A Day in A Life of Treading Water: Borderline Personality Disorder.

A Day in a Life of Treading Water

Introduction

This is a case study of a 23-year old Canadian Caucasian woman who has been diagnosed as suffering from Borderline Personality Disorder, and is under the care of a psychiatrist for medication (Effexor and Loxapine) and talking therapy. Before this she was diagnosed with depression since 8 years of age, and suspects sexual abuse when 2-3 years old.

When asking her to examine her problems of pain and suffering, she decided to tell her story in the form of recounting a day in her life. I then asked her two specific questions directly: Why do Bad Things Happen to Good People? And Where is God when You need Him?.

A Day in My Life

Over the last 10 days, I have been feeling suicidal ideation and extreme depression. I have cut. I wake up from nightmares with imagery around animals e.g. bugs; snakes and rats infested my space. Snakes chase me in a garden and rats in my room but none on me. There is environmental hostility – I dream of the wrong road to my Grandmother’s cottage and me climbing a cliff over gravel. So I wake up having worked very hard. When awake, I have anxiety about the day. This may be carried forward from my nightmare – I feel unsafe. I then have immediate thoughts that my boss may be angry or that it is slippery outside.

Last night I was crying as I feel asleep. I felt lonely, empty, a lack of light in my being, especially when with my partner or family or people I love, because the feeling for them has gone. I can still sense their love for me but I feel guilty because I can’t reciprocate. All the love I have for people has shut down. When it is a good day i.e. a feeling day, I feel loving towards them. I feel awake. My thoughts carry forward to my dreams and to the next day. “It is kind of like hell; feels like worst thing ever”. Worse than missing someone when they die – then I felt grieving but my heart felt full with love although sad. Missing my Grandfather in death was less painful than being depressed around him when he was alive. I was not depressed when he died. Usually I spend 1 hour lying in bed thinking of the pros and cons of getting out of bed: Will I be disappointing people? How can I be distracted? Do I have sugary cereal? I want to self-sooth or distract.

Today - why was I out of bed immediately? Because I found an ice-cream bar to jolt or distract me – the adrenalin release made me so jittery but I had the energy to get dressed. I had a smoke and a coffee. It is tough – only hit 9:30 am by now – so much of the day to go. Then go to work or appointment. On the subway I listen to upbeat music – like funk or pop. This helps to distract me. When very depressed it takes me to neutrality - if it works. If the first song doesn’t work, I spend time skipping songs until I find one that does. Then I listen to the same song 3-4 times in a row. The first 2 hours of the day when I interact with co-workers or customers is the best because the focus has shifted onto communicating.

When I wake I am sad if I spent 2 hours with my partner. I try to get away by sleeping in or staying in the bathroom a long time. Generally if I am alone and I wake with lots of energy from coffee or something sweet, I try to pretend I’m in a movie and I imagine my life as a movie with different scenarios or a person e.g. from the movie “Working Girl”, watching someone getting dressed to music. It helps in transit while listening to music: “Makes me feel free of limitations I woke up with, because I can create other limitations for that character that I’m not afraid of”. Lowers my fear. Has worked for a long time.

Around 3 pm I feel a slump where I feel depressed. Haven’t eaten for a few hours. Think about food. Have a lot of judgement of myself around food because what I can afford is not always healthy. So judgement about my body – I’m not feminine enough, delicate enough, and thin enough. Pressure came from parents and grandparents e.g. Mom happy when I wear feminine or delicate and she gladly tells her friends – causes me pressure. Pressure from one of my Mom’s friends. In high school she stayed with us and so judgemental about my dress, my makeup, girls I like, and that my Mom is overweight. She was obsessive and totally phoney.

So it depends on whom I’ve seen or talked when I get hungry. Mom is on a diet and lost a lot – I must do the same because I’m overweight. I argue with myself for 45 minutes about what I will eat – having energy and feeling full vs. feeling I won’t gain weight. Sometimes I eat or I don’t eat and have diet coke and smokes. After I eat I feel guilty and anxious for having eaten so I phone people to say “HI” and plan for after work to include drinking and to get drunk later. It helps.

From 4-7 pm is pretty difficult so I want to go to sleep but if I have plans then I meet friends and I drink with them as soon as possible. If I feel good after that, I stay out and continue to drink. “Having two beers is like a litmus test”. If not better after two beers, then I go home to sleep because at the bar I am around someone I love and feel so bad. I want to cry; often I do cry in front of them or on the subway. There is pain in my solar plexus and sternum from 4-7 pm, but I cannot cry at work. I make plans to get rid of the pain.

