Does DBT Work?

In the previous post, the question came up of whether DBT works.  I have not undergone this therapy, so I invite responses from anyone who has.  

In the meantime, here is a bit of unexpected skepticism towards DBT from an article in a British journal on psychiatric treatment:

Dialectical behaviour therapy (DBT; Linehan, 1993) is based on the principle that BPD is essentially the result of deficits in interpersonal and self-regulatory skills and that these skills can be taught in therapy.  Defective affect regulation is seen as particularly important.  Treatment consists of weekly individual and group therapy sessions based on a skills-training model, together with out-of-hours telephone contact with the therapist.

Dialectical behaviour therapy has been shown, in a single study, to be superior to 'treatment as usual' in reducing self-harm and time spent in hospital, but not subjective experiences such as depression and hopelessness (Linehan et al, 1991).  There were also significant improvements in social and global functioning and anger (Linehan et al, 1994).  However by one year after the end of treatment, rates of self-harm were no different in the DBT group and treatment-as-usual groups, although both had improved (Linehan et al, 1993).

Despite this essentially negative finding, DBT has attracted considerable interest; however, Linehan's study is open to a number of methodological criticisms.  Only 39 patients were studied, all of them female, and of these only 20 were fully assessed.  The level of self-harm required for entry into the study (two episodes in the last five years and one in the last eight weeks) may have led to the inclusion of patients who were less severely disturbed than those commonly seen in clinical practice.  Furthermore, DBT involves a high level of input from professionals and it is not yet clear whether it is the skills training itself or simply the high level of support which leads to the reduction in self-harm.

-Anthony P. Winston, "Recent Developments in Borderline Personality Disorder" (2000)

This assessment of DBT surprised me.  I had never heard negative remarks about this therapeutic approach before.  Reading Linehan's dense tome on CBT for borderlines helped me a lot in reconfiguring my attitudes.  The idea of radical acceptance was at first a big frustrating puzzle to me - another opaque window - but gradually it settled inside me as something useful that I can draw on, especially regarding family relationships.  

Anybody else have thoughts on DBT, CBT, Linehan, or this methodological critique from Winston?

Ask a Borderline

A reader of Girl in Need of a Tourniquet emailed me this week with some follow up questions, and with her permission I am sharing our correspondence with readers of this blog. Thanks, Joanna, for collaborating with me on this post!

On Tue, Oct 26, 2010 at 9:32 PM, joanna george wrote:
Hi Lisa,


I realise you're probably extremely busy with all your responsibilities as an author and professor but I just wondered if you'd have time to answer a few quick questions regarding your book/BPD.  If not, I completely understand.


I thought your book was amazing, by the way, very real and unique to other autobiographies I've read by people with Borderline.  It certainly helped me in my obstacled journey as a Borderline, although I'm now reflecting more on my own thoughts, feelings and behaviours, especially of the past.  Hopefully, this will be some form of self-therapy for me.  It is certainly comforting to know I'm not the only one who has offbeat thoughts and emotions.


So my questions - I was wondering if you have done DBT which is thought to be groundbreaking therapy for Borderlines, and if so, was it helpful?  I have done two modules of DBT and to be honest, while it has helped with some of my behaviour where interpersonal relationships are concerned, it hasn't helped greatly with making me 'feel' better.  As you mentioned in your book, (from another author) when one is pathologically anxious or in distress, methods such as meditation and physical exercise don't work too well.  I find when I am in what I call 'one of my rages' or need for self-harm, there is nothing stopping me, and meditation and mindfulness are the last things on my mind.


My other question - I believe you were diagnosed quite late, in your early thirties, as I was too (just a year ago actually).  Did you experience similar emotions, feelings, thoughts and behaviours when you were much younger and just went undiagnosed, or do you believe it is something that appeared later for you?  I always knew I was different (different in the sexuality as well as mental sense) and went through my twenties just thinking it was depression/dysthymia.  I didn't even start self-harming until I was in my early thirties, although I always went for some very fast and out of control drives when the tension and anger rose.


And one last very tiny question - even though you're now married, do you still feel like there is perhaps a 'hole' or something missing (I am actually not sure if you spoke of this in your book anyway)?  I have a wonderful girlfriend but still feel as though something is missing in my core, my soul.  It is something now that I'm older I realise will always be there.


Anyway, thank you for reading my email, and thank you so much for writing your book.  I just wish it went on for longer!


Take care,
Joanna

Hi Joanna,

Thanks for writing.  I am happy to answer your questions.  Would you be comfortable with me using your email and my responses on my blog? 

I have not gone through DBT, but I have listened to Pema Chodron for many years now, and I read a book called Feeling Good which is a CBT-based book, and both of these sources provided the kind of cognitive reconditioning I needed in order to improve my overall mental well-being.  I have been lucky to find that I could implement ideas from books and audiobooks in my life with minimal therapeutic supervision.  From what I understand, most people need more structured guidance, but if the choice is between books/audiobooks and nothing, then I say try the books :-)  The best tactic for me is to read and listen during periods of low-grade anxiety as a way to manage my emotions and keep them from getting too big and uncomfortable.  I also reduced my alcohol intake significantly because I finally understood and accepted that alcohol amplifies my negative feelings to a level where I cannot manage them, so it is like a "gateway drug" into emotional chaos.  I was diagnosed around age 31, about six years ago, but I did always know something was off for me.  Like you, I thought it was depression, and I thought it was basically what I learned in my undergraduate literature courses to call the "human condition." 

