I Am Not Just a Box on the DSM-V

I thought they were mistaken when the doctors first began tossing around the term “borderline personality disorder” in reference to me. I didn’t – couldn’t- have that. That was Winona Ryder in “Girl, Interrupted.” I may be crazy, but I never chased a bottle of aspirin with a bottle of vodka, dismissing this act by famously proclaiming, “I had a headache.” It didn’t help that initially, the case manager threw around the diagnosis in the manner he would if he were trying to decide if a yellow or blue scarf would offset my eyes more. His insensitivity aside, it felt like he was not criticizing my life – both past and future- into a confused paralysis between neurotic and psychotic. Some of you may raise your eyebrows at this dramatic description. I challenge you to Google how the term ‘borderline’ was originally coined and then come talk to me about the implications of being placed into this category.

As I set out on my 12th path through structured treatment, I struggled with what it meant to be borderline. No amount of self-discovery, no excruciating examination of my thoughts, behaviors or emotional experience seemed to shed any much light on what diagnosis meant. The trouble with semantics in psychiatry is that we often take no notice of how minor parts of speech or turns of phrase change the definition of what it means to live these diagnoses on a daily basis. That is, however until those things become what feels like the defining part of who you are. When someone is diagnosed with depression, you won’t hear them say, “Oh I am depression.” This is equally unlikely with a patient diagnosed with anorexia or bi-polar disorder, or even schizophrenia. A rare few psychiatric conditions enjoy the pleasure of being both an adjective to describe one’s mood or a classification of their behaviors, and being a noun – a label- to encompass all of who someone is. Alcoholics. Addicts. And borderlines. Unfortunately for me, I identify with all of these conditions.

But even as I write this, I find myself battling my own definition of being borderline. I have never allowed myself to fall neatly into a box of any type, or more accurately, have never wanted to. For example, I am blond, but I would more likely slap someone than allow them to stereotype me as a Barbie manifestation or a dumb blond. Same with the stereotypes attached to being classified as Boston Irish Catholic. The trouble is that much of my behavior is so ”classically borderline” that it’s tough to break away from this label. Desperate attempts to avoid abandonment? Check. Untrusting? Dramatic? Reactive? Check, check, check. Unrelenting standards for self and others that cause massive vacillations between idealization and devaluation? Triple check. So I find myself questioning if and how I can be more than my diagnosis.

I don’t have the perfect self-proclamation to tie this story into a neat little bow. I am more than borderline, just like I am more than my hair, eye, skin color or where I went to school and who my parents are. I think my therapists, psychiatrists or pretty much anyone who has ever met me will tell you that. Despite this, it is still a daily struggle to see myself beyond borderline. Nor do I seek to oversimplify or dismiss the anguish of my experience or that of others. Most days, I don’t see this silver lining. But I have to hold onto the hope that I am and will be more to myself, to my family and to the world than just a diagnosis or a hospital patient. I’ve never settled for a box before and I am certainly not about to start now.

The tools I need to create a better life for myself have always been readily available; I just didn’t know enough to access them. Going through treatment helped me to develop a readily available tool kit of coping mechanisms that were healthy and not destructive. Who knew that something besides drowning my emotions in alcohol could work? For so many years, my first and second instincts to any and all intense emotions were to drown them in substances or to starve them away. Makes a lot of sense right? To someone deep in the throes of my disease, it did. But now I know that drinking my problems away just makes them worse. Because eventually I have to come out of the fog, out of the black out. And when I do, I feel all of the things that I set out to escape – sadness, emptiness, toxic shame, anger – plus another round of guilt and shame for having drank at all.

So what is my alternative? Today I can call my friend Anne who I met in treatment. Anne actually knows me. The me beneath all the layers of the onion, the layers of the badass preppy girl. She has been in group with me when I am insatiably chatty about psychological stuff because I have to know everything – and she still likes me. Anne and I share the misfortune of both being from snobby Boston suburbs, though she wears it with  ironic appreciation as opposed to my disdain. She has an energy about her that makes it impossible not to like her. She is engaging and interesting – when she wants to be. And if I hadn’t gone through the program, I would never have met her or any of the other fantastic people I met there. So the people I have met in treatment, they are my silver lining. Because without them, I would not be who I am today.

