It’s the middle of the night. All is quiet. I’m alright, then SWHOOSH–the fire lights up. I think part of the gasoline was poured earlier today with the hearing test results at the hospital (I had the infusion done too).

I’m now having what can only be described as a hellish night. FUCK YOU PLDs! You may be pretty but you’re fuckin’ mean!

I don’t get how I can turn such a sharp corner from feeling alright to crying in the bathroom, getting myself to be mindful, to refocus on the present moment and not dissociate.

Ok, ok, start your breathing exercises. What does the floor feel like? Step on it. Feeeeeel it. Ok. It’s cool. Say your Serenity Prayer. Go back to bed now.

But then it all starts over again and I’m heaving and moaning like some zebra that just got striked by a lion and though he’s got a mean grip at my throat, I’m not quite dead; I’m gasping, and I think, “Oh god, I have to be up at 7:30 so I can take the bus, 1 and a half hour ride to the university for my very first appointment back in therapy.”

Oh and today at the hospital…

I don’t get it. I don’t get how I can go from being ok to crawling into a fetal position wanting so badly to jab and tare up a vein and watch it all drain out, slowly and peacefully.

Then I see this.

It made me think of Angel Fractured ’cause of the wings.
Taken from http://www.facebook.com/understandingbpd

And more than the words, the bright green and red colors–the complementary color contrast soothes. In DBT this would be, “self sooth” and “distract” skills for distress tolerance and emotional regulation.

And I realize I’m choosing to use my coping skills as best I can (though I did take one of my year-old, spare Clonazepam).

I’m choosing to use my wise mind. My heartbeat is back at a regular pace. Hopefully after writing this I’ll catch some sleep.

Advertisements

…and thought, “What’s the point?”

Yeah, I’m in a shitty mood. Very shitty. This fuckin’ relapse period needs to end soon. I’m sick of it, been sick of it, been done being sick of it. I’m trying to hold on but the thread feels so thin. And I’m not a spider.

So I wrote a poem.

Progress came to mind in a large scale but also in a small scale–inner and outer, yours and mine. And I think, “fuck it!”

I thought about how much I used to be involved in activist organizations and how even though that helped, I would eventually crash. And I’ve realized how I long for the involvement but how crippled I feel and how trapped in myself I’ve been after everything that’s hit me this year (guys this mental crippling is far worse than the bone condition that has me using a wheelchair).

I don’t care to know what’s going on in the world when I’m depressed (am I depressed?), much of it is because the world can be so depressing and I don’t want to set off my piss-o-meter. But know it’s a perspective. What I know and what I feel and think to know can be so, uhhh, dissociated? Everything seems so foreign, unreal. I’ve been living in a dream again.

I feel like crying but my well is dry.

The more hopeless you feel, the less you think you can do something to change anything. False beliefs. What is reality but what’s in you? As Anais Nin said, “the world is not how it is but how we see it” or something like that. I have the full quote in my Shenanigans page.

It’s a cycle for me, a circle–to jump into the spotlight with others, to embrace this world, to help others, then run away and hide in myself, my womb, not allowing myself to be helped. I am in my own utero, a baby, only allowing myself to be nourished there. Problem is, I don’t have enough to nourish myself. I need more nourishment. I need the nourishment of this Earth, of others. And what of others? You don’t want others. That’s what the Pretty Little Demons (PLDs) say.

Once again, months ago, I become hallow into myself. I’m hollower still.

A need for self-destruction… A ridiculous mind game those PLD’s play.

I must be a cocoon ready to kill the worm inside of that which I am, rebirth the self, re-invent, recreate, reopen.

I’m tightly sealed. There is no drawbridge, only walls. Am I in a cocoon?

I hope so, better than a bricked dungeon, better than steel chains.

I can only hope.

Then, as usual these days, I had the breathtaking, heart-curdling anxiety and the stomach churns when I got out of bed. My chest hurts and I feel like vomiting.

I ate breakfast and still feel like vomiting. Every morning it’s been like this.

****

Off I go to make some more calls in search for a therapist. At this very moment, THAT is progress.

*******************************************************************************************************************************************

Here’s another woman, like Anais Nin, another woman I admire: Camila Vallejo.

addendum: Today is Memorial Day. Realized that after the third call was picked up by an answering machine. Ooops. Silly mouse. In that case, I’ll dedicate my last poem to those who’s lost their lives, been wounded (physically and mentally) and who’ve survived senseless battles.

And as far as finding a therapist, well shit, I’ll have to try tomorrow dammit!