It is not the human condition, I now know.

And in fact I was fascinated to read that some of the authors and artists of the so-called human condition (e.g., Sartre, Munch) were suffering from severe abandonment depression related to childhood loss of attachment figures.  I am married now, but as I say in the book, marriage is no cure for an attachment disorder (I prefer "attachment disorder" to "personality disorder," because of the way the term shifts focus to the dynamic of pain rather than the person herself).  I still experience loneliness, frustration, abandonment feelings, engulfment feelings, and a basic restlessness, but I don't look to my partner to correct those feelings.  It is my responsibility to explore, manage, ventilate, and refuse to be at the mercy of these emotions.  I have made enormous progress towards what psychologists call "integration" as a result of writing the book and doing the cognitive reconditioning that accompanied my writing process.  Old painful memories have taken on a less frightening dimension.  My working models of self, other, and world have all shifted in a positive direction. 

I am working to shed the "goat girl" narrative of myself as monstrous and unwanted, and to replace it with a more friendly view of myself as valuable, interesting, pleasant, and so on.  My view of others is shifting from the other as disapproving judge to the other as simply someone living their own life with their own hangups and gifts just like me.  And the world looks less hostile now, more neutral and interesting.  Those changes (as opposed to my marital status) are helping me feel full instead of empty and to feel whole instead of like a "hole."  The work really has to do with what's going on inside us, but I am lucky to have a partner who will engage in ongoing conversations about such things, who pushes me to keep reconditioning myself to be less easily thrown off my mood, and who listens earnestly when I say I feel unheard or invalidated and who is open to making changes in our interpersonal dynamics to improve the space of our marriage for both of us. 

I hope these responses are helpful to you.  Again, thanks for writing me and for supporting the book.

All best, Lisa Johnson

An angst-filled mix-tape of a story

This is the best review of the book so far.  Thank you Kathy Wise!  You are so right - the book IS a mix tape, a prose poem, and a big open question about the line between sane and insane.  I am honored to be a staff pick at Shelf Unbound.

The cited soundtrack to Girl in Need of a Tourniquet is the soundtrack to my own coming out in the early '90s, minus the borderline personality disorder. It is the shaved-headed power of Sinead O'Connor, the burning passion of Lisa "Left Eye" Lopes, the bi-ambiguity of Ani DiFranco, and the Juliette-Lewis-in-a-mental-hospital video drama of Melissa Etheridge. An angst-filled mix-tape of a story, Johnson's memoir serves as a beautifully crafted prose poem about an absent mother, unrequited love, sexual identity before the L Word, and mental illness, begging the question of where sane (or youth and a lack of consequential thinking) ends and crazy begins.

-Kathy Wise

Girl in Need of a Tourniquet - Video Short - thanks to AJ Mahari for providing an audiofile of this reading!

Interview w/Merri Lisa Johnson by Amanda Smith, Exec. Dir., Florida Borderline Personality DIsorder Association

This was my first interview about Girl in Need of a Tourniquet.  It took place the very week of the book's release. Go to: Florida Borderline Personality Disorder Association and scroll down to the link to an mp3 of the interview.

(Hopefully it's working now . . .)

Interview w/Merri Lisa Johnson by AJ Mahari, Psyche Whisperer (June 29, 2010)

Listen to internet radio with Psyche Whisperer AJ on Blog Talk Radio

Whose Eggshells?

I've written so many different descriptions of Girl in Need of a Tourniquet as I prepared the manuscript and worked on publicity for the book.  I just ran across one that might be useful in sparking conversation about the dynamics between borderlines and our partners or familial attachment figures:

My mission in this memoir is to convey the strangeness and intensity of borderline personality while at the same time retracing the flawless - if dysfunctional - logic of borderline cognition.  The borderline doesn't like walking on eggshells any more than her partner or family members do.  She would never have intentionally strewn them on the floor.  She often thinks you (her partner, her mother) put them there!  You may both be putting sharp broken things in the path of your relationship without meaning to, without knowing you're doing it.  

This description isn't meant to shift blame from the borderline to the partner, but rather to foreground the fact that the touchiness captured so well by the image of walking on eggshells is produced by an interpersonal dynamic, not from the borderline in a vacuum, and, most importantly, that this interpersonal dynamic can be reconfigured through the acquisition of improved skills in communication and emotion regulation.  This is a commonplace view in imago therapy and family systems therapy, but it rarely comes up in conversations about borderlines. 

Within two months of weekly therapy sessions with a couples counselor who uses imago therapy strategies, my partner and I saw dramatic improvement in our relationship, and we still use the concepts, language, and tactics we learned there on a daily basis. 

Plus we listen to a lot of Pema Chodron.  

Just sayin' . . .

Strengths and Resilience, Not Flaws and Damage

The label "borderline personality," like all personality disorder diagnoses, can be powerfully disheartening when you are on the receiving end.  It seems like an all-encompassing marker for a deeply flawed person.  I felt embarrassed by the term at first and was so relieved when a colleague of mine at another school suggested I research the "strengths and resilience" school of thought in Psychology (in place of the focus on assessing damage) and urged me to reframe borderline personality in terms of the gifts of empathy and other emotional strengths that come along with this personality organization.

In Jenne' Andrews' recent blog post on Loquaciously Yours - "Don't Call Me Borderline" - she writes about the destructive power of the term borderline personality disorder in her mother's life and in her own, and about the ways she and her mother both experienced a kind of eclipse of their creative strengths in the face of heavy pressure from the world of psychiatry to accept a view of themselves as terribly sick.

