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.      

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