*trigger warning, though it does have a hopeful message akin to ‘art is my salvation’*

********

The Heiligenstadt Testament or What Mouse Likes to Call Beethoven’s Suicidal-ish Letter to His Brother(s)

(English translation)

For my brothers Carl and [Johann] Beethoven

Oh you men who think or say that I am malevolent, stubborn, or misanthropic, how greatly do you wrong me. You do not know the secret cause which makes me seem that way to you. From childhood on, me heart and soul have been full of the tender feeling of goodwill, and I was ever inclined to accomplish great things. But, think that for six years now I have been hopelessly afflicted, made worse by senseless physicians, from year to year deceived with hopes of improvement, finally compelled to face the prospect of a lasting malady (whose cure will take years or, perhaps, be impossible). Though born with a fiery, active temperament, even susceptible to the diversions of society, I was soon compelled to withdraw myself, to live life alone. If at times I tried to forget all this, oh how harshly I was I flung back by the doubly sad experience of my bad hearing. Yet it was impossible for me to say to people, “Speak louder, shout, for I am deaf.” Ah, how could I possibly admit an infirmity in the one sense which ought to be more perfect in me than others, a sense which I once possessed in the highest perfection, a perfection such as few in my profession enjoy or ever have enjoyed.–Oh I cannot do it; therefore forgive me when you see me draw back when I would have gladly mingled with you.

My misfortune is doubly painful to me because I am bound to be misunderstood; for me there can be no relaxation with my fellow men, no refined conversations, no mutual exchange of ideas. I must live almost alone, like one who has been banished; I can mix with society only as much as true necessity demands. If I approach near to people a hot terror seizes upon me, and I fear being exposed to the danger that my condition might be noticed. Thus it has been during the last six months which I have spent in the country. By ordering me to spare my hearing as much as possible, my intelligent doctor almost fell in with my own present frame of mind, though sometimes I ran counter to it by yielding to my desire for companionship.

But what a humiliation for me when someone standing next to me heard a flute in the distance and I heard nothing, or someone heard a shepherd singing and again I heard nothing. Such incidents drove me almost to despair; a little more of that and I would have ended me life — it was only my art that held me back. Ah, it seemed to me impossible to leave the world until I had brought forth all that I felt was within me. So I endured this wretched existence — truly wretched for so susceptible a body, which can be thrown by a sudden change from the best condition to the very worst. — Patience, they say, is what I must now choose for my guide, and I have done so — I hope my determination will remain firm to endure until it pleases the inexorable Parcae to break the thread. Perhaps I shall get better, perhaps not; I am ready. — Forced to become a philosopher already in my twenty-eighth year, oh it is not easy, and for the artist much more difficult than for anyone else. ‘Divine one, thou seest me inmost soul thou knowest that therein dwells the love of mankind and the desire to do good’. Oh fellow men, when at some point you read this, consider then that you have done me an injustice; someone who has had misfortune may console himself to find a similar case to his, who despite all the limitations of Nature nevertheless did everything within his powers to become accepted among worthy artists and men.

You, my brothers Carl and [Johann], as soon as I am dead, if Dr. Schmidt is still alive, ask him in my name to describe my malady, and attach this written documentation to his account of my illness so that so far as it possible at least the world may become reconciled to me after my death”.

At the same time, I declare you two to be the heirs to my small fortune (if so it can be called); divide it fairly; bear with and help each other. What injury you have done me you know was long ago forgiven. To you, brother Carl, I give special thanks for the attachment you have shown me of late. It is my wish that you may have a better and freer life than I have had. Recommend virtue to your children; it alone, not money, can make them happy. I speak from experience; this was what upheld me in time of misery. Thanks to it and to my art, I did not end my life by suicide — Farewell and love each other —

I thank all my friends, particularly Prince Lichnowsky’s and Professor Schmidt — I would like the instruments from Prince L. to be preserved by one of you, but not to be the cause of strife between you, and as soon as they can serve you a better purpose, then sell them. How happy I shall be if can still be helpful to you in my grave — so be it. — With joy I hasten to meed death. — If it comes before I have had the chance to develop all my artistic capacities, it will still be coming too soon despite my harsh fate, and I should probably wish it later — yet even so I should be happy, for would it not free me from a state of endless suffering? — Come when thou wilt, I shall meet thee bravely. — Farewell and do not wholly forget me when I am dead; I deserve this from you, for during my lifetime I was thinking of you often and of ways to make you happy — please be so —

Ludwig van Beethoven

Heiligenstadt,

October 6th, 1802

********************************************************************************************************

Though he never completely was able to rid himself of his depression, Beethoven went on to write Symphony No. 9, his most famous work to date, after writing this letter/will, much after he was pretty much completely (no my favorite but a damn good one). Life has more irony than fiction.

