What does a diagnosis mean? Am I still the same person as I was before the diagnosis? I have sometimes struggled with my identity, for example when I came off antidepressants temporarily to escape my feelings of depression, I remember telling my friends that I didn’t know who I was anymore. These are friends which I no longer speak to, a fate all too commonplace for those of us with borderline personality disorder. This is described as a condition where you have no emotional shield and emotions are experienced much more intensely. My mind is always racing with many thoughts at a time, seemingly destined to ruminate endlessly over past relationships, mistakes, arguments. A cycle of push and pull when it comes to relationships; fearing abandonment and pushing others away to deal with this, yet still ending up abandoned. These are often the fears and cycles of a person with Borderline as well as chronic emptiness, substance abuse and eating disorders.
My emotions are volatile; I struggle with bouts of rage and intense sadness over things that others often don’t understand because they seem small, but the effect physically and emotionally is nonetheless very real. Invalidation has been commonplace my whole life, from my parents who denied the presence of mental illness in myself at age 12 and left me to deal with my struggle alone for years, to my experiences with other people who had the same disorder and denied my own struggles because it was seemingly less obvious than their own. This is often a sad reality regarding mental health: no matter how much that person is trying their best to pretend that everything is okay, once things reach a boiling point the issue becomes undeniable.
Those with BPD seem to have an innate sense, often described as an enhanced empathic ability, that allows us to find others who are going through the same thing as us. Despite only 1.6% of the population having received this diagnosis, I have met many friends whom I have had intense relationships with who also suffered from the same thing. At the time, I wasn’t aware of my own condition, but I was aware of wanting to help them because my own empathy understood the depths of their despair. Unfortunately, two people with BPD is double the emotional intensity and fears of abandonment. But it is also double the thrills, excitement and passion. These relationships were intense, and I still struggle with my own feelings of abandonment despite being the one to push them away for my own sanity. We relished in each other’s vulnerabilities, and this in turn led to increased destruction. I still care deeply about these people, as I do most others who I have met in my life, something that is both a blessing and a curse. Attachment issues are commonplace for those with BPD, and we often struggle with idealising others.
Imi Lo is a consultant for highly intense and sensitive people who has written about the gifts that come with BPD. Her view steers away from the view that it is a character flaw but is instead a limitation in a person’s capacity to regulate emotions. Lo explains the trauma in upbringing that can cause this disorder: ‘As a response to confusing or neglectful parenting, these children had to ‘amp up’ their empathic functioning in order to protect themselves. They were trained by their environment to become highly attuned to the subconscious cues given out by their parents so that they can be prepared for their unpredictable behaviours.
Without an environment where they can learn to set healthy boundaries and experience secure attachment without exploitation, these children develop ’symptoms’ such as an inability to self-soothe and regulate emotions, a fear of rejection, and a deep sense of internal hollowness.’ Struggles to manage triggers often stems from a lack of support and validation in childhood, resulting in an inability to process emotions. Every trigger will send that person into fight, flight or freeze mode. To read more from Imi Lo, visit https://www.psychologytoday.com/gb/blog/living-emotional-intensity/201805/the-unexpected-gifts-inside-borderline-personality.
An example of someone deeply creative yet whose struggles seemed to align with those of BPD is the belated singer Amy Winehouse. Those with BPD have a life expectancy of 27, and many of those within the ’27 club’ struggled with mental illness. A friend has said about the singer: ‘She could make you feel so important and then all of a sudden very unimportant, and then make you feel so important again. That was what she did, she liked to get people into an important decision, and then shock them.’ To me this was a clear sign of idealisation and devaluing, or in other words, splitting. This is something that I really struggle with myself- black and white thinking, experienced amongst those with autism as well, means that we struggle to see the full picture due to our intense emotions. In moments where strong emotions are triggered people are either amazing or awful, with little in between.
