Saturday, March 12, 2011

Quotes from the Borderline

'We paced along the lonely plain, as one who returns to his lost road, and until he reaches it, seems to go in vain.'

Dante, 'Purgatorio' in the Divine Comedy

Thursday, March 10, 2011

Rescue me: Conceptions of Borderline Personality Disorder - Part 2

I've talked about self-destructive behavior before but not from a damsel in distress sort of perspective. John G. Gunderson's next conception of BPD is: 

- Repetitive self-destructive behavior, often designed to prompt rescue:  

Self destructive behavior is always an indicator that 
something is wrong. What exactly is wrong is sometimes impossible to pin point. There may be no rational idea of what it is, only a feeling that something isn't right, necessary, and not there. When you can’t identify the cause in yourself, it’s a natural extension to look outward, to someone else for ‘answers’. When you can’t help yourself, maybe someone else can. Now, I will say that a lot of people that embrace self-destructive/masochistic behaviors may not be looking for rescue or help. It is an indicator that there is something wrong but many people that display such tendencies keep these hidden. I’ve fluxuated though I tend to keep it hidden.

For those that don’t make an attempt to hide these behaviors, they are very often a cry for help. When you have no idea what is causing such empty, hollow, toxic feelings it’s like your mind has been dropped into a pit of despair with no way to claw yourself out. This might be a foundation for why people with BPD latch on so tightly to those close to them. Look to them for help to pull themselves up. Or to be their savior and pull them out of the dark completely.  Talking through problems is normal, but someone with BPD doesn’t feel things normally. Feelings are intense, often brutal, needing release /right now/, causing the person to act out in ways that will gain them attention. Attention that will make people notice /right now/. Act, right now. Attention from someone that will care for them, care for them enough to stop them, to protect them from themselves and the emptiness or hurt that is so pervasive. Rescue them from themselves. 

In general and especially when I was in college I kept my self destructive behavior completely hidden. I didn’t want help. I didn’t want to let anyone in. I didn't want anyone to know I was in pain. I didn't want anyone to know I was vulnerable. It was my way of coping, reminding myself that I was still alive, connected to the world when I had no one to lean on.

It’s incredibly embarrassing for me to admit that I have ever done this with the intention of gaining someone’s attention. In high school I did this more times than I care to admit (though not as much as I could have), but only with one specific person.  Be it a cry to help stop my eating disorder or threats of suicide, I needed to know someone cared. Someone that I wanted so badly to care for me, to care. Oddly when I was cutting or burning I rarely let anyone know and hid this as best I could.

Evil-ex would spin me out of control so bad that I would have complete nervous breakdowns, destroyed by the shear levels of anxiety and inability to maintain my own sanity. I needed to remember that I was connected to something. Instead of cutting I would beg him to take my knives away and keep them from me. This got his attention but also contempt. I never got the care or support I so desperately needed. Eventually I no longer needed to injure myself. Dating him, living with him, was more painful than anything I could do to myself.
The few times Boring-ex and I broke up were the only times I got emotional with him at all. I couldn’t stand being with him most of the time. But I was frantic at the thought of losing someone else once I had ended it. The last time we broke up was actually a shock to me and I acted out without thinking, made a veiled threat of suicide… he needed to know how badly he had hurt me. I needed him to remember I wasn’t someone he could throw away. Wanted him to take back what he’d said and want to take care of me. (This was immediately after we broke up so of course I wanted him back). While I did injure myself, I didn’t actually have any intention of killing myself, but he didn’t know that. This got the cops called on me and a trip to the psychiatric ER. Fail.  

The only commonality between these incidents; none of them have ever gained me the outcome I’d hoped for. Never once, did I get the kind of love, protection, or caring that I wanted. Utterly ineffective and only resulted in more pain and drama for everyone involved.

Considering I have an 18 year history of self-harm the times I’ve done it with the desire to have someone care for me are relatively rare. Except in my most turbulent periods, generally I’ve never believed in anyone enough to rely on someone to rescue me.  I have to rescue myself. Everyone else just let’s me down.

I’ve also come to the realization that this is a terrible way to get attention. While yes, in the short term it may inspire immediate reaction and attention, once the initial shock is over, it often inspires fear, disgust, and the people you want to be closer to push away. Most people can’t handle, or don’t want to be the rescuer. Regardless of how much you may want someone to rescue you, someone else will not see it this way. Having such a big responsibility thrown at them is scary and may cause them to draw away in order to avoid the drama and frustration of dealing with someone that is incapable of dealing with themselves. Your average person also isn’t equipped mentally or emotionally to handle such situations. Going to someone you care about, telling them that you need help and support to get professional help is a much wiser course of action that will be much healthier in the long run.  

