I Hate You--Don't Leave Me - Jerold J. Kreisman [3]
Though laudable in some respects, these recommendations complicate the communication of information. Although we abhor the implied disrespect and dehumanization of referring to people by their medical conditions (“Check on the gallbladder in the next room!”), we have nevertheless chosen, for the sake of clarity and efficiency, to sometimes refer to individuals by their diagnosis. For example, we use the term “borderline(s)” as a kind of shorthand to represent the more precise designation, “human being(s) who exhibit(s) symptoms consistent with the diagnosis Borderline Personality Disorder, as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR).” For the same reason, we alternate pronouns throughout, rather than burden the reader with the “he/she, him/her” construction. We trust that the reader will grant us this liberty to streamline the text.
Chapter One
The World of the Borderline
Everything looked and sounded unreal. Nothing was what it is. That’s what I wanted—to be alone with myself in another world where truth is untrue and life can hide from itself.
—From Long Day’s Journey into Night, by Eugene O’Neill
Dr. White thought it would all be relatively straightforward. Over the five years he had been treating Jennifer, she had few medical problems. Her stomach complaints were probably due to gastritis, he thought, so he treated her with antacids. But when her stomach pains became more intense despite treatment and routine testing proved normal, Dr. White admitted Jennifer to the hospital.
After a thorough medical workup, Dr. White inquired about stresses Jennifer might be experiencing at work and home. She readily acknowledged that her job as a personnel manager for a major corporation was very pressured, but as she put it, “Many people have pressure jobs.” She also revealed that her home life was more hectic recently: She was trying to cope with her husband’s busy legal practice while tending to the responsibilities of being a mother. But she doubted the connection of these factors to her stomach pains.
When Dr. White recommended that Jennifer seek psychiatric consultation, she initially resisted. It was only after her discomfort turned into stabs of pain that she reluctantly agreed to see the psychiatrist Dr. Gray.
They met a few days later. Jennifer was an attractive blond woman who appeared younger than her twenty-eight years. She lay in bed in a hospital room that had been transformed from an anonymous cubicle into a personalized lair. A stuffed animal sat next to her in bed and another lay on the nightstand beside several pictures of her husband and son. Get-well cards were meticulously displayed in a line along the windowsill, flanked by flower arrangements.
At first, Jennifer was very formal, answering all of Dr. Gray’s questions with great seriousness. Then she joked about how her job was “driving me to see a shrink.” The longer she talked, the sadder she looked. Her voice became less domineering and more childlike.
She told him how a job promotion was exacting more demands—new responsibilities that were making her feel insecure. Her five-year-old son was starting school, which was proving to be a difficult separation for both of them. Conflicts with Allan, her husband, were increasing. She described rapid mood swings and trouble sleeping. Her appetite had steadily decreased and she was losing weight. Her concentration, energy, and sex drive had all diminished.
Dr. Gray recommended a trial of antidepressant medications, which improved her gastric symptoms and seemed to normalize her sleeping patterns. In a few days she was ready for discharge and agreed to continue outpatient therapy.
Over the following weeks, Jennifer talked