Osteogenesis Imperfecta (OI) often causes hearing loss. Whenever people find out that I have pretty severe hearing loss (in my right ear mostly) and know that I’m also a musician, they almost always mention Beethoven.

“Oh, that must suck, but you know Beethoven…”

I often feel ambivalent towards their attempt to comfort me. I don’t like to mention my hearing loss because I don’t want people feeling sorry for me, but I often have to so people can know not to whisper around me. Imagine how difficult it is to have severe social anxiety with normal hearing, and then having a loss like that just multiplies the anxiety. If Beethoven lived in our modern day, he’d be labeled with “social anxiety disorder” and “major depressive disorder” for sure–among other things.

Whenever people start to give me their puckered face and their, “Beethoven did…” speech, I always want to show them this letter he wrote, as if to say, “SEE, it wasn’t easy! Beethoven wanted to kill himself for many years. So please, don’t give me that fuckin’ shit! In fact, some say he may have drank himself to death! But yes, you’re right, he did keep on writing his music. And thank you for your kind words, you make a good point about determination. Whew. Sorry, didn’t mean to go off on ya…”

The good thing is I’m learning to habituate. Again, art has been my salvation. And this letter has been a source of comfort.

*********************************************************************************************************

May is Mental Health Awareness Month.

Resource:
http://www.all-about-beethoven.com/heiligenstadt_test.html

So, just one more for today. I’ve been working (trying to at least) on this invitation card design all day. It’s for a non-profit I’ve volunteered for in the past. I’d promised to get it in last Monday but because of my little incident, I couldn’t . There goes the flakiness I was talking about.

Anyway, I AM getting it done now. How’s that for cognitive and behavioral restructuring?

The title of the invitation is:

“Down With Wage Theft FIESTA!”

Pretty cool, huh? Yeah, I figure if I’m doing things like this, I’m still maintaining. I’ve gotten a referral for group (DBT) therapy because I requested it, and I’m waiting on that now… Haven’t heard back from the psychiatrist though and probably won’t considering what the receptionist told me. Blegh. “You have to go to the ER. We don’t handle emergencies.”

And my mind has been racing all over the place. And family got together, just my little family of four, but when we get together we sound like ten. So I’m super hyped still and in my hyped state I wrote a WHOLE BUNCH of posts that have become a little series now. heehee

I’m titling this series, “Borderline Girl Songs” because these are songs that have always reminded me of my mental struggles and kept me company in some way or another.

Now I know I shouldn’t be listening or reading anything triggering right now (oops already did accidentally). However, even though this first song I selected, “The Outsider,” by A Perfect Circle may be an angry song, it’s actually a song that has often  motivated me not to commit suicide, or so I think.

Oh, Maynard you can make me swoon by listening to your crooning and/or your yelling voice all day.

Enjoy!

*I suppose to or should I add a trigger warning here?*

So I post a comment, right. And then I post another because I realized I hit send before I wanted to add something else. Then I realize, I TYPED IT WRONG because I’m typing TOO FAST and my hands are shaking even though I haven’t had my coffee yet and I don’t have my splint on so my hand is still a little weird and needs retraining… THEN… when I hit the “post comment” button again (for the third time), WordPress tells me this in BIG RED letters so I could be sure not to miss it:

“You are posting comments too quickly. Slow down.”

I was stunned, taken aback. And I think WordPress really means to say this:

“P, what the fuck? Seriously? Another string of comments? WordPress is tired of this shit and so are the bloggie people who have to hit “approve” buttons and get cluttered emails. Just, just hold it up a second. Hold it one minute girl.  SLOW. YOUR. ROLL. ALSO, didn’t you say you were going to the mental hospital and were going to be out for a while? What the fuck?! What are you doing back so soon? Aren’t you going to stick to your promise? SLOW. THE. FUCK. DOWN. Before we block you!”

What the fuck WordPress? I thought we were cool again?

And no. No! We are not blaming it on the borderline personality disorder this time! We are not blaming it on no hypomania. You’re just picking on me.

I’m out.

Life is beautiful, it’s precious, it’s [insert other euphemism]. It is the only one we know we’ll get. So why waste it? Why throw it away?

