Becoming Borderline

Disclaimer: this is some heavy shit with references to thoughts of death and other negative thinking. It’s a story I believe people need to grapple with, but make sure it’s the right time and place for you to read it.

DIsclaimer #2: I will refer to myself as crazy. That does mean it’s cool for you to call people crazy. It’s just part of my story.

April, 2005.

The first time I sought therapy, I quit after my first day. I was 15. I don’t want to say it was the therapist’s fault, but seriously, what counselor doesn’t let a teenager talk about themselves? My memory might be skewed by pubescent rage, but I’m pretty sure I never finished a sentence. At the end of the session – and I remember this as clearly as I remember getting caught making out at a Bar Mitzvah in seventh grade – she told me “you’re like a simmering pot of water that’s about to boil.” She said it like she’d just discovered the fountain of youth.

No shit. I’d just spent an hour trying to tell her what I was mad about because I didn’t want to be mad all the time. I didn’t need anyone to tell me I was mad. I lived with my anger everyday, burning so badly I often mistook it for hunger. I didn’t need some cute metaphor to help me see my anger more clearly. I’m getting angry just writing about it.

The next week I simply no showed her, earning me an e-mail about how she could be using her time to help other kids. I told her I felt better and was ready to move on. I knew it was a lie, but I was also pulling straight A’s and had deluded myself into thinking I could earn some sort of college basketball scholarship. I thought I was was too good to have mental health problems.

January, 2012.

I don’t remember why or how, but I spent the winter break of my junior year of college convincing a complete stranger with a PhD that I was crazy. The crazy (pun? intended) thing is, I always go into meetings with mental health professionals thinking that I have to be on my best behavior. If my behavior is too extreme, I worry they’ll think I’m just there to get a fun drug.

Despite this attitude, I was falling apart in minutes. I told him things I’m still building up the courage to tell my current therapist (she’ll be reading this at my next session). I didn’t trust my friends. I hated how I treated my friends. I loved this boy too much. This boy was never going to love me because I was such a piece of shit. I wasn’t suicidal, but I was fantasizing about getting a rare disease so I could die gracefully. I wanted to live, but I hated life. I was scared, and I didn’t know how to ask my peers for help. I didn’t want them to stop loving me. I wasn’t sure that was something I even had to lose. And that’s the easy shit.

I don’t know what he diagnosed me with. I believe he was the first person to realize I was actually bipolar, with borderline personality.

I know that the talk therapist he sent the recommendation to said “it doesn’t sound like you.”

I know the psychiatrist who received the recommendation and who had literally never spoken to me put me on Prozac and Adderall.

I know I didn’t get better.

December, 2014.

This time, I found a specialist who could diagnose me and write a prescription, right then and there. The problem? I had 15 minutes to ask a lifetime of questions. I was supposedly lucky to even have those 15 minutes. Washington, D.C.’s Kaiser had a 3 week waiting list, but there’d been a cancellation. I was assured they were working on improving their mental health services.

I was crying, but after almost a week of sobbing in bed, it felt normal. I’d even gone to the grocery store in that emotional state because I thought fried chicken would make me feel better. Even with the bottomless tears I’d intended to just take the train and walk the rest of the way, but it was pouring rain that morning. I truly believe the weather has just as dark a sense of humor as I do. I managed to call my mom to tell her I was ready to give up, but she told me to get my ass in an Uber and that if it was that big of a deal she would send me a check.

I knew – I thought I knew – that I suffered from depression and ADHD. I was there to get back on Prozac for the depression. As for the ADHD? I don’t like adderall. Obviously, I’d tried it in college, and to be honest briefly become mildly addicted. Fortunately, the attacks of explosive diarrhea every fifteen minutes forced me to kick the habit.

“Have you ever considered you might be bipolar?” He asked, with 1 minute left.

No, I hadn’t, not since I’d been teased for my mood swings in junior high. Deservedly so, if you actually think anyone deserves to be teased. I could be a real bitch.

In that moment, I didn’t have enough energy, wherewithal, or knowledge of what bipolar even was to answer the question. “I’m never happy,” was all I could think to respond.  I meant that I didn’t experience mania, the “high” end of the bipolar emotional spectrum. I didn’t know what mania meant.

I left with a head full of thoughts, still crying, and hoping that Prozac would be my magic pill.

It wasn’t.

April, 2017.

