December 17, 2024 • 38 mins
In the stories about Borderline Personality Disorder that Mala was familiar with, a borderline woman was always toxic – intense, erratic, angry, manipulative. And she was almost always the villain in someone else’s story. But no one ever talked about the *source* of the intense emotion – what was at the heart of it.
More to read about borderline:
I'm A Black Woman with Borderline Personality Disorder | Business Insider
Why I'm Distancing Myself From My Borderline Personality Disorder Diagnosis
Diagnosis of Borderline Personality Disorder Is Often Flawed | Scientific American
How Infinite Jest tethered me to life when I almost let it go | Aeon Essays
Borderline Personality and Self-Understanding of Psychopathology | Psychiatry At the Margins
I Have Forgiven Myself for My Pre-Diagnosis Recklessness | by Zuva Seven | An Injustice!
Skill Issues | Dialectical Behavior Therapy and Its Discontents
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hey there, I'm doctor Maya Schunker, and I'm a scientist
who studies human behavior. Many of us have experienced a
moment in our lives that changes everything, that instantly divides
our life into a before and an after. On my
podcast A Slight Change of Plans, I talk to people
about navigating these moments. Their stories are full of candor
and hard won wisdom, and you'll hear from scientists who
(00:22):
teach us how we can be more resilient in the
face of change. Listen on the iHeartRadio app, Apple Podcasts,
or wherever you get your podcasts.
Speaker 2 (00:31):
Hey, it's okay. Basket Case gets into some heavy topics
about mental health, and this episode contains references to self harm.
Please take care while listening.
Speaker 3 (00:41):
One analogy that I've given is uh to try to
explain it to people, is like, imagine that you felt
like you're being crushed to death. How much would you
do to escape that feeling? And I think that is
what's driving it so much. It's like you feel like
you've been crushed to death, Like how far would you
go to escape that feeling? But then what's terrible is
that if you cause destruction, now you have to deal
(01:03):
with that Wras's gonna want me, Mason's gonna want with
what person's gonna want me? When I have depression an anxiety.
Speaker 2 (01:13):
This is basket case. I'm enke so. In the earliest
versions of the DSM, the ones most influenced by Freudian thinking,
people experiencing mental distress were sorted into one of two categories,
psychotic or neurotic. Psychotics were characterized by an unstable relationship
with reality, and neurotics were suffering from repressed anxiety and
(01:36):
a general melancholia. But some patients appeared to have characteristics
of both neurotic and psychotic personality. Their moods would oscillate
between melancholy and mania, and their perceptions of reality were
not considered reliable. They were on the borderline between psychosis
and neurosis. Between the nineteen thirties and nineteen seventies, this
way of being was given different names, emotionally unstable, care
(02:00):
character disorder or borderline schizophrenia. The label borderline personality disorder
or BPD was formally recognized by American psychiatrists in the
nineteen sixties, and it was included in the d S
III in nineteen eighty. Officially, BPD symptoms include emotional instability, impulsivity,
distortive thinking or distorted perceptions of reality, and a pattern
(02:23):
of intense and unstable relationships. From the beginning, BPD was
a somewhat controversial diagnosis, and its legitimacy is still being
debated today. Among mental health professionals, it's considered one of
the most difficult mental illnesses to treat, and it's also
incredibly stigmatized because borderlines are also known as unreliable narrators,
(02:45):
as manipulative and untrustworthy, as difficult to work with in
a therapeutic context, and for this reason, therapists sometimes refuse
to even work with borderline clients. But there is a
growing discourse at the intersection of gender studies, disability studies,
and philosophy that's based on the idea that a borderline
worldview is valid and that there is such a thing
(03:06):
as a borderline way of knowing, thinking, and feeling that
isn't necessarily disordered because it's.
Speaker 3 (03:12):
Really philosophically, really philosophically interesting. I was a big part
of why when starting to thinking right about mental philosophically interesting.
Speaker 2 (03:22):
This is Mala. She's a law professor who recently wrote
about her experiences being borderline for the LA Review of Books.
