I quit unpacking and headed straight for the public library and the microfiche kiosk. Under the category “Subject—Borderline Personality Disorder,” three books were listed, and one caught my eye immediately: I Hate You, Don't Leave Me.
Those were the words Dr. Padgett had used to describe the alternating love and hate of my black-and-white relationships. It wasn't just a phrase he had coined but the title of a book—a book that was entirely devoted to a diagnosis the doctor had, for some reason, failed to tell me. Why hadn't he told me?
I drove to the bookstore with the library computer printout in my hand. I Hate You, Don't Leave Me: Understanding the Borderline Personality by Jerold J. Kreisman, M.D., and Hal Straus. I found the blue paperback on the psychology shelf and spent the rest of the evening and the next morning devouring it.
It was compelling reading, a comprehensive portrait of severe mental illness—one that could cause damaging consequences, not only to the ones suffering from it, but also to their loved ones.
“Borderlines,” as they were called, had an overwhelming inclination toward self-destruction. Ten percent of borderlines committed suicide; even more engaged in dangerous, impulsively self-destructive behavior. Chemical addictions and abuse marked the disorder, as well as reckless driving and eating disorders.
Clearly Dr. Padgett had been telling the truth when he said that therapy was a matter of life and death. Not only was borderline personality disorder (BPD) serious, but, according to the authors, also exceptionally difficult to treat.
Borderlines were disproportionately represented in the psychiatric inpatient population and were prone to a host of other mental illness episodes as well: major depression, chemical dependency, and anorexia, to name a few. Often the best that could be hoped for was to treat these episodes as they occurred and to possibly control some of the BPD-related behavior such as explosive rages, damaging manipulation, and compulsive acts of self-destruction. Controlled but not cured.
The prognosis was bleak, and a significant number of borderlines were destined to lead lives of turbulence. Lifetimes spent in and out of psychiatric wards, prisons, and institutions. Significant recovery from the illness was rare and almost always meant several years of intensive psychotherapy.
This couldn't be me, could it? There must be some mistake. To discover this answer for myself, I closely reviewed the criteria for BPD in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), the thick book psychiatrists used to determine a mental illness diagnosis.
Diagnostic criteria for Borderline Personality Disorder: A pervasive pattern of instability of mood, interpersonal relationships, and self-image, beginning by early adulthood and present in a variety of contexts, as indicated by at least five of the following:
(1) A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of overidealization and devaluation. The black-and-white thinking, the good guy/bad guy phenomenon Dr. Padgett had pointed out. A definite yes.
(2) Impulsiveness in at least two areas that are potentially damaging, e.g., spending, sex, substance abuse, shoplifting, reckless driving, binge eating. (Do not include suicidal or self-mutilating behavior covered in [5]).Promiscuous sex with more partners than I could either count or remember until Tim came along. Heavy drinking and illegal drug use that had slowed with the births of Jeffrey and Melissa but were still present. Midnight runs would probably meet this criterion. Certainly anorexia would. Dr. Padgett was always bringing up my out-of-control behavior. This one was a yes too.
(3) Affective instability: marked shifts from baseline mood to depression, irritability, or anxiety, usually lasting a few hours and only rarely more than a few days. Another definite yes.
(4) Inappropriate, intense anger or lack of control of anger, e.g., frequent displays of temper, constant anger, recurrent physical fights. I had struggled my entire life to keep this one under control, trying to heed Sister Luisa's warning from years ago about the damaging power of words. However, outbursts against Tim had been increasing, and my explosive temper with Jeffrey had driven me to seek help in the first place. Dr. Padgett, who loosened my defenses and thus my reins on my emotions, had witnessed such intense and inappropriate anger countless times. I had to admit this was a definite yes too.
