Therapy Crisis

It is almost Christmas, and I notice that yet again I have not written for a while.

When all goes well, when life happens according to neat schedules and routines, when the people around me are there for me, I can pretend, I can even genuinely believe, that I am "better". That I have well and truly left behind the angry, confused and defiant 17 year-old I once was. That I am almost 25 now, a real adult, and that, with age, maturity and resiliency have naturally developed.

Indeed, when looking from the outside in, I am doing well. I am coming up to my three year wedding anniversary and could not be happier. I am gearing up to go back to university next year and I am looking forward to the challenges I will face there. I have been in my new part-time job as an after school care supervisor for just over two months now and I am loving it. After having looked after babies and toddlers for years, it has been interesting to learn how to interact with primary school aged children. Of the three supervisors, the children have dubbed me their favorite, and I would be lying if I did not say that that really stroked my ego.

But if you looked closer, you would see that I am spending most of my mornings in bed. Getting up at 12 or 1pm, just in time to get ready for my job at 2.30pm. And the days I do not have to work, I spend in bed or on the couch. I am trying to avoid having to socialize with friends, even though I would love some friendly company. Simple things, like getting groceries or returning library books, seem so insurmountable that they require days of planning and procrastinating. After having so bravely handed over my stockpile of pills to Jay, the only thing stopping me from seeing my GP for some tranquilizers, is the half an hour drive I would have to make to get there.

The catalyst for all this?

Jay has been quite unwell for the last three months. I have seen him once since September and I will not be seeing him until February next year, provided he is feeling up to it. This makes one session in 4.5 months (where I normally see him twice a week). Over the last three months Jay and I have scheduled session after session, only to be canceled mere days beforehand, because he was not well yet.

I was taken aback by how upsetting this was for the little girl inside me.

The first criterion cited by the Diagnostic and Statistical Manual of Mental Disorders for Borderline Personality Disorder is "Frantic efforts to avoid real or imagined abandonment." These days words like "abandonment issues", "depression" and the likes, are thrown about so lightly that they can lose their meaning. People use the word depression when they actually mean sadness or having an off-day. In the same way "fear of abandonment" doesn't even come close to describing the absolute terror I experience when someone leaves me or when someone is absent.

It is almost as if therapy, and by extension the therapist, provides a kind of "holding" environment for all the parts and bits that make up me. The scared little girl, the angry and confused teen, the anxious and needy adult. I can be all of these within the therapy room and know that I am still okay. I can be disproportionately angry, knowing that Jay will not retaliate. I can be the abused adolescent that learned she could make men do what she wants by using her body, without Jay ever taking advantage of me. I can be the sulky young girl who is too scared to show her vulnerability, knowing Jay will treat her with great care and respect.

And when therapy temporarily stops, it is as if there is no "holding" environment for all of me. I literally feel like I am disintegrating and falling to pieces. Swinging back and forth between being desperately needy and scared Jay will die (even though I know that is highly unlikely), and being defiant to mask that fear and neediness. Acting out for the mere sake of acting out and taking revenge. Wanting to cause him as much anguish as he is causing me, by refusing any interim help from him, hoping it will make him worry about my safety. And I know full well how childish these games are and how Jay deserves better and more of me, yet I can't seem to stop myself.

Jay is finding this disruption to our work as frustrating as I do and has offered to have regular phone contact. He has arranged a locum for me and he has told me I can email him as often as I like. And a small part of me desperately wants to hold on to that, while the rest of me thinks "it hurts so much not to have all of you, that I will make sure you cannot hurt me anymore, by pushing you as far away as I can". And I guess it is this part of the borderline behavior that often drives loved ones mad. The constant clinging onto and pushing away. The ever present “I hate you, don’t leave me”.

So there you go. When life throws me a curve ball, I do not seem all that different from the six year old girl I looked after at work today. She threw the biggest tantrum because she thought I was giving her older sister more attention than her. She stomped her feet and yelled at me, when what she really wanted was to sit down with me and play a game of “Agitation”. I guess in the same way I give Jay the silent treatment, when what I really want is for him to make the sad and the missing go away.

Today, though, I swallowed my pride and gave the locum Jay arranged for me a call. We have set an appointment for next week and I will try my hardest to give the guy a real chance. Hopefully seeing another professional will help reintegrate and soothe part of me, until I can resume therapy with Jay next year.

Wishing you all happy holidays.

Thank you for reading.

Yours truly,

GI

Who am I?

If you would look at my high school record, it would say I have been stood down twice for a whole week. The first time for having formed a “destructive friendship” with a girl who, like me, was a self-harmer. It will not mention that I was introduced to this girl by my guidance counselor with the words: “I have another girl here that cuts, maybe you two could be friends and help each other”. It will not mention our counselor facilitated our introduction and it will also not mention he knew both of us were not “in-recovery”, whatever that means.