Please don’t get me wrong, I’m not saying I’ve never worked with people whose inner systems fit the criteria for the DSM categories of Borderline, Narcissism, and others. The difference is that I don’t use the categorical and shaming word “Personality Disorder” to describe a person’s experience and I don’t view people as fundamentally flawed. Deeply wounded, yes, powerfully protected, yes, but fundamentally and irreparably flawed, no.

I am especially drawn to the implication in her statement above that the "ugly" or "difficult" parts of borderline personality disorder are indicators of a very powerful and, I would add, often self-defeating system of defense mechanisms. I think of borderline personality disorder (or its less intense form, borderline personality organization) as a set of defense mechanisms gone haywire. Little bombs and tripwires and short fiery fuses set up in a circle around us and inside us. I definitely agree with the move to foreground trauma survival, trauma reenactment, and post-traumatic stress syndrome as the emotional musculoskeletal structure of borderline personality disorder. The idea of borderline personality as, also, a set of emotional strengths, resilience, and gifts is the very important other half of the new-and-improved story so many of us are now trying to tell about life with borderline personality organization.

The Accidental Sociopath

My partner and I often discuss the film, Girl, Interrupted, as a blurred portrait of the borderline/sociopath.  In the film, the borderline personality is the main character, Susannah, played by Winona Ryder, but the character we both think most people see as borderline in the film is Lisa, played by Angelina Jolie. Lisa, however, is a sociopath.  (For Angelina's critique of the film, click here.)  Part of the reason we imagine this blurred portrait happens is that the general public misconceives of borderline personality as a standard sociopath.  Someone who will, as a therapist once described to me, cut your throat and laugh while you bleed out on the floor.  This is partly a problem of misinformation, partly a problem of cultural and professional bias against borderline personalities as difficult, scary, or overwhelming, and partly a problem of there being something a little bit true in the blurring of these two types.  There are moments when borderlines skid sideways into sociopathy:

Clearly there are fundamental differences between borderline personalities and sociopaths, differences which I appreciate. At the same time, when the borderline personality’s rage or desperation is evoked, one sees (and not rarely) responses that can closely correspond to the sociopath’s calculating, destructive mentality.

Once inside this mentality, I’m suggesting that borderline personality-disordered individuals can lapse into a kind of transient sociopathy. Commonly, victims of the “borderline’s” aberrant, vicious behaviors will sometimes react along the lines of, “What is wrong with you? Are you some freaking psychopath?” They will say this from the experience of someone who really has just been exploited as if by a psychopath.

Because this isn’t the borderline personality’s default mentality (it is the sociopath’s), several psychological phenomena must occur, I think, to enable his temporary descent into sociopathy. He or she must regress in some way; dissociate in some fashion; and experience a form of self-fragmentation, for instance in response to a perceived threat—say, of abandonment.

These preconditions, I suggest, seed the borderline personality’s collapse into the primitive, altered states of self that can explain, among other phenomena, his or her chilling (and necessary) suspension of empathy. This gross suspension of empathy supports his or her “evening the score” against the “victimizer” with the sociopath’s remorseless sense of entitlement.

-Steve Becker,  
"The Borderline Personality as Transient Sociopath"

For the most part, this article by Steve Becker trips my internal Borderline Bias Alarm System.  Lights flash.  Sirens set my teeth on edge.  For one thing, it's posted on a blog called LoveFraud.  Ick.   The article is part of the dense cyberforest of anti-borderline treatises, rants, warnings, and notes of regret posted to the web by non-borderlines about borderlines.  So I take what Steve Becker says with a grain of salt.

However.

I'm intrigued by the idea of the transient sociopath.  It rolls off the tongue like the accidental tourist or armchair psychologist or incidental charges.

If you read the chapters, "Rocket Girl" and "Tantrum Artist," in Girl in Need of a Tourniquet, you will see that I descended into near-psychosis as a result of remaining suspended for too long in an affair with an unavailable lover.  I didn't have thoughts of "evening the score," as Becker says, but I definitely regressed, dissociated, and experienced temporary self-fragmentation.  I lingered on the psychotic end of the neurotic-psychotic borderline spectrum.  I collapsed, on occasion, into primitive, altered states of consciousness.

So.  What do you think of Becker's ideas about borderline personality and transient sociopathy?  

Do admissions (like my own) of a borderline breakdown that blurs lines between crazy-borderline and crazy-sociopathic risk further misidentifications of and biases towards the borderline personality?

Has your borderline personality ever threatened to trade hats with its sociopathic best friend?

What are we to make of this intersection of diagnoses?

Beyond Remission, Beyond Stigma

Check out Kiera Van Gelder's intelligent discourse on the challenges facing individuals with borderline personality disorder as they reduce symptoms but continue to experience baseline affective dysphoria, longings for intimacy and community, and the stigma attached to the diagnosis.  Kiera is the author of the newly released memoir, The Buddha and the Borderline, and her work as an advocate for BPD individuals and as an educator of the general public and the professional psychoanalytic community is pathbreaking, passionate, and highly admirable.  I count her among my friends, colleagues, and best writerly compadres. 


Beyond Remission: Mapping BPD Recovery by Kiera Van Gelder from Kiera Van Gelder on Vimeo.

