My light-bulb moment for the month

It is May. I have survived my first term back at school and it has been very challenging, but in a good way. I thought that once I would be back at school undertaking a counseling course, I would have plenty of material to write about on here. Instead I find myself reluctant to share my experiences as I feel I am not where I am “supposed” to be. I am not doing as well as I think I should be doing.

And for the life of me, I could not figure out why. I was in a really good space by the middle of 2010. I had decided to stop trying for a baby for now. I signed up for my counseling course and passed the admission’s interview. I got a job working with children in an after school care program. Yet I have regressed so much over the last few months.

I know part of it was due to Jay being very sick and having to cancel most of our sessions between September 2010 and February 2011. I might have seen him a total of five times during those six months. But since February we have been having our normal two sessions a week, so why am I still so all over the place? I am so clingy one moment and so withdrawn the next. Therapy is beginning to feel like a waste of time. Ever since I was first forced into this minefield of mental health treatment I seem to make progress only to lose it again after a few months. Perhaps I am meant to stay insane.

Jay has also noticed that I seem to be doing therapy halfheartedly. He calls it me “not showing up” for our sessions, in the sense that I am there but not really willing to engage in deeper level stuff. He has been trying to get me to have a think about wanting to do therapy for me, not for him, not for my family, but doing it because I want to. Otherwise it will never work.

He asked me to have a think about this and email him my thoughts. An extract from that email (edited only to hide identifying details or leave out irrelevant stuff):

“[…] I was thinking about how you said I should want to do the work for me, not for you, not for other people, but for me. And how I just don't seem to want to. I can work on stopping self-harm, because I don't want to get thrown out of my course, I don't want the parents of the kids I look after to find out, and because I know it is expected of me. But really, if I had a choice, I'd like to have that option available to me. I don't mind self-harming every once in a while.

And I was thinking about how for most of my life I have looked to other people for cues on how to behave, what expectations to meet, what not to do. Even now, I will sit in the lunchroom at school and watch other people make small talk and laugh at jokes, and I’ll make mental notes on how to behave. How to engage in small-talk, when to laugh at jokes that I just don't find funny.

[…]

It sometimes seems like I don't really have that sense of self. I am always looking up to other people to see what they expect of me and how I should behave. I do therapy the way I think you want me to. I am a wife to my husband, always trying to please him and anticipate his needs, and forever assuming that every unhappiness in him is caused by me […].

Am I doing therapy for me? I don't know. I want to stop self-harming because it is expected of me. I want to stop acting out coz I risk hurting those I care about. I want to "get better" so everyone gets off my back. But do I want it for me? In an ideal world where no-one would care whether I was sane or crazy, I'd probably prefer to stay crazy.

The only time where I kind of felt like I was doing it for me was when we were trying for a baby. […] But it seems Mother Nature has already figured out I'd be the crappiest mum ever, so then what's the point.

I know you've often said I have to do the work because I want to do it for me. And I just don't think there's a "me" underneath all this. Of course there's a G.I. that experiences awful feelings and she hates feeling like that. But even that can feel like something "foreign" sometimes, that has to be gotten rid of, by either self-harming or acting out in other ways. And then she's back to feeling like this shell of a person. I imagine my body almost to be like a shell. And there's this huge emptiness inside. No organs or bones or anything. Just emptiness. So I go from person to person trying to fill that up. And I know there's certain ways in which I should behave to get the love and care that I seem to forever lack. So I do all the right things, behave in all the right ways, and most of the time that means someone will look after me or love me or care for me or laugh with me. So I can kind of "do the work" to get my needs met. But if there had been easier ways to fill up my empty shell, I sure would have grabbed a hold of them. So in a way I don't feel like I am doing all this work for me. I am doing it because that is how I get other people to respond to me and give me what I want. But it's not how I would prefer to behave.”

As I wrote this to him I felt utter hopelessness. Why, after all these years of treatment, am I still not “better”?

Jay had a very different perspective. He found it enlightening to read about how I view myself as this empty shell without a real sense of self. He explained that children form that sense of self during their first few years by having their caregivers respond to them attentively and by reflecting to the child what they are feeling. An angry, young toddler, does not know they are angry. An adult has to tell them “I can see you are very angry right now”, before they learn to connect the upset that they are experiencing to being angry. They also need adults to teach them that these feelings are temporary and that the upset they are experiencing will eventually subside. Jay explained that this did not happen during my early years and he was struck by how I described this emptiness inside me now. He believes that during our fourth year of therapy (2010) I slowly trusted him with more and more of the disintegrated parts that make up me. And by him kind of “holding” all those parts and integrating them little by little, I was slowly creating that sense of self, which is often much harder to do as an adult, than had it gone right the first time around when I was younger. Nevertheless, we were making progress. But then he got sick, and this process got interrupted. Even though most of me says “oh well, I dealt with it, no big deal”, it most probably scared the hell out of the younger part of me. And that is why it seems we are back at square one. Unconsciously I have decided not to bring my vulnerability to Jay as he has proven to be unreliable. And that is probably also why I feel so “all over the place” at the moment.

It was such a relief to hear him explain my craziness like this. It was my light-bulb moment for the month. He gave a name to all these things that I had been experiencing and that had been making me feel like I was destined to stay crazy forever. But in fact I had been making good progress and had he not fallen ill, I would probably still be doing really well right now. But the disruption to our sessions caused my “holding environment” to fall apart and in doing so, it disintegrated that fragile sense of self I was developing.

So that now leaves the hard work of me slowly allowing myself to bring my vulnerability into the therapy room, rather than to withdraw and/or act out. Easier said than done, but I do really believe that understanding is the first step toward becoming a whole person again. (Or perhaps to becoming a whole person, full stop, as it seems it was never really there to begin with, for me.)

This week is the first time in months I felt like there might just be some hope for me. To be continued…

Thank you for reading.

Yours truly,

G.I.

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.