Borderline personality disorder (BPD) is a pervasive psychiatric illness, affecting all aspects of a person’s – of my life. BPD has injected its tentacles into all areas of my life, including my career, my love life, my sexuality, my family and friends and my creativity. In some of these areas, I’ve been successful and in some, I’ve been too fearful to venture out.
I’ve been fortunate in that I’ve had access to the intensive treatment I’ve needed to achieve full and sustained recovery; initially dialectical behavior therapy (DBT) on an inpatient long-term unit that specialized in treating patients diagnosed with BPD with DBT. DBT, developed by Dr. Marsha Linehan, provides clients with new skills to manage painful emotions and decrease conflict within relationships. DBT consists of four modules: mindfulness, emotional regulation, interpersonal effectiveness and distress tolerance. I spent ten months on that unit from mid- 1991 through early-1992.
I felt safe on that unit. With scars on my arms and my thighs, for the first time I didn’t feel as though I was a freak. I could speak freely of my two suicide attempts and no one said ‘how could you do that to yourself?’ The women, the patients bonded and we formed a strong community in which we spoke easily about taboo subjects such as sexual abuse and addicted parents. I cried when I had to leave because my insurance refused to pay for additional time.
I’d become fascinated by the process of therapy. How did the therapist know what to say and when to say it? When to stay silent? In 1998, when I was thirty-eight I went back to graduate school to get my master’s degree in social work. I graduated with a 4.0 GPA in 2000. School wasn’t easy. My perfectionist tendencies kicked in and if I received less than an A on a paper or exam, my urges to self-harm, either to cut or starve myself took up urgent residence inside my brain. I was in individual therapy during school, but there were times of extreme stress when I gave in. It was either that or explode.
In 2005 I entered TFP (transference-focused psychotherapy) with Dr. Lev, a psychiatrist who specialized in working with patients diagnosed with BPD. She was one of those rare psychiatrists who loved to do therapy. TFP is a psychodynamic treatment which focuses on the relationship or the transference which develops during the therapy. The premise is the relationship holds up a mirror for all the other relationships in the patient’s life and the insight she gains in therapy will help her improve those relationships.
Fully trusting Dr Lev took years. Accepting she wasn’t going to abandon or reject me, laugh at what I was saying or tell me I had no right to feel a certain way was a process. My fear and lack of trust came from being raised in a home with an alcoholic father who was demanding and who consistently let me know my feelings had no place in the home in which my brother and I grew up.
“Stop crying or I’ll really give you something to cry about.”
I was terrified my words had the power to injure or even kill Dr. Lev. The last criterion for BPD in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) is “transient, stress-related paranoid ideation or severe dissociative symptoms.” When the Eyjafjallajokull volcano erupted in Iceland in April, 2010, it sent a cloud of ash across the rest of Europe. Dr. Lev was supposed to go on vacation and her plane couldn’t land. I told her I was the one who made the volcano erupt because I didn’t want her to leave me.
When I revealed this delusion about the volcano to Dr. Lev (at the time, I was not convinced it was a delusion), I saw nothing but compassion and acceptance in her face.
Once I fully trusted her, I began talking about topics I’d never spoken about with any of my previous therapists. I revealed my deepest, darkest thoughts:
I’m evil personified.
I’m the devil.
I speak with a forked tongue.”
I loathed myself. I starved myself, cut myself, and tried to kill myself. I tried multiple times and varied methods of self-destruction.
Through our work together, my urges decreased, then faded. I refocused the energy I spent on harming myself into working on relationships, my career and my newfound passion – writing.
Writing helped me shed my patient identity. During a major depressive episode from 2005 through 2008, during which I was unable to work, I took a writing class and wrote about what I knew best – my mental illness. I found a welcoming community in my fellow writers and the instructor who were non-judgmental and kind. My instructor suggested I submit my first essay, about anorexia, to an anthology with a theme of illness and healing, and it was accepted. Seeing my name in print gave me a high, a different kind of high than cutting or losing weight did. It was a sustainable high. I became a writer, no longer a patient.
I’d never talked about sex before. Not even with my mom. I was ashamed I was still a virgin when I entered therapy with Dr. Lev. With her encouragement I spouted my fantasies and experimented in real life. I came to the conclusion I was asexual and found the AVEN community. I’ve never married and I’ve never had children. I have no regrets. Maybe one. I’ve never been in love.