I plan to write a series of articles in the upcoming academic year about the question of calling someone A BORDERLINE or self-identifying as A BORDERLINE.  In this lecture at Yale University's annual BPD conference (in 2008), Kiera states a strong dislike for the rhetorical pattern of calling someone A BORDERLINE because it holds a person in the stigmatized and static space of a diagnosis and identity that is widely maligned.  She is totally right, but I want to complicate the picture a bit by using this idea as a point of respectful departure in order to begin thinking about what a queer feminist crip theory of borderline personality disorder would look or sound like.  I'm interested in borrowing Rosemarie Garland-Thomson's description of feminist disability theory -- embracing the supposedly flawed body of disability -- to make a similar proposal for mental illness in general and personality disorders in particular.

By embracing the term BORDERLINE as an identity, I am working to destigmatize the label and to throw light on the biased norms that shape the stigma, to demystify the illusions of normalcy that make us believe most people are mentally balanced and physically whole and symmetrical, while a few of us freaks or gimps or borderlines are tearing our hair out and muttering to ourselves about paperclips and conspiracies on the subway.

I'd like to begin thinking about ways of reclaiming and revalancing BORDERLINE like others before me have reclaimed and revalanced QUEER and CRIP, drawing on the work of Nancy Mairs, who wrote the oft-cited essay, "On Being a Cripple," and the more recent follow-up piece, "Sex and the Gimpy Girl," as well as on Robert McRuer's powerful philosophical treatise, Crip Theory, and on the examples being set by figures like Bethany Stevens on Crip Confessions and another up and comer blogging under the name CripChick.

"We're here, we're borderline, we're fabulous!"

It has a certain ring to it.


This approach would be less about educating the public on neurodiversity and more about taking an anti-bias approach to borderline personality advocacy.  (For more information about anti-bias education, look here and here and here.)  What I like about the anti-bias approach to education is the way it replaces the so-called politeness of ignoring difference with attention to the social production and maintenance of difference through the internalization of bias, the reproduction of stigma, the manufacturing of consent to norms that are unhealthy and unjust, and the inequitable distribution of resources.

I'm curious to hear everyone's thoughts on this preliminary sketch of an idea to use crip theory (a kind of in-your-face self-naming that refuses the usual hierarchies of normal/abnormal, able/disabled, sane/insane) in order to get past the mistaken notion that personality disorders, attachment disorders, and mood or affective disorders are unusual or rare,or signs of weakness or marks of moral failure.  They are actually, as I say in Girl in Need of a Tourniquet, as common as dirt, and it would be nice if the world around us stopped pretending otherwise :-)

Of course, just like the word queer, it's one thing to self-identify as queer and quite another for someone else to call you a queer, so perhaps a queer feminist crip stance towards reclaiming borderline personality may need to remain a first-person kind of thing, something you call yourself in specific contexts to make specific interventions in cultural narratives of mental illness or misogynist bias, not something other people (your doctor, your ex, your boss, your lover) should ever call you.

What do you think?

Can BORDERLINE be reclaimed and revalanced in an analogous way to QUEER and CRIP?

And what do you think about using crip theory to talk about mental illness and personality disorders in addition to the usual topic of physical impairments?

Should CRIP be reserved for radical disability activism devoted to physical/visible impairments?

Is "borderline pride" a useful strategy for acknowledging borderline personality as a "type" rather than a terrible illness or untreatable condition?  Or does it undermine potentially life-saving changes in behavior among borderline personalities?  Can one have borderline pride and a deep commitment to improving quality of life (a.k.a., recovery) for borderlines?

Let me hear from you.

Borderline Personality at Work

This blog post is a follow-up to comments made on my previous post, "Waiting to Exhale: A Question of Borderline Personality Stigma."  I tried to post it as a comment, but it was too long, so here it is as a blog post of its very own :-)

I am touched and reinvigorated by these stories of coming out or staying in the BPD closet.  I really appreciate everyone sharing your own evolving experience of being borderline and your decisions on how to navigate this condition in specific contexts (e.g., education, the work place). 

I especially connected with Cheri's post above:

"Before I came out at work, people didn't understand why I sometimes reacted strangely - in one meeting they thought that I was angry and glaring at everyone, when in reality I was trapped in my own head flogging myself, riddled with anxiety and unable to speak.

I much prefer putting myself out there a bit and explaining why I sometimes have difficulties than people thinking that I'm being a bitch."

Being out as a borderline personality at work is something I am just now experiencing -- barely -- because of course my book came out and my colleagues are congratulating me on the publication.  No one has addressed the subject matter of BPD specifically, which is kind of nice for now, since it remains such a controversial and stigmatizing diagnosis.

I am fascinated by the idea of having colleagues who know enough about BPD to recognize silence as a sign of anxiety instead of disengagement, anger, contempt, or a disgruntled attitude.  I've been thinking a lot in the past few months about how I come across in meetings with other faculty, and about how I come across in the university classroom.  Students have remarked in the past that I looked angry, or that I seemed angry when they didn't understand something, when of course my memory of such days are of feeling overwhelming anxiety at the prospect of being unclear or unsuccessful in my attempt to teach them something.  When I'm upset with myself, when I feel my veneer of apparent competence is cracking - the look of anger visible to other people is really a look of anger directed toward myself.

I hate the idea of being misunderstood, of having my good intentions and collaborative energy lost in the whirl of my uneasiness when my ideas are questioned.  I want to be seen as industrious and insightful, but my Rosie the Riveter impersonation tends at times towards the abrupt.  

