Given the range and severity of Diana’s symptoms, it’s not surprising that outpatient psychotherapy failed her. A number of psychiatrists and psychologists have debated Diana’s condition in the British press, offering diagnoses ranging from addiction to obsessive-compulsive disorder to narcissism. But none adequately explains Diana’s disordered thinking, behavior, and relationships. Nor does pinning everything on her bulimia, which was commonly done by both her friends and journalists. In fact, her eating disorder was a manifestation of her illness, not the illness itself. “Don’t make a mistake by focusing on bulimia,” said a psychologist familiar with Diana’s case. “Bulimia is a window.”
To a striking degree, Diana’s disturbances conformed to the borderline personality disorder. Neurotics may experience anxiety but still have a clear sense of themselves, while narcissists tend to be self-important and disdainful. Borderline personalities feel inferior and dependent and are typically confused about their identity. They are self-destructive, easily depressed, panicky, and volatile. But on the surface they are apt to be charming, insightful, witty, and lively. As in Diana’s case, they tend to be perceptive about other people, and many work as counselors, doctors, and nurses, providing the kind of care they would like to receive. One hallmark of the borderline personality is the ability to appear “superficially intact” while experiencing “dramatic internal chaos.” Among other notable figures who exhibited borderline behavior was Marilyn Monroe, who, like Diana, was obsessed with finding her identity, harbored a terror of solitude, and suffered from crushing despair.
The term “borderline” has been around since the late 1930s as a catchall category for people who are more severely ill than neurotics but lack the distortions of reality that incapacitate psychotics. The condition exists on the “border” of long-recognized mental illnesses such as manic depression, anxiety disorders, and schizophrenia. Two leading American psychiatrists, Dr. Otto Kernberg of Cornell and Dr. John Gunderson of Harvard, came up with a definition that was officially recognized by the American Psychiatric Association in 1980 and subsequently by the World Health Organization.
The possibility that Diana suffered from borderline personality disorder was discussed by a few people close to Prince Charles. One of them consulted a psychologist and a psychiatrist, each of whom told him that Diana’s behavior “fit the description of the borderline personality in quite extraordinary detail.” The suggestion was made publicly as well, most notably in a 1995 column by Nigel Dempster, who reported in the Daily Mail a “growing feeling” Diana’s symptoms pointed toward a borderline disorder. Yet Dempster undercut the potential helpfulness of his suggestion by using it as evidence of Diana’s “predatory,” “manipulative,” and “egocentric” approach to men. “It can only be hoped that she is not allowed to sink further into the indulgence of the victim or the aggressive manipulation of the predator,” he wrote.
While one cannot say with certainty that Diana had a borderline personality disorder, the evidence is compelling. The most important factor setting the borderline personality apart from those with other disorders is early parental loss—in Diana’s case the departure of her mother and the emotional withdrawal of her father for several years following the Spencer divorce. Even the timing of the usual appearance of borderline symptoms in late adolescence fit Diana’s profile, as did the trigger of intense pressure, which in Diana’s case was brought on by her royal marriage and the lofty expectations of the public and the press. Borderlines can frequently maintain a facade of normality “until their defense structure crumbles, usually around a stressful situation,” according to psychiatrist Richard J. Corelli of Stanford University.
The borderline personality is also more prevalent than one would expect. According to the Harvard Mental Health Letter, an “estimated 2.5 per cent of the American population suffers from borderline personality disorder—six million persons, or three times the number with schizophrenia.” From fifteen to twenty-five percent of all patients seeking psychiatric care are borderlines. It is by any measure a major mental health problem, although it remains little known and largely misunderstood.
Many people have the traits of the borderline to one degree or another, but someone with the disorder experiences them severely and chronically, as Diana did. The traits are “intricately connected, interacting with each other so that one symptom sparks the rise of another like the pistons of a combustion engine,” wrote Dr. Jerold Kreisman, a leading expert in the study of borderline personalities.
At the core of a borderline’s psychology is an uncertain self-image. In his eulogy, Diana’s brother Charles referred to her “deep feelings of unworthiness.” Diana spoke of her self-hatred to Andrew Morton, James Hewitt, and any number of friends. She constantly sought ratification from friends, the press, and crowds of strangers. Her preferred source of approval was the public, but even after mingling with adoring fans, she felt inadequate. As she once explained to Evening Standard editor Max Hastings, she cried after public events “because of the strain of feeling that so much is expected of me.”
Diana couldn’t accept that her attributes were a fixed part of her personality—a typical borderline reaction. Instead, she relied on the most recent judgment she had heard, whether from her husband, her friends, the press, even people she met in hospital wards. This tendency largely explains why Diana felt she was “never praised.” If someone had applauded her two weeks earlier, it didn’t matter, because she required continuous encouragement to avoid plunging into depression over her imagined deficiencies. James Hewitt felt worn down by Diana’s need for praise about her beauty “to the point where he had repeated it so many times that he feared his words had lost their meaning.”
