by Anna Berry
It is in fact extremely common for persons eventually diagnosed with BPD to have had numerous other disease labels applied to them first, not only because many clinicians are not trained in recognizing BPD symptoms, but also because BPD tends to coexist with other mental illnesses, such as depression and anxiety disorders.[6] Indeed, it is common for all mentally ill persons, regardless of their specific illness, to receive as many as a dozen different diagnoses from scores of different practitioners over the course of their lifetime. I think this helps explain why I’ve frequently been diagnosed with various types of depression—but whether that depression was actually a symptom of BPD or a coexisting condition is up for debate.
Psychologists who support the diagnosis of BPD state that the ability to “act” as if you are perfectly sane and stable to those around you while feeling suicidal and volatile inside is trademark “borderline” behavior. And my trademark “perfect storm” of near emotional collapse buried underneath a serene, happy exterior is indeed one of the classic symptoms of BPD.
The ability to act as if everything is all right when in fact nothing is leads many BPD sufferers to pursue careers in the arts, especially the performing arts. Indeed, “unusual artistic talent” has been identified as having a strong correlation with BPD.[7] The day-to-day torture of having to create inner and outer selves simultaneously, and maintain both convincingly, is perfect real-world training for a professional actor. It’s just as effective for someone who wants to be a writer too. When your mind is split into two complete selves—one peaceful, self-lobotomized, and seemingly perfect; the other a raging, screaming, frightened, depressive monster—your entire existence revolves around fabricating scenarios for both of those characters (neither of which represents your true self) in which to dwell. Living with BPD is like living inside your very own custom-made, three-dimensional soap opera, with your split self playing all the roles and doing all the histrionic backstabbing on a TV series that runs only in your own mind.
What else have I been diagnosed with at some point or other? Let’s see.
Multiple personality disorder. Again, I couldn’t buy this one because I never had other personalities, so I’m not sure why this one was even offered.
Episodic depression. This means you only have depression at certain times, cycling with either normal behavior or mania. Your depression becomes a series of episodes, popping up at regular intervals like a running gag on a TV show. I suppose you could make the argument that I did have this because I had episodes of depression starting in my early teens through my late twenties; but that seems to me more “chronic” than “episodic.”
Seasonal affective disorder. I suppose this diagnosis is common for people who live in the Upper Midwest like I do, given how dark, long, and cold our winters are. But I’m not sure it applies to me since some of my worst depressive and psychotic episodes occurred in sunny, warm weather. My moods never depended on the weather, per se—I just happened to get this applied to me when I saw a psychotherapist during a January cold snap.
Cyclothymic disorder and/or dysthymic disorder. These are both mood disorders related to depression. Cyclothymic disorder involves cycling between mild to moderate depression and mania and is considered a less severe version of bipolar disorder, while dysthymic disorder means you’ve had a constantly depressed mood for two years or more, feeling hopeless and unable to concentrate, without necessarily being suicidal. As with their more severe counterparts, I was missing several of the required criteria for these diseases, and since I considered suicide more than once, I don’t think either was the right fit for me.
Antisocial personality disorder. I take particular offense to this one. I don’t appreciate being placed in the same basket with murderers and rapists. Antisocial personalities possess a profound lack of empathy and act without conscience or regard to the well-being of others. That can mean anything from being a career criminal to the guy who steals his coworkers’ lunches from the office refrigerator and then lies about it. Since I’ve frequently been plagued by guilt or fear of what and how others will think of me or do to me if I make this or that choice, it seems a profound lack of empathy isn’t one of my problems. I’m also the first to cry at sad movies, I often beat myself up for not giving enough to charity, and I frequently do way too much volunteer work at the expense of my personal and professional obligations. In that regard, I’m really more of a codependent with a guilt complex.
Histrionic personality disorder. The DSM-V also calls this disorder the “theatrical” or “dramatic” personality disorder. Since I’m a trained actor and playwright, I suppose I can see why I got this diagnosis, given that my livelihood depends in part on a flair for the dramatic. But I don’t think it fits me because when I’m not participating in theater (which isn’t much these days, now that I’m raising two young children), I actually cannot stand being at the center of attention all the time, as the disease criteria require. Unlike when I’m on the stage, in reality I’m more of an introvert. I prefer a quiet evening at home catching up on reading or cleaning the bathroom to making a spectacle of myself at the discotheque or in the returns-and-exchanges line at the mall.
Schizotypal personality disorder. The DSM-V states that this disorder is one that elicits behavior of “extreme solitude.” Sufferers tend to show deep anxiety in social situations, have odd or strange social behaviors, and be extremely uncomfortable maintaining close relationships with others. None of those criteria apply to me. While I am a bit of an introvert, I have a wide circle of friends and enjoy going to parties and gatherings, and I’m frequently complimented on my politeness and knowledge of social etiquette—hardly a symptom of being socially awkward. The only reason I can think of why I might have received this diagnosis is because at the time I was choosing to hang out with people who didn’t share my values and often belittled me, but that had more to do with my own low self-esteem than social anxiety.