Sure, there are tsunamis that claw over, killing hundreds of people and hurricanes and tornadoes and earthquakes all leaving ravage in their wake; there’s disease and famine, and worst of all, the man-made stuff–if you don’t count some of the natural disaster stuff being partially an effect of some of the man made stuff.

But still, why throw it away?

I have often wondered “How does one get to that point?” of taking your own life, of constantly being bombarded by thoughts of suicide. I wonder about this, even when I myself have been there countless times. So I can only imagine how incomprehensible it maybe for someone who’s never dealt with chronic depression and chronic thoughts of suicide like I have.

I say take this as a trigger warning, please: I will refer to suicide a lot in this post. Read the rest of this entry »

I’m on the border y’all.

Not only am literally on the border (Texas borderlands) but I’m also on the border mentally.

It’s “official”.

It’s set on paper with nice black ink–though not in stone or anything–but it was kept from me, KEPT FROM ME!

Kept from ME by my own therapist, my Young Therapist.

Guys I’m going to warn you. Before you go any further with this post, know this: I’m actually going to be serious for a moment and I’m going to be saying some things that are not easy for me to say. I’m going to say some things that may be triggering to some of you. AND, I’m going to be serious without cursing! (Yeah, I know!)

Here’s where I bore you to death or at least until you’re nearly as suicidal as me. *trigger warning*

********

Let me explain, I suspected it ever since Young Therapist let it slip that her dissertation/PhD concentration is on Borderline Personality Disorder. In fact, I suspected it long before then. I suspected it nearly two years ago when I started with her and she gave me these handouts on dialectical behavioral therapy (DBT). When we began, I’d get packets–one after another. I’d get a new packet every week and now I have a damn book’s worth of packets in a folder. A chapter on mindfulness, a chapter on progressive muscle relaxation and diaphragmatic breathing, a chapter on DEAR MAN, another on Cognitive Restructuring of Mental Distortions and Distress Tolerance and the list goes on.

One day I asked Miss Young Therapist about this Dr. Marsha Linehan who was the author (you could read it on the fine print on the bottom of the handouts). Young therapist answered that Dr. Linehan was pretty much the mother of dialectical behavioral therapy (DBT) which is primarly used on borderline patients.

“But just because I’m giving you these packets P., doesn’t mean I’m saying you’re a borderline patient.”

That was, until I had my last session with her on Wednesday this week. The first half hour or so we did the usual, “How are you doing this week? Wha’ts going on? And this and that.”

I’d brought my “release of information” form signed for her so she could send my files to the new therapist I’ll be seeing at the community clinic. I was waiting for her to bring up the termination thing and sure enough she did.

“So, this is our last session,” she sighed, “is there anything you want to say?”

“Yep, it is.” I looked intently, sighed, then looked away towards my wheelchair where I’d placed my folder. “Oh, I brought the release form signed. I went to the clinic and found out the name of my new therapist and got the fax number and everything here for you.”

I pulled it out of the folder and handed it to her.

I went on and told her that I’d like a copy of the two reports she’ll be faxing in to them–the “Termination Summary” and “Intake Evaluation Report”–because since it’s a community hospital she can’t just send it directly to the therapist. And I added that since it would have to go through the medical records office which can take over a month, she might as well give me a copy of each just in case.

“Yes, of course, I’ll give you a copy when we head out.”

I wasn’t lying about the medical records office. They’re terrible! But, I did do something with double intention there. I wanted to get a hold of my records without being too obvious about it. I know right? Why couldn’t I just upright and tell her I wanted a copy? Why was I so nervous about that? It’s the dynamics I tell you, and my own anxiety and hesitance.

We went on to discuss what I’d benefited most from and she asked what I thought I’d become better at handling. I mentioned some of the mindfulness stuff and managing my anger. She said that I was one of the most “committed clients” she’d worked with as well as one of the clients with the most extreme life stressors. “You’ve had to deal with more than most people. And you’ve done extremely well considering that, I think,” she said.  She went on with the whole patting me on the back, flattering, and good job thing. I don’t doubt she was being honest though. She genuinely seemed pleased with my overall progress.

When we went out to the front desk and I paid her my dues, she wished me luck with the new therapist again and said bye. I thanked her and then just stared at her for a minute.

“Yes?” she asked looking confused.

“Um, aren’t you going to print out the Termination Record so I can have a copy?”

“Oh, oh, right.”

I don’t know why, maybe I’m just overly critical, but I once again felt she was holding back on me. She could’ve honestly forgotten but I don’t know.