While I was researching this episode, I noticed that many
women of color, especially black women, seem to be disavowing
their BPD diagnoses. Instead, they attribute their symptoms to complex trauma,
the trauma of being black women and femmes in a
(03:42):
society that punishes them for it. But Mala embraces and
appreciates her diagnosis. For Mala, it's been a useful framework
and for her there's a clear dividing line, Mala before
BPD and Mala after.
Speaker 3 (03:57):
Yeah, it had incredibly tense emotions my whole life, Like
I have this best friend. I joke that he's the
person who has suffered the most from the outputs of
my VPD, because we would have fights and.
Speaker 2 (04:13):
I would Malla at Christen College when they were eighteen.
Chris isn't his real name. They were both philosophy majors,
and they both belonged to a community of weirdos, the
freaks that they're prestigious and otherwise very traditional and somewhat
conservative college. From the beginning, their friendship was rooted in
talking about the things they both loved. The music they
(04:34):
listened to, the movies they both liked. Malla loved all
kinds of psychedelic music and going to raves, and she
would take Chris with her. They got close, their friendship
felt deep, but then Malla started seeing Chris differently. She
felt that pull, that ache, a crush and because of
the crush, which for whatever reason, Chris didn't reciprocate, but
(04:57):
because of the crush, Mala was extra sensitive to the
way Chris treated her. That wasn't the issue, honestly, that's relatable,
but I felt.
Speaker 3 (05:06):
It so intensely, and what it moved me to do
was latch out, like send him a bunch of rage texts,
and I would feel shame about it, and I would
seek validation from like friends, like do we all agree
that like this was insensitive? And the answer to be, yeah, yeah,
that was for sure, but no one would say this,
(05:28):
But like, I also know it's the case that my
other friends like wouldn't respond that way to the same
you know, insensitivity, And the way that I did it
was almost like I thought the intensity of the emotion
was it self evidence that I was right about what
I was feeling so intensely about, And so that was
(05:49):
a kind of recurring phenomenon, particularly with relationships that were
especially close to me and that I most wanted affection from.
We didn't want to be abandoned by.
Speaker 2 (05:59):
But despite these relations flare ups, Chris stuck around. They
both did. They even kept studying philosophy together in the
same master's program. And then Malla introduced Chris to another
good friend. I'm gonna call her Naomi. Naomi and Mala
had been close since college. Naomi had also studied philosophy,
but where her friendship with Chris was intellectual and aesthetic,
(06:20):
Malla's friendship with Naomi was built on a deep emotional intimacy,
in ability to talk transparently about their feelings and experiences.
When Naomi met Chris, they vibed. Naomi felt that pull,
Chris felt it too. Chris and Naomi fell in love.
When Malla thinks back to this time in her life,
(06:42):
it says if she was two different people at once one.
Mala loved both Naomi and Chris and thought they were
good for each other. She wanted them both to be
happy together. Processing was a feature of this friend group,
also relatable, so there was lots of checking in about
Chris and Naomi's developing reallyationationship. Malla would talk to each
of them individually, and then the three of them would
(07:04):
talk together, very mindful. There was a lot of trust
between them, and curiosity and vulnerability as the three of
them really tried to understand and reassure each other.
Speaker 3 (07:15):
This.
Speaker 2 (07:15):
Mala did not want to ruin her friend's relationship, but
the other Malla couldn't stop thinking about the past, about
having feelings for Chris and what it felt like when
he'd softly rejected her. She couldn't stop thinking about how
she'd once felt neglected in their friendship, how he hadn't
always been careful with her feelings. That Mala also felt
(07:36):
betrayed by Naomi. How could Naomi, someone who claimed to
care about her, allow herself to fall in love with
the person who had treated Malla so insensitively.
Speaker 3 (07:49):
But then there would be moments my mind would fix it,
and I'd experience the swell of intense emotion, and I
would feel the need to express to her rage, like
I can't believe you could even be with this person
that like caused me pain in the past, and like
(08:12):
how I don't understand you know. And then and then
this person that this person that like caused me pain
in the past. And the thing that I remember very
distinctly is this was this was obviously very painful for
(08:34):
her because she felt very, very conflicted. He and I
would have my fulldoutful conversations where they would ask, is
it that you want us to not be together? And
like they were falling in love, and I said, no,
that's not it. You know, we're all trying to thoughtfully
navigate the situation.