Brief psychotic episode. This isn’t an illness so much as it’s an acute symptom of a larger problem, which can have any number of causes ranging from several different psychiatric diagnoses to drug or alcohol intoxication and even dehydration.[8] But in the interest of being truthful, I’ll admit to having more than a few of these. You’ll read more about a couple of them in this book.
Post-traumatic stress disorder (PTSD). This one I wholeheartedly agree with, and you’ll learn more about some of the childhood (and adult) trauma I endured that is likely behind it in this book. Some of the symptoms of PTSD can mimic other psychiatric disorders, and that might explain why I’ve gotten so many different diagnoses over the years.
Exhausted yet? Then just imagine what it must be like to be a patient swimming through this constantly changing alphabet soup of illnesses! Imagine a diabetic being told by his doctors that he isn’t diabetic, but he actually has lung cancer, and he gets treated for that instead of diabetes. Then a couple of weeks into chemotherapy, he finds out he never had lung cancer in the first place, but in fact he actually had Crohn’s disease, so his treatment protocol has to change. And his diabetes still hasn’t been diagnosed at all, let alone treated. It seems absurd, but it’s not all that different from what a lot of people with mental illness go through. Small wonder most people with mental illness don’t seek help at all.[9]
The one thing I can conclude from all of this is that the DSM-V is a good starting point for identifying and treating mental disorders, but if my experiences are any example, it’s far from perfect. Clinicians should always remember that people don’t always fit into these neat little boxes. And being different or outside the established “norm” for one illness or another doesn’t mean we’re beyond help. Quite the opposite, in fact. We should also recognize that mental illness is a chronic disease that can change and evolve over the course of our lives. The diagnosis we got twenty or thirty years ago might no longer apply, but that doesn’t necessarily mean we’re “better,” either.
“Chronic” means treatable, but not curable. If yo
u’re unfortunate enough to be born with nutjob DNA, or to grow up in a nutjob family environment that skews and scars you for life, you will never be cured. Not totally, anyway. The best you can hope for is merely to manage your chronic illness—that is, keep it from killing you—just as a diabetic must manage his sugar levels with painful insulin shots to keep from dying, just as a cancer patient must endure excruciating radiation and chemotherapy to get her life-threatening tumors to go—temporarily—into remission. So it is, too, with mental illness. There are no miracle cures, no final triumphs over this most sinister and misunderstood of afflictions. There is merely an ever-present series of small battles and skirmishes, fought one day at a time, in an endless war against the terrorist acts committed by an unstable mind.
Sounds depressing, doesn’t it? And it is. But it doesn’t have to be.
Mental illness—this most difficult and costly of all chronic diseases—is manageable. It’s survivable. Better yet, it’s even a disease under which you can thrive, improve, better yourself, and reach a higher human potential than you ever thought possible.
And despite what the American pharmaceutical industry wants you to believe, in many cases, you can accomplish all of these things without ever popping a single pill.
How do I know this?
I’m very proud to say that in more than fifteen years of psychotherapy, I’ve never once taken any psychiatric medication.
Not once. Now before you dismiss me as a crackpot for saying that and throw this book across the room, please know I realize that for some people this may not be an option and that psychiatric medication may be good and even necessary in some instances. But for me, I’ve managed to avoid going down that path.
That’s not to say that I didn’t want to be medicated. Often, I did. I even specifically asked psychiatrists for antidepressants on more than one occasion. But every time, I was denied the prescription—either because my health insurance wouldn’t pay for it (90 percent of the time) or because whatever therapist I had at the time thought I’d respond better to cognitive therapy (10 percent of the time; and those were the therapists who had my best interests at heart. Thank you).
I’m also very proud to say I don’t “hear voices.” Not the demonic ones that tell me to hurt myself or others, anyway. The ones I hear are inspirational, like the character voices I hear when I’m writing a play, or the plot bunnies that pop into my head when I’m taking a shower and that I have to go instantly write down so they can become part of my latest novel. There can be good voices and bad voices inside our heads. The good ones can be truly beautiful, and it can be just as damaging to suppress those as it can be to listen to the demons who tell us to destroy ourselves.
And any playwright can tell you that “hearing voices” is absolutely necessary when writing a play. Playwrights “hear voices” in their heads in the same way that composers of symphonies hear entire string quartets or woodwind sections in their heads, in the same way that architects see unfinished buildings floating before their eyes or sculptors see a beautiful woman’s body in an uncut block of marble. Whenever I sit down to write a play or a story, I stop to listen to the voices in my head and then strive to give them a home of their own.
I suppose in my own peculiar way, I’ve managed to channel one of the main afflictions of my family DNA into a creative art form. I also suppose that if I couldn’t write plays, I would be heavily medicated, unemployed, and on permanent mental health disability—just like my older brother Mark[10] is now. Just like my mother is too—even after more than thirty years under the care of psychologists and psychiatrists.