Anyway, she printed it out and handed it to me and said, “If there’s anything you have questions about, about what’s on here, feel free to call me.” She gave me this look I can’t describe. It’s was a sort of apologetic look.

“Ok.” I looked at the paper and said, “This is just the termination summary, can I get the intake evaluation report as well?”

“Uh, mmm, I don’t know, I’ll really have to ask my supervisor about this P. Sorry.”

Again, I felt a little put off. But oh well, I figure I’ll call in a week and ask for her supervisor and try to get it directly from him.

*******

When I was in the car I began reading the termination summary, and read something that shocked me a bit it. At the end of the report, it read:

Diagnosis:
Axis I
296.32 Major Depressive Disorder, Recurrent, Moderate

Axis II
301.83 Borderline Personality Disorder

Axis III
Disease of the Musculoskeletal System and Connective Tissue: Osteogenesis [Imperfecta] <–She’d left out the imperfecta part.

Axis IV
Occupational problems
Economic problems
Problems with access to healthcare services

Axis V
GAF Current: 75
GAF Long Term: 55

What shocked me was the Borderline Personality Disorder diagnosis. But why? I had suspected it even though she never told me, ever, and even though I’m not big on holding to a diagnosis. What I mean is, I take a diagnosis with a grain of salt, a BIG grain of salt. They are merely there to draw a delineation the person’s major mental problems and a course of action.

BUT, then again, I contradict myself, because a part of me was and has been desperate, yearning even for some sort of label. With that I would have proof! I know, me wanting a label sounds shocking in and of itself! See I’d gotten a bipolar label after my monumental mental meltdown in 2008. That was the first time I’d seen a mental health professional in my life. And I got diagnosed only after the second session.

I’ll tell you though, getting something on paper felt like a relief then. It was a validation. I could no longer tell myself (even though I still do): “See P, you’re just making all this up. There’s nothing wrong with you. All of humanity is insane anyway! And you, you’re just weak! You’re just crying over nothing. Go on, cry like a baby over nothing. Always have! The baby you’ve always been. You can stop all this, you know? You’re just making it up anyway. They were right about you, your family and everyone! You and your antics and your dramatics. That’s all it is! There’s no such thing as mental illness girl! Yeah little, stupid, little selfish girl. You don’t need their help. You don’t deserve it either. Just straighten up and quit the crying! Quit it! Quit hitting your head against the wall and get that damn razor out of your hand!”

So you see, getting it in paper meant that I wasn’t just being dramatic as I’ve always been called. I’ve held my little BP label as a trophy even, in a sort of twisted way but I don’t think people can truly understand what I mean until they’ve been there in front of that psychiatrist or therapist looking like hell (oops, just a little curse).

Then, I didn’t stick around with that first psychiatrist in the spring of 2008.

“I hate them all! Nothing but drug dealers for the Big Pharma Co.s, nothing but pill pushers. They don’t care about you.” And then I caved and went back to another and then another and another all in the span of a year.

I eventually landed myself in one of the university psychiatrist’s hands by pleas and begging of my first therapist.

“Please go. Just try it,” she’d say.

So I went.

****

You? bipolar? I’m not sure. No se. Vamos a ver. I doubt it. But I’ll have to see more of you to be sure. Nos daremos cuenta con el tiempo,” he said.

He was an old Cuban man and I hated him the instant I saw him (not because he’s Cuban yall; I’m Colombian remember, so there’s a lot not to like there 😉 I kid). I just got a terrible vibe from him. I didn’t trust any psychiatrist then (am still hesitant) and I sure as hell didn’t trust some old mangy one covered in liver spots.

“I don’t think I’m going back there,” I told my first counselor/therapist, the one I was seeing at the university’s psychological services center (this is not the same place where Young Therapist works. Young therapist works at the College of Social Sciences in the Psychology  department).

“P. you really should go see a psychiatrist to help you stabilize those mood swings,” the counselor said. “Look if you don’t want to see that man, there’s this really good psychiatrist, just came back. She was going to retire but decided not to just yet.”

Needless to say she finally convinced me to go and I returned.

An awkward moment occurred when I went to see this new “good psychiatrist” and Dr. Cuban Liverspots said hi to me when he was marching with his coffee cup on the way to his office, right next to new “good psychiatrist’s”! Well, turns out this was the third or fourth psychiatrist (I honestly don’t remember how many I’d seen by then) and she said that I did not have bipolar (BP). But she didn’t say what it was that I did have. If it wasn’t BP, then what I wondered. I never asked though. I guess I can be passive in that sense. The only thing I knew, is when I went to the cash register to pay, the bill read, “Major Depressive Disorder” (MDD) and “Generalized Anxiety Disorder” (GAD).

