psychiatric disorders are beginning to create programs based on the concept of peer support, I need these kinds of tricks to help me stay balanced. It seems like every time I go to a meeting, I encounter someone who has been hospitalized for years on end or who is completely discombobulated from electroconvulsive therapy, who lectures me on the ways BPD is a tool of oppression. I’m full of arguments and vitriol in these encounters. You’d think that if any community would be a little helpful with the diagnosis, it would be other mental patients, but no. Or at least it feels that way. I end up exhausting myself trying to legitimize my diagnosis amidst psychiatric freedom fighters, and then I crawl back to Ethan, angry and demoralized. Of course, Ethan first wants to know why I have to join that community. My reply remains the same: I want to feel like I belong somewhere.

  “But if the cost is too much, what can you do?”

  I don’t know. It’s never clear to me when it’s time to pull back and cha
nge direction. Linehan mentions that the borderline mind cannot easily let go of preconceptions (Linehan 1993a). Everyone wants life to be a certain way, but in our case, the emotional amplification can make the facts irrelevant, like a child screaming for a toy that no longer exists, unable to recognize that some desires are destined to remain unfulfilled. Ethan and I go over the fact that other people have their own limitations, and we examine how this conflicts with my attachment to what “should be.” When I’m not in emotion mind, I can often see things from other perspectives. But even then, if I can’t understand others’ motivations, I’m incited. Why, for example, do people who are walking down the middle of a crowded sidewalk decide to suddenly stop? It’s not like they don’t know there are a hundred people behind them. So do they not care? If I kicked them or pushed them out of the way, not entirely gently, as I passed by, would it help?

  “The truth is, you’ll never know all the reasons people do the things they do,” Ethan tells me. “That’s when you can say to yourself, ‘What the fuck.’ At a certain point, you just have to walk away and let other people have their perspectives, their way of dealing. You can try radical acceptance, obviously. But sometimes it’s just easier to throw up your hands and turn away. Let yourself be baffled and stop trying to make things work.”

  “What the fuck,” I repeat. It’s got a good cadence.

  “That’s the fourth state of mind in DBT,” Ethan says. “It’s called ‘wiseass mind.’”

  The desire for belonging and purpose continues to be a huge theme in my life, and the advocacy work is my main outlet for this, despite how exhausting it is and how often it triggers me. Ethan occasionally goes out on a limb and asks if advocacy is an effective way of satisfying this need to belong. As always, the answer is dialectical. I know that by publicly declaring that I have BPD, I automatically jeopardize my relationship with most people because of the stigma and the belief that it’s dangerous to be in a relationship with a borderline. On the other hand, I’m still empowered by these efforts; in fact, advocacy is the only activity that brings me into contact with people who really understand and validate me as a person with BPD. And while presenting at conferences, I’ve been meeting BPD clinicians and researchers, and many of them treat me as a colleague.

  And these connections bring even more opportunities. The Borderline Personality Disorder Resource Center hires Bill Lichtenstein, a documentary producer, to create an educational film about BPD called Back from the Edge, and I’m one of the people featured in it. A residential treatment community in Pennsylvania called Project Transition invites me to collaborate with one of their medical directors, Loren Crabtree, on presentations about BPD. In half a year’s time, I’m flying down to Philadelphia regularly to provide consultation services and train their staff, even their bus drivers, on BPD. Dr. Crabtree introduces me to every doctor and clinician as “Kiera, a consummate educator.” Here my position as a person with the disorder is considered precious, a resource to be cultivated and nurtured. And when I’m just about ready to throw in the towel with the consumer community, Moe Armstrong, one of the leading advocates in mental health and the grandfather of psychiatric peer support, invites me to the table and champions the value of my contribution.

  So yes, in many senses it feels worthwhile, but the balance is tipping too heavily in the direction of exhaustion, and I’m also starting to feel trapped. I don’t want to be the borderline poster child forever. I hear my mother saying, again, “You need to get more outside yourself. Focus on something other than your problems!” It’s not bad advice, even if she did always say it when I most needed validation. I’ve begun making life maps in my journal, diagramming all of the people, places, and activities that I have relationships with. I draw little houses, motorcycles, and stick figures and draw connections to show the networks that are evolving. Work leads to Raymond and Renee. Taylor leads to his friends, his family, and the motorcycle community. BPD leads to Listservs, consumer communities, and advocacy organizations. And I’m trying to expand outward even more. Taylor’s mother belongs to an artist collective, and I venture there for weekly workshops until I feel too overwhelmed by the personalities and my own frustration with the creative process. My internal managers are so insistent on perfection that at the end of a session I destroy a clay sculpture I’ve spent two hours shaping. I try to make my own friends rather than relying on Taylor’s circle. I’m getting to know a woman in my advanced DBT group, but friendships aren’t allowed in our program, so it feels like we’re having an affair, and this is exacerbated by my growing sense of possessiveness about her. Just as with Taylor, as soon as I feel like she’s ignoring me, I get so angry that I want to destroy the relationship.