Speaker 2 (08:51):
But most of all, she feared being replaced. That once
krist and Naomi had each other, there wouldn't be any
more room for her, and once that feeling, the fear
had grabbed her, it wouldn't let her go.
Speaker 3 (09:04):
You're kind of spiraling, and you feel like you're losing
grip and you're replaying stuff. You're going through it again
and again, making the argument again and again. You're fixating.
And I always felt I guess it's kind of two
sides of the same coin, one being sort of taken
(09:25):
by the intensity. The intensity of it, the sense that
it controls you. It drives you to do things that
don't feel like reason choices, even if the emotion like
the thing that you feel, I feel left out like
feel in that sense is something many people would feel,
but feel in the sense of like the phenomenal quality
(09:49):
of this emotion and the intensity of this emotion, the
crushing feeling, and the overwhelmingness, the all consumingness, that you
can't put it out of your mind and you have
to act on it.
Speaker 2 (10:01):
As her feelings intensified, as her hurt turned to anger
and then to rage, Mala couldn't escape that pressure.
Speaker 3 (10:09):
And it's because you're suffocating with the weight of this emotion,
and your instinct is to cause harm.
Speaker 4 (10:16):
To the source of the emotion, like it's yourself or
it's some person. But it's not because you want to
harm this person so much as you don't want to
feel this feeling anymore.
Speaker 2 (10:27):
Malla held her phone in her hands, thinking about Naomi.
She felt desperate to escape the force of her own emotion,
her fear of being left behind, of losing Naomi and Chris.
With every minute that passed, this swell of emotion inside
became more and more unbearable.
Speaker 3 (10:43):
And I just sent her a long text saying I
don't think we can be friends right now. And it
was just like a rage text in the middle of
the day, sort of out of nowhere, and it was
really sort of driven by like impulse and pain and
not mindful at all of the impact that that would
have on her, and it had a really really really
(11:04):
bad impact on her.
Speaker 2 (11:05):
And then setting the text, does it bring relief or
does it just bring like a different smell of emotions?
Speaker 3 (11:10):
Yeah, so it does bring relief, but then yeah, brings
different emotions. I think the best example of this kind
of a response is cutting. It's something that happens in
a moment of intense, intense, intense emotions and a desperation
to escape it. It's a desperation to feel something else
(11:30):
and to also release this rage. And so what happens
you cut yourself, You experience some relief, but then maybe
after your like, fuck now I have to contend with
this other thing that just.
Speaker 2 (11:45):
Happened, Naomi wrote back.
Speaker 3 (11:47):
She responded saying, like, I'm so hurt that you would
send me a message like this. We've been working so
hard and having all these mindful conversations and just like
just throw in the towel, And I think the break
needs to be in death it and it took us
a long time to actually feel our friendship. If you
(12:07):
cause destruction now you have to deal with that, and
probably now you have other emotions that further crossed to you,
and it's a terrible feedback loop that you end up in.
Speaker 2 (12:23):
That loop was the overwhelming emotions requiring relief, relief that
came in the form of lashing out, and the shame
that followed, which would eventually require its own outlet, repeating
the cycle. That loop was not something that Mala before
BPD could see, and admitting that maybe she was the
source of someone else's pain was terrifying, but.
Speaker 3 (12:45):
Then also kind of wanting validation because the intensity just
made me feel crazy. I would feel a kind of
need to talk through whatever I was upset about with
my friend runs a lot and say like, am I right?
Speaker 2 (13:01):
Am I?
Speaker 3 (13:02):
Right? Am I crazy? Like isn't this so bad? Isn't
this fucked up? The reason that it had to be
that I was justified is that if I wasn't justified,
I just caused so much pain. The narrative has to
be that I was justified in doing that, because the
alternative is that I'm a toxic, fucked up person.
Speaker 2 (13:26):
I've told you that Mala attended a prestigious university and
that she's a lawyer and the philosopher, and lately a
published author. She's now a law professor at a different
prestigious university, and that's because she's channeled her intensity into
academic and professional achievement. It's like an engine that propels
her upwards, keeps her head above water, keeps her from
(13:46):
sinking back into what she calls the darkness, the darkness
that's been there since she was a kid. But a
few years ago, Mala slipped in her bathtub and wound
up with a concussion. For a period of time, she
wasn't able to move much or do much of anything.
