Sunday, April 3, 2011

Jane Sutures It Up; or, Can You Have a Personality Disorder and Be a Feminist Too?

A reader recently wrote to me in a mixture of admiration and distress over her experience of relating strongly to my first book, Jane Sexes It Up: True Confessions of Feminist Desire, and again to my most recent one, Girl in Need of a Tourniquet.  She loved the bold feminist protest of Jane and the raw psychological wounds of Girl.  In a voice not unlike my own as I sorted through the conflicting and confusing evidence of my relationship history in the memoir, she wrote to ask, What does this mean?  Which one is true?  Who was good?  Because I found her inquiry so challenging, I wrote back to ask if I could take some time to think it over and answer her on the blog.  

She said yes, so here goes.

Merri Lisa,
Congratulations on your great new book! I finished it a few days ago, and I wanted to write and say how much it moved me. The huge life changes that you’ve gone through were obviously shattering, yet they gave you such amazing insights. The suffering you describe was tough to experience vicariously, but your strength and bravery that were ultimately conveyed were inspiring.

You have no idea how many people I convinced to read JSIU after I discovered it in 2003. It sparked many intense and fruitful dialogues with my feminist- and non-feminist-identifying girlfriends, and even my boyfriend.
As I just said, I absolutely loved Girl, but it seemed like it was written by a totally different person. My friends and I responded deeply to Jane (all the essays, but especially the ones you wrote) because its ambivalence about men, gender roles, and feminism reflected our inner tensions and doubts. We identified completely with your searching for a different kind of heterosexuality. Your book embraced both the dangerous, unruly rawness of desire and the essential truths of feminism.
So I guess I’m left with the question of what you see when you look back at your earlier work. Is there something other than pathology to be salvaged in Jane? When you think back on how you captured contemporary girls’ dissatisfaction so poignantly, do you see anything more than just symptoms of borderline personality disorder and/or repressed lesbianism?
[Then I wrote to ask for more details on the comparison . . . ]
The differences I see in the two books have everything to do (I assume) with the changes that have happened in your life in the past five or so years. Three big ones: the BPD diagnosis, coming to terms with lesbianism/coming out, and getting married. Girl is about these circumstances, the revelations they brought, and how you still struggle with those revelations. To me, it reads like a chronicle of your 30s, while JSIU was a chronicle of your 20s.
I'm wondering about how you connect these two chronicles. Is the sole connection a therapeutic narrative that finds in Jane a repository of symptoms of BPD? Should young women who see themselves in your Jane essays get therapy, stat? :)
Again, thank you for ALL of your beautiful books. Thank you for struggling through the trauma to reach healing expression.

Amanda's questions zero in on precisely the most complex philosophical work in front of me these days as a self-identified queer crip academic feminist person-with-borderline-personality-disorder.  

  • How to write about female psychosocial disorders without reinforcing sexist stereotypes of women as inherently crazy, irrational, excessive, and generally off our rockers.
  • How to make nuanced distinctions between the feminist protest of asymmetrical and otherwise unsatisfying hetero-relationships and borderline styles of reaction to distress, which are markedly disproportionate and self-defeating.  
One might say of the borderline personality what Melanie Klein (via Joan Lachkar) says of the patient in a paranoid-schizoid position: 

She stands up for herself in bizarre and inappropriate ways.

Such concerns will be at the center of the scholarly monograph I have begun to imagine, where I will theorize in more detail the movement between shoring up identity categories while simultaneously calling them into question, staging an encounter with stigma in order to loosen its hold on the category of borderline personality, and negotiating between the perspectives of feminist critique and those of 'crip' critique to expose a gap between them that resembles the gap Cheshire Calhoun reveals between 'feminist' and 'lesbian' viewpoints on matters of sexuality.

The decision to write Girl in Need of a Tourniquet was prompted, in a way, by my realization that the bad feelings described in "Fuck You and Your Untouchable Face: Third Wave Feminism and the Problem of Romance" (chapter 1 in Jane Sexes It Up) were coming up in similar ways in my lesbian affair, a realization that definitely made me question my insights in JSIU for a while.  (Maybe the problem wasn't the guy.  Maybe it was me.  Why did I always take the faucet end of the tub after all?  My capacity for self-subordination outstretched the influence of male-dominant couplehood dynamics.)  Gender roles were no longer the obvious culprit, so I dove into the wreck of my personal psychology, family history, and ungrieved losses, leaving feminism behind for the time being.  