Wednesday, March 9, 2011

Conceptions of Borderline Personality Disorder: Intense unstable relationships

As I was just discussing Gunderson’s work I will continue with another of his conceptions of BPD. It’s not necessarily new information, but it’s succinct and gets right to the heart of borderline behavior and thoughts.
Gunderson, a psychoanalyst, is respected by researchers in many diverse areas of psychology and psychiatry. His focus tends to be on the differential diagnosis of Borderline Personality Disorder, and Cauwels gives Gunderson's criteria in order of their importance:
  • Intense unstable relationships in which the borderline always ends up getting hurt. Gunderson admits that this symptom is somewhat general, but considers it so central to BPD that he says he would hesitate to diagnose a patient as BPD without its presence.
  • Repetitive self-destructive behavior, often designed to prompt rescue.
  • Chronic fear of abandonment and panic when forced to be alone.
  • Distorted thoughts/perceptions, particularly in terms of relationships and interactions with others.
  • Hypersensitivity, meaning an unusual sensitivity to nonverbal communication. Gunderson notes that this can be confused with distortion if practitioners are not careful (somewhat similar to Herman's statement that, while survivors of intense long-term trauma may have unrealistic notions of the power realities of the situation they were in, their notions are likely to be closer to reality than the therapist might think).
  • Impulsive behaviors that often embarrass the borderline later.
  • Poor social adaptation: in a way, borderlines tend not to know or understand the rules regarding performance in job and academic settings.

Intense. Unstable. Relationships. In which the borderline always ends up getting hurt. Why am I repeating this? Because it’s true. The inability to regulate emotional control does not allow for a borderline to maintain emotional safeguards. Whether the issues that arise are due to the other person or internal (or external) conflict brought about by someone with BPD, it is all felt internally, as an emotional attack. With no way to shield from {self} inflicted damage, no protective emotional layer, it’s nearly impossible for someone with BPD to escape unscathed from a relationship. Any amount of change, fear of abandonment, or even perceived excessive closeness can disrupt the fragile stability that a borderline holds to. This can cause an almost simultaneous fight, flight and fear response. When emotions run so intensely there is an inner conflict of needing to protect oneself and needing to be protected. Wanting someone close, and needing space in order to not get hurt. Especially after several relationships of always getting hurt and expectations that this will continue. When someone gets too close the need to run away, push away, pull back to preserve the tenuous sense of self is increasingly strong. To not let someone close enough to hurt them again, is even stronger. In order to do this someone with BPD may lash out, pick a fight, or any number of ways to fend off a suffocating closeness – to fight free.  If not immediately, soon after, these feelings are replaced with fear, panic at the thought of being alone. The need to regain what could be lost forever if it is not won back right away. Emotional displays, promises, intense affection, apologies, anything to regain what a borderline fears to lose may be done to regain an emotional stability. It’s difficult for someone without BPD to understand this intense clash of emotions, and even more difficult to deal with at times. Someone who doesn’t understand what is going on is likely to respond in kind to whatever action is being taken. Someone with BPD, in the moments of panic, cannot always internalize their own role in what is happening. They can only feel what is being directed at them compounded on top of their already unstable emotions. Even if the non-BPD person tries to do the opposite; be kind, understanding, it may also be met with conflicting emotions. A borderline will feel even more smothered, increasing the need to run, making him/her feel even more misunderstood because what they need is not being recognized. The rub though, is that someone with BPD doesn’t always recognize what it is that they need. They only feel that someone/thing is wrong or too much or detrimental or out of their reach without knowing how to rationally work to fix this.  The result is an intensely fluxuating relationship of needing to be close and safe and needing to preserve a sense of self... to be safe.

I wasn’t originally going to discuss each of these criteria on their own, but while writing this I realize I  have too many thoughts on many of these points so I’ll make this a multi-part series.

Monday, March 7, 2011

It can stop now. Please?

Hard decisions are hard. Everything hurts. I’m so tired of everything hurting. 

Realized my time marker was mid-April not mid-March. Can’t wait that long with everything eating away at my insides. Told Friend everything that has been crushing me. Tearing me apart. It went exactly as I expected it to, and not as I wanted. That, I have to accept. Doesn’t make it hurt less. He’s not in love with me, which I knew. He does love me. Go to the ends of the earth for me, closest confidant and friend, blah blah blah. Doesn’t want to lose me. I told him I need him to stay away from me. I need space for a while.

::tears:: I hate how everything keeps changing. And I’m still left alone. I just want something to stay. It feels so cruel to me to have so much and then to have it change so suddenly. I just, can’t. I don’t know how to deal with this. Is like someone reached through my ribs, grabbed my stomach and twisted it up into my throat.

I get so invested. So attached. I don't know how to not.

