Very Rough (and Incomplete) Prologue

Ok. I put this down yesterday. The idea is to provide a little background before launching into the main text.  Having never done anything like this before, I’d be happy to get any feedback you might have…

Prologue

I don’t know how long I’ve met the diagnostic criteria for Borderline Personality Disorder (BPD). My other mental health issues, bipolar disorder, eating disorder, substance abuse disorder, were much more obvious and readily identifiable to both myself and the slew of mental health professionals I worked with over the years. Of course, in retrospect, none of the other disorders can hold a candle to the destruction that BPD had wrought on my life.

Bipolar disorder has its ups and downs (pun intended).

The depression leaves me wracked with suicidal ideation, searching for a reason, any reason, to go on living. There is no meaning to anything… what’s the point in working? what’s the point in family? just, what’s the point? I carry myself around as if I weigh several tons. I’m definitely not one of those depressives that manages to paste on a happy face when with others, only to break down sobbing in the solitude of my own room when I finally get a moment to myself. No, I fucking wear that shit like a badge of honor. I feel like shit and I have neither the inclination nor energy to pretend otherwise.

While I’m in a depressive state, it feels like I’ve felt that way since the dawn of time and will continue to feel that way until I eventually draw my last breath, which I sometimes attempt to bring about a bit sooner than nature seems to want to dictate. I’m miserable to myself and pretty damn miserable to anyone who is foolish enough to try to be around me. Negative self-talk (a.k.a. verbally beating the shit out of one’s self) becomes run of the mill. Ruminating on all the harm I’ve caused others becomes a mindless equivalent of daytime television (especially, when I can’t get out of bed to make it in front of an actual television).).

I despise being depressed. I know I have no good reason for ever feeling that down, even when I am that down. That tends to make it even worse. Of course, and I’m evidently quite capable of maintaining this particular cognitive dissonance, I also know that bipolar depression, or any ‘flavor’ of depression for that matter, is a completely legitimate disease and a very, very valid explanation for feeling like you are the scum of the earth.

Now, mania, on the other hand, is something I have no real problem with (mostly) and will typically welcome (again, mostly) on the somewhat less frequent schedule on which it chooses to make its appearances. I feel like I hit the mental illness jackpot when I feel mania start to creep into my life.  And, why not? Before I gave up alcohol in favor of hard drugs, I had no real way to relate the feeling to others in my life. Now that I’ve partaken of such substances as cocaine and crystal methamphetamine, and am surrounded by individuals who have done the same, drawing a parallel becomes ridiculously simple: being manic is roughly equivalent in feeling (and resultant craziness) to using a fairly substantial upper, without actually getting high.  Who wouldn’t like that?

I throw out the word ‘mostly’ because there are, like any quality mental illness, negatives associated with such a state of being. For one thing, I tend to get a lot of ideas that I think are fantastic. I’m flooded with brilliant ideas. If only there were enough time to enact them all. (There actually is a lot more time… one of the symptoms is a marked decrease in the need for sleep.  I typically will drop to, not just getting by, but actually thriving on 3 or 4 hours of sleep, typically for weeks on end.) Not surprisingly, a great deal of these ideas are steeped in grandiose delusion. If I’m lucky, I won’t actually enact any of my plans or, maybe, just one or two. They typically don’t end well. More on that later…

So, yeah, bipolar disorder has fucked with my life somewhat, but it does have the benefit of being, principally, a neurochemical disorder and, as such, can be kept partially at bay by a strict psychopharmaceutical regime. As far as psych meds go, I’ve been through quite a few: mood stabilizers (Depakote, Lamictal, lithium, etc), antidepressants (Prozac, Lexapro, Effexor, etc) and atypical antipsychotics (Abilify, Latuda, Risperdal, etc). I’ve also finagled (doctor shopped) for stuff I didn’t need.  For instance, when I realized I was dealing with an eating disorder, in addition to my mood disorder (BPD was still yet to be mentioned), I snagged a prescription for Topamax. I honestly don’t even remember what class of drug Topamax belongs to or what I said to justify getting the prescription. I do know that one of its main side effects was a significantly reduced appetite. That was the sole reason why I wanted that drug. It worked… until my treatment team realized I was using it to facilitate starving myself, at which point I was promptly cut off.

