I Hate You--Don't Leave Me - Jerold J. Kreisman [12]
Long-term studies confirm that many patients recover over time and even more improve significantly. Over a decade 86 percent of borderline patients achieve sustained relief of symptoms, almost half of those within the first two years. However, despite diminution of defining symptoms, many of these patients continue to struggle in social and work or school environments. Although recurrence rates are as high as 34 percent, after ten years, full and complete recovery with good social and vocational functioning is achieved in 50 percent of patients.21,22 Many borderline patients improve without consistent treatment, although continued therapy hastens improvement.23
The Question of Borderline “Pathology”
To one degree or another, we all struggle with the same issues as the borderline—the threat of separation, fear of rejection, confusion about identity, feelings of emptiness and boredom. How many of us have not had a few intense, unstable relationships? Or flew into a rage now and then? Or felt the allure of ecstatic states? Or dreaded being alone, or gone through mood swings, or acted in a self-destructive manner in some way?
If nothing else, BPD serves to remind us that the line between “normal” and “pathological” may sometimes be a very thin one. Do we all display, to one degree or another, some symptoms of borderline personality? The answer is probably yes. Indeed, many of you reading this first chapter might be thinking that this sounds like you or someone you know. The discriminating factor, however, is that not all of us are controlled by the syndrome to the degree that it disrupts—or rules—our lives. With its extremes of emotion, thought, and behavior, BPD represents some of the best and worst of human character—and of our society in the nascent years of the twenty-first century. By exploring its depths and boundaries, we may be facing up to our ugliest instincts and our highest potentials—and the hard road we must travel to get from one point to the other.
Chapter Two
Chaos and Emptiness
All is caprice. They love without measure those whom they will soon hate without reason.
—Thomas Sydenham, seventeenth-century English physician, on “hystericks,” the equivalent of today’s borderline personality
“I sometimes wonder if I’m possessed by the devil,” says Carrie, a social worker in the psychiatric unit of a large hospital. “I don’t understand myself. All I know is, this borderline personality of mine has forced me into a life where I’ve cut everyone out. So it’s very, very lonely.”
Carrie was diagnosed with the borderline syndrome after twenty-two years of therapy, medication, and hospitalizations for a variety of mental and physical illnesses. By then, her medical file resembled a well-worn passport, the pages stamped with the numerous psychiatric “territories” through which she had traveled.
“For years I was in and out of hospitals, but I never found a therapist who understood me and knew what I was going through.”
Carrie’s parents were divorced when she was an infant, and she was raised by her alcoholic mother until she was nine. A boarding school took care of her for four years after that.
When she was twenty-one, overwhelming depression forced her to seek therapy; she was diagnosed and treated for depression at that time. A few years later, her moods began to fluctuate wildly and she was treated for bipolar disorder (manic depression).