She spent weeks at home on her couch in a
major depressive episode, reading the same book over and over.
(14:08):
Without the engine of her ambition pushing her forwards, she
struggled to justify her own existence. She thought about ending
her life a lot.
Speaker 3 (14:18):
Took a bottle of pills or whatever, and then I
sort of that moment, I had the wherewithal to text
my friend, and then she took me the emergency room.
And this emergency room doctor, it's like random dude is
asking me some questions. Spue's like thirty seconds with me,
and all he knows is that I tried to kill myself.
(14:38):
He says, you might have borline personality disorder and then
just walks away. We didn't go through the criteria. It
just says this and just walks away. Obviously, I'm like
what And this became this very dark, like a darkly
funny moment in my friend room because apparently in my
state of being drugged, I said, does he know who
(14:58):
I am?
Speaker 2 (15:00):
You were familiar with borderline though, like that label meant
something to your.
Speaker 3 (15:03):
Yeah, the label did mean something to me. I associated
it with this image and the media, the villain image,
just the toxic, manipulative girl by antagonist, very very erratic emotion,
very unstable who in my mind, there was no vision
(15:25):
of herterier life. And that is the image that I had,
not the person that anyone wants to be.
Speaker 2 (15:35):
We're going to get into that image of the toxic
borderline woman after the break. At the same moment that
(16:00):
the BPD was added to the DSM in nineteen eighty,
the DSM's authors finally removed another long standing diagnosis, hysteria,
a maybe physical and maybe mental affliction that only affected
cis gender women. Accounts of hysteria date back to ancient
Egypt and ancient Greece. The word hysteria actually comes from
the Greek word for uterus. Greek physicians believed that the
(16:23):
uterus could wander around the body, disrupting a woman's emotions
and physical health in the process. Early hysteria treatments involved
dangling pleasant smelling substances near the genitals or foul smelling
substances at the mouth in order to lure the uterus
back into its proper place. And that's sorry, but that
(16:44):
is funny. Later at medieval and Victorian doctors also believed
it was caused by malfunctioning reproductive organs, but they opted
to treat it with hysterectivies and sometimes also with medically
induced orgasms. And I really urge you to google Victorian
vibrators if you are not already familiar. Symptoms of hysteria
included irritability, insomnia, anxiety, water weight, and having sexual desires
(17:10):
and being crazy enough to talk about them. Then, in
the early twentieth century, Daddy Freud located the cause of
hysteria not in the bodies, but in the minds of
women and in the experiences they were having as women
in society hysteria was ultimately discredited in nineteen eighty, deleted
from the DSM and considered a bygone Victorian relic, and
(17:30):
at the same time VPD was added, though I should
say that there were psychiatrists who opposed that decision. But
it's kind of hard not to see the connection between
borderline and hysteria, especially because today around seventy five percent
of people diagnosed with BPD are CIS women. People who
question whether BPD is even a legitimate disorder think that
(17:52):
the diagnosis plays into paternalistic stereotypes about women, that they
were erratic and overly emotional by pathologizing what they considered
to be a reasonable response to living in a society
that is hostile to women.
Speaker 3 (18:05):
Borderline has these roots in female hysteria, in this condition
that physically only women could have that doesn't exist, right,
and then more women get diagnosed with it, and then
we keep associating it with women, and then more women
get diagnosed with it because we keep associating it with women.
This kind of like feedback loop, you know, roughly similar
(18:26):
symptom inhabiting individuals. If there are women, they get diagnosed
with borderline more, and if they're men, they get diagnosed
with complex PTSD.
Speaker 2 (18:33):
More it's been suggested that when CIS men exhibit classic
BPD symptoms, they may be more likely to receive a
diagnosis other than borderline, like antisocial personality disorder, and one
recent study in the academic journal Transgender Health found that
trans and gender not conforming people are even more frequently
diagnosed with BPD than cysgender women. But in the popular imagination,
(18:58):
the borderline diagnosis continues to be most strongly associated with
CIS women, who are at best tragic and at worst
vindictive and inconvenient, out of control, erratic, needy, hysterical. In
pop psychology books like nineteen eighty nine S I Hate You,
Don't Leave Me Understanding the borderline personality or nineteen ninety
(19:19):
eight s Stop Walking on Eggshells, Taking your life back.