I guess that makes for a good segue into the next of my significant mental illnesses: my eating disorder (ED). My disordered eating usually manifests itself as bulimia, though I have been ‘blessed’ with a couple rounds of anorexia. Since the ED tends to be all over the map, I think my formal diagnosis has always been EDNOS (Eating Disorder – Not Otherwise Specified), although I think that’s from the old DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, version 4).  The DSM-V came out in 2013 and the name for that diagnosis is now OSFED (Other Specified Feeding and Eating Disorder), though I can never seem to remember how that acronym breaks out and, so, still just use the EDNOS nomenclature.

Now, although there is a history of ED in the family (three generations, all men, me, my father and my son), one of the nine symptoms of BPD, from our beloved DSM is:

  • Impulsive and often dangerous behaviors, such as spending sprees, unsafe sex, substance abuse, reckless driving, and binge eating.

I would typically chalk up binge eating (and the subsequent purging) mentioned in the BPD symptoms as coincidental, were it not for all those other dangerous and impulsive behaviors that are also mentioned (and the other 8 BPD symptoms, as well). I do take some umbrage with the ‘reckless driving’ behavior. I readily acknowledge being a poor driver and typically try to not get behind the wheel whenever possible, but that doesn’t necessarily make me reckless. Actually, now that I think about it, I do have a history of driving under the influence (though I was never caught), which, I must acknowledge, is pretty damn reckless. Anyway, what I’m getting at is, I believe my unhealthy relationship with food is directly attributable to my BPD.

Similarly, I also believe my history of substance abuse, from alcohol and weed through heroin and meth, originates, ultimately, from my BPD. I firmly conclude that whatever it is that drives me to throw up my food, also leads me to stick needles in my arms (and also causes other ‘maladaptive coping mechanisms’, e.g., self-harm).

So, I think it’s time we get to the crux of why I’m writing this which is predominantly to allow, hopefully, people who struggle with an affliction such as this, to know that they are not alone or, in 12-step speak, to give those people the opportunity to ‘identify, not compare’… and, perhaps, to give people not familiar with BPD a brief glimpse into what is actually going on inside the head of a mentally ill, eating disordered, drug addict (trust me, it’s not a fun place to be).

In their entirety, the symptoms of BPD are:

  1. Frantic efforts to avoid abandonment, whether the abandonment is real or imagined
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
  3. Identity disturbance, such as a significant and persistent unstable self-image or sense of self
  4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
  5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
  6. Emotional instability due to significant reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
  7. Chronic feelings of emptiness
  8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
  9. Transient, stress-related paranoid thoughts or severe dissociative symptoms

It takes any 5 (or more) of those symptoms to be diagnosed with BPD. That’s a total of 256 different combinations that could potentially land you with the diagnosis. I didn’t do the math… I looked it up. Regardless, that’s a lot of different ways that having BPD could occur. Couple that with a health insurance industry that can sometimes be reluctant to treat it because (1) it takes a long time to treat properly (i.e., it’s expensive) and (2) until the relatively recent advent of Dialectical Behavior Therapy (DBT), it’s prognosis wasn’t particularly good (so, why spend the money).

Of those symptoms, I have, well, all of them. Sometimes an individual symptom will wax or wane periodically, but they are all there. I’ll go into these in more depth as I go into the stories I tell. Just to give an example, though, let’s take a quick look at the first symptom, which basically centers on irrational fears of abandonment. I’m currently working my drug addiction recovery through a program called Refuge Recovery. Refuge Recovery is a, sort of, Buddhist-based version of Alcoholics Anonymous or Narcotics Anonymous. In Refuge Recovery, I have a mentor, James, who is helping me to work through my underlying issues behind my drug and process addictions. I am currently so worried about James just flat out not wanting anything to do with me, because I am just too fucked up to be bothered with, that I have started to not share everything I probably should. In the last few days, I have written multiple, detailed text messages, describing my current thought processes, only to freak out and delete everything, lest he sees how truly crazy I am.

That said, I’m about to disclose exactly how crazy I am, so I guess that worry, upon publication of this memoir, will rapidly become moot. Anyway, on with the show…

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