I was running a successful small business, even though I’d only had 1 month of training. I had a knack for sales. Real talk, sales is easy when you’ve spent a lifetime convincing people you’re happy so they’ll leave you alone. I got married, and I’m still married. I’m not going to talk about that. Just starting to think about everything he’s done for me is making me leave teardrops on my keyboard, and I really don’t like having to steal lines from Taylor Swift. But he’s private, and I respect him too much to break his trust. All I can say is I would not be so far along my journey towards what might be considered “recovery” without him.

But I wasn’t OK. The day to day of rich women complaining that their ten dollar stretchy bracelets didn’t come with a lifetime warranty or that sterling silver tarnishes was getting to me. People telling me they “knew the owner and she always gives me a discount” who clearly didn’t know me…was getting to me. It was petty bullshit, and I knew it, but it was getting to me.

I didn’t really know how to seek help in the adult world. I had insurance, and my understanding was that it covered more than 2015 era Kaiser. But other than that, I’d only ever sought help through educational institutions. So I did what any millennial would do: I asked for therapist recommendations on Facebook.

I really thought I had arrived. I found my girl. I didn’t get into all my shit, but I told her the true level of my pain and cried on the phone. We talked for almost as hour, and I liked her. We had similar taste in TV shows, she was bisexual like me, and she had gone to college on the east coast like me. I felt a flicker in my stomach that was hope, not butterflies.

After she set up my intake appointment, the dreaded words came out of her mouth: “I don’t take insurance.”

“What?”

“I offer a sliding scale. If my $150 fee is too much, I can bring it down to $100.” For reference, my copay is $15 with providers who do take my insurance.

I know it was rude, but I hung up on her. Fuck her, I thought. A mental health professional should know better than to let someone talk about their traumatic shit before disclosing her fees. It felt like emotional extortion.

I drank a lot after work that day, and spent the next day hearing about the waitlists for the therapists who did take my insurance.

I picked the one who could see me the soonest.

She wasn’t a good fit.

January, 2018.

I’d sold the business and made a promise to myself not to seek work until I was happy, or at least OK. 

Without a job or school to suck up my energy, I could finally focus on figuring out the source of my suffering. Before, I’d relied on others to recommend therapists, schedule appointments, and read my diagnoses. How could that have ever worked? I didn’t tell them about tracing my veins with my fingers, imaging they were seams I could rip apart like a doll’s. I once pulled my hair out so vigorously it left a bald spot. I’d worn a hat until it grew back. I hate questions about my pain, and have used everything from acting skills to outright lies to avoid talking about it. That way, only I know what lurks behind my forehead. Yes, I give into anger and lash out. I push away people who get too close. I got close to people I shouldn’t have because they encouraged self-destructive behavior. I did all of that and a host of other things. But I genuinely don’t want to be a burden.

But I had bigger reasons to hide the messiness of my brain. On a national scale, mental health is stigmatized. I came from a part of the country that was accepting of the existence of mental illness and those who struggled with it, but anti corporate fervor made my community anti medication (for the record, I’m anti corporate, but sometimes you can’t escape them). I took the bullshit “happiness is a choice” memes to heart, worrying my loved ones would think I had chosen these feelings. Multiple people I trust recommended changing my diet and exercise over therapy and medication, even though I experienced these symptoms when I was a varsity athlete who lived on health food.

It took 27 years, but I finally knew for certain that all that was bullshit. When it comes to your health, letting anyone tell you what to do is bullshit. If you struggle with mental illness and you only take one thing away from this, that’s the thing. If you don’t struggle with mental illness, then learn that we don’t need your fucking opinions. We need your support for the path we choose for our own recovery. 

Once I finally walked into that office, with a full length appointment with a person who could write my prescription right there, the rest was surprisingly simple. I knew why life just punched me in the stomach a little bit harder. Why my humor had to be just a little bit darker. Why I felt an urge to push people away, just in case I died a little bit younger.

I have bipolar disorder and borderline personality disorder. I said to him at the time, “aren’t those the kiss of death? Am I fucked?”

“No,” he said. “You’re a fighter, and now you have help.”

Today – May, 2018.

It matters to have labels and words. It grounds me, gives my treatment plan purpose. I am not just trying to escape pain, I am trying to moderate my mood swings; develop stronger impulse control, especially anger-based impulses; and develop a stronger belief that I am loved, and that I deserve to be loved.

Bipolar, the mood swings, was relatively easy to start treating. It took a month, but I adapted to my meds and noticed a change in my affect. Taking a month or two to adapt to meds is fairly common, so keep that in mind the next time a TV show acts like the first dose can save someone’s life that quickly.