I needed to do this. I was so angry this weekend. Both him and his wife were texting me like mad to come over and worried that I wasn’t well. She wanted me to come over for dinner Sunday. I fought with myself and tried to excuse myself by telling her I was off food again (Cleanse, not a random fit of anorexia). She said she they really just wanted my company. ::sigh:: So what do I do? I make a pie. Homemade, from scratch, my own recipe that I’ve worked on for years and is the pinnacle of perfect, 2.5 hours, Dutch Crumble Apple Pie. Last week it was Chocolate French Silk.  I don’t know why I do this. Baking and cooking is one of my ultimate distraction techniques.  It’s a running joke that I make multi course gourmet meals, stunning, that I don’t eat. ::headdesk:: I was uncomfortable, couldn’t even look at them hardly, couldn’t even pretend anymore. No false smiles, no jokes… Though finding out that Bitter Melon was made of hate, did make me laugh out loud… left early, drove through the rain longer than I had to. Fitting.

Rage. He’s all understanding and infuriating. How am I supposed to stay mad when people are all caring? Fuck.

I was furious all weekend. Today I was calm enough to collect my thoughts but bordered on detached.  I should have felt something, a release, some relief, but I didn’t. Just a low dread waiting for the repercussions… which didn’t come? He really is a good friend. I’m crazy. Crazy people don’t get real relationships (this completely is not true, my rational brain knows this but it’s how I feel right now). I get, understanding? Which probably just hurt worse because for as wonderful and beautiful as he tells me I am, still not good enough. Heartache and hurt… and then nothing. Well, I have a mild headache but I think that’s from not having solid food for the last four days. And sleep, I should probably sleep.

Nothing. Damn. I hate that. Flip switch to not feeling is bizarre. One minute I want to curl up in bed, the next I can chat with Roommate and appear to be just fine. Except for the feeling like I’m floating two feet to the left of my own body. Glasses to in focus, two television screens framing the life I’m seeing. It’s not unpleasant, just, not normal.

Tired of hurting. Tired of being alone. Tired of things always changing. No control. No stability.

I feel too much. I wish I knew how to temper it. To experience things the way normal people do. I'm told, I know, it's a symptom of my disorder. I feel too much. Can't stop everything rushing in at me.
Knowing that, doesn't stop it from hurting.

I don't understand. Don't understand. I'm not a bad person.  

I break my own heart more than anyone I’ve ever known. I can’t stand it anymore.

I can't.

I can't.

I can't.

Everything hurts.

Book Review: Prozac Nation

Book Review: Prozac Nation  

Synopsis: Twenty-six-year-old Wurtzel, a former critic of popular music for New York and the New Yorker, recounts in this luridly intimate memoir the 10 years of chronic, debilitating depression that preceded her treatment with Prozac in 1990. After her parents' acrimonious divorce, Wurtzel was raised by her mother on Manhattan's Upper West Side. The onset of puberty, she recalls, also marked the onset of recurrent bouts of acute depression, sending her spiraling into episodes of catatonic despair, masochism and hysterical crying. Here she unsparingly details her therapists, hospitalizations, binges of sex and drug use and the paralyzing spells of depression which afflicted her in high school and as a Harvard undergraduate and culminated in a suicide attempt and ultimate diagnosis of atypical depression, a severe, episodic psychological disorder. The title is misleading, for Wurtzel skimps on sociological analysis and remains too self-involved to justify her contention that depression is endemic to her generation. By turns emotionally powerful and tiresomely solipsistic, her book straddles the line between an absorbing self-portrait and a coy bid for public attention.

Review: I liked this book. It was very easy to relate to and the language was engaging, not clinical. I spiral down into clinical depression also occurred when I was 12 (puberty age <~~~ hate this word). The more extreme accounts of her actions seem very desperate and almost exaggerated… but I think that’s part of the point: things seem more desperate, more traumatic internally then they appear to be externally. This book covers all the things she tried in order to cope with her depression from drugs, men, study, therapy, hospitalization, etc. Having often fallen to alcohol in order to self medicate it’s easy to understand how she could so easily lose herself to the drug culture. While I haven’t had the hospitalization experiences (though probably I should have) it gives a good account of what depression can do to drive someone to madness. It exemplifies the devastating effects that depression can have on someone, the hopelessness, the lifelessness, the lack of control, inability to function, the desperation to feel something, anything, that is not depression.

Living now, just a few years after this was published, it was very hard for me to believe that doctors refused to medicate, or were reluctant to medicate her for her depression. Nowadays doctors throw medication at everything. Having fought against and struggled to maintain my sanity on my own (without medication) for nearly 17 years, it’s interesting to see just how far someone else can be taken in order to deal with something so insidious. I do like that she did try virtually every option available to her before she was given prescription meds. I do believe doctors throw drugs at people much too quickly which does not actually help a depressive learn to cope with life. What I ultimately took from this was: No matter how much help, how many distractions, how many attempts to control depression, it is a chemical imbalance. Like any other disease, it is very difficult to treat a medical imbalance without medication and expect recovery. Medication alone is not enough though. For chronic, clinical depression therapy should also be encouraged to better learn how to cope with mood disorders.
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