I go to bed as soon as possible, and sometimes I’ll call Mum if I can’t sleep, and then I sleep. Mum helps because she gives me hope for the next day. Maybe she will take care of me and I won’t feel so bad. “It’s a gamble”. If I’m generally depressed it doesn’t work, but nice to look forward to. Often I cancel plans I’ve made the day before. Weekends it’s different not necessarily better.

My psychiatrist gave me homework piece reflections. I feel that when people express feelings or enthusiasm, it is received by me as pressure – I feel hopeless and depressed and angry e.g. my boyfriend pushing me to play at a bar. I express my anger in cutting myself if for an irrational reason. I know he is supportive. I express my anger in normal ways if deemed by me to be rational. My Dr. said it is not written anywhere that anger has to be for rational reasons. I got excited.

My new homework is to express my anger and not to cut. I also don’t express anger because of how others treat my Grandmother. When they express anger to her then she cries – then the focus from them is to make sure she’s OK. I don’t want to make people cry so I don’t express my anger. I warned my boyfriend that I will be expressing my anger. It makes me angry if he talks about a comedian but doesn’t share it. Dr says to use family therapy to practice expressing my anger.

[Feeling in last 10 minutes I want to stop because it gets sad after a while – sad to think that this happens 5-7 days a week for the last 3 months. It feels strange to break down my rituals].

I suspended the interview until the next day as a compassionate response to my client.

I asked to stop the interview because I got sad after an hour of thinking about “a day in my life” for months over the last 10 years. I feel too tired to engage in skilful behaviour – I’m paralysed. I slept after we talked. I swing between rational and emotional and not wise mind (from my DBT training). My Dr. asked: ‘Can I accept that I bounce back and forth, and that middle ground exists’. For me there is so much swallowing of anger that I end up on rational side, and I go to intellectualizing. I got caught up in the emotion after our first interview. I was totally overwhelmed and scared that I’ll never get out of it. Seeing a picture of a 17 lb rabbit in a magazine I bought in a store helped me realize that the world is full of random stuff that makes me laugh. If I just hold on and just remember to be strong.

From our first talk, I mentioned the techniques I use – music and a movie game. There are other processes I go through. It is hard because nobody knows I do it. They can’t see it – it is invisible to others. I am tired all the time when in crisis – I can do little. I have 300% more energy when not in crisis. Therapy is better for me at the beginning of the day because I am spent by 3 pm. I also get muscular pain from my mood, in my back, neck and shoulder.

Why do bad things happen to good people?

Same reason bad things happen to bad people. A part of the planet Earth is that there’s good and bad. With challenges we learn to grow in exceptional ways, and we share with people to help our planet. Sometimes I think that I’m doing this with crisis. Yet it doesn’t feel worth it. Pain and loneliness would be OK if it is because I’m doing it for our planet for a reason. Depression is a narcissistic disease. I focus on myself. It takes precedence over everything. It would be OK if I felt that I was doing someone else some good. I can’t see it. If I could alleviate others suffering or they feel less alone. I haven’t yet fully explored ways of doing this. You need to function at a certain level to help others but in crisis I am not at that level.

So far in getting treatment and receiving help, I think I am and I feel very lucky. I have been blest with people who have open minds. Yet I still cut and feel worthless and have self–destructive behaviour and thoughts. I feel really grateful for resources but feel bad because with all the resources “I still feel s**t”, so what about the rest of my life. I see God in help I get. He doesn’t give us a challenge we can’t handle.

Where is God when I need him most?

When rational I think that I feel disconnected from source energy or God. It is like my umbilical cord to Him is clamped. We are God. The cord is connected to others and everything else. In crisis, I’m here and everyone else is here, but my mind is noisy so I can’t hear God. “My mind is screaming and God is whispering”. In emotional crisis there is no cord. No God in my life. I feel that my work is done and it’s time to go.

Ultimately death is up to God but if he wanted me to be here it would go easier. By world standards life is great. In my heart I feel disconnected, so it is a huge struggle to stay here. When I have no energy, God must think it’s finished so it’s my time to go. Yet if it was finished, He would take me in my sleep. I struggle between these two views. I care about God. He means all the things that can’t be explained – and that excites me. It suggests that there is a purpose to my condition, but “why do I have it if I can’t do God’s work?”

Commentary

Kushner (1981) concludes that we live in an imperfect world and that even God may be imperfect, especially in His creation. I believe that this is possible, and that we could take a stance that good and bad things happen to good and bad people. In other words, to classify people as good or bad and to attribute events based on this is futile. We live in a chaordic world and are subject to the laws of the Universe. God is in us and around us by our sides as we struggle well in an imperfect world. In this way we are co-creators with God in bringing greater enlightenment to an evolving world in order to bring it closer to perfection.

Reference

Kushner, H.S. (1981). When bad things happen to good people. New York: Avon Books.