  Somewhere in this period, I begin to understand that my progress and stability aren’t just because of my management of my BPD symptoms. It’s as much due to the environment, again confirming Linehan’s idea that the disorder is created, and can be dismantled, in the context of relationships (1993a). Seemingly mundane aspects of life that so many people take for granted—having a job, a relationship, a place to live—are as critical to my recovery as learning the skills and being in treatment. They form a structure that keeps me from falling backward.

  One of the most powerful experiences I have in understanding BPD recovery comes during my participation in a film project. Dr. Crabtree invites me to Project Transition, and the two of us join three borderline women who are in the residential program. As a group, we discuss the recovery process and where each of us stands. One woman is newly diagnosed and just entering the DBT program. She struggles with her behavior and pain constantly, a phase that Dr. Crabtree and I dub “surviving the dysregulation zone.” The second woman has been in the Project Transition program for almost a year. She’s in stages two and three, which Dr. Crabtree calls the place of emergence. She’s starting to think about dating, going back to school, and getting her own apartment, and she struggles to enter each challenge without falling entirely back into stage one.

  I can identify with all of the women, but I relate to the third most deeply. She’s getting ready to leave the program after a couple of years of treatment, and, like me, she’s on the cusp between stages three and four. We’re both struggling to figure out how to cross that chasm from symptoms into normalcy, from patient to person. Both of us are reestablishing connections to the world and finding our place in it after decades of alienation, displacement, helplessness, and failure. At this point, our fragility isn’t as obvious, but it’s still there—and it’s scary because there’s an expectation that we’re cured or at least over the hump. It’s understandable. We all want to believe that BPD can be reversed. No one in recovery wants to think of this struggle as a lifetime condition, nor do our friends, our loved ones, or any of the people who believe in us. But what if it is? What if we will always be ­challenged and need a wide array of resources and support to keep our symptoms in check? Does that mean we’re screwed?

  As we discuss the future, it’s clear to all of us that, whether you call it being in recovery, recovered, or in remission, with BPD the process isn’t like mending a broken ankle. At every stage there’s still more hard work to do, and we still need help. I recount how just dating Taylor triggered me so much that I thought I wasn’t going to make it. And even now, when outwardly I seem so together, I still feel lost. I’m still living out of suitcases while staying at Taylor’s, and I’m still terrible at handling stress. And when I’m triggered, I can go back to hating myself and seeing the world as hostile in an instant.

  “Each new challenge,” Dr. Crabtree comments, “brings with it another destabilization and potential loss. And so as you get ‘better,’ there’s an ongoing need for more support, not less.” We all nod at this. It’s so very true. Success and progress would seem to be a good thing, but they can rip the ground away. This takes many forms: being discharged from a program; losing the empathy of others because they now believe we should be over it; and even—or maybe especially—inval
idating and berating ourselves because we insist that we should be cured. If this last stage is real, with its promise of connection and mastery and all of the benefits of getting better, we need to have a different perspective on the process itself.

  We decide that the last stage is about integration and examine how bridges and pathways might be created to get to this new place. At Project Transition, they consider clients to be lifelong members—not to stigmatize them as eternal mental health patients, but to acknowledge them as part of an enduring community that will always have a place for them. They can return to Project Transition whenever they need to, without shame. This creates a more porous interface between treatment and life, and this recognition—that integration can take years for some of us—allows us to inch backward and forward during these stages, or to slam into walls, and have a safety net either way.

  If ever I doubted the benefits of getting a group of borderlines together, I am now a believer. At the end of the two days spent talking and filming at Project Transition, I go back to my life map to look for where I can keep creating pathways and communities to help my process of integration. More than ever, I’m realizing it takes a village to help a borderline. Treatment can give us the tools, and for those lucky enough to be at a program like Project Transition, professionals will be there to help with integration. Ultimately, however, we have to make this happen for ourselves.

  But how? From the first session with Ethan, I’ve explained that I feel I don’t belong anywhere. It’s one of my deepest and most enduring feelings. That’s why the 12-step community was so positive for me for a long time, and why being a Deadhead or a goth, or even just somebody’s girlfriend, seems like a solution. Belonging is a primal need. But with BPD, it goes beyond this. To drink from the source of someone else’s presence, no matter how sour it may eventually taste, creates a temporary sense of self. And in truth, I worry that I may be doing this even in my role as an advocate. I still don’t understand or have much connection with myself beyond the roles and goals I set for myself.