(5) Recurrent suicidal threats, gestures, or self-mutilating behavior. The suicidal ideation and threats were so frequent they had prompted Dr. Padgett to threaten to commit me. The two runs to the West Side, before and during my first hospitalization, fit this criterion. I wasn't sure whether anorexia fit into this category or not. I'd never made a bona fide suicide attempt, never swallowed pills or put a gun to my head, but I'd thought about it plenty and talked about it frequently. I surmised this was a yes as well.
(6) Marked and persistent identity disturbance manifested by uncertainty about at least two of the following: self-image, sexual orientation, long-term goals or career choice, types of friends desired, preferred values. Clearly I hated myself, although on occasion I could be prone to delusions of grandeur followed by crushing lows. Now coping with the concept of fragmenting (conflicting selves), my self-image was definitely a serious problem. In the area of heterosexual versus homosexual orientation, I hadn't had self-doubt, but I had very serious difficulties accepting my gender. Long-term goals were nearly impossible for me to contemplate, much less to hold, even briefly. This also had to be a yes.
(7) Chronic feelings of emptiness and boredom. I made frenzied attempts to stay busy as hell to escape them, which never seemed to work for long. This point was a no-brainer yes, something I'd known about myself long before I ever entered therapy.
(8) Frantic efforts to avoid real or imagined abandonment. (Do not include suicidal or self-mutilating behavior covered in [5]). The tough, I-don't-give-a-shit part of me resisted identifying with this one, loathing the concept of dependency. But Dr. Padgett had specifically pointed out the abandonment fears on several occasions. I had to give this one a yes, although I preferred to think of it as a qualified yes.
The question now was about my prognosis. I had already been a psychiatric inpatient three times in less than a year and was going to three therapy sessions a week. Was this something I could expect for the rest of my life?
Having arrived for session two hours early the next day, I strolled the grounds of the hospital and surrounding neighborhood, listening to the melancholy strains of Supertramp, trying to make sense of my most recent discovery. Granted, I'd always known I was different, messed up in many ways. But seriously mentally ill? The thought was overwhelming. I had to see Dr. Padgett right away. I couldn't bear waiting another minute.
By the time the session began, my uncertainty and confusion had turned into rage. I immediately walked to my chair, intentionally leaning forward and tightly folding my arms. It was confrontation time. I didn't need any time to collect my thoughts. I started in right away.
“You lied to me! I can't believe you lied to me!”
“Lied?” Dr. Padgett had the innocent look of one who sincerely had no idea what I was talking about.
“You know what I was doing until four in the morning? Do you? I was reading I Hate You, Don't Leave Me. It's not just a phrase some shrink coined, you liar. It's a book—about a diagnosis you didn't have the balls to tell me about.”
He nodded. Now he knew exactly what I was addressing.
“Borderline personality disorder,” he said.
“Yes, borderline personality disorder. I'm sick as hell. I'm a fucking mental case, demented. I'll probably be in and out of this goddamned hospital for the rest of my life. Sitting in here for 120 bucks a throw, ad infinitum. And you were gonna keep it from me, weren't you, you asshole? Just keep on sucking the cash from the little fuck-up until you retire.”
“I didn't lie,” he said, as calm as I was agitated. “The diagnosis was on the treatment plan, very openly. You read it; you signed it. I haven't lied to you about anyth
ing.”
I rolled my eyes, tapped a drum roll on the table, and began to swivel the chair back and forth. I wanted to strangle him. I wanted to run. Goddamnit. I wanted to run and never stop.
“Bullshit! This is all bullshit. I signed so much crap in the hospital, filled out so many forms. Who reads it all anyway? A bunch of bureaucratic, psychobabble paperwork bullshit. You're a chicken shit; that's what you are, a spineless chicken shit. From that very first session when you didn't have the balls to give me the test results to my face, just tossed me some goddamned written report on my way out the door. And now I've got some psycho, demented mental illness. I despise you. I wish I never ever met you.”
By now the drum roll had reached peak intensity, the chair not only swiveling, but rocking wildly back and forth, my feet tapping the floor, body shaking, ready to explode.
