Loud in the House of Myself (19 page)

Another complication: there are drugs definitively proven to help the bipolar, but not so the borderline. The most promising treatment for borderlines remains behavioral therapy—specifically, DBT—in which skills training provides us with the cognitive tools to manage our symptoms. Mood stabilizers have worked wonders for me, which has led more than one psychiatrist to affirm the bipolar diagnosis. The prevailing logic about BPD has, for some time, been that the disorder does not respond consistently to medication, and as such a borderline who responds to medication must have a comorbid Axis I disorder. However, a paper recently published by the National Alliance for Research on Schizophrenia and Depression (NARSAD) refutes this logic, stating:

So there is some evidence that borderlines respond to psych meds. The problem is that none of this has been proven for sure. For so long, BPD was seen as a “garbage can” diagnosis, a name—for lack of a better one—for the patients who showed up frequently in emergency rooms and therapists’ offices, chronically threatening suicide in response to the normal vicissitudes of life. That borderlines failed to respond to traditional psychoanalysis, to the degree that Freudian therapists spoke of our “coming apart on the couch,” was further “proof” of our hopelessness.

And so we floundered, until behavioral therapy came along. For the first time, therapists saw positive response. However, given our unresponsiveness to traditional talk therapy and our tendency to drop out of treatment, due to factors such as banishing our therapists for perceived slights and failing to show up for therapy on days when we were consumed by our own personal dramas, cognitive behavioral therapy was only somewhat effective.

DBT changed all that, at least for me, because of two things: the focus on the dialectic, or gray area, between good and bad, and the strict adherence to the rules required. One of the things you hear over and over again in DBT is that as long as you haven’t been hit by a piano, you’re able to get yourself to therapy. Many times I’ve heard those in DBT say, “I just couldn’t get here,” and therapists respond, “No, you didn’t
want
to.” DBT therapists love to talk about “mood-dependent behavior,” and tell us frequently that we have the power to “act opposite” to those moods. At first, we fight:
No, you don’t understand, he broke up with me, she called me a bitch, I failed (a test, a job, a relationship, a person), I was paralyzed.
The DBT response:
Could you still move your arms and legs? Then you weren’t paralyzed.

This is, of course, infuriating, and our response to being infuriated is to thrash and wail and rend our garments. When we do this, our therapists sit quietly and wait for us to stop. And eventually, seeing that we’re not getting a response, we do stop. This ability to stop is nothing short of miraculous to us, and before long we see that, given a choice, feeling good is way preferable to feeling shitty. The outbursts get less frequent, we learn to calm ourselves down (sometimes, then most of the time), and even if we relapse and lose our shit completely, our therapists stick with us. Unless we hurt someone else or fail to show up, we can’t get kicked out of treatment (my program at Payne Whitney had a very strict three-strikes-you’re-out policy, and if you were more than seven minutes late, that was a strike. Seven minutes and thirty seconds and they wouldn’t let you in the door, period). But as long as we showed up, of which we were, surprise of surprises, capable, our therapists wouldn’t leave us. They would refuse to see us for twenty-four hours after a suicide attempt, teaching us that suicide attempts had consequences, but they would never refuse to see us simply for being difficult. They expected us to be difficult, and they didn’t abandon us. That, for me, was the most astounding aspect of treatment, and the one for which I am most profoundly grateful.

DBT can change the lives of borderlines, particularly the concomitantly bipolar. I know that most people to whom the diagnostic criteria for borderline personality disorder apply are female. I enjoy pontificating about brain chemistry and pondering the whole chicken-and-egg question as it pertains to mental illness: Did I get this from my father’s DNA or from his parenting? Did I get more of his neurotransmitters than my mother’s and that’s why we’re so much alike? Or rather, is BPD a diagnosis that could be applied to just about any young, sensitive, artistic woman? I present to you the diagnostic criteria, and I set them forth with the corresponding suggestion that you could take almost any weird girl hiding in the art classroom on her lunch breaks, cleaning paintbrushes, listening to Cure CDs, and wearing too much black eyeliner, and you could run down this list and diagnose her as borderline.

