I Hate You—Don't Leave Me (28 page)

Reared in a working-class Catholic family, Elizabeth had three older brothers and a younger sister, who had drowned in a swimming accident at age five. Elizabeth was only eight at the time and had little understanding of the event except to observe her mother becoming more withdrawn.

For as long as Elizabeth could remember, her mother had been hypercritical, constantly accusing Elizabeth of being “bad.” When she was a young girl, her mother insisted that she attend church with her, and forced her father to construct an altar in Elizabeth's bedroom. Elizabeth felt closer to her father, a passive and quiet man, who was dominated by his wife. As she entered puberty, he became more distant and less affectionate.

Growing up, Elizabeth was quiet and shy. Her mother disapproved of her involvement with boys and closely watched her friendships with girls; she was expected to have “acceptable” friends. Her brothers were always her mom's favorites; Elizabeth would kid with them, trying to be “one of the guys.” Elizabeth achieved good grades in high school but was discouraged from going to college. After graduation, she began working full-time as a secretary.

As time went on, the conflicts with her mother escalated. Even in high school, Elizabeth's mother had denounced her as a “tramp” and constantly accused her of promiscuity even though she had had no sexual experience. After a while, having endured the shouting contests with her mother, she saved enough money to move out on her own.

During this turmoil, Elizabeth's boss, Lloyd, separated from his wife and became embroiled in a painful divorce. Elizabeth offered solace and sympathy. He reciprocated with encouragement and support. They began dating and married soon after his divorce was finalized. Naturally, her mother berated her for marrying a divorced man, particularly one who was ten years older and a lapsed Catholic.

Her father remained detached. One year after Elizabeth married, he died.

Five years later, her marriage was disintegrating, and Elizabeth was blaming her husband. She saw Lloyd as a “thief” who had stolen her youth. She was only nineteen when she met him, and needed to be taken care of so badly that she traded in her youth for security—the years when she could have been “experimenting with what I wanted to be, could be, should have been.”

In the early stages of treatment, Elizabeth began to talk of David, her most recent and most important affair. He was twelve years older, a longtime family friend, and the parish priest. He was someone known and loved by her whole family, especially by her mother. He was the only man to whom Elizabeth felt connected. This was the only relationship that she did not control. On and off, over a period of two years, he would abruptly terminate the affair and then resurrect it. Later, she confessed to her psychiatrist that David was the father of her child. Her husband was apparently unaware.

Elizabeth became more withdrawn. Her relationship with her husband, who was frequently away traveling, deteriorated. She became more alienated from her mother and brothers and allowed her few friendships to flounder. She resisted attempts to include her husband in therapy, feeling that Lloyd and her doctor colluded and favored “his side.” So, even therapy reinforced her belief that she couldn't trust or place faith in anyone because she would only be disappointed. All her thoughts and feelings seemed to be laden with contradictions, as if she were in a labyrinth of dead-end paths. Her sexuality seemed the only way out of the maze.

Her therapist was often the target of her complaints because he was the one “in control.” She would yell at him, accuse him of being incompetent, and threaten to stop therapy. She hoped he would get mad, yell back, and stop seeing her, or become defensive and plead with her to stay. But he did neither, and she railed against his unflappability as evidence that he had no feelings.

Even though she was accustomed to her husband's frequent business trips, she started to become more frightened when left alone. During these trips, for reasons not yet clear to her, she slept on the floor. When Lloyd returned, she raged constantly at him. She became more depressed. Suicide became less an option than a destiny, as if everything were leading to that end.

Elizabeth's perception of reality became more frail: She yearned to be psychotic, to live in a fantasy world where she could “go anywhere” in her mind. The world would be so far removed from reality, no one—not even the best psychiatrist—could get to her and “see what's underneath.”

In her daydreams she envisioned herself protected by a powerful, handsome man who actively appreciated all of her admirable qualities and was endlessly attentive. She fantasized him as a previous teacher, then her gynecologist, then the family veterinarian, and eventually her psychiatrist. Elizabeth perceived all these men as powerful, but she also knew in the back of her mind that they were unavailable. Yet, in her fantasies, they were overwhelmed by her charm and drawn irresistibly to her. When reality did not follow her script—when one of these men did not aggressively return her flirtations—she became despondent and self-loathing, feeling she was not attractive enough.

Everywhere she looked she saw women who were prettier, smarter, better. She wished her hair was prettier, her eyes a different color, her skin clearer. When she looked in a mirror, she did not see the reflection of a beautiful young woman but an old hag with sagging breasts, a wide waist, plump calves. She despised herself for being a woman whose only value was her beauty. She longed to be a man, like her brothers, “so my mind would count.”

In her second year of outpatient therapy, Elizabeth experienced several losses, including the death of a favorite uncle to whom she had grown close. She was haunted by recurring dreams and nightmares that she could not remember when she awoke. She became more depressed and suicidal and was finally hospitalized.

With more intensive therapy she began recalling traumatic childhood events, opening up a Pandora's box of flooding memories. She recalled severe physical beatings by her mother and then began to remember her mother's sexual abuses—episodes in which her mother had inflicted vaginal douches and enemas and fondled her in order to “clean” her vagina. These rituals began when Elizabeth was about eight, shortly after her sister's death, and persisted until puberty. Her memories included looking into her mother's face and noting a benign, peaceful expression; these were the only times Elizabeth could remember when it appeared her mother was not disapproving.

Elizabeth recalled sitting alone in the closet for many hours and often sleeping on the floor for fear of being molested in her bed. Sometimes she would sleep with a ribbon or award she had won in school. She found these actions to be comforting and continued them as an adult, often preferring the floor to her bed and spending time alone in a quiet room or dark closet.