When someone you care about has borderline personality disorder, borderline
women are talked around or about. They're rarely spoken too,
through the villains and someone else's story, which tracks with
the images we find in pop culture where borderlines are
rarely depicted as complex subjects. Girl Interrupted a BPD memoir
(19:43):
is perhaps a notable exception, and that story the main
character narrates her own experiences of being treated for BPD
in a psychiatric facility, but the borderline woman is usually
cast and the role of the antagonist someone more like
Alex in the nineties erotic thriller Attraction, hurt and angry
and insistent. After the end of her affair with Dan,
(20:05):
a married man, Alex transforms from a person to an
obstacle for the previously happy and stable family to overcome
spoiler alert, they kill her at the end. Like Malla
said earlier, Alex is not the person that anyone wants
to be. This popular image of the toxic borderline woman
(20:26):
and the stigma she reflects, is one of the reasons
that people who suspect they might be borderlined don't seek help.
They don't want to see themselves in that image. But
as Mala wrote in her essay, stories like these are
not describing what BPD is.
Speaker 3 (20:41):
But rather the shadows that it casts, the outward reverberations
rather than what seeds inside.
Speaker 2 (20:49):
And when what sees inside fails to be recognized, not
just seen, but held and witnessed, the isolation and anger
that borderlines feel can lead to the very rejection and
abandonment that they fear.
Speaker 3 (21:01):
The most lack of any understanding or representation of voice
given to what the borderline is experiencing makes all of
the focus on how we affect other people and the
people that are affected by us and what it suggests.
And maybe it's not conscious, or maybe it is like, oh,
(21:22):
we've given up hope on the borderlines, like they're never
going to be anything other than toxic and manipulative and whatever.
All that matters is like people who have the ill
fortune of knowing them, right, I think there's kind of
a self fulfilling prophecy in such a sad way.
Speaker 2 (21:43):
After the er doctor's casual and unsolicited diagnosis, Malla went
home in a kind of daze and told her boyfriend
what the doctor had said. Mala's boyfriend, Brian, now her partner,
was sensitive and thoughtful like Mala. Before they started dating,
other people had told her that he was unfathomably kind.
Mala loved that with her. He was so empathic. He
(22:03):
had been close to someone with the mental illness before,
and he's like.
Speaker 3 (22:06):
Yeah, that was really fucked up. And then he says,
but also, you might you might look into it before
I say with what he's like, Yeah, I mean, you
just feel so much pain, Like obviously when he said
was fucked up, and like he didn't have any day
of saying that. But you do go through so much
(22:27):
and it happens really fast, and it's so intense. And
I think, Betty is what borderlines experience is really really
intense emotions that suddenly come on. Maybe there's a dish
at all help that you can get. And then he
just like changes the subjects. I'm looking at him like
what the fuck? And I started spiraling a little bit
(22:48):
in my mind. I had literally never heard anyone describe
borderlines before as people in pain. Ever, I was like,
to other people not feel controlled by their emotions, and
he was like, yeah, people bury their emotions all the time.
And I was like, that feels literally impossible to me.
(23:12):
I actually have no idea how that is even possible.
If you are in boiling water and you've just never
felt you have never felt the other water, it's really
difficult to glean that without help.
Speaker 2 (23:28):
And the stories about borderline that Mala was familiar with,
no one ever talked about the source of the intense emotion,
what was at the heart of it. So this observation
became a wide open door. Malla felt curious and she
stepped through it.
Speaker 3 (23:44):
I just started to notice by reactions more like him
saying this. Dropping this framework in my mind was what
enabled me to have a little bit of space to
clock my emotional responses to things. The big day that
(24:05):
I saw it in me, I was walking to the subway.
The sun was shining, and I was having one of
those moments of like euphoria where I was like, Wow,
everything is great. I feel so much better. Life is fabulous.
All my problems are solved forever. And I even send
a text to like my girlfriend's group chat because I
had been talking to them the night before about how
(24:27):
I was depressed, and I was like, ugh, I'm doing
so great right now, guys. The sun is shining, like
it's all good, everything is fixed. I'm vibing.