“Rachel, you're an adult. You're not crazy, and you can control your body motion. Stop with the tapping, stop with the feet and the chair, calm down, and listen.”
Without raising his voice in the slightest, he had delivered his command with clear authority. Still seething, I stopped moving.
“First of all, you know the rules here. We can't work on your intense feelings when you physically act them out. We need to use words.”
“Okay then. Fuck you!”
“That's not what I'm talking about, and you know it. Cussing me out is just another way of acting out. It doesn't tell me what you feel or why you're feeling it.”
That one took me aback. It was the first time he had censored my speech and called it “acting out.” I felt the cold slap of having stepped over the line. I could feel my face flush, and I was silent.
“Are you listening now? Are you ready to look at this issue now? Is the adult in control?”
I nodded.
“Okay.” Even the blank screen couldn't hide his irritation, but under the circumstances he was containing it quite well. “I wasn't trying to hide any diagnosis from you. It was on the treatment plan that you signed; that's not hiding it. We've been dealing with a lot of important issues right now. The diagnosis is an issue in itself, but I don't think it's as relevant as others we've been discussing.”
“You don't think borderline personality disorder is relevant? Look … How can I say this? I'm really trying to control myself here. I was up until four in the morning reading this book about what seems to be a very serious illness. I meet the criteria. I've gotta say I can't see a whole helluva difference between having BPD and being just a manipulative asshole. Can you really blame me for freaking out?”
“It's a very broad and general diagnostic category, maybe too general, in my opinion. BPD encompasses all kinds of people with all varieties of behavior. It doesn't define you.”
“So you're saying I don't really have it? That it really isn't that bad? Maybe mine is a milder case?”
“No, I'm not saying that. You meet the criteria, and you are in a very serious situation.”
“So I am sick.”
“Yes, you are sick. I've never said anything to contradict that. I've always said therapy was a life-and-death matter for you. But you aren't a lousy person, Rachel. At your core you are a good person who's been through an awful lot.”
Touchy-feely affirmations. I knew that argument; everyone is good at the core. The eloquent defense lawyer paints the tear-jerking portrait of the neglected, abused “kid of the streets.” The lawyer plays on sympathies, tugs on heartstrings, and twists everything around so that somehow the rapist or murderer becomes the victim. Perhaps the lawyer's story of neglect and abuse is true. Sad, perhaps. But to me, it never cut it as an excuse. The dead person is the victim, and the murderer is the murderer.
I was cynical of the core-goodness philosophy since it was so often used as a weak justification for anything goes. What good were morals, what value was to be had in character if everything could be blamed on a bad background? Was everything inexcusable based on somebody's troubled childhood?
I felt very strongly about this and told Dr. Padgett so, fully expecting him to disagree, perhaps even attributing these thoughts to my father's legacy. He surprised me.
“I don't disagree at all with anything you're saying. As a matter of fact, I do believe there's a definite line between right and wrong and that there are people who cross that line and deserve to be punished and face the consequences. And it doesn't matter what happened in their childhoods. I believe in the death penalty in certain cases.
“But you haven't crossed that line. Maybe you've done some things in your life you regret; maybe you've done some things you should regret. But you've paid for them dearly and punished yourself much more than you've ever deserved.
“I'm not disputing anything you've brought up from the book. Yes, there are a lot of borderlines who will never recover. But I believe you are one of those people who can overcome this. Not just control it, but fundamentally change and be freed from it. If I didn't believe that, I wouldn't have committed to therapy. I wouldn't have chosen you.”
Chosen me. Words I'd met with cynicism before were just what I needed to hear right now.
“What I'm trying to say is that borderline personality disorder is too broad a category to make any one-size-fits-all conclusion. Most psychiatrists think Adolf Hitler was a borderline, but they also think Marilyn Monroe was too. Can you see the difference there? I'm not going to understate how serious this is for you. It is grave. But the nuances and differences in borderline personality disorder are like stations on a radio. A radio can be turned up full blast, to the highest decibels of intensity, but the musical scores you hear when you tune from one station to another can be completely different.”