Or I suddenly feel like the little girl out of place, dressed up in a business suit that swallows her whole, and I want to run from the room and cry.  I have cried over work with the same tormented hurricane tears usually associated with the borderline personality in love.  I have sat in my car and screamed into my hands while my face streaked red and wet.  

I don't know that I would expect students or colleagues to translate my facial expressions differently based on knowledge of my diagnosis, but the process of thinking through how I am perceived could maybe help me adjust my demeanor so I don't broadcast anxiety/frustration/disappointment/self-loathing to my audience in the skewed images of rigidity/standoffishness/arrogance/my-way-or-the-highway-ness.

  

Not that I have full control over my emotional demeanor.  Sadly, I still experience a kind of "frozen" affect that feels like insecurity but looks like impatience.

Amanda Smith also made a great comment on the question of stigma and being out as borderline at work: "And don't forget self-stigma. Even with lots of current information about the disorder, I sometimes think, 'Gosh, I should have a handle on this behavior or that behavior by now. Why can't I be more like him or her?'"

Why can't I be more secure.  Why can't I be more patient.  Why can't I be more confident.  Why can't I respond in a lighthearted way, without my voice quavering or my mouth going dry. 

The questions irritate like saddle sores beneath the yoke of the workplace.

Ben writes, "Too often, sensitive people take their disenfranchisement and run with it, advancing into the margins instead of facing their society squarely, bravely."

This is definitely the challenge facing all of us.  Some days I get it right.  Some days I still want to close the blinds and hide :-)

I am looking forward to starting a new academic year -- new classes, new meetings, new colleagues -- and knowing that my at times strangely intense feelings of rejection at work are just as disproportionate and internally generated as the feelings of rejection I experience in romantic love.  I may not be able to change the feelings just yet, but I am eager to find out the difference it will make to say to myself, "These feelings are too big to be about this meeting, or this colleague, or this student," and to take a step back while the intensity storms through my body and leaves and, in the big picture, means much less than I once thought.

The feelings, in fact, may not mean anything.

They may simply be there.  And then not be there.

I picture myself returning to my office after a difficult meeting or class period and smiling upon my discovery that the world has not gone up in a ball of fire, that the sky is not falling, that my job is secure, and that I am just fine.

Waiting to Exhale: A Question about Borderline Personality Stigma

In the lesbian, gay, bi, trans, and queer community, people often remark on the fact that "coming out" is a strange and misleading image of what it means and what it feels like to reveal one's sexual orientation.  The usual image of coming out looks like this: a person walking through a door, stepping out of a closet, standing up in a gesture of pride once and for all to say I am gay and I am glad for everyone to know about it!  But of course coming out doesn't work that way.  As a lesbian, and now as spouse to a transguy, I come out, stay in, walk through the grocery store in an oblivious haze, take the microphone at a rally, correct (or do not correct) pronouns over dinner or in a hallway conversation at work every single day to some degree or another.  It is a constant flow of outness and in-ness and in-betweenness.

There is no single coming out moment.

The same is true of coming out as a borderline personality.

I can come out or not as borderline personality depending on my comfort level, my audience, my mood, the stakes, and so on.  As with my late-blooming lesbian-ness, I rarely expect people around me to react in a positive way to my coming out as borderline personality.  Mainly, this is because I am paranoid as shit.  Turns out, the people around me are pretty cool about the borderline thing (and about the lesbian thing and the transguy spouse thing). 

My campus publicity office has put my new book on blast as a top headline on the university's website.  I feel all melty and in love with my campus for doing this. Usually I feel like they hate me.  Obviously, my borderline personality patterns extend beyond my loved ones to work acquaintances I rarely even see in person who probably do not hate me or love me or think about me very much at all.

I came out again on The Frisky.  I held my breath and waited for the mean comments.  But the comments weren't mean. They were engaged, enthusiastic, uplifting, personal, earnest, vulnerable, and real.  Authentic.  My absolute favorite emotional demeanor.

My new friend Kiera wrote a book called The Buddha and the Borderline.  It's coming out on August 1, 2010.  As part of the pre-release publicity, Kiera came out of the psycho closet.  I like her bold language.  She sounds fearless.

We are in the age of coming out.  We may actually be in a post-coming-out era.  Coming out is so nineties, you know?  I kissed a girl and I like it.  I have borderline personality and I'm kind of okay with that, too.  Or, I want to be okay with it but I'm still kind of nervous.  The general public is playing it cool, though, standing with one hip cocked to the side and singing along with Perry Farrell that nothing's shocking.

Has borderline personality rocketed from psycho closet to cause celebre?  I'm relieved but also really surprised. 

Tell me what you think.  Is the stigma not as bad as I thought? 

BPD, NPD, Glee, & the Lock-and-Key of Romance on TV

Here's my Glist of BP/NP appearances on on Glee:

Borderlines

Rachel

Terry

Emma

Narcissists

Finn

Puck

Jesse

Mr. Schu

Click on the linked names for media critiques, fan-fiction, interviews, and other material about each character.  So far, these analyses have not ventured into the characters' psychology, but I am seeing BPD/NPD couplings everywhere on Glee.

Post a comment if you disagree or want to make additions, revisions, or web-links to this list.  For more information on this relationship structure, see Joan Lachkar's book on the subject.