I often times wonder what would have or could have happened if I had “taken” to treatment during my first go around. Or my fifth. Or even my ninth. Would I be on Politico’s list of top 30 under 30? Would I have realized sooner that I wanted to work with people directly, helping them to improve their own circumstances? Would my former romantic and platonic relationships fallen apart in the dramatic ways that they did, or would I be married and be on my way to having the family that I so desperately crave? Maybe. But this exercise is futile – it is more an exercise in self-flagellation than it is a constructive use of my time. My road through hell and back happened the way that I needed it to – I needed to reach all of those Inferno like bottoms in order to truly realize that I could not and did not want to continue living in the way that I was. If I were asked three years ago what I was willing to do to recover from my diseases, I may have been willing to stop drinking. Or stop starving myself. Or even stopping using romantic interactions to fill the bottomless hole in my heart. But I was not ready to fundamentally rebuild my interpersonal interactions, to change my coping skills, and most importantly, I was not willing, ready or able to experience my emotions. I was still trapped in my emotionless fantasy world, where I could shut pain and suffering on and off, like a light switch. In DBT therapy, we are taught that emotions are like waves and can be ridden.

The DBT gurus from the program teach patients how to ride these emotional waves without making things worse. This is a noble lesson. And likely, incredibly useful for 95% of the borderline patients who go through an intensive DBT program. But for me, it took more than didactic lessons to learn to implement these skills into my life. I had to make mistakes and learn from them in real time– often times to the horror of my treatment team and family. Often times, these mistakes, my failures to adhere to the treatment protocol baffled my treatment team and parents. I believe – though I do not know – that all these people occasionally blamed themselves for my self-destructive behavior. I probably blamed them too at times. I resented them calling me “one of the most complicated cases in their thirty years of experience.” As I reflect back now, it was not their fault. Mostly, I was hell-bent on protecting my own misery, because it was the only dependable companion I have ever known. Even if I think back to my “happy” high school years, that self-critical, self-loathing voice was my closest companion.

Driving a wedge between my true self and this negative, hate-fueled version of Jenni was a truly Herculean effort. It took years to put enough space between the two selves for me to even begin to recognize the existence of this voice. It took months of true ambivalence about life to wake up one morning and look myself in the mirror and see the utter defeat and sadness that had taken over. It took another round of treatment in an alcohol facility to grasp some wisp of hope that if I could cut the shit, stop the self-destruction, that I could have a better life. My true self deserves better. The little girl who danced around effortlessly in pink and purple sparkles deserves better. The girl who talked to strangers just because deserves better. The person who dreamed of changing the world through hard work and devotion to equality deserves better.

At one treatment center I went to, during my clinical intake with the psychiatrist, after hearing my story in its entirety, he asked me, point-blank, how I was possibly still breathing. I shrugged my shoulders and said I didn’t know. This may seem cavalier. I am a lot of things, but cavalier is not one of them. I honestly don’t know how I survived all the physical torture I put my body through. I don’t know what I think about a higher power. I don’t believe in fate. Much to my mother’s chagrin, I know Catholicism is not my thing. But there has to be some greater purpose to my life than what it has been so far. And in the darkest of my days, of which there have been many, I have always found solace in the small ways of making life better for other people. So if my story, if my pain can help save someone else from making the same mistakes that I have, then I guess it was worth it.

Today, I woke up energetic. Today, I did not plot how I could become invisible. I can once again look people in the eye. Don’t get me wrong – I still have my moments of despair. Sometimes, I still put my headphones on for Metro rides without actually playing music so that no one will talk to me. I do not look myself in the mirror in the morning, chanting loving mantras at myself. But I can look in the mirror without seeing the sum of all my flaws. I can look in the mirror and see beyond all the psychiatric and other labels that people have ascribed to me. Yes, I may be a borderline, raging alcoholic, depressive, former anorexic patient. But I am also a friend. A daughter. A sister. A niece. A cousin. A soon-to-be teacher.  A lifelong student. I am becoming dependable. I am ambitious. I am intelligent. I am a woman.

My life and path to recovery has followed a dark and twisted road. But each wrong turn has made me stronger. At the end of the day, I am who I am today because of what I have lived through. Someday, I will be able to look at it all and be grateful. Someday, I will look in that mirror and be proud of what I have been through. When that day comes, I may just surprise myself and be happy to be me, in spite of any box the world tries to put me in. Until then, I am okay with who I am. I will never be able to live up to my narcissistic ideal of who I should be. But I would rather be me than anyone else. That is the true accomplishment of all the treatment I have gone through. For that, all my treaters over the years should be proud. Because I am proud. 

Let others know that there is hope and understanding about mental health. Together, we can become stigma free.