By the time the session ended I felt relieved, albeit only temporarily. The notion of borderline personality disorder was still staggering to me, and something I would be grappling with for a long time. But Dr. Padgett still believed in me, no matter how bleak the prognosis might be.
Perhaps one day, I thought, I can believe in me just as much as he seems to.
Chapter 10
The morning sun was burning through the bedroom window, the heat on my face a wake-up call. 7:30. Sounds of the shower were coming from the hall. The sheets were crumpled next to me; Tim was getting ready for work.
I tiptoed past the kids' rooms. Melissa, no more a morning person than I, was still sleeping soundly, a tiny little toddler's snore, her black hair peeking out from her Barbie blanket. Jeffrey was up but content with a dot-to-dot coloring book. I crept downstairs into the basement.
I went to the brand-new scale, digital and state-of-the-art. I'd purchased it ostensibly to monitor my weight prior to the hospital stay so I could keep the pounds from declining. Tim had been amenable to the idea; diligent monitoring was the way I had kept the postbaby diets from getting out of hand. But he had realized quickly that I was using the scale almost constantly to check the progress of my true goal: weight reduction. After seeing me step on it one too many times and disgustedly remark how fat I was getting, Tim couldn't bear to see me step on it any longer or even to see the scale itself. It was a reminder of his wife's emaciation and how helpless he was to do anything about it.
I'd told him that I'd given the scale away. But instead I tucked it into a storage corner of the basement. I would sneak down several times a day to check up on my progress. I had to sneak because it would kill Tim if he knew I was still doing this weeks after enduring the pain and expense of the voluntary three-week hospital stay.
As part of the ritual, I dropped my robe to the floor, took off my pajama top and bottoms and weighed myself. It read 101, a pound less than my weight when released from the psych ward.
All that time, all that pain, all that drive. A three-week separation from the kids. All for nothing. I'm just as anorexic as I ever was.
I had actually been up to 105 a few days earlier but could not live with the number on the readout. I'd skipped breakfasts and lunches, picking at my dinners, tripling my workouts when
Tim wasn't around. The big rock of anorexia hadn't waned a bit. It had only become far sneakier.
Then the demon within took over.
Hmm … 101, not bad. It's about time. Only two pounds from double-digits. Keep it up! You're not anorexic. They want you to be fat.
The sessions since my hospital release had been dominated by dreams, the borderline diagnosis, and my childhood abuse and feelings. I hadn't brought up my weight, nor had Dr. Padgett. I had even been sneaky with him. I vowed that in today's afternoon session I would turn myself in and come clean.
I slumped in my chair, penitent-to-confessor again. The small little girl voice. The eyes downcast. A bad girl deserving punishment.
“Dr. Padgett, there's something I have to tell you. I weighed myself today. I weigh 101 pounds. I'm still losing weight. I've been exercising and skipping meals and checking the scale constantly, and I've been hiding it from everybody, including you.”
I braced myself for admonishment that didn't come.
“What are your thoughts on this, Rachel? What do you think is going on?”
“She's taking over, Dr. Padgett. She's taking over completely. I can't win. I'm trying so hard, and nothing is happening.”
“She?”
“The part of that wicked, little inner child, the one who hates me. She's trying to kill me, and she knows she's stronger than I am. She knows I'm weak, and there's nothing I can do about it. Please, can you help me?”
“The only solution is to put food in your mouth. I can't do that for you. Only you can.”
“But I could die. Don't you see that?” I pleaded. “You've told me that. How can you just sit there and do nothing? I thought you were like a father to me; I thought you cared, you loved me.”
“You're an adult, Rachel. You're twenty-nine years old, and you have two kids. You can control this. You can bring yourself to eat. You just choose not to. I can't make you do that; only you can.”
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