313 Days Remaining
When I was first gathering all the reading material I could about bipolar disorder, trying to figure out if this was indeed the problem that had been plaguing me for so many years (see "Admitting It Is the First Step"), I had come across the term "borderline personality disorder" on a few of the accounts I read. It was referred to fleetingly and in terms that almost made it seem as though it was on par with being a psychopath. I thought I knew what was wrong with me, so I continued to research bipolar disorder (BP) and felt a sinking despair when I read about the many different cocktails of chemicals that were used to treat the disorder. A chemical imbalance in the brain could only be treated by introducing new chemicals that could counterattack, right? Most of the texts mentioned that no single drug was used to treat the disorder, and that it could take a while to find the prescription that would work for each individual. Often, a BP patient would have to be on one particular drug for a long period of time, side effects and responsiveness closely monitored, before they would try another one. Most would take a long time to show effectiveness, although the side effects - such as weight gain, irritability, thyroid problems - which I already had - stomach irritation, and memory or concentration problems, would often show up quickly. The books did not paint a pretty picture.
The idea of chemical treatment was not one I enjoyed. Lithium, in particular, worried me, as it often presented with all the side effects mentioned above and more, and was usually the first drug of choice to treat BP. With my family history of thyroid problems and my recognition that if I did have BP, it would probably be classified as "rapid cycling" (as I mentioned in my last post, my elevated emotional reactions did not last for weeks or months at a time, but instead moved quickly from one to the next with no necessary nor, sometimes, apparent cause), I was not looking forward to that initial prescription I was likely to receive. Lithium, they said, is often not effective on rapid-cycling BP, and often takes a few weeks to reach effectiveness. It worried me that I might have to try it and that there was a great chance that it would not work at all. I also worried about becoming dependent on any chemical, although I recognized that if it were something that could control the behavior and the mood swings, it would be necessary. I reasoned that if I had diabetes, I would take insulin; if I had cystic fibrosis, I would take antibiotics and steroids, in both cases to help my body - and brain - function the way it was unable to on its own. I resigned myself to a future filled with prescriptions, but knew that if it got me out of this endless cycle, I would accept it.
Two months after my doctor suggested that I may have BP, I finally got in to see the psychiatrist that she had referred me to. Let me tell you, if I disliked the idea of going on antipsychotics, lithium, or antidepressants, I liked the idea of going to see a psychiatrist at the Eric Martin Institute even less. When I was growing up, the EMI was the place where all the "crazy people" went; if someone was acting in a strange manner we'd all call them nuts and joke that they'd "end up at the Eric Martin" - essentially, the "looney bin".
I pulled in to the parking lot with my heart beating a mile a minute, but it wasn't just from the stigma of potentially being spotted by peers who would make fun of me; more important was the fact that I was getting closer and closer to a diagnosis. I would finally know what was wrong, finally have a name for it, and finally be able to work toward getting better. I was at over 50 days "rage-free", marked on my calendar with those big red X's and ever-increasing number count, and I hoped that this psychiatrist could help me continue the streak. I put aside any worry of being judged and faced the music with hope that I could start down the path toward a healthy future. Of course, I had already started when I made the decision to seek help and began jotting down notes of what triggered me and different ways of helping myself deal with the reactions, but I was still under the impression that I had BP and would require medication to continue healing.
The psychiatrist was great. He listened as I recounted my experiences and asked a question here or there. When I had finished telling him everything I could think of - and of course I soaked through a few Kleenexes - he asked if I had done any research on bipolar disorder, and asked how well I thought the description fit what was going on with me. I explained how a lot of it seemed right, but that it had niggled at me that my so-called "manic" and depressive episodes could switch in a matter of moments. Everything else, I assured him, seemed to point to BP.
He sat back and appraised me. The gesture was so like that of the stereotypical TV psychiatrist - although his glasses were not low on the bridge of his nose, but firmly pushed up - that I would have never allowed any character I wrote to act that way, for fear of it being dismissed as "too cheesy". I nearly expected him to pull the glasses off and stick one temple bar in his mouth as he leaned against the black leather of his creaky desk chair.
Instead, he rummaged below his desk and came out with a book. Its cover featured a close-up black-and-white picture of a young girl staring into the distance. "Get me out of here", it beseeched the reader, with the subheading "My Recovery from Borderline Personality Disorder".
"I want you to take this book and read it," he urged, "and the next time you come back here, I want you to tell me if any of it resonates with you." I recalled the few words I had read about borderline personality disorder (BPD) and my impression that it was a psychotic disorder - in short, that I really was crazy - and that meant I would be ostracized and abandoned. Nonetheless, I nodded, and I took the book home with me that day.
I lost myself - and then found myself - in Rachel Reiland's true story of how she had suffered as a teenager from extreme emotional imbalance. I read how it carried over into all her relationships, into her marriage, with her children, with her family. I read how she couldn't control the immensity of her feelings and wondered what was wrong with her for years; how she alienated people who cared about her because she would lash out at them in rage; how she felt that no one understood her, that no one could possibly understand her. Everything in Rachel's story resonated with me. I felt as though I was reading my own life on those pages.
The book brought me to some online research, where I found a list; the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) had certain criteria with which they confirmed the existence of BPD in an individual. Of the list of nine presenting criteria, a person could be classified as having the disorder if they exhibited five of more of the symptoms. I exhibited - and had for years - seven of the nine.
I told the psychiatrist as much at our next meeting. "Yes," I said; "this makes sense. Everything here is me. I have experienced everything that she went through."
"Well then," he told me, "that's it then. You've just diagnosed yourself with borderline personality disorder."
From the DSM-IV list of BPD criteria: BORDERLINE PERSONALITY DISORDER: A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. identity disturbance: markedly and persistently unstable self-image or sense of self.
4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. transient, stress-related paranoid ideation or severe dissociative symptoms