The “crazy artist” stereotype is ubiquitous for a reason. Many of us artistic types walk a very thin line between sanity and madness, a very thin line painted at varying thicknesses according to our ability to express ourselves. If ever that ability gets trampled upon, if it ever melts or is simply erased, then the mad-bad voices start creeping in to start telling us that we must destroy ourselves in order to survive. It’s a strange dichotomy, but I know from experience that self-destruction—whether through alcoholism, drug use, abusive relationships, casual sex, or whatever—is what keeps someone whom the mad-bad voices have imprisoned alive. For a time, anyway. Some, like Brian Wilson,[11] Carrie Fisher,[12] and Dick Cavett,[13] manage not only to stay alive but to triumph over the mad-bad voices and even to harness them as tools that make their art that much more successful and beautiful. But others—Vincent Van Gogh, Spalding Grey, Marilyn Monroe, and scores more—take the bargain but lose the battle, finally succumbing to the demons that help murder artists by their own hands. The mad-bad voices suck all the doomed artist’s lifeblood dry in order to feed the great Beast that dwells above all of us, the Manic Muse that we both love and hate, that we both rely upon and fear.
My mother, my brother, and several of my ancestors have all “heard voices” at one time or another. My mother and brother still hear voices whenever they forget to take their antipsychotic medication—and sometimes they still hear them through the drug-induced haze they live in while medicated.
Years ago, my mother heard the voices of tired old women telling her that “company was coming to visit soon”—special, fancy company that required an immaculate house and exceedingly well-dressed children. I remember days when I would come home from school to our house in Indiana and find my mother in a frenzy—dusting furniture that had no dust, straightening pictures and throw pillows that weren’t crooked, mopping floors already so clean they could be used as polished platters for baked Alaska. As soon as my brother and I set foot in the house, Mom would order us to change out of our school clothes and into the “best of our best”—me, a crisp, white-lace, ankle-length dress I wore for my first communion at St. Mary of the Lake Catholic Church; my brother, a three-piece suit of light blue polyester and a clip-on maroon tie he’d gotten as a present from our grandmother, Memaw Jones. Then Mom would make us take up prim positions on the striped-blue velvet couch in our living room to wait for the mysterious, nameless “company” that never arrived.
The only person ever to show up at our front door on those long, itchy afternoons when I sat motionless, trying hard not to scratch at the First Communion lace around my neck, was my father when he got home from work demanding his dinner and wanting to know why the hell everybody was dressed like it was the goddamn Academy Awards.
Each time this happened, I asked Mom where she’d heard that company was coming. Did someone call? Did she get a letter? Did the Jehovah’s Witnesses that came by our house once a week maybe want to stay for coffee and cake? What? She avoided the question the first couple of times. Then the third or fourth time, she said simply, “I thought, maybe. I thought maybe.” Every time thereafter, whenever the voices told her something was going to happen that didn’t, her standard response to those of us outraged at the inconvenience of First Communion lace and rearranged furniture was “I thought maybe.”
It wasn’t until years later, when I was in college and Mom was in one of her rare periods of unmedicated lucidity, that she told me the truth about the dry old women she heard in her head, the ones who insisted she clean and dress us for the phantom company that she thought for sure would come, the company that had to come so she wouldn’t die.
My maternal great-grandfather Papaw Scott—whom my mother says my older brother Mark resembles in many ways—heard the voices too. I only met Great-Papaw Scott once before he died when I was barely a toddler, but the stories of the voices in his head are legendary in my family. Great-Papaw Scott grew up desperately poor in the mountains of western Virginia and got a job working on the railroad when he was in his teens. He married young and had children before he was twenty. He “retired” young too—in his late forties, by bribing a doctor to write a letter to the railroad company saying he had a heart condition that rendered him unable to work. (He was in perfect health. Physically, at least.) He then moved from rural Virginia to Evansville, Indiana, to be closer to his children (including his daughter, m
y Memaw Jones,[14] whom he constantly begged for money) and spent the rest of his life tinkering in his tiny bungalow, building beautiful folk-art model houses out of scrap wood and trash and listening to the voices in his head.
Great-Papaw Scott’s voices started out in the mid-1950s as the FBI. By the 1960s, they had become the CIA (and occasionally, Interpol). The FBI, Interpol, and the CIA told Great-Papaw Scott, via all-points bulletins only he could hear, that he could not work outside the home because they were spying on him, monitoring his every move, and if they didn’t like what he did or where he went, they would kill him. My mother believes that the voices told him to quit his job with the railroad and told him to bribe a doctor to write the fake disability letter for him too. The voices wanted Great-Papaw Scott under their complete and utter control. They used him as a tool for their own ends—just as they use everyone who falls under their spell.
At first, Great-Papaw Scott’s voices only affected him. But near the end of his life, his voices so controlled him that he refused to leave the house—even to go out into the yard or collect the mail—and forbade everyone who came to visit him from speaking aloud in his presence. He would only communicate through notes written in a simple letter-replacement cipher code because he didn’t want the CIA and the FBI to overhear him and track him down. Relatives and friends avoided him because they didn’t want to write coded notes back and forth to Great-Papaw Scott just so they could have a conversation.