Personality Disorder Test - Still Scoring High in Several Areas

Disorder	Rating
Paranoid:	High
Schizoid:	High
Schizotypal:	High
Antisocial:	Moderate
Borderline:	Very High
Histrionic:	High
Narcissistic:	Very High
Avoidant:	High
Dependent:	Moderate
Obsessive-Compulsive:	High
-- Personality Disorder Test -- -- Personality Disorder Information --

I have become fascinated by the way borderline and narcissist traits fluctuate and intermingle not only between two partners but within a single personality. 

Sick Enough

Reposted in newly edited and hypertexted form from my Facebook note (original date: Jan. 21, 2010)

The recent NYTimes article by Abby Ellin on women with eating disorders "not otherwise specified" interests me in particular because of the theme of not thinking they are "sick enough" to get help.

That theme has come up for me in several areas of life: am I depressed enough for anti-depressants? am I food-depriving enough to be anorexic? am I dependent enough on alcohol or substances to enter AA or NA and claim the ominous titles of alcoholic or addict. am I self-injurious enough to be considered a cutter? am I psychotic enough to need hospitalization?

Am I crazy enough? Am I lesbian enough?

The labels work as obstacles. The barrier for me of pursuing therapeutic support for my chaotic romantic relationships, and my painful or confusing family relationships, and my neurotic or conflict-riddled work relationships was precisely this question of labels, categories, or what constitutes “enough pain,” “enough dysfunction,” “enough self-defeating behaviors” to need therapy, or to see myself as in any way mentally ill. Am I sick enough to be borderline? Am I borderline enough to write a memoir about it?

Clarity comes and goes, but it seems to boil down to two things: the degree to which the pattern affects your everyday life, and the degree to which professional support or support groups or medication or whatever would lead to positive improvements in basic feelings of security, self-love, and comfortable being-in-the-world.

Ultimately the decision is a matter of assessing the benefits and disadvantages of claiming the label, the diagnosis, or the medical intervention.

What felt like a question of entitlement (not wanting to wrongly assume a painful identity that belongs more rightfully to others who suffer more than me) has fallen away and in its place I grapple instead with questions of use-value, borrowing an idea of “strategic essentialism” from the academic fields of feminist postcolonial studies and critical autobiography studies of life-writing by women with disabilities as postcolonial texts about medically colonized bodies.

I title one of my memoir chapters “Becoming Borderline” as a reference to the idea of "borderline" as a complex identity that simultaneously provides ground on which to stand (there is something liberating about finally understanding oneself in terms of a given narrative or category or diagnosis) and at the same time colonizes the body standing on that ground (in adopting the label I become subject to the stigma, media misrepresentations, psychiatric counter-transference, and catastrophizing attitudes among the general population about what a borderline is - my story gets overwritten, in a sense, by the pre-existing story of borderline-ness.

So, as I inhabit this amorphous terrain of identity, subjectivity, imperialist medical and patriarchal narratives, and psycho-social geography, I begin to see that there is no definite answer to the question am I borderline enough to be entitled to the word, label, diagnosis, treatment, or memoir. I would not want to consider myself at the mercy of the label so that my every thought, word, action, or feeling are necessarily determined by my essential borderline-ness.

However, I claim the term to the degree that “becoming borderline” enables me to reflect on, get perspective on, undergo treatment for, talk about, and redirect my psycho-socio-neuro-physiological patterns of reaction and the attachment style (disorder, malfunction) that result from these reactions.  In this way, I am writing borderline in an autotheoretical tone in order to consider the intersecting line within the self between the personal and cultural texts of this diagnosis.

At this point, I advocate moving away from the question of entitlement – of being sick enough – and thinking instead about the gains or losses involved in claiming any particular identity.  I am crafting a concept that borrows “strategic essentialism” from debates about identity politics and applies it to borderline personality to adopt “strategic borderline-ness” as a way of moving through or around the problem of being borderline and refocusing on borderline personality as a cognitive and affective structure, a spectrum of behaviors and cognitive patterns that deplete me and drain my capacity for joy or intimacy.

Maybe the intervention I want to make in the "sick enough" or "not sick enough" structure of thought could be seen as a parallel to bell hooks' intervention in debates over the label of "feminist."  So many scholars and students get hung up in the back and forth questions of what constitutes a feminist. Can I be a feminist and have a boyfriend? Can I be a feminist and wear lipstick? Can I be a feminist and shop at Abercrombie and Fitch? The Feminist Majority Foundation has a t-shirt campaign that says "This is what a feminist looks like," a smart effort to make the wide range of kinds of people who claim the identity of "feminist" visible to the world.

I can imagine wearing a "This is what a Borderline Personality looks like" t-shirt for the same reason.

Or, more simply, "This IS crazy."

But ultimately I prefer to follow bell hooks in refraining from thoughts about what a feminist is or who is entitled to the label to the more pressing and thrilling concern with advocating feminist movement. I do not want to be borderline at this point so much as I want to understand borderline as something I do (and something I can stop doing), not a predetermined essential innate quality but a learned set of behaviors, a psychological predisposition, a cognitive and affective structure available for deliberate redesign in my personal life, and, ideally, a platform for borderline advocacy.

Bluebird Theory: Borderlines and the Quest for Happiness

I want to return to the idea of borderline personality in the key of blue from a different angle that still has to do with moods but also has to do with the cultural politics and diagnostic pathologization of emotions.

I am a diehard Six Feet Under fan.