But I remember the girl I was at sixteen, the one who had no idea who she was (
identity disturbance
) and who thought sometimes she existed and other times thought maybe she didn’t (
unstable self-image
). Sometimes the only thing that seemed real was her self-righteous (
intense, perhaps inappropriate
) anger, the acid fury she directed toward the willfully ignorant, those who refused to wonder and question and educate themselves. When she thought she had found someone with a similar level of passion, she fell in love easily and the fire burned bright, but inevitably lovers disappointed her and she wondered what she’d seen in them in the first place (
unstable and intense interpersonal relationships, black-and-white thinking
). And I know I did the best thing I could for her when I got her the hell out of Prairie Grove.

The most truthful assessment I can give of my mental health at this time is that I struggle for it, and some days it’s relatively easy, and some days it’s hard. The days when I feel like I can conquer the world still alternate with the ones where I lie in bed crying. It’s just that now neither extreme is quite as, well, extreme. The eating disorder is the hardest to banish; I’ve lost way too many friendships, lovers, and opportunities over my hatred of my body and the evil things I’ve done to it. Still, I don’t know if I’ll ever look in a mirror and see what’s really there. To anyone who thinks eating disorders are something rich, bored white girls do to get attention, I bid you bite me. I have frequent, intense, inappropriate outbursts of anger over the lies little girls are told about what is beautiful.

I was the girl in whom most saw nothing and some saw everything. There were just enough of the latter to keep me alive. The Birkenstock-wearing vegetarian drama teachers, the manager at Sound Warehouse who introduced me to weird bands and cult movies, my boss at the punk rock clothing store—these are the wolves who raised me. Every one of them was, or is, some kind of outlaw. They taught me that the only thing that matters is
You, Speak
. The only thing we can do as human beings is tell our stories. In the end, that is the only power we ever had.

I will write this story on my body, anyone can read it, I will dance around the room.

It takes a posse to make a book. Here is mine:

Jill Bialosky, my editor at W. W. Norton, who plowed through a mountain of tangents and found the book at the center, and her astute assistants Adrienne Davich and Alison Liss, who are good at answering questions (and lots of them).

Penn Whaling, my agent, who took the risk, reminded me frequently to calm down, and could be counted on to whip out a rousing rendition of “Bohemian Rhapsody” when I needed it most.

Katie Boyle, Ann Rittenberg, Bonnie Egan, Marya Hornbacher, and Sydelle Kramer, who provided invaluable literary wisdom along the way.

Denise de la Cerda, Kathy Rosenfeld, Emma Feigenbaum, Amy Stephenson, Scott Bateman, Nigel Melas, Jude Almeida, Todd Whitworth, Cera Byer, Alexandra and Catherine Chandler, Jean Vink, and Paul Bloch, my besties, who loved me through the years despite the crazies, and who could be counted on to read my countless drafts. You guys kick ass, seriously.

Butch, Karen, and Cameron Pershall, my amazing family, who instilled in me the bizarre Pershallian sense of humor and allowed me to use it to write a book. Thank you for always reading to me. I love you.

Sarah Johansson Locke, Sera Solstice, and the righteous babes of Alchemy Tribal Collective and Solstice Studio, who reminded me throughout the writing process that the most important thing, always, is to dance.
Lilililililili!

William Faulkner and Flannery O’Connor, who, by singing to me, taught me everything I know about writing the music of Southern speech, and Anne Sexton, who provided the title.

The people of Prairie Grove, Arkansas, who have been overwhelmingly supportive and helpful.

And most of all, Glenn Becker, who knows the stories before I tell them and can retell them with sound effects. One day we will be cranky old tattooed people in rocking chairs on a porch, surrounded by cats, crabbing about how kids today can’t spell. I love you most and best.