Lacking any firm identity, Diana frequently felt lonely, empty, and bored—another marker of the borderline. She often started up relationships to fill the vacuum. Since she frequently felt victimized, as most borderlines do, this urge to find relief in new friends or lovers was paradoxical. But for Diana, the possibility of a disappointing relationship was preferable to solitude.
The comfort Diana sought from bulimic bingeing and purging was also an example of the impulsive behavior characteristic of a borderline. A number of studies have shown that as many as a third of bulimics suffer from the borderline personality disorder. Diana’s well-documented episodes of self-mutilation, as well as her suicidal gestures and threats, were related forms of impulsiveness consistent with the disorder. As Kreisman observed, “self-mutilation … is the hallmark of borderline personality disorder … more closely connected … than any other psychiatric malady.”
The most poignant aspect of the borderline personality is the inability to sustain close, mutually gratifying relationships. Diana brought a ferocious intensity to her relationships, pleading for attention and time, and demanding complete loyalty. She showered people with affection and gifts, then cut them off with little or no explanation. “If you have been rejected by your mother and then rejected by your husband,” Rosa Monckton explained, “you feel that as soon as people get to know you they will reject you.” Diana “was so incredibly insecure, and whenever people got close she got frightened.” Diana actually alternated between fears about intimacy and anxiety over separation. If people came too close, she felt suffocated; if they kept a slight distance, she felt abandoned. These problems were invisible to the public. Only intimates saw her worries and erratic behavior.
In her closest relationships, Diana showed the borderline’s frantic effort to avoid abandonment. Jonathan Dimbleby described numerous examples of this behavior, beginning early in her marriage when Diana repeatedly insisted on Charles’s presence “to the exclusion of all else in his life.” When Charles went off to work, Diana interpreted his departure as a lack of love. James Hewitt, Oliver Hoare, and Hasnat Khan all were the objects of the same pattern of urgent dependency. To the end, when Diana talked about her ideal man, she envisioned someone “who would be there for her twenty-four hours a day,” according
to energy healer Simone Simmons.
When Diana was alone, she felt trapped and isolated. After a close friend or lover left Diana’s presence, she reacted in a childlike fashion, as if she feared the other person wouldn’t return. She also experienced what psychiatrists call the “paling effect of time”: When she was cut off from someone to whom she was intensely attached, her favorable memory of that person would be quickly eroded by feelings of doubt. It may have been to assuage these misgivings and fears that Diana would call people repeatedly or spend hours with them on the phone. “She had no governor that operated,” said her friend David Puttnam. “If you said, ‘This is the sixth time you’ve called,’ she would say, ‘No, I’ve only called once,’ ”—a form of denial also typical of the borderline’s occasional disconnection from reality.
Always distrustful, Diana listened in on phone conversations, opened mail, and lingered in hallways to catch comments that proved her worst suspicions. In some cases, Diana had reason to be wary; plenty of people took advantage of her. But most of the time she overreacted, mainly because she tended to see people in black or white, a defense mechanism known as “splitting.” It is a classically juvenile response frequently seen in borderlines who “cannot tolerate human inconsistencies and ambiguities” or “reconcile another’s good and bad qualities into a constant coherent understanding of that person.… At any particular moment, one is either ‘good’ or ‘evil’ … idolized one day, totally devalued and dismissed the next,” a behavior pattern often exhibited by Diana.
At the outset of close relationships, Diana usually screened out negative characteristics in the other person. But, inevitably, the object of her affection would let her down, perhaps by failing to praise her enough. Then she would see only the worst in that person. Virtually everyone was destined to fail her, because Diana couldn’t accept the fact that every relationship has its ups and downs.
Diana’s sudden mood shifts typified the borderline personality’s “emotional hemophilia,” an absence of “the clotting mechanism needed to moderate spurts of feeling.” As her friend Clive James wrote, “Clearly on a hair trigger, she was unstable at best, and when the squeeze was on, she was a fruitcake on the rampage.” Even her sunny side had a slightly manic edge. “I never thought she was unstable when I first met her,” said one of her friends. “But I noticed as I got to know her better the inconsistencies in her behavior. She was a tremendous giggler, but her laughter had a touch of madness, almost uncontrollable. Her giggles were always faintly hysterical—like a combination of tears and laughter.”
By her own description, Diana had felt a sense of detachment (“in the wrong shell”) since childhood, another trait of the borderline, especially in times of severe stress. “Diana seemed to look at the world through a glass, and was unable to form relationships while seeing others form relationships, and she was tormented that she couldn’t do it too,” said a man close to Prince Charles. As is often seen in “high functioning” borderline personalities, tied into Diana’s sense of being an outsider were instances of “magical thinking”: her belief in premonitions of events in her life such as her father’s stroke, her reports of hearing voices that instructed her, and her conviction that she possessed healing powers.