The cold blue tones of its opening sequence and the music with its weird minor chords and music like bottles clinking together hypnotized me.  Even its Christmas episodes were ironic and angry and rude.  Think Billy, post-mental-hospital-inpatient-stay on "It's the Most Wonderful Time of the Year" (2002): "Happy's a concept I try not to buy into.  It gets me into trouble."  Billy's bipolar expeditions took place years before my diagnosis as borderline, but the pain he felt and the anti-social behaviors felt and sounded familiar.  If I were Claire, I would have dated him too.  Several years later, with my diagnosis and three therapists behind me, I would know better and walk away from Billy.  He is the siren song of the abyss.  Plus, I'm gay.

Anyhoo, his words about not chasing happiness still strike me as right on.  Pursuing happiness has translated in my life into a series of addictions of the opiate and amphetamine variety, as well as the headlong dive into various illicit affairs, a structure of desire I think of as the crack cocaine of romance.  That's not happiness's fault, but it was borderline personality hedonism which I mistook for happiness for a long time, even though it hurt and made me miserable and sick.

Fact: My grandma gave me a glass bluebird when I was a teenager to remind me to look for happiness.

Fact: When I moved away to graduate school, after an early marriage, divorce, and major episode of depression, I put the glass bluebird in a drawer as a gesture of protest.  There is no bluebird, I wanted to say.  There is no happiness.

Fact: After I ended an affair with a woman who dated me for about 18 months while choosing not to leave her long-term partner, I got a big fat bluebird inked into my shoulder and told people it was the bluebird of happiness which eludes me.

Now we have entered a moment of bluebird of happiness critique both in the mainstream publishing industry and in the world of academic theory.  Ariel Gore's book, Bluebird: Women and the New Psychology of Happiness, has garnered many positive reviews for "filleting the bluebird" (pardon the gruesome meat-eater imagery):

• “Everybody, it seems, wants to know why women aren’t happy. But Bluebird suggests that maybe that’s the wrong question to ask. In reframing the age-old, exasperated query of what women really want—from themselves, their partners, their jobs, and their families—Gore’s exploration of happiness offers a probing, inspiring, and deeply humane alternative to the powerful positive-thinking industry. Bluebird is radical in the truest sense—and as a recovering pessimist, I'll be keeping it handy.”   —Andi Zeisler, cofounder and editorial director, Bitch magazine

• “Ariel Gore expertly fillets the plastic bluebird of happiness to reveal its faintly beating heart. Eloquent and sensitive, Gore is one of the best feminist writers of our times.” —Susie Bright

In an interview on Feminist Review, Gore responds to a question about whether smart and happy can go together in women's lives:

• In American culture there has been a massive campaign to sell us all on cheerfulness. It has been an important part of capitalism and has been part of the oppression of women. Women have been endlessly told by others what we need in order to be happy. Maybe they say we need a husband or children or a fantastic career or a spotless kitchen or multiple orgasms. In any case, we are being told what is good for us. Of course we rebel against false cheerfulness and being told what to do when it's wrapped in the nonsense of it being “for our own good.”

I picked up my campus mail yesterday and to my delight, my copy of Sara Ahmed's new book, The Promise of Happiness (2010), had arrived.  I am cuckoo for cultural theory, so this is the bluebird critique I am frothing to read.  She completely thrilled me with her last book, Queer Phenomenology, so I am already on Team Sara Ahmed before cracking this new book.  Feminist theorist Rita Felski sings its praises in an endorsement of Ahmed's "bold critique of the consensus that happiness is an unconditional good" and celebrates the intervention not only into "happiness studies" but also into the wrongheaded assumption that feminism "destroy[s] women's happiness."  So, yay.  These are great lines of inquiry and I can't wait to read more.

Still.

Billy Chenowith lingers.

And this is not really a book review.

The queer, feminist, and queer feminist critiques of happiness overlap with borderline personality concerns, but they are not exactly the same, so I am moving towards something like a queer feminist cripistemology of borderline personality and the bluebird of happiness phenomenon.  (Note to self: finish reading Robert McRuer's Crip Theory.)

I don't want to suggest that I am anti-happiness, or that my next book will be the borderline personality version of Dostoevsky's Notes from Underground, or that I will write a memoir that reads like the long groan of the toothache, to borrow an image from the Underground Man himself.  Yet the story of borderline personality is, for me, very much the story of pursuing the bluebird of happiness and then shouting angrily when it flies away instead of sitting companionably in one's lap like my true spirit animal and dog of my heart, the shih tzu.

When I got the bluebird tattoo, I meant for the ink to function as a sort of totem, a commitment to searching out happiness and refusing the lures and pleasures of despair.  I went out to a bar (no place for bluebirds or recently broken up borderlines) and kissed a strange girl who did not celebrate my bluebird tattoo but offered me this rejoinder: "But you must also wrestle with the raven."  Of course I immediately thought I loved her, or could love her, and I longed for a more thorough conversation about bluebirds and ravens and the meaning of life, punctuated by more kissing.  Alas, she was straight and did not take my calls, so I had to figure out the answers for myself.  Four years later I still don't really know what she meant, but I think it had to do with balance, and maybe with the dangers of fearing the loss of happiness. 

Here is my contribution to the field of Bluebird Theory.

For the borderline personality, the problem is not happiness or sorrow (or dating married lesbians or kissing straight girls, although neither of these activities helps).  The problem has to do with peripheral or secondary emotions.

Fear of happiness, fear of sorrow, fear of heartbreak, fear of loss.

Borderlines are emotion-phobic.

