You should know that some of my best friends are mental health professionals. Indeed, my best friend is a clinical psychologist and I’ve nothing against the profession per se. True, there have been occasions when the system has let me down – sometimes quite badly. Like the time when, in the immediate aftermath of a serious trauma, a trainee RMN pitched up with the suggestion that I be referred to an alcohol dependency unit without being aware of my specific circumstances (I had, as it happens, just been raped).
Or the time my GP sent me to the local A&E because I’d carved ‘Siân is a bitch’ into my forearms (yes, I even did the circumflex); the duty psychiatric nurse asked me a few cursory questions then told me to ask my doctor for a course of Prozac.
Or the time when, sensing an imminent descent into the emotional abyss, I contacted my local community mental health team to ask for help. The reply I received was courteous but patronising, more or less implying that unless I staggered into the surgery with my wrists already slashed there was nothing they could do.
The upshot of all this? The worst in short-term planning. Instead of trying to avert the crisis why not wait until it comes crashing through your front door in all its bloody glory? Those few pennies you might save by limiting preventative care will be peanuts when you’re presented with the bill for my incapacity to engage with society – and pay my taxes.
Please don’t misunderstand me. I’m not suggesting the entire NHS should rearrange its priorities to account for my every change in mood swing, and I’m sure some of you – from the Julie Burchill School of Empathy, perhaps – will be shouting at your computer telling me to get a grip. I don’t want your pity, I really, really don’t; all I’m asking for is a little more consistency and some ‘joined up thinking’.
For example: I have been, more than once, referred to a therapist of some kind but the referral always comes with some sort of proviso. Normally it’s a limited number of sessions; last time it was six which was just about time for us to get to know each other. I had the option to continue on a private basis but a recent outbreak of BPD had left me with a paltry, part-time income.
Then there was the time I struck up a productive relationship with a Freudian psychotherapist. What should have been – and did, indeed, start out as – a fractious, adversarial relationship ended up like a marriage made in heaven.
Does it sound like a physical relationship? In some ways it was – only without the intimate contact, of course – because it has to be intense. Sadly, after a summer of psychotherapy, she suddenly disappeared. I never did find out what happened to her; I managed, eventually, to get an appointment with someone else but when I told him I was feeling better he declared me fully restored to health and no longer in need of therapeutic support.
Three months later I was up to my old tricks again and never really let up for the best part of eight years. I should add that in all that time various GPs, medical professionals and even the police were nothing less than understanding; what constrained them, what we were all fighting against, was – still is – an inflexible, unimaginative system. A system that insists that mental illness is no longer taboo but hasn’t yet worked out how to deal with it. Whether through ignorance, lack of funding or wilful desire, it just doesn’t take us seriously.
But I’ll say it again. I don’t want your pity and I certainly don’t want to stretch the resources of an increasingly-underfunded public service which, in any case, can’t offer much more than a metaphorical plaster and a patronising pat-on-the-head. On the basis that prevention is usually better than cure what I would really like to see is a radical rethink on the nature of BPD; of what it means to be sane or insane. It’s an argument that is more sociological than medical because BPD is as much a political condition as a psychological malady.
In Madness Explained, an excellent exposé of the myths surrounding mental health, Richard P Bentall argues that mental illness is not a product of brain dysfunction than can be cured – usually with medication – but a series of symptoms only a minority of which cause significant problems for the ‘sufferer’. In the words of one Amazon reviewer ‘I go to the doctors and they want to drug me to get rid of everything ‘wrong’ with me and flatten my personality … when only 10% of these symptoms are actually causing me any distress!’
Perhaps we should dissect the nomenclature. According to Bentall, the term Borderline Personality Disorder was coined to ‘describe a type of personality characterised by extreme emotional instability, severe problems of self-esteem, self-destructive behaviours and intense and unstable relationships with others’. All well and good; that’s an accurate-enough description of my own condition but phrased in a manner which would seem to render me pretty much incapable of living anything resembling a ‘normal’ life.
Not that I’ve any desire to live a ‘normal’ life; sounds like complete and utter madness to me. The fortunate truth is that I’m perfectly capable of being a fully-functioning, productive member of society – for most of the time. There are certain environments in which I couldn’t survive: the office, the nine-to-five; the corporate world or the micro-managing boss. But within the relative freedom of self-employment I thrive.
But society loves labels; whether it’s class, race, gender or sexuality it insists on packaging the relevant behaviour and prescribing it as the norm. Then capitalism comes in and sells it back to us; we no longer live lifestyles, we consume them.
Society will tolerate a certain amount of variation from the norm – the English love an eccentric, after all – but it also has its boundaries and when we transgress them we are considered deviant.
Deviant, disordered and, sometimes, dangerous.
Because that’s what it all boils down to, isn’t it? My personality is on the borderline; the borderline of what? Of what society perceives as functional and dysfunctional? Normal and abnormal? If, during a period of intense emotional distress, I feel compelled to cut myself I am doing so for a reason. I don’t expect to be condemned for my behaviour and even on the warmest summer day I’ll cover up the scars to spare your distress.
The problem is that the cutting comes with the territory; it’s a coping strategy to deal with a society I consider to be alien and hostile (there’s the paranoia talking) and any attempt to treat it, to remove it from my emotional repertoire, would be tantamount to a full-frontal lobotomy. It would kill my creativity, imagination and character stone dead.
Your sanity is my insanity; your chaos my order. Madness is as much environmental as it is neurological, if not more so. I’m a bit like a snake in the grass: leave me to my own desires and I’ll cause you no harm; trap me and try to change me and I’ll do my best to bite back.
If you missed Part 1 of our BPD trilogy, it’s here.
Siân is author of The Society of Sin, a Victorian Goth-erotic fiction inspired by her Dorset connections, and is currently in the process of publishing her autobiographical novel Death by Eyeliner. You can find out more about her here.