Borderline, the behaviors and beliefs, was a fucking nightmare to get started. Mood stabilizers help with my impulse control, but there isn’t a clear change in my symptoms in the same way there is with bipolar. The only real treatment is Dialectical Behavioral Therapy (DBT – I’ll explain what that is in a minute), which put me back in the awkward position of switching back and forth with my insurance and various facilities figuring out if there was a snowball’s chance in hell I could make it affordable. Some centers required money up front just to get “evaluated”, with the possibility of being rejected. I remember sitting at my kitchen table wondering “do I play up the crazy? Do I try to seem easy to fix? How are there therapy auditions now?” 

After about 2 weeks, I found a center, and had a relatively short 3 week wait to get started. I’m still unsure if my insurance will cover it, but unlike my individual therapists, every single DBT center I’ve talked to has basically said “we don’t deal with insurance” the way an experienced nanny says “I don’t do windows.” I paid the hefty fee up front (with a surprise credit card surcharge – I’m sure my insurance will love that). I can’t get reimbursed until I prove I actually did the therapy. Once I get the certificate of completion I can submit that to my insurance for reimbursement and start the whole cycle over again with the next DBT class. 

I’m glad I committed to making it work. DBT is a kind of group therapy, though it would be more accurate to call it a life skills class. We even have homework, which includes everything from experimenting with various meditation techniques to dumping your face in a bucket of ice water to stave off a panic attack. I have found this format, which was developed by a wonderfully snarky women who lived with borderline personality herself, to be the most helpful form of therapy I have ever been in. While we are required to at least try the various skills, the goal is to find the combination that works for each individual. We don’t really talk about what’s going in our lives unless we want to.  We are asked to share how we’ve applied the skills in our lives, but I find this helps me hold myself accountable to transferring the skills into my everyday life. We are also building a language to better communicate what’s happening in our heads to loved ones. After my first session, I kind of wondered why these emotional coping skills aren’t just something we all learn, like ABC’s and counting to 10. Everyone experiences emotional pain, everyone can benefit from learning how to manage it.

In Conclusion

I cannot emphasize this enough: I did not figure the mental health care system out until I turned it into my full time job. Most people with mental illness find it difficult to access care not just because it’s hard, and it is, but because they simply don’t have the time. Not to mention the poor and homeless disproportionately suffer from mental illness, and are financially barred from access to many resources. Even when people do find the time and energy to start the process, a diagnosis might be wrong, you might relapse before your medication has had time to start working, you might have to wait too long to see the specialist you need, or you might run into any one of the other situational barriers beyond an individual’s control. All of these challenges to accessing care are especially difficult when the symptoms of your illness include decreased motivation, fatigue, and/or lack of faith in your worth.

Indeed, now that I have faith in my own treatment plan, my bigger concern is that mental health care is perfectly set up to induce anxiety attacks. If you’re serious about being an ally to people with mental health, that means taking a long hard look at America’s continued commitment to privatized health care. At minimum, insurance needs to cover all aspects of healthcare, and provide greater freedom for people with mental illness to find a therapist they connect with. Prices for medication, therapy, and diagnostic evaluation need to be regulated or subsidized so that they are accessible not just to the wealthy, but to everyone. However, it would be better to streamline the process so we don’t have to find the person we spill our guts to off of an approved list written by our corporate overlords. Yes, I’m talking about universal healthcare. 

That all may sound like I’m losing focus from my own story, but the politics of mental health have always weighed heavy in my heart. The biggest barrier to healing has always been fear. When I acted out in middle school and junior high, people called me crazy. And while I felt they had a point, I was afraid of the consequences of admitting that. I was afraid of my anger in High School, but even more afraid of the stigma of seeking help. I was afraid of my mania – partying and online shopping – in college, but I was more afraid of the judgement of seeking medication. I was afraid of the way my mental illness would affect my job prospects, to the point I was afraid to have it on my medical records.

Things do seem to be changing, but my hope is only for my individual journey. Every time I go to DBT group, I’m reminded of how privileged we are to even have help. I’m grateful, but I’m angry. Every human deserves to be happy, even the ones it’s a little bit harder for. As a society, we need to start doing better, and the first step is to actually listen to us. Don’t worry; we’re more afraid of you than you are of us.

And once more for the people in the back: when it comes to your health, letting anyone tell you what to do is bullshit. If you struggle with mental illness and only take one thing away, that’s the thing. If you don’t struggle with mental illness, then learn that we don’t need your fucking opinions. We need your support for the path we choose for our own recovery.

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s