Yet I always conceived of this memoir as a form of feminist social commentary.  

In preparation for writing the book, I took a course taught by Deborah Siegel and sponsored by the National Women's Studies Association on how to write book proposals for trade publishers called Making It Pop, a course with the explicit aim of educating academic feminists on the practical skills of reaching a wider audience rather than restricting our conversations to the smallish world of academic journals.  In short, the feminist cultural work of the book as I imagined it had to do with countering misogynistic and mentally ableist portrayals of the borderline personality woman as 'psycho girlfriend,' a la Fatal Attraction, Play Misty for Me, and, for a more lighthearted demonization, My Super Ex-Girlfriend.  I even shopped the book to agents and publishers under the title Psycho Girlfriend Apologia for a few months.  I hoped to contribute a humanizing portrait of borderline personality disorder as a mishmash of trauma reenactment, attachment disorder, and emotional dysregulation, and to suggest that what appears irrational in her behavior has a persuasive logic to it, the flawless logic of the neurotic to borrow a phrase from Karen Horney, which is perfectly pieced together but rooted in paranoid delusions and ego fragmentation.  

After spending the requisite period of time worrying that the new book reveals the old book as precisely such a delusion, the fog of self-doubt lifted, and I saw a very different relationship between the two.  

Far from undermining the feminist analysis of hetero-patriarchal romantic narratives, power dynamics, and gender roles that appears in Jane Sexes It Up, I believe Girl in Need of a Tourniquet excavates the psychological dynamics that produced in me a hypersensitivity to the insults and injuries that come with the work of feeding egos and tending wounds, the emotional labor, that is, of hetero-romance.  

(Whenever I write or teach about hetero-romance, I find it necessary to pause and explain that I don't mean to suggest that same-sex relationships are blissful or free of conflict.  The point I'm making by identifying the subject of hetero-romance is not about drawing a contrast between straight and gay relationships, but rather it is a way to emphasize the social constructions of heterosexuality as a form of desire structured by the eroticization of gender inequalities.  Now back to our regularly scheduled programming.)

It is my borderline personality that made me feel the discomfort so acutely that I was moved to produce a critical anthology on sexual politics and third wave feminism.

It is my borderline personality that works like a forked branch vibrating over buried springs of fresh mountain water, leading me to wells of emotional intensity and, at times, emotional inequalities running beneath the surface of a relationship.  

This view of borderline personality as emotional giftedness works in important ways to balance the usual understanding of borderline personality as emotional dyslexia.  My therapist said many times that borderline personality comes with gifts as well as challenges, but the public sphere has rarely made space to address borderline gifts of creativity, perceptiveness, empathy, and expressiveness.

So, should fans of Jane Sexes It Up seek help immediately for borderline personality disorder?  Is there something besides pathology and closeted lesbian desire to be salvaged from Jane?  

To the first question, I guess it depends on what parts resonated with you.  If it was the longing for a more equitable sex life, then no.  If it was breaking your favorite wine glass in the sink during a fight, then maybe therapy would be worth a try.  (What needs fixing is not the anger but the management of anger.)

To the second question, I have to admit that when I reread my chapters in JSIU now with almost a decade since its publication, I draw little smiley faces in the margins next to the previously unrecognized traces of lesbian sexuality and borderline psychology in that narrative.  Those things are definitely there.  But I consider them the queercrip excess of Jane Sexes It Up, a bit of subject matter spilling over the top of its main ideas about queer feminist heterosexualities, not the 'true' or 'real' story beneath the false consciousness of feminist critique.  

Towards the end of chapter 1 in JSIU, I asked the question on so many undergraduate Women's Studies students' minds: Can I have a boyfriend and be a feminist too?  And I offered a tentative 'yes' to acknowledge the difficulty of reconciling feminist politics with hetero-desire while encouraging women to try to do so anyway.