At least I got my answer, I thought. That’s when the alphabet soup of my psychological disorders got spicy. I now had a gumbo soup of disorders.

Then this! This Borderline Personality Disorder. It sounds so macabre! So fantastical. So unreal. So STIGMATIZING! I’m sorry to break it to you guys, my dear BP internet buddies but my belief is that as stigmatizing as BP is (and it really is), the BPD label is ten times more. Why? I’ll explain in part two.

****

“What?! You got that borderline personality disorder!? What is that? Is that like when you have multiple personalities? OH MY GOD, you got multiple personalities P? You gonna go Dr. Jekyll and Mr Hyde on me P?”

“No! Come on! I don’t have multiple personality disorder, that’s not even called that by the way; it’s been updated by the APA. It’s now called dissociative identity disorder, Dee-Eye-Dee (DID). I’m just me, the one and only PAZ. I’m still the melancholically manic mouse, only now I fit the ICD and DSM and [insert random acronyms for other diagnostic manuals] criteria of a borderline meloncholically manic mouse. I’m a borderline melancholically manic mouse  is all. Maybe it’s because I grew up in a very unstable environment though my family was always tightly knitted and mostly very loving. Maybe it’s because I’ve had to deal with a lot of traumatic events, especially in my childhood so I’m somehow ’emotionally scarred’. Maybe I regress to childhood if you were to ask Freud, though the behavioralists wouldn’t agree. Maybe my brain does fire off too quickly, and if that’s the case, the pharmas are more than happy to hear. Maybe my limbic system has a malfunction and thus, my amygdala is hyperactive or hypersensitive; maybe it’s a genetic mutation like my malformed bones and that’s why I’m so quick to rage. Or maybe I was conditioned to rage by my mother’s rage and abuse. The behavioralists would agree with that one. Maybe I do have a shortage of dopamine, norepinephrine and serotonin or GABA or some other neurotransmitter. Maybe I don’t, but maybe I do, and maybe I have all of the above or none of the above. All I know is I have the emotional stability of a five year-old. I guess it fits my toddler height.”

Really, how do you explain all that? It just makes my alphabet/acronym soup spicier and more foreign than a crunchy Samosa plate served with dhaal soup.

Mmmm. Samosa.

********

Alright, some of you may know what this is already, this BPD and BP and Axis I and Axis II nonsense, but to those of you who don’t and are interested, let me explain what some of this is  (it’s a good thing I’m a nerd that’s into psychology and I have several books on it).

When I got home, you best believe I dug out those books from my book shelf.

First, the various “Axis” levels go like this:

Axis degrees are used as intersections of a person’s main mental problems in order to diagnose a mental disorder. Each Axis affects the overall diagnosis as each affects/intersects and correlates with the other.

Axis I: clinical disorders.    
Symptoms that cause distress or significantly impair societal or occupational functioning such as anxiety disorders, major depression, bipolar disorders, etc.

Axis II: personality disorders and mental retardation disorders. (now why’d they have to dump me in with the mental retardation folks? It’s just like they did when I was in PE class in middle school! P in PE with the retarded kids.)
Chronic and enduring problems that generally persist throughout life and impair interpersonal or occupational functioning.

Axis III: general medical condition.    
Physical disorders that may be relevant to understanding or treating a psychological disorder.

Axis IV: current psychosocial and environmental problems.    
Problems (such as interpersonal stressors and negative life events) that may affect the diagnosis, treatment, and prognosis of psychological disorders.

Axis V: global assessment functioning (GAF).
The individual’s overall level of functioning in social, occupational, and leisure activities. (Now I’m not going to go into detail with this one but if you want more info go here. You probably won’t though since no one clicks my links. hehe

****

Then there’s the Borderline (BPD) diagnosis. I had already known about BPD but again, I thought if anything I fit more into the BP criteria (tell me if this is getting confusing). I could just relate to those who have BP, who I’ve  talked to either face-to face or in online forums. The BPD people folks though, I said to myself, are said to be manipulative and I’m not manipulative, no, no I’m not. Am I? No. I’m not.

I’m not going to talk about the major depressive (MDD) diagnosis because that was a given for me.