To get a better picture of how the BPD brain operates, I asked my good friend and fellow sufferer how ‘splitting’ or the valuing/ devaluing process impacts her life. This is what she had to say:
‘The process of splitting creates extreme fluctuation in the dynamic of my various relationships. I admire and force such extreme expectations onto them which they are unable to uphold. This process is a mirror of the relationship I have with myself. Once a person acts questionably, I am submerged by completely irrational anger and see the perpetrator as some type of evil being. I can’t see the nuance in someone’s behaviour. This happens no matter how close I am to the person. The emotion pushes me to make irrational decisions in order to regulate my nervous system that has reached overload. I am often left embarrassed by my actions and fearful that the person will leave me. I then overcompensate by being overly affectionate and needy, idealising them again. The cycle repeats itself, with each time being a little less difficult. Now I can often release that anger, as I have learnt with age to tame it.’
If you search for BPD online, you will see many forums of people discussing those with the disorder as ‘manipulative’ or ‘abusive’. Fear of abandonment often requires validation, so when someone sees that harming themselves or others gains this reaction from others, sometimes they will repeat the process, aching for that same validation that they so greatly need. Some with this disorder may exhibit behaviours or coping strategies that can be leveraged in abusive ways, but it is ableist to assume that all of them will present that way. Whilst the diagnosis loosely describes a very diverse group of people who cannot be lumped into one summary, there is often a very unfair bias against people with BPD. Yes, some people with this disorder can be manipulative and cruel, but these are characterisations and not necessary components. ‘The reality is, we relinquish abusers of their responsibility if we attribute their abuse to mental illness, rather than demanding that they take ownership of the harm that they’ve caused. And when we equate a particular mental illness with abuse, we draw false equivalences that actually harm survivors and psychiatrically disabled folks alike,’ (https://letsqueerthingsup.com/2017/08/15/your-bias-against-people-with-borderline-is-still-ableist/). There are 256 ways in which borderline can present itself within the diagnostic criteria. Not everyone will act or be the same. Abusers are abusers, separate from their diagnosis. Someone’s mental illness is not a scapegoat for everything that you dislike or disagree about them- this is stigmatising and incredibly damaging. In fact, the majority of people with this condition have been subject to abuse themselves. People with BPD are kind, with heightened sense of empathy. We’re creative, passionate, and we love deeply. My experience of mental health problems has caused me to gain a strong love for the things around me whether it be animals, nature or other people. I place my love into these things as opposed to myself because I need to see good in the world. I’m much better at looking after others than I am myself.
An excerpt from an assignment I had written in second year rose to the front of my mind once again after receiving my diagnosis. Mental health has always been a big theme within my life, and writing has always been a way to express and explore my emotions. I remember writing to allow a councillor I was seeing at the time to understand what I was feeling, and to which she could only reply ‘this is dark’. Looking back at this, I can see all of the symptoms were there. Unfortunately, lack of knowledge surrounding the disorder meant that I was struggling undiagnosed and in denial for many years. I shared my thoughts and feelings with people, went to Cognitive Behavioural Therapy, yet still no one seemed able to put two and two together. This is the fate for many, particularly those with quiet BPD, who tend to internalise their symptoms rather than outwardly show it.
'For as long as I can remember I have had intrusive thoughts invade my mind without release. As a child painful imagery would run through my mind on repeat, a thought would push itself to the front of my mind with no reasoning and would then refuse to leave.
When I was twelve I was taught to learn shame by my mother. I told her I felt different to everyone else, that there was some kind of fault in my brain. I had anxiety. Like many others in my generation my attempt to explain how I felt was invalidated by my parents and instead of the help I so desperately wanted I was lectured, shouted at, reminded of my privilege. I cried the whole night and didn’t open up to anyone about my feelings for another 5 years, the shame so ingrained that my only option was to try and repress my anxiety. I would later realise that this was not possible without exterior help and the years I spent silent only prolonged recovery, tainting my childhood with feelings of isolation.