I could have seen this train-wreck coming from miles ahead, but my “counselor” (who was merely a social studies teacher, doing a little bit of psychological experimenting on the side) was genuinely disappointed when he found out we were indulging in our self-destructiveness, rather than being the textbook 12 step recovering addicts he had hoped us to be.

The second time I was stood down was for having a crafts’ knife on me. Everyone was allowed to have those at school, except for me, since I had a history of self-harm. The thing is, no-one told me this, or I would have hidden it better. So after having been back at school for just one week, they sent me home again. I thought detention would have been more appropriate, but welcomed the holiday nonetheless.

On the last page of my school record it will say I dropped out, and left school voluntarily. The truth is I was given the choice between being expelled for setting a bad example at school (and thereby making university entrance nearly impossible) or signing myself out. I chose the latter.

I was the typical borderliner-in-the-making.

If you would look at my medical records from the various public mental health services I was sent to, it would make interesting reading. It seems every shrink had his favorite flavor of the month when it came to diagnosing. It started with “Generalized Anxiety Disorder”. Then came the all-encompassing “Major Depressive Disorder”. To see if I was psychotic as well, I was put on a course of anti-psychotics. If they made me “better” then clearly I was psychotic, but to no avail, I was still the same obnoxious, defiant, manipulative, almost-old-enough-to-warrant-the-dreaded-borderline-label GI. And then when I did reach the age, a big fat “BPD” (Borderline Personality Disorder) was stamped across my file, relieving every mental health worker from having to try to help me. After all, BPD is incurable.

It seems that once you have the borderline label, you have become this whole new species. The receptionist at the mental health service no longer looks at you with a smile, but instead looks right through you, telling you without words she thinks you’re a waste of resources. Psychologists are pulled from your case, because talking won’t help the incurable. No more weekly sessions, or therapies, just a once-every-three-months visit to a psychiatrist for meds that will keep you doped up enough to keep you from seriously harming yourself. If you complain you still feel like crap, your daily dose is upped or a new drug is added to your tropical cocktail of psychotropics. If you complain the meds are not working and you want to stop because they make you feel like a zombie, you’re defying authority, and illegible notes will be added to your file about how your BPD traits are getting worse.

Nobody told me I had BPD attached to my forehead, until I was about 20. It had been in my file since my teen years, but there was never a “hi, you have a borderline personality” until I went to see my current therapist, Jay. When I asked him whether he thought I was a borderliner or not, he gave the classic “Why is it important for you to know that?” “What significance does knowing have for you?” I have found out through years of being a patient, that this is therapist speak for “yes”.

Borderline Personality Disorder. It’s got its own little subheading in the DSM (Diagnostic and Statistical Manual of Mental Disorder), every shrink’s bible. Apparently there used to be only two types of personality disorders: Neurotic Personality Disorder and Psychotic Personality Disorder. But this left a whole cluster of crazy people without a label, even though they were clearly not as functional as those that call themselves normal. So all exhibited symptoms of this group of people came to be known as a Borderline Personality Disorder, not quite neurotic, not quite psychotic, but definitely insane. There are nine so-called symptoms, and if you tick at least five, consider yourself a winner.

Borderline Checklist

1. Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behavior covered in Criterion 5] It’s up to your shrink to decide what “frantic” is. No-one likes being abandoned. That’s how we’re programmed in my opinion.

2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation. Sometimes we hate our partners, most of the time we love them. Where does a relationship become intense and unstable, and when are we just making our way through the world, trying to find our mate.

3. Identity disturbance: markedly and persistently unstable self-image or sense of self. Yeah, that was me. Once. Like about 99% of adolescents.

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5] Show me a person who hasn’t indulged in any of those.

5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself. Ok, I guess this one applies to me. That’s one out of nine.

6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days). I definitely struggle with this. Once a month. Every month.

7. Chronic feelings of emptiness, worthlessness. Don’t we all feel like this during certain periods of our life?

8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights). I guess I’m a little intense, although I wouldn’t say I have an anger problem, and I’ve definitely never been in a fistfight.

9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms. I’m not even going to try to understand what that means.

Source: http://en.wikipedia.org/wiki/Borderline_personality_disorder

I find the BPD label highly useless. Most of these symptoms are exhibited by most people in some degree. It’s up to your doctor to decide whether you’re crazy enough to be awarded the honorary title of borderliner.

I have found life as a borderliner difficult when it comes to dealing with health professionals simply because of the stigma attached to it. But I wouldn’t trade it for anything. I reckon life is more intense, with higher highs and lower lows than most people experience life. My loving husband always jokes he’d be bored to death if he’d married a “normal” woman.

My name is Gracefully Insane and from time to time I’ll share my disordered thoughts here.