So a very, very short description of Borderline Personality Disorder (BPD) is that it is essentially a disorder of extreme and pervasive emotional disregulation characterized by impulsivity and instability in moods, relationships and self-image. (Karen Huffman)

None of this is catch all, you see. We are still people with unique personalities and cultures, histories and separate though connecting lives. We’re individuals, even those like myself who now have had the personality disorder diagnosis slapped on.

****

I cried uncontrollably for about two hours Wednesday night. It could’ve been PMS and a thought about L. I don’t know why I didn’t get so worked up about the other diagnosis (Dx) in my past. Then it dawned on me the more I thought about it. Could it be that  it’s because I think it’s actually the most accurate Dx I’ve had to date? And then, could it be that this has made me subconsciously think about all of the things I’ve been through, all that I’ve done? All the extremes in my life? I mean, all the psychiatrists never saw me for who I was. They never saw me more than twenty minutes at most and once every month or two (again, at most).

Young Therapist did see me for who I was, at least partly. She saw me for an hour every week for almost a year, then every two weeks for another. And she had me do tests and talk about so many things which I never did with the others. Young Therapist actually saw me cry. I cry a river damn near ever day when I get depressed but I don’t cry in front of people! And Young Therapist saw me get shaky to the point of telling her I had to puke, to the point of having to put my arms down and sit on them. Young Therapist, if anyone, would know how to diagnose me. So maybe I cried because I got the sense that not only did I get diagnosed with a very severe, very misunderstood and stigmatized disorder (albeit relatively treatable), but I felt for the first time they got to the core of me. Maybe, I was also crying out of relief.

In order to qualify (ha,  “qualify” like a merit) as having BPD in America, you have to fit at least five of these within your problem scheme. Here are some of the criteria according to the damn (oops) DSM-IV:

  1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

Ok this one got me. I don’t think I make frantic efforts to avoid any kind of abandonment. Do I? No, you don’t P. But maybe I fear it so much I’m in denial? Maybe P, maybe. Or maybe this one just doesn’t pertain to me. Remember, it’s not a catch all.

  2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

Yes. Yes. Yes. That’s definitely me. Just this week I said, “Damn you WordPress. You suck! Why do I bother with you,” then, “Oh Dear WordPress. Don’t leave me. I love you. You’re the best. What would I do without you?”

  3. identity disturbance: markedly and persistently unstable self-image or sense of self.

Yes. Maybe. Yes. No. Maybe. I’m the best! I’m the worst! I’ll talk about this later. What do you mean by this anyway? Of course I have an identity! It’s not disturbed. Ok. Hmmm. Maybe. I don’t know. I change my mind about what I think about myself, what I want to do with my life and many people do that right? Yes P, but not at such extremes. I doubt what my strengths are. Am I good at writing? No! But I love writing. I’m good at it. Yes? Should I stick with editing video then? But I want to write documentaries and dramatic films. I like to draw too. Could I write comics? Who am I kidding, I’m not an artist. Should I be a therapist? Yes. Yes! I’m so wise, so loving. I want to embrace everyone. No! You’re a misanthropic nihilist. Nothing fits. Am I splitting? What about the web design thing you were trying to do, and what about the multimedia journalism masters at UT? What about the Latin American Studies masters you’d thought about too P? What about your music P? What about your photography P? And what about your poems P?

Yeah, I’ll have to get back to this one later.

  4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

Yes. I’m a highly reactive and highly impulsive person even though I tend to over-think things before I do them–so in that sense I’m not impulsive. I hesitate too much on doing them, say choosing a college degree or buying a flavor of yogurt or talking to someone I find attractive. My impulsivity in other aspects, however, has gotten me in trouble and put me in dangerous situations. I’ve done drugs. Many. I did cocaine with L. I was always a bummer, never a buyer. I bummed drugs off of people whenever they were offered, so I never considered myself a “real” user. I was a functioning alcoholic or as the AA people would say, I am an alcoholic in recovery.

I’ve also had phases in my life where I binge eat, particularly to deal with stress. People with BPD, especially young women tend also have a comorbid eating disorder, most notably bulimia nervosa. Though I’ve never been bulimic per se, I have always punished myself in some way or another after binging. My weight has also fluctuated drastically throughout my life. Right now I’m more on the healthy weight to slightly-underweight side.

Sex. That’s a difficult one. I was a shy, late bloomer, a wallflower. But I knew a lot about sex at a very young age. Growing up with an older brother and always hanging out with the guys, you find out about porn early on. Then I lost a close friend because of my impulsive sexual behavior. However, I’m still extremely shy, self-conscious and have issues about my body so I’ve turned down many sexual encounters due to the fact that I have terrible anxiety about it. I’m really short, have brittle bones (some of which are a bit disfigured), use a wheelchair and I always felt no one would find me attractive. I mean, really, who would find a girl in a wheelchair attractive, I’d tell myself. There are ignorant folks out there who still refuse to believe someone like me could have a thriving sexual life.