Now a parallel concern is unfolding in reader and audience responses to Girl in Need of a Tourniquet:
  • Can I have a personality disorder and be a feminist too?
  • Can I admit to psychosocial disability and interrogate misogyny, able-ism, and medical authority at the same time?
  • Can I claim the label of borderline without signing away my rights to a feminist perspective on relationships that drive a girl crazy?
Again, I'm gonna say yes.  

Tentatively.  Critically.  Self-reflexively.  

The path is unclear, but I think I can get there from here.

Thanks for the great questions, Amanda!  

Tuesday, March 1, 2011

March Madness

A lot of questions have been coming my way about the problem of gender bias in borderline personality disorder diagnoses, and in honor of today's kick-off to Women's History Month, I offer this blog post not as a response but as an invitation to begin a collaborative inquiry.  Let's figure it out together.  Two components of gender bias stand out immediately: (1) the disproportionate diagnosis of women as borderlines, and (2) the overlap between borderline personality traits and traditionally 'feminine' traits.  A number of important feminists have worked on the question of how psychiatric labels have been used to subjugate women (Phyllis Chesler, Jane Ussher, Jean Baker Miller, to name three out of a throng of feminist scholars).  A smaller group of feminist disability theorists have pushed back against this feminist renunciation of psychiatric labels, advocating for the labels as 'enabling fictions' that provide us with a useful way of understanding and describing psychological distress, not to mention an avenue of access to social and medical support (mainly I'm thinking here of Andrea Nicki's article, "The Abused Mind," but there are others working along similar lines).  

In the specific context of borderline personality disorder, Dana Becker has advanced a strong feminist critique of BPD, a condition she says is "arguably the most pejorative diagnosis of our time," so I'm pasting a segment of her work below (pulled from the website for the Association for Women in Psychology).

Let the conversation begin!  

Is borderline personality disorder a big ol' sexist ruse?  Does it have any liberatory dimensions worth celebrating? 

Borderline Personality Disorder:  The Disparagement of Women through Diagnosis

Dana Becker, Ph.D.  Professor, Bryn Mawr Graduate School of Social Work and Social Research

Borderline Personality Disorder (BPD) is currently defined in the Diagnostic Statistical Manual of Mental Disorders as a persistent pattern of instability (both personal and interpersonal) and impulsivity. Its symptoms range from self-damaging and suicidal behavior to intense mood reactivity, feelings of emptiness, and problems controlling anger.  It entered the DSM in the 1980 edition and is currently the most frequently diagnosed personality disorder.

The primary characteristic of any personality disorder is said to be its stability over time, but as described in the current DSM-IV-TR, BPD is characterized by instability—of identity, of mood, of behavior — and there are well over 100 ways to combine its symptoms that qualify a person for the BPD diagnosis. Given the diversity of its symptomatic picture, many, even in the psychiatric profession, have had difficulty conceiving of BPD as a single disorder. According to the DSM-IV-TR, about 75% of people diagnosed with Borderline Personality Disorder are women.  This was not always the case.  BPD criteria have been altered appreciably over the past fifty years to include more and more symptoms related to emotion, accounting at least in part for the sex bias inherent in the diagnosis.  Many researchers have challenged the validity of BPD, some concluding that BPD has become a catch-all label given to people, especially women, who experience acute sadness, emptiness, and emotional reactivity (particularly in the form of rage). The BPD diagnosis overlaps with other diagnoses such as Histrionic and Dependent Personality Disorders, which have been assailed for pathologizing behavior (e.g., dependency, seductiveness) that many women have been socialized to exhibit. 

Some women who have been diagnosed with BPD have histories of psychological maltreatment, neglect, and/or childhood sexual or physical abuse, and they may have difficulty expressing anger “appropriately.”  The ways in which “borderline” women express their pain has occasioned a vast clinical literature on how to treat “borderlines” and how to manage the strong emotions they may arouse in their therapists.  So-called borderline women are often described as angry and manipulative, when in fact they often act out because they do not trust that others will meet their needs if they express them straightforwardly.