In the hospital Elizabeth spoke of the different sides to her personality. She described fantasies of being different people and even gave these personality fragments separate names. These personae were independent women, had unique talents, and were either admired by others or snobbishly avoided social contacts. Elizabeth felt that whenever she accomplished something or was successful, it was due to the talents of one of these separate personality segments. She had great difficulty integrating these components into a stable self-concept.

Nonetheless, she did recognize these as personality fragments, and they never took over her functioning. She suffered no clear periods of amnesia or dissociation, nor were her symptoms considered aspects of dissociative identity disorder (multiple personality)—although this syndrome is frequently associated with BPD.

Elizabeth used these “other women” to express the desires and feelings that she herself was forced to repress. Believing she was worthless, she felt these other partial identities were separate, stronger entities. Gradually, in the hospital, she learned that they were always a part of her. Recognizing this gave her relief and hope. She began to believe that she was stronger and less crazy than she had imagined, marking a turning point in her life.

But she could not claim victory yet. Like a field officer, she commanded the various sides of her personality to stand before her and concluded that they could not go into battle without a unifying resolve. Elizabeth—the core of her being—was still afraid of change, love, and success, still searched in vain for safety, still fled from relationships. Coming to accept herself was going to be more difficult than she had ever imagined.

After several weeks Elizabeth left the hospital and continued in outpatient care. As she improved, her relationship with her husband deteriorated. But instead of blaming herself, as she typically did, she attempted to resolve the differences and to stay with him. She distanced herself from unhealthy contacts with family members. She developed more positive self-esteem. She began taking college courses and did remarkably well, achieving academic awards. She slept with her first award under her pillow, as she did when she was a child. Later she entered law school and received merit awards for being the top student in her class. She developed new relationships, with men and women, and found she was comfortable in these, without having to be in control. She became more content with her own femaleness.

Little by little, Elizabeth started to heal. She felt “the curtains raising.” She compared the feeling to looking for a valuable antique in a dark attic filled with junk—she knew that it was in there somewhere but couldn't see it because of all the clutter. When she finally did spot it, she couldn't get to it because it was “buried under a pile of useless garbage.” But now and then she could see a clear path to the object, as if a flash of lightning had illuminated the room for a brief instant.

The flashes were all too brief. Old doubts reared up like ugly faces in an amusement-park fun house. Many times she felt as if she were going up a down escalator, struggling up one step only to fall down two. She kept wanting to sell herself short and give credit to others for her accomplishments. But her first real challenge—becoming an attorney—was almost a reality. Five years before, she wouldn't have been able to talk about school, much less have had the courage to enroll. The timbre of her depressions began to change: her depression over failing was now evolving, she recognized, into a fear of success.

“Change is real hard work!” Elizabeth often noted. It requires conscious retreat from unhealthy situations and the will to build healthier foundations. It entails coping with drastic interruption of a long-established equilibrium.

Like Darwinian evolution, individual change happens almost imperceptibly, with much trial and error. The individual instinctively resists mutation. He may live in a kind of swamp, but it is
his
swamp; he knows where the alligators are, what's in all the bogs and marshes. To leave his swamp means venturing into the unknown and perhaps falling into an even more dangerous swamp.

For the borderline, whose world is so clearly demarcated by black-and-white parameters, the uncertainty of change is even more threatening. She may clutch at one extreme for fear of falling uncontrollably into the abyss of another. The borderline anorexic, for example, starves herself out of the terror that eating—even a tiny morsel—will lead to total loss of control and irrevocable obesity.

The borderline's fear of change involves a basic distrust of his “brakes.” In healthier people these psychic brakes allow a gradual descent from the pinnacle of a mood or behavior to a gentle stop in the “gray zone” of the incline. Afraid that his set of brakes won't hold, the borderline believes that he won't be able to stop, that he will slide out of control to the bottom of the hill.

Change, however gradual, requires the alteration of automatic reflexes. The borderline is in a situation much like a child playing a game of “Make me blink” or “Make me laugh,” struggling valiantly to stifle a blink or a laugh while another child waves his hand or makes funny faces. Such reflexes, established over many years, can be adjusted only with conscious, motivated effort.

Adults sometimes engage in similar contests of will. A man who encounters an angry barking dog in a strange neighborhood resists the automatic reflex to run away from the danger. He recognizes that if he runs, the dog would likely catch up with him and introduce an even greater threat. Instead, he takes the opposite (and usually more prudent) action—he stands perfectly still, allows the dog to sniff him, and then walks slowly on.

Psychological change requires resisting unproductive automatic reflexes and consciously and willfully choosing other alternatives—choices that are different, even opposite, from the automatic reflex. Sometimes these new ways of behaving are frightening, but they typically are more efficient ways of coping. Elizabeth and her psychiatrist embarked on her journey of change in regular weekly individual psychotherapy. Initial contacts focused on keeping Elizabeth safe. Cognitive techniques and suggestions colored early contacts. For several weeks Elizabeth resisted the doctor's recommendation of starting antidepressant medicine, but soon after she agreed to the medication, she noticed significant improvement in her mood.

Change for the borderline involves more of a fine-tuning than a total reconstruction. In rational weight-loss diet plans, which almost always resist the urge to lose large amounts of weight very quickly, the best results come slowly and gradually over time when the weight loss will more likely endure. Likewise, change for the borderline is best initiated gradually, with only slight alterations at first, and must begin with self-assessment: before plotting a new course, one must first recognize his current position and understand in which direction modification must progress.