Who would find a midgety, malformed mouse attractive? So when I found out that I was found attractive indeed, when I was put on the spot, I often backed away. I’m very impulsive sexually though so there’s a tug of war going on in my head. “I can’t but I want to so bad”. Once I get comfortable enough, I’m very impulsive with sex so much so that L and two male “friends” of mine who used to called me a nymph. That’s when the alcohol and drugs come in to play as well.

Oh, and I’m also bisexual, though I mainly just identify as queer and don’t tell people I am. I guess I’m still in the closet about it.

  5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

Triple yes. Though I’ve never really attempted and don’t think I make “gestures” of my suicidality to people. In fact, I try to hide it as much as possible. I don’t talk about my suicidal ideations or depression, the only exception being the therapist and even then I’m very vague about it.

As far as gestures… I don’t know. Maybe I make them and don’t realize it? There was, however, one time when I got in a huge fight with my brother not too long ago and I became a “maniac P., you’re acting like a manic! Chill! Chill! What are you…? Oh, f****, hi officer. No, no she’s alright. No, I don’t think I need to take her to the ER. She’s my sister. Yes. She just needs to sleep. I just need to get her to bed. No, I got it. Ok, yes, I’ll see if I take her to the nearest ER. I’m just getting to my apartment right around the corner. I will call them once I’m there, yes. Thank you.”

A cop had pulled us over because my brother wasn’t watching the road because he had to pull me back as I was trying to jump out of his car while screaming, “LET ME OUT”. Maybe that’s a suicidal gesture? I’m not sure. I don’t recall much of of it since I felt out of my body. I only remember sitting on the curb of some parking lot near his apartment complex that night crying and shaking uncontrollably and then, eventually, getting picked up by my dad who later said I couldn’t make a coherent sentence. Very impulsive indeed. Oh and that’s another thing with BPD. Borderlines supposedly have a tendency towards depersonalization  and derealization as well as transient psychotic or psychotic-like breaks under crisis situations, something I’m very familiar with.

Self-mutilation. Yes. I’ve never been much of a cutter, but when I have, it’s been extreme. I’m going to leave it at that. And I’d banged my head against walls ever since I was about ten or eleven or younger even. When I was in middle school, I got into the habit of scratching and slapping and punching myself and pulling bits of my hair. So triples yes on that one too. This is embarrassing guys.

  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).

Yes, it’s one of the things that got me the initial Dx for bipolar. There’s something that should be said about this one though, because unlike the criteria, I usually don’t just have these episodes for only hours or days thought that is the case sometimes.

  7. chronic feelings of emptiness

Not as much as years back. It fluctuates for me. The way I see it: I fill up and then I drain, I fill up and then I drain.

  8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

Yes to the power of ten. I’m a recovering rageaholic too. When I was a kid, I threw a butter knife at my brother over a simple remark he’d made and smashed all the plates. It hit him in the forehead. Fortunately, it was only a butter knife and my weak hands couldn’t throw hard enough for a blunt force to seriously hurt him. And these types of violent outbursts were not at all uncommon for me. I have dozens of similar stories ranging as early as when I was four.

  9. transient, stress-related paranoid ideation or severe dissociative symptoms

Yes. People are after me. I make terrible, mean comments on WordPress and that makes everyone get offended and so on and so forth. I have dissociation episodes galore. Where am I? Are those shadows moving? Are they people? Am I there and not here. I’m outside of myself!

********

Ok, I’m going to leave it here for now, but I plan to write more about BPD, what I think of all of this and all of the psychological research I’ve read about it as well as the co-morbidity of BP and BPD.

Hey? 🙂 You there?

See, I bored you to death. 😦

*Le mouse sigh*

***********************************************************************

Resources

Handbook of Personality, Third Edition: Theory and Research edited by Oliver P. John, Richard W. Robins, and Lawrence A Pervin

Psychology In Action, 6th Edition by Karen Huffman

PsychCenteral

Mayo Clinic

National Education Alliance Borderline Personality Disorder (NEA BPD)

National Alliance on Mental Illness

National Institute of Mental Health

About.com, Borderline Personality Disorder Guide

Wikipedia, Borderline Personality Disorder

BPD Today – DSM-IV TR Diagnostic Criteria