People diagnosed with BPD tend to have problems with relationships of all kinds. My younger brother Daniel, who at one point when I was so ill, took on more of a parental role especially after our mother passed away in 2002. He helped me out financially, emotionally and constantly checked in with me. As the vestiges of my BPD fell away, our relationship became more balanced and we are now best friends. In 2018, he asked me to walk him down the aisle at his wedding.
My progress in my relationship with Daniel transferred to other relationships in my life. I was able to make good friends and keep them based on mutual respect and a give-and-take solid friendships demand. I have friends from two former jobs, friends from the writing community, friends from the entrepreneurial world and friends who’ve I picked up here and there. Cultivating and sustaining friendships takes work, but the rewards remain unlimited.
I was having issues at work in that I craved constant approval and accolades from my supervisor for a job well done. I was incapable of validating myself. This stemmed from wanting to please my father and chasing his approval until he passed away in 2013. I never heard the words, “you are good enough,” escape his lips. When the praise from my boss wasn’t immediately forthcoming, I started having “accidents” at work. I slipped on a puddle of coffee someone spilled in the waiting room and suffered a concussion. I tripped over an upturned carpet and chipped a tooth. With Dr. Lev’s assistance, I was able to gain insight into this pattern of behaviors and alert myself to these feelings when they cropped up, before the need to act out arose. Eventually, I was able to tell myself I was good enough and believe it. The need for validation from my superiors disappeared. Though it’s still nice to be appreciated for my hard work once in a while.
At the end of 2015, I told Dr. Lev I wanted to spend the next year terminating our treatment and she agreed it was time. At that point she and I had been working together for ten years, so to spend one year terminating our therapeutic relationship was appropriate. I couldn’t believe I was the one who initiated wanting to end therapy. I once thought I would never be able to survive without having someone to talk to each week.
The last week in December of 2016 was approaching. I wanted to give Dr. Lev something to show my appreciation. In my eyes, she had saved my life and given me a life worth living. Since I was a writer, I decided to write her a letter, which ended up being eight typed pages. Here is an excerpt:
You stuck with me.
Over the course of eleven years I imagine that you experienced anger, frustration, indignation and, at times, I imagine you wanted to lift your leg off your ottoman and kick some sense into me.
You stuck with me.
Through hospitalizations, lies, firings, dramatic faxes, heightened health anxiety and numerous ER and doctor visits, a suicide attempt, weight fluctuations, a bankruptcy, watching me self-destruct, my father’s death, experimentation with BDSM – shall I go on?
You stuck with me.
I recall asking you several years ago if you knew what you were getting into when you took the referral and you said no. I think I was too fearful of your response to ask if you would have taken me on if you knew.
You stuck with me. You didn’t give up on me. And you saved my life.
I believe that if I had not met you, I would be dead by now. I would have been dead long ago.
And look at me.
As little as a year ago, I did not think I’d be capable of functioning in this world without you and then my world shifted. You helped the axis tilt. It wasn’t as if the earth swung 180 degrees all at once. I didn’t feel the degrees go by – one day I looked at the cloudless sky and realized that I would be okay in my own world.
And look at me.
I’m walking out under my own power into the world with a child’s curiosity and the thrill of discovery. Sunday night I went to a winter solstice ritual/fire ceremony at my poet and hypnotist friend’s home in Hasting-on-Hudson. I enjoy being included in her circle of friends. They are creative people, mostly poets and they are an interesting crowd to move among and converse with. I could not have done this as easily as I did or felt as comfortable Sunday evening even a year ago. After the solstice ceremony, I asked Kristin if I can burn something in the fire. I explained briefly about the history of my illness to the people in the circle and then I burned (copies of) the Creedmoor transfer notice that Charlie had signed when I left the long-term BPD unit. And I burned the next-to-last bill from you. The feeling of letting go was one of a slow release as I stared at the papers being swallowed up by the flames. The sparks danced upwards and I was back at summer camp feeling a child’s joy at capturing fireflies in mason jars.
Andrea Rosenhaft is a licensed clinical social worker in the New York City area. She is recovered from anorexia, major depression and borderline personality disorder(BPD). Andrea writes and blogs on the topic of mental health and recovery. She is the founder of the mental health advocacy and awareness organization, BWellBStrong, which focuses its efforts on BPD, eating disorders and major depressive disorder. She lives in Westchester, NY with her rescue dog Shelby.
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