Speaker 5 (24:37):
And and then like literally later that day, I.
Speaker 3 (24:48):
Come back home and I lie down on my bed
and I feel overcomp with like the most intense depression.
It's like intense isn't like psychedelic intense, like you know
when depression is really bad, it's like you're tripping. It
was like that where I just felt swallowed, and then
(25:12):
Brian comes over my partner, and I'm trying to talk
to him. I feel that feeling of like I'm in
a prison right now, Like I'm the tripping I'm in
a prison, Get me out of here. And I'm just
kind of looking at him and he's looking at me,
and I have this sense that this person doesn't care
(25:33):
about me. He's presenting this, he's questioning everything, like just
overcome with what I think. We're truly paranoid thoughts. I
go to bed, I wake up, and I like look
back on the arc of this day, and it really
does feel like like I just went on this insane
journey and it doesn't make sense to me. And so
(25:54):
I'm really seeing like this happens a lot, but this
was the first time I really saw that it didn't
make sense.
Speaker 2 (26:06):
A lot of the discourse about Borderline suggests that its
impact is most felt on the level of interpersonal relationships,
but privately alone, Mala was also experiencing a kind of
emotional whiplash. She was constantly being pulled from one reality
and then smashed into another without warning.
Speaker 3 (26:25):
These episodes happen like multiple times a day, and then
you are trying to make sense of the you that's
like persisting over time in these episodes, and it's extra
puzzling because you can feel really alienated from yourself an
(26:46):
hour ago, like multiple times in one day. But when
you're in it, it's like, this is the most important
thing in the world. I was wrong all along when
I didn't feel this way. When you're in it, you
believe that it's the real you. I can feel I
was in one world five seconds ago, and like now
I'm in a different world and I have to make
(27:07):
sense of what just happened.
Speaker 2 (27:09):
Interesting can't necessarily explain or predict when that shift will occur,
but you are aware when the shift has happened.
Speaker 3 (27:17):
So this is the trippiest thing. So my favorite book
is Infinite Jest. I think it's like the best book
that I have read exploring mental illness. And it gives
this analogy and one then Yette, a kid wakes up
from a nightmare, looks on the floor. I sees a
face on the floor, a terrifying face on the floor,
And as he sees the face, he comes to believe
(27:37):
like this face has been.
Speaker 2 (27:38):
There all along.
Speaker 3 (27:40):
And this idea of when you're in it, you believe
now I'm seeing the truth is so overwhelming that to
be able to from within tell yourself, no, you're having
a distress episode is the great Jedi mind trick. You
(28:01):
need to be able to pull off in order to
just get out of the distress episodes.
Speaker 2 (28:06):
Looking back on that day, Malla realized that she couldn't
always trust that what she was feeling was reality. But
the experience also taught her that, with help, she could
learn to separate her feelings from facts. That's after the break.
So there was Malla before and Mala after. Right, What
(28:29):
distinguishes Mala before from Mala after is a framework. Her
official diagnosis of BPD allowed her to see herself as
separate from the symptoms and the behaviors that borderline caused,
and her new narrative that a borderline woman was simply
a woman in pain, that she was a person in
pain that was something she could work on.
Speaker 3 (28:50):
It was kind of like a mind's blowing experience. I
think one way that I also describe it is like
it simultaneously both validated and debunked my intense emotions and
like this suffering that they caused me, Because on the
one hand, it's telling me, like, yeah, you have really
(29:11):
intense emotions, like you're not imagining that, Like you you
experienced really really tense emotions. I'm much more intense, not
with people's that's real. But at the same time, like
you experience really a tench emotions, like they're not the
same with other people's, and like that should give you
pause with acting on them. So it both gave it
(29:31):
empowered me to both feel validated and liberated about my emotions.
Speaker 2 (29:38):
The diagnosis gave her a way to make sense of
her past experiences and a new way to understand herself
and the present. It also gave her the language she
needed to articulate her experiences, her pain to the people
in her life most impacted by her actions.