Like any other student I went to a club last night and drank alcohol, the only difference being that this interacts badly with my medication. Now I feel anxious- I tried to meditate like my councillor said but with my eyes closed the room shook and spun. This effect of fluoxetine makes me feel worse and to stop it I have to open my eyes, making meditation impossible. Since being medicated I find it difficult to concentrate as well as to make the things I say reach people on the level that I want it to. My brain seems rewired and often I feel as though I am on a different and unnatural level to everyone else when trying to communicate the things in my mind that just don’t translate. At times it feels like nothing will take my anxiety away and the internal emotions become visible; I started hyperventilating and crying almost as if wishing for someone to hear me and understand my thoughts. I thought for a second maybe it would be better if I was dead since I can’t do anything without feeling anxious. I turned the bright light off in my room- it was making me feel trapped, the usually dim light now blinding and all consuming. Its twenty to six, I still haven’t done any work because I can’t focus; my thoughts always digress to something negative like why the boy I’m talking to hasn’t replied to me or other self-deprecating cycles. I had seen it in others but never experienced myself- until recently contemplating suicide had been foreign to me. Death seems to be all around me and it’s as if it is a natural solution to what I’m feeling, like a magnetic pull. The event that forced me to realise this was just a small inconvenience which made me feel the darkest I had ever felt in my life: a surge of grief accumulated from every traumatic event that I had ever experienced.’
Now that I have received my diagnosis, I feel not only overwhelmed by everything that it entails, such as the subsequent stigma and reality of how serious the condition is, but also relieved. I can look back at my past self with sympathy- I’ve been dealing with this for a long time with very little help. I now have an explanation for my feelings and behaviours, and I can work towards healing.
The stigma attached to mental health continues to be a burden on service users, their families and carers. However, it is encouraging to note there are some improvements. The annual Attitudes to mental illness 2011 survey, based on English statistics, highlights changes over time. Key findings include:
• the percentage of people agreeing that “mental illness is an illness like any other” increased from 71 per cent in 1994 to 77 per cent in 2011
• the percentage of people disagreeing with the statement “increased spending on mental health services is a waste of money” decreased from 89 per cent in 1994 to 82 per cent in 2011.
(more information can be found at https://www.nhsconfed.org/~/media/Confederation/Files/Publications/Documents/Key_facts_mental_health_080911.pdf)
Stephen Fry has said something on the subject that stuck with me for many years. ‘It’s not all bad. Heightened self-consciousness, apartness, an inability to join in, physical shame and self-loathing- they are not all bad. These devils have been my angels. Without them I would never have disappeared into language, literature, the mind, laughter and all the mad intensities that made and unmade me.’ People with BPD and other mental health issues are undeniably creative, a symptom of their deep sensitivity and desire to escape reality. However, at a population level, attitudes towards employing those with a mental health condition continue to be poor. Just four in ten employers would hire someone with a mental health condition, compared with 62 per cent of employers who would hire someone with a physical condition. As a budding journalist, I have to take into account that coming forward with a mental illness risks damaging my credibility in the eyes of future employers. And despite the development and expansion of treatments such as psychological talking therapies, a high proportion of the public believe that people with a mental health condition should be kept in a psychiatric hospital. This increased from 52 per cent in 2009 to 57 per cent in 2010.
Another reason to destigmatise mental illness is offered by Dr. Anita Federici, who states that in the face of chronic invalidation, the individual is unable to build their own internal self-validation system (as it was so rarely modelled). Instead, they internalise the harsh, rejecting qualities of the environment and become caught in a toxic cycle of self-criticism and shame. There are ways of counteracting this, however. Dialectical Behaviour Therapy was created by a person who suffered from borderline herself- Marsha Linehan. It teaches people to live in the moment, develop healthy ways to cope with stress, regulate emotions and improve relationships with others. 1 in 10 people with BPD condition complete suicide, showing just how much work we need to do to support others, destigmatise mental health and adapt to neurodivergent needs. I am now embarking on a second course of therapy, which is a great privilege. I also have faith, for the first time in my life, that I can heal myself from negative thought patterns and can finally see a life for myself free from inner conflict and unhealthy coping mechanisms.