Borderline personalities are notoriously difficult to treat. They are frequently misdiagnosed, and they tend to move from one therapist to the next, as was the case with Diana. Antidepressants such as Prozac can ease some symptoms, but borderlines usually don’t take medications as prescribed, at least in part because they view pharmacotherapy—as Diana did—as a form of “mind control.” For therapists, treating a borderline can be arduous. The mistrust and inconstancy of the disorder can erode the therapist’s professional confidence, not to mention his patience. As a result, the borderline is considered by many in the mental health professions to represent “a kind of ‘Third World’ of mental illness … indistinct, massive, vaguely threatening.”
On one level, Diana grasped how close to the edge she lived. Washington Post publisher Katharine Graham wrote that Diana had once been asked if she gambled. “Not with cards,” Diana replied, “but with life.” Such moments of clarity were rare. Most of the time, Diana was too troubled to find appropriate care on her own. Nor was anyone around her able to take charge. Given the complexity of her problems, it would have taken someone of keen understanding, great patience, and unwavering love to keep her on a helpful therapeutic course. The royal family were incapable of dealing with Diana, and her own relatives weren’t up to the task. “Her mother wasn’t there, and for her father everything Diana did was perfect and wonderful. He wouldn’t say boo to a goose,” said a relative of the royal family. In the view of Charles’s former aide Michael Colborne, “Most people look at it as if it was her fault, but it wasn’t. Everyone contributed to her downfall.”
Under the right circumstances, Diana could have been helped. She needed to be in a structured and predictable environment, out of the limelight, away from the media’s deifying praise and flashes of criticism. She probably could have benefited from practical therapy that avoided delving too deeply into analyzing the past and instead concentrated on managing her symptoms. Borderlines require years of therapy, but they can learn new emotional reflexes in order to deal with stress and relate better to others.
From the time she entered public life, Diana conveyed her vulnerability with her eyes, her gestures, her speech, and her touch. Alongside her beauty, this evident fragility made her a star. Once the breadth and depth of her emotional struggle became known, she struck an even deeper chord: She became the fairy-princess version of the troubled everywoman.
Diana had a certain kind of strength as well. Even under the most extreme pressure, she did not seek a hermit’s retreat. Her hunger for the love of her public may have accounted for at least some of that determination to keep going. But she also had a willfulness that prompted her to buck royal proprieties, whether it meant roller-skating through the halls of Buckingham Palace or publicly hugging and kissing the sick and dying. Her defiance won her an even larger place in the public’s heart.
Diana talked about a sense of destiny, her need to achieve good by fulfilling a role she had trouble defining. Although her identity was fractured, she kept to her quest and seized opportunities, sometimes willy-nilly, to do her bit for society. But Diana couldn’t sustain her good works for the simple reason that her own problems consumed so much of her time and energy. As one of her former aides said, “Her life was her drama, and I am not really sure she could move beyond that.” Yet, given the extent to which Diana was ruled by her inconstant emotions, the wonder is that she accomplished as much as she did.
A Note on Sources
This book was based on interviews with 148 people as well as numerous books and articles in newspapers and magazines. Sixty-eight of the individuals I interviewed asked to remain anonymous, and though these sources contributed significantly to the book, they do not appear in the chapter notes. All quotations excluded from the chapter notes are from these confidential interviews. In citing periodicals, I have listed only publication names and dates. Conversions from British sterling to American dollars were based on International Financial Statistics (tables of foreign exchange rates) from the Board of Governors of the Federal Reserve System. Computations of current dollars compared with values in past years were based on the U.S. Department of Labor’s Bureau of Labor Statistics Consumer Price Index.
ABBREVIATIONS
Publications
DEx Daily Express
SuEx Sunday Express
Gua The Guardian
DM Daily Mail
MOS The Mail on Sunday
Mi Daily Mirror(The Mirror as of 1997)
SuMi Sunday Mirror
NOTW News of the World
TNY The New Yorker
NYT The New York Times
SuPe Sunday People
PE Private Eye
ES Evening Standard
DS Daily Star
Sun The Sun
DT The Daily Telegraph
SuTel The Sunday Telegraph
Ti The Times (London)
ST The Sunday Times (London)
To Today
VF Vanity Fair
WP The Washington Post
WO Woman’s Own
Books
Works cited more than several times will be abbreviated as follows:
B-SB Royal Service: My Twelve Years as Valet to Prince Charles (1983), by Stephen P. Barry
B-WB The Housekeeper’s Diary: Charles and Diana Before the Breakup (1995), by Wendy Berry
B-TB Fayed: The Unauthorized Biography (1998), by Tom Bower
B-JD The Prince of Wales: A Biography (1994), by Jonathan Dimbleby
B-SF My Story (paperback edition, 1997), by Sarah Ferguson, the Duchess of York
B-PJ1 Diana Princess of Wales: A Biography (1982), by Penny Junor
B-PJ2 Charles: Victim or Villain (1998), by Penny Junor
B-RK Although not actually a book, Diana: The Untold Story, by Richard Kay and Geoffrey Levy, ran as a twelve-part series in the Daily Mail in 1998 and will be regarded as a book to distinguish it from Richard Kay’s daily writing.
Diana in Search of Herself Page 52