I Hate You--Don't Leave Me - Jerold J. Kreisman [65]
Maybe it is because he has settled into a more routine lifestyle that no longer requires periodic outbursts—drinking binges, suicide threats, or other dramatic gestures—to achieve his needs. Perhaps with age the borderline loses the energy or stamina to maintain the frenetic pace of borderline living. Or perhaps there is simply a natural healing process that takes place for some borderlines as they mature. In any event, most borderlines get better over time, with or without treatment. Indeed, most could be considered “cured” in the sense that they no longer fulfill five of the nine defining criteria. Long-term prognosis for this devastating disease is very hopeful (see chapter 7).
Thus, those sharing life with the borderline can expect his behaviors over time to become more tolerable. At this point the unpredictable reactions become more predictable and therefore easier to manage, and it becomes possible for the borderline to learn how to love and be loved in a healthier fashion.
Chapter Seven
Seeking Therapy
I’m gonna give him one more year, and then I’m going to Lourdes.
—From Annie Hall, by Woody Allen, about his psychiatrist
Dr. Smith, a nationally known psychiatrist, had called me about his niece. She was depressed and in need of a good psychotherapist. He was calling to say that he had recommended me.
Arranging an appointment was difficult. She could not rearrange her schedule to fit my openings, so I juggled and rearranged my schedule to fit hers. I felt pressure to be accommodating and brilliant, so that Dr. Smith’s faith in me would be justified. I had just opened my practice and needed some validation of my professional skills. Yet I knew that these feelings were a bad sign: I was nervous.
Julie was strikingly attractive. Tall and blond, she easily could have been a model. A law student, she was twenty-five, bright, and articulate. She arrived ten minutes late and neither apologized for nor even acknowledged this slight on her part. When I looked closely, I could see that her eye makeup was a little too heavy, as if she were trying to conceal a sadness and exhaustion inside.
Julie was an only child, very dependent on her successful parents, who were always traveling. Because she couldn’t stand being alone, she cruised through a series of affairs. When a man would break off the relationship, she’d become extremely depressed until embarking on the next affair. She was now “between relationships.” Her most recent man had left her and “there was no one to replace him.”
It wasn’t long before her treatment fell into a routine. As a session would near its end, she’d always bring up something important, so our appointments would end a little late. The phone calls between sessions became more frequent and lasted longer.
Over the next six weeks we met once a week, but then mutually agreed to increase the frequency to twice a week. She talked about her loneliness and her difficulties with separations, but continued to feel hopeless and alone. She told me that she often exploded in rage against her friends, though these outbursts were hard for me to imagine because she was so demure in my office. She had problems sleeping, her appetite decreased, and she was losing weight. She began to talk about suicide. I prescribed antidepressant medications for her, but she felt even more depressed and was unable to concentrate in school. Finally, after three months of treatment, she reported increasing suicidal thoughts and began to visualize hanging herself. I recommended hospitalization, which she reluctantly accepted. Clearly, more intense work was needed to deal with this unremitting depression.
The first time I saw the anger was the day of her admission, when Julie was describing her decision to come to the hospital. Crying softly, she spoke of the fear she had experienced when explaining her hospitalization to her father.
Then suddenly her face hardened, and she said, “Do you know what that bitch did?” A moment passed before I realized that Julie was now referring to Irene, the nurse who had admitted