Speaker 3 (29:51):
It was interesting, actually to talk to my friends about
it post diagnosis. One thing they said is it never
struck any of us that you were being on reason
about this was wrong or this was insensitive. It was
always just that the emotions were so intense.
Speaker 2 (30:09):
The main mode of treating borderline personality disorder is called
dialectical behavioral therapy or DVT. It's a talk based therapy
designed by an American psychologist, Marshall Lenihan. Lenihan was borderline
herself and she saw a need for a therapeutic modality
that would be effective for people who suffered because of
their emotions, especially people prone to self harm and thoughts
(30:31):
of suicide. The d and DBT dialectical describes the process
of combining two contradictory ideas into one cohesive new idea.
In the case of therapy for borderlines, Lenihan wanted to
guide patients to hold both the need for self acceptance
and the need to change.
Speaker 3 (30:49):
It's very effective because when you're in it, you're thinking, oh,
I need to burn everything down, I should quit my
job and my relationship, I want to hurt myself. And
what deact will be ever will he tries to do
is say, okay, well, if those things are true, they
will still be true after you're out of the distress episode.
Speaker 2 (31:09):
Distress tolerance is one of the primary DVT skills, a
strategy to help people navigate painful feelings in the moment
and cope with them.
Speaker 3 (31:17):
Distress tolerance is about like helping people who like me,
when in distress their instinct is to hurt themselves or
hurt other people, to be able to not do that.
That's literally what it's about. It's about don't hurt yourself
and don't hurt other people.
Speaker 2 (31:33):
It's not, And in that way, DVT can be literally
life saving, since around one in ten people who receive
a borderline diagnosis eventually turn to suicide for relief from
their pain. But like almost of therapy, DVT isn't without critics,
some who say that it doesn't focus enough on the
broader social conditions that can cause mental distress in the
first place. And that critique might sound familiar to regular
(31:58):
listeners of this program, but Mala hates that argument.
Speaker 3 (32:04):
One reason that I get really irritated by these sort
of like quote unquote leftist critiques of like behavioral therapies.
It can be true that all this stuff is the
product of all kinds of unjust conditions, but also we
should give people who don't have the ability of like
not hurting themselves instinctively when they're in distress. If there's
(32:27):
a tool that can help them, we should let them
have that tool. It's a recurrent like argument that I
think comes from privilege of like being able to intellectualize
about how, oh what we should really focus on is
like not dialectal behavioral therapy, but like a Marxist revolution
or whatever, and it's like, dude, that's because you maybe
(32:48):
don't need dialectical behavioral therapy in order to save your life.
In hindsight, I see it so much like I see
it so clearly in hindsight that it going on all along.
I've were in Arizona, then we moved to India for
a year and a half, then New Jersey for a
year and a half. Then Colorado, which is the second
(33:10):
place that I lived the longest. I mean pictures like
a lily white suburb and like pretty like well to
do there's two non white people, like in my entire
elementary school, my entire middle school, and then my high school.
Speaker 2 (33:23):
Compounding this feeling of alienation, Mala was chronically ill.
Speaker 3 (33:27):
I have these autoimmune conditions and when I was a
child they were extremely debilitating. So it was very sick,
but no one believed me. My teachers all thought I
was faking sick and treating me like shit. I was
like suffering constantly. Trying to just like graduate from high
school was like a battle. I was in pain and
I wanted to go home, and like I have memories
(33:48):
of a teacher yelling at me saying like I'm not
going to be able to succeed in life because I
can't do anything. And I was pulled that again and again,
and then all of a sudden learning that I have
two weeks to finish an entire class because my teacher
has decided that I can't make it up. Then you know,
a week later, I'm in the hospital for a week
because I have like an infection. My pain ahorance is
(34:10):
so high that often I end up in the hospital
with a doctor being like, Mala, what the fuck you
should have come to the hospital a long time ago,
because now you're in an emergency situation, And like what
was happening was I was ignoring my pain, and I
think that is a product of being told that my
pain isn't real and I'm weak, and actually, like it
(34:32):
turns out that like, no, actually it very much was real.
And so I think, you know, like to question myself,
to question my pain, to question everything, to you know,
it's very much fueled by this stuff. My whole life.
It would just be a freight truck that just came
in and torpedoed everything, and like, you