The BPD diagnosis has been used in court to institutionalize and/or medicate women involuntarily, deny them custody of their children, and have their parental rights terminated.  Women diagnosed as having BPD have also frequently been discredited as witnesses in court cases involving rape or sexual abuse. 

Categorizing a particular set of disparate symptoms we now call “borderline” as a personality disorder encourages clinicians to focus on a particular style of coping learned under adverse circumstances rather than on the forms of abuse and emotional invalidation that originally made that style of coping necessary.  The association between women and what is arguably the most pejorative diagnosis of our time can create fear and avoidance, if not frank hostility, on the part of students of psychotherapy and practicing professionals toward a population of extremely vulnerable women.

Becker, D.  (1997).  Through the looking glass:  Women and borderline personality
disorder.  Boulder:  Westview Press.

________.  (2000).  When she was bad: Borderline personality disorder  in a
posttraumatic age.  American Journal of Orthopsychiatry, 70 (4), 422-432.

________.  (2001).  Diagnosis of psychological disorders:  DSM and gender. 

In J. Worrell (Ed.), The encyclopedia of gender, Vol. 1 (pp. 333-343).  San Diego: 
Academic Press. 

Becker, D., & Lamb, S.  (1994).  Sex bias in the diagnosis of borderline personality

disorder and posttraumatic stress disorder.  Professional Psychology:  Research and
Practice, 25,  55-61.

Brown, L. S. & Ballou, M.  (1994).  Personality and psychopathology.  New York:  Guilford.

Herman, J. L., Perry, J. C., van der Kolk, B. A.  (1989).  Childhood trauma in borderline personality disorder.  American Journal of Psychiatry, 146 (4), 460-465.

Nurnberg, H. G., Raskin, M., Levine, P. E., Pollack, S., Siegel, O., & Prince, R.  (1991).  The comorbidity of borderline personality disorder and other DSM-III-R Axis II personality disorders.  American Journal of Psychiatry, 148 (10), 1371-1377.

Ogata, S. N., Silk, K. R., Goodrich, S., Lohr, N. E., Westen, D., & Hill, E. M.  (1990). Childhood sexual and physical abuse in adult patients with borderline personality disorder.  American Journal of Psychiatry, 147 (8), 1008-1013.

Shaw, C., & Proctor, G.  (2005).  Women at the margins:  A critique of the diagnosis of borderline personality disorder.  Feminism & Psychology, 15 (4), 483-490.

Saturday, February 19, 2011

5 Things Not to Do When Someone Is Angry With You

Anger is scary.  I react to it like I'm a little kid and the world is ending.  It says 'grrr' and I turn to run away.  I want to learn to react like a grown up, with some grace and stability. 

Some segments below have been tailored from the original source to directly address PWBs (people with borderline personalities).

  1. Do not keep pushing and prodding for explanations or for conversation in general.
  2. Do not overcompensate.  Going to desperate lengths to fix the problem comes across as phony and makes the person more angry.
  3. Do not beat yourself up.  Tearing yourself apart will not improve the situation.  Resolve to yourself to make a change.
  4. Do not turn the situation around and get angry at them.  Resist the urge to make them the problem.
  5. Do not try to get revenge.  [I find this one confusing, like, what on earth kind of revenge would one take on someone for being angry, but 4 out of 5 helpful tips is not bad.]

  1. make a sincere apology
  2. give them space
  3. assure them you will be there when they are ready to work things out
  4. maintain emotional balance because falling apart is a flawed and unfair defense  (see previous post)
Specifically, this last one means you still have to eat, sleep, exercise, hydrate, go to work, and take care of any children or pets in your care, and, if possible, do extra little things to nurture yourself like bake cookies or go for a long walk and smell the warm spring air and accept a world where someone being mad at you can coincide with an unseasonably sunny Saturday in the impossible month of February.  

The world hasn't ended.

Watch Grey's.  Go to sleep.  Wake up tomorrow.  

Try again.