Scared of feeling something good and then losing that feeling.  Scared of expecting a particular feeling and ending up with another.  Scared bad feelings will never end.  The glass bluebird and the one inked into my shoulder are not celebrations of happiness for me, they are totems against ever feeling bad, and that's crazy.  Or, in more professional terms, that's schizotypal, avoidant, and emotionally self-injurious.


Picture me scuttling away from the light like a spider, scuttling away from the human hand like a hermit crab, or walking sideways towards my attachment figure with the odd gait of a woman with disorganized attachment disorder.  I don't want to wrestle with the raven anymore than I want to worship the bluebird, actually, but I don't want to fear the flight of dark and light in and out of my life anymore.  Maybe my first stop on the summer pleasure reading train should be Miriam Greenspan's Healing through the Dark Emotions: The Wisdom of Grief, Fear, and Despair.  Not exactly a beach-lite title, but if it lightens the load of emotion phobia I carry inside my hermit crab shell, I will gladly make room for it in my straw tote underneath a brightly striped towel and take my mood/identity/attachment disorder on a mental vacation.

Precocious Succubi: The Psycho Ex-Wife Problem

I will be developing my thoughts at more length soon on the subject of gender bias and borderline personality disorder for a guest post on Randi Kreger's Stop Walking on Eggshells blog on Psychology Today Online, so let me just note for the moment that the blog I discovered this afternoon on a (maybe) borderline ex-wife is sort of sickening.  As the daughter of divorce (three marriages for both my parents), I know ex-wives can seem, be, act, and/or go crazy.  However, the vitriol being directed at this person or the population she supposedly represents makes me somewhere between uneasy and queasy.  There is something truly crude about comments like the following:

"All Psycho Ex-Wives Are Precocious Succubi Sent From The Depths Of Hell To Gnaw On The Souls Of Men!"

Or this:

"My godson just divorced the 'tart without a heart' last week."

Tart? Succubus? Grr.  Frustration makes sense.  Packaging it in age-old anti-female chestnuts, well, that could surely be avoided.  People can be scary and invasive when they are losing a relationship or attachment figure.  I get that.  I just don't think being mean (or perpetuating stigma/stereotype/misogyny) is the best response to the problem.

There are 173 responses to the post on the main page of The Psycho Ex-Wife Blog.

So much ranting.  So little insight.

If you are curious for more details, or are just generally drawn to blogospheric trainwrecks, click on the title of this post to be redirected to the artless undignified spectacular display of sexist psychobabble passing for a blog.

Or you could just go watch Fatal Attraction again, followed by its lesser known predecessor, Play Misty for Me.

Splatter flicks with a vengeance against my so-called personality disorder.

And yes, ranting is contagious :-)

And no, I don't always sound this psycho ;-)

Grief Impacted; or, Borderline in the Key of Blue

"Unacknowledged grief will keep you stuck in the active throes of Borderline Personality Disorder." -A.J. Mahari

I started a new thread on the discussion board of my Facebook fan page for my new book, Girl in Need of a Tourniquet: Memoir of a Borderline Personality, to share thoughts on impacted grief as a root cause and persistent symptom of borderline personality disorder.  In hoping to hear thoughts from lots of people, I decided to revisit my initial efforts in January towards blogging on the lived experience and diagnostic politics of borderline personality. 

Here, reposted, is my discussion prompt (apologies for profspeak):

What I figured out for myself during the long process of writing the book was that my series of borderline personality symptoms (affairs, substance abuse, chronic depression and feelings of emptiness, a general nonbelongingness, deep-rooted bad-person feelings) come from what I've learned to call "impacted grief," long ungrieved losses from childhood. Even though I knew writing the book would help me grieve but would not represent The End of Grieving for me, I'm still disappointed to be sitting under such a heavy load of grief this week over how things unfolded in my family of origin. 

I saw a book once called Bereft by a woman who lost a sister to a violent death, and I never read it, but it has been in my head for days now. The word captures my sister-grief feelings so well, and sometimes I wonder if I will ever stop feeling these sister-grief feelings. 

When on earth does grieving end? 

The loss cannot be recuperated, events of history cannot be reversed, and I want to be over it, but my sister-grief feelings persist like lost limb trauma. The neural pathways keep snapping inside me and I feel like I forgot something or missed a step or overlooked a clue or left someone behind or arrived as the bus was pulling out of the station. 

My sisters are alive.  I know them. 

But I am haunted by memories of them as little girls and can't stop working at the unsolvable puzzle of what might have been, how things might have gone differently, what would have happened if we had grown up together instead of apart. 

The neurotic loop is exhausting. 

I wonder if anyone has stories of grief, grieving, moving past grief, or if it is more about living with grief without being capsized by it. 

Fill me in . . .

Oh, and because I am a compulsive researcher, here's a smidge more from the secondary resources:

"In his classic article, Engel (1961) posed the question, 'Is grief a disease?' Grief is not generally considered a disorder but rather is viewed as an adaptation to a loss. In this respect, the process of grieving is similar to the process of healing. It involves working through the stages of grief. The tasks of grieving include experiencing the pain of grief, accepting the reality of the loss, adjusting to an environment in which the loved one is missing, and withdrawing one’s emotional energy and reinvesting it in another relationship. Failure to complete these tasks can result in impacted grief, which is a prolonged type of grief associated with depression. Impacted grief can block further growth and development." -William F. Doverspike, "Grief: The Journey From Suffering to Resilience"