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.