Pretty Little Defense Machine

One question that comes up repeatedly at public readings from Girl in Need of a Tourniquet goes something along the lines of 'how did you gain perspective on your own symptoms?'  They want to know how I am able to see through the haze of borderline cognition to see and accept my own complicity in the painful experiences I describe.  Most of the time the question makes me feel special, like I am a borderline savant who is gifted with insight into her own flawed perceptions, but the truth is that the insight comes from other people.  I see the emotions I'm experiencing as authentic reflected in their faces as false and strategic.  It has often been the case that I ran the other way when I saw this distorted reflection because I believed the person was seeing me the wrong way, and I wanted to hide to protect myself from the unfair picture.  

Occasionally I can admit that what they are seeing is accurate.  

Sadistic verbal attacks?  Yes, I've made a number of them.  

Wild swings from idealization to devaluation?  Definitely, over and over again. 

Paranoid misinterpretations of other people as hostile and out to get me?  Again, yes. 

Sudden frightening bursts of anger?  In the words of Natalie Portman, 'Don't test me when I'm crazy.'

The one saving grace in this awful picture is that once I see the behavior for what it is, I am generally able to change it.  I am holding on to this glimmer of hope today because I just saw a whole new set of personality disorder symptoms in myself, and they are not attractive and, more importantly, not functional.  Sometimes I wonder if maybe I made this whole  being borderline thing up.  Like maybe there's nothing wrong and I just went all Lauren Slater metaphorical on borderline personality disorder and used it as a narrative device to capture the feeling of being in extreme emotional pain, or worse, maybe I made it up as an excuse for bad behavior like one of my Feminist Disability Studies students said on Thursday about how people abuse diagnoses by using them to get away with things.  I said her comment was ableist.  I said those defenses are symptoms, too.  She looked frustrated.  I think maybe she wished I would hear what she was saying about the importance of accountability despite the diagnosis.

Just as I begin to wonder about whether my diagnosis is real (and just as I block a student from addressing crip accountability), the psychoanalytic karma fairy drops  a whole new load of 'behaviors' in front of me, and I realize something. You can call it being borderline or having a personality disorder or just being a bad person - who cares what anyone calls it, who cares where the line being normal bad person and abnormal bad person is when you hurt someone you love and then watch yourself like a character in a bad movie trying to get off scot-free instead of sticking around to deal with the pain and anger directed legitimately at you (at me) - it is not okay to hide out inside a false reality where you are  always seen as right and good, or, at worst, wrong but impaired.  

So anyway, long story short, I'm a defense machine, and I am pretty grossed out by my defenses right now, so in the interest of seeing them for what they are, and towards the end goal of us PWBs (people with borderline personalities) and people in general, really, being honest and accountable for our hurtful behaviors, here is the list I made today of my tactics for avoiding responsibility when I do something wrong:

  • crying when someone is mad at me so that they switch from anger to compassion
  • positioning myself as a martyr, encouraging them to take their best shot, like I am jesus savior good when I am really judas traitor bad, like I am somehow generously giving something up by facing my responsibility for their pain
  • describing myself as all bad (see above) so that others will rush in to say I'm not all bad
  • depriving myself of basic self-care (the long goodbye of the hunger strike, in Aimee Mann's words) as a kind of emotional threat so that my partner becomes afraid for my well-being and doesn't feel free to express anger
  • making it all about me, apologizing so that I can be forgiven, offering to do whatever they say so that I will be seen as compliant easy docile when I am really stubborn difficult recalcitrant, treating guilt like a hot potato I don't want to hold
  • lying (I won't pretty this one up with imagery)
  • writing a book or a blog post because I don't know how to be sorry in person
  • referencing a cool band or song in the title to cover up my emotional deficits with a veneer of hipness 

I kept my one-year-old niece last weekend, and I noticed she cried really intensely every time I told her no (like, no don't pull that drawer out, or no don't grab the dog's tail), and I sort of identified with her, thinking hey I don't like to be criticized either.  Crying is not simply the expression of pain and sadness.  Crying is a defense.  The thing is, she's one and I'm thirty-eight and acting like a baby.  Self-pity does not wear well at this age.  I'm still groping around for a model of what mature regret looks like, though.  

I'm hoping the people who follow this blog will explain it to me like I'm five.  

Draw me a picture.  I want to do better.