By late September I’m a MAP veteran, an old-timer in a place where the typical shelf life is two weeks. Cait and Sadie, and even Todd, have left. The groups proceed with the same topics, people come with the same broken lives and tortured souls. I get my tongue pierced again (though I stop short of the nipples; the last time was just too painful) and I show up for groups in combat boots, fishnet stockings, and dark glasses. I go to ManRay and “gyrate in dark rooms,” despite my mother’s plea for normal socializing. I wait.
Scott is determined to get my family on board before insurance pulls the plug. “You need their help and support,” he insists, “especially given your housing situation.” It’s true that things are worsening: Patty’s lovers are multiplying, with a new man shuffling through the downstairs every few days, and the landlord has announced a rent increase I can’t afford. Scott hands me applications to fill out for disability housing and department of mental health client status. He says that it will take months for them to be processed. “In the meanwhile, you need your family. You need them now. You need a ‘family meeting.’”
I’m used to this last desperate grab for alternatives. No one invites my parents to the table until insurance runs out, then suddenly they’re important again. Meanwhile, my parents have long ago dissociated themselves from my mental health, and each other. If you want to see an example of “splitting,” said to be such a borderline trait, look no further than my parents. Divorced by the time I was six, my mother used to tell us that my father was a “bad man.” She could barely look at him those weekends she’d hand me and my brother over for visitation. Was this bad man the same person who took us for ice cream and told us he loved us? What monstrous thing caused my mother to never talk to him again? What made my mother’s parents turn their backs on him so completely? I thought he might have been a murderer, a bank robber, or a vampire—which confused me, since she always handed us over to him for weekend visits anyway. But as I’d eventually come to learn, he wasn’t a monster. He was, in fact, a lot like me: a disappointment, a drunk, inconstant, and irresponsible. My mother hated him because he ruined her dream of the perfect marriage. And he did little to redeem himself over the years, breaking our hearts with his absences and failed promises time and time again.
It was only after my brother died that my father and I became friends. Ben’s death was sudden and shocking—a freak brain virus that killed him within hours, and destroyed the last remains of our family, as well. It finalized my mother and stepfather’s decision to divorce.
It prompted my mother to flee her grief that next year by traveling alone around the world for her first teaching sabbatical. People have said how brave she was to leave everything and travel. All I knew was that she was leaving me, and though I’d finally gotten my GED and had been accepted into a liberal arts school in upstate New York, I was utterly, nightmarishly alone. Expected to pay my own way through school, I could barely make it to midday classes, while my using escalated to the point I was carrying bottles of whiskey around with me and driving regularly to New York City with theater students to score crystal meth for weekend binges. Yet that black hole also restored my father to me somewhat. When I was nineteen and utterly, nightmarishly alone and devastated, my father called, visited, and brought me cigarettes. He took me to AA and NA meetings and held my hand. He arrived just when everyone who said they loved me disappeared into their own grief. He didn’t turn away from my pain.
My brother’s funeral was the second to last time in my memory that my parents talked, sharing a few words at the memorial service, next to the grave. The very last time was a decade ago, at the hospital where I got sober. Just as Scott is now suggesting, the therapist called them together as a last resort to help find me a place to live and offer me some financial support. I know Scott’s effort now will be futile, just like ten years ago, but there’s nowhere else to turn. So one evening at the appointed hour, I wait outside the MAP building for my parents to arrive. My father shows up first, here from New York. He stands with me for a bit, hugs me, and tells me it’s going to be alright, but I can see how nervous he is, that he doesn’t know what’s expected of him, or what my mother will say or do. Ten, fifteen, twenty minutes pass, and still my mother doesn’t arrive. This is so unlike her that I wonder if she got into an accident.
Then her car careens past the building and disappears down the road. I wait. The car approaches again and I try flagging it down, but it passes. From the brief glimpse I get of her face, she looks absolutely frantic—so frantic that she can’t slow down enough to see that she’s passing the building over and over again. Finally I stand in the middle of the road and flag her down, hoping she won’t hit me or go off the road. Once out of the car, she’s breathless: Classes ran late, then traffic was a nightmare, and she almost got into an accident. She hugs me and tells me not to worry, that everything is going to be okay. I so wish I didn’t have to go in there with them.
An hour later, my parents and I walk to the cafeteria, where we sit and try to make sense of what to do. My goal of getting their help somehow collapsed in the meeting. The collision of my parent’s perspectives, combined with their limitations and ideas about what I’m supposed to be doing, dismantled the conversation so quickly that even Scott was scratching his head. At the end of the meeting, he says, “I think it’s best if you keep talking about this yourselves.”
“I have to tell you what I need,” I say when we’re settled at a Formica table. I look down at the cheat sheet Scott helped me put together the day before. “I can’t support myself financially and I need your help. I have a mental illness that you guys don’t seem to understand. I need you to learn about it. I need you to work together with me. I feel like all my life I’ve been on my own. And every time I can’t take care of myself, you just get more angry and frustrated—or you ignore me completely.” Somehow, my list of “needs” quickly turns into an escalating rant about how neglected I feel. And, since this is the first time in two decades I’ve had their audience together, without a therapist or a funeral procession, I’m not reining myself in.
“You two have done nothing to help me with this. I’m sick of fighting on my own. It’s been a constant struggle, and you’re always blaming me. Why can’t you support me?” I start crying. “Why can’t I get your help?”
“I’ve been supporting you your whole life!” My mother erupts, in tears now too. “How can you accuse me of that?”
“You mother’s right,” my dad says. “If there’s anyone here who should be blamed, it’s me. Don’t do this to her.”
I look at the two of them. This is unreal! He’s backing her up. Maybe they’ll have a bonding moment and go out for dinner when all of this is over.
“I think,” my father continues, “it’s those student loans of yours. You’re overwhelmed with the idea of having to pay off so much money.”
My mother rebukes him: “Can’t you understand that’s the last of Kiera’s worries? She’s been in this hospital half the summer!”
My head is spinning. I was hoping they’d each pledge me a bit of monthly money and agree to some family counseling. My mom is crying hard. My dad holds his head in his hands, sighing deeply. I take my mom to the restroom.
“We’re in a mental hospital,” I say. “If there’s any place it’s okay to lose your shit, it’s here.”
“I hate this! I don’t know what I did wrong.”
I try to assure her that she didn’t do anything wrong, that I’m just really sick and need a lot of help, that I’ve needed a lot of help that no one has seemed to be able to give me. She shakes her head. “I don’t understand why all this treatment isn’t helping.”
We go back to my dad. “I’m sorry,” he says, “but I’ve got to drive back to New York.” My mother wipes her eyes and says she needs to leave too; this whole meeting has exhausted her, and she’s got classes to teach in the morning. The three of us walk to our cars and drive away in different directions. Family meeting adjourned.
So this is Ethan, my new therapist. He’s about my age, thirties-ish. He’s neither tall nor short, and except for that one smile, his face, topped by dark, cropped curls, is as blank and smooth as white marble. He’s part of the DBT team at this new hospital but specializes in CBT and anxiety. When we stand up, I notice he’s wearing his pressed black slacks just a bit higher than most people would, old-man-style, and that his white oxford shirt balloons a bit too much the way it’s tucked in. It gives him a nerdy air that, combined with his glasses, offsets his attractiveness and makes it hard to think of him in bed with me—an image that eventually enters my mind with almost any attractive man, especially one I think of as a savior.
“When can we start?” I ask, trying not to sound desperate. They confer over Ethan’s PalmPilot and set a date two weeks away—not a long time for most people, but an eon when every minute is pure survival.
“I don’t want to sound like I’m threatening,” I tell them, “but I’m not sure I’ll make it till then.” Ethan doesn’t look at all alarmed. He nods as though that makes perfect sense and writes down the numbers for his office phone and after-hours pager. I look at the card with suspicion. Therapists always say you can call them in an emergency, but what they really mean is that you can call between the hours of 9 a.m. and 4 p.m., leave a message, and they’ll get back to you the next day. And their answering machines add, without fail, “If this is an emergency, please call 911 or go to your nearest emergency room.”
Since I am pretty much a walking emergency, I highly doubt that Ethan is serious about this offer, but he leaves me with these instructions: If I feel like I’m in trouble, page him or leave a message. He will get back to me. He is my therapist now.
11
Safety
I don’t know what to make of Ethan as we finally sit down for therapy. He’s dressed like before, his face unreadable and his eyes clear as he sits across from me with his hands folded. I expect us to follow the same routine I’ve gone through for decades: hashing over the details of my fucked-up life. We’ll begin with my childhood, climb over the demolished landscape of my adolescence, and survey the desolate wasteland of my adulthood, figuring out what to fix as we go.
Ethan clicks open his pen and looks down for a moment at the blank legal pad on his lap. Then he says, “The first thing we need to do is establish some goals.” He scribbles something on the pad. “The first is to get you safe. That means managing self-harm and suicidal behavior—not hurting yourself. And making sure therapy is safe too, for both of us.”
Safety. Always a big word in therapy. I have a good idea of what I need to be safe: Give me a place to live where I don’t have to fear leaving my room. Give me a way to make money that doesn’t kill me with anxiety and exhaustion. Give me a lover who isn’t entangled with an ex. Give me a medication doctor who doesn’t make me feel like a lab rat. Give me proof that people with BPD get better. Give me someone who understands.
Ethan gives me a worksheet.
Oh dear god. If Ethan insists on three mood monitors a day, I don’t know what I’ll do. I’ve already signed a contract committing myself to working with him. And yet I signed a similar one for the previous DBT group, and if I’d known I’d spend the next seven desperate months being dragged through a meandering confusion of worksheets, musical chairs, and philosophical discussions on Hegelian dialectics, without the help of a trained DBT therapist, I would have had second thoughts—if I’d been able to think clearly. I’ve been hoping that Ethan will take me down a different road, but seeing another worksheet makes me cringe.
“It’s a diary card,” he says.
“I keep a diary.” Well, I call it a journal.
“It’s a DBT diary card. In order to be in therapy with me, you’ll need to fill one out every week. It’s part of the treatment.”
I look down at the diary card. It’s got all of the DBT skills listed, so that each day of the week you can check the ones you’ve used. It also has a section where you rate all your urges for self-destructive behavior and your negative emotions, an area to list the drugs you’ve taken, and a place to rate your level of joy. Ha! There’s even a little box to declare how badly you want to quit therapy.
“So this is part of the therapy I never got before.” Ethan nods. “What else are we going to do?”
He explains the phone coaching sessions. When I’m feeling like I need help outside of therapy, I can page him. He’ll call me back and provide skills coaching. He clarifies that the phone calls are not therapy sessions. “It’s like having a coach on the sidelines while you’re playing the game.”
“Can I call you at 2 a.m.?” I ask. A lot of my game gets on after midnight.
“No.”
Actually, Ethan doesn’t have to worry about that with me. Getting me to call will be the hard part.
We go over the diary card and determine I’m pretty much overwhelmed with every negative emotion, and while I’m not acting on my urges, I still want to die, still want to hurt myself. I am instinctively afraid of revealing this to him. My symptoms overwhelm people, even those with professional credentials. I need too much. I am impossible to please. I try to pick up on Ethan’s body language, the set of his face, anything that might confirm he feels I’m dragging him to the edge of the cliff with me.
He hands me a piece of paper with my goals written on it and a stack of diary cards. I tell him I don’t have much faith that this will work. Even if the previous program was incomplete, I’ve learned the DBT skills and am even more familiar with the CBT skills. I don’t understand how I can have so much information in my head and still not be able to change.
“Marsha Linehan says that people don’t fail DBT,” Ethan tells me. “It’s the therapy or the therapist that fails them.”
“Really?”
He nods. “She also says that therapists are jerks.”
“I’m liking this Marsha.”
So for now, the plan is that I’ll see Ethan twice a week to go over my diary card, address my self-destructive urges, and work on my living situation. I’m to page him if I feel the need, and he promises he’ll call back. I’m to end things with both MAP and Anna. As soon as the new DBT group has a spot, I’ll enter it.
When I leave Ethan’s office with my diary card and the promise of another session in three days, I’m relieved and terrified. This could be a whole new beginning. Or it could be yet another false start. I can’t count the number of blank journals I’ve bought, or the date books with their numbered pages and little graphs for listing plans, or the self-help books, all with the expectation that this time it will be different. It’s the same way with every therapist and medication. Maybe you have to be delusional to keep going back—or masochistic. But now I have that other motivator: the anger. I’m not going to let this thing kill me.
And then there’s Anna. Sweet, ineffectual Anna. I have to break up with her once and for all. After three years of working together, I sit in her office and explain that I’m going over to Ethan. She’s upset and wants to know what this new therapist can provide that she can’t. When I explain that he’s trained in DBT and CBT, she shakes her head. “You need someone who really cares about you, who you can talk to. These new therapies, they’re formulaic. You might find them interesting, but they’re not the solution.”
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“What is the solution?” I ask, reminding her that despite all our work together, I was only getting worse.
“Sometimes it’s darkest just before the light,” Anna says.
“Or sometimes you just have to try something new,” I respond.
She shakes her head. “I wish you the best of luck, Kiera. I really do, but I’m certain you’ll be back. I can almost guarantee it.”
I take my backpack and thank her for all of her help. And I really mean it. She tried her best. But I know that even if Ethan doesn’t work out, I won’t go back.
During my third session with Ethan, I ask him his opinion of the BPD diagnosis.
Like everyone else, he winces, but since it’s Ethan, it’s just the faintest little cringe. “It’s not a very positive association to have,” he says.
“And yet, I have all the symptoms…”
“Do you think you’re a ‘borderline’?”
“I think I have BPD. I don’t really know the difference between having BPD and being a borderline.”
“Well, I’ll tell you why I’m not comfortable with the diagnosis. You might have the symptoms, but with BPD, the rest of the world typically reduces the person to the disorder, which isn’t fair or true. And it’s still classified as being ‘inflexible and enduring.’ I’m not sure that’s the right attitude to take if you’re looking to get better.”
I know on some level that Ethan is being sensitive, but encountering yet another deflection incites me. And Ethan is no longer looking like a therapist I want.
“I’ll talk about it with you,” Ethan adds. “About BPD tendencies, symptoms, the ways it affects your life. But I’m not calling you a borderline.”
I’m still suspicious. “Do you know anything about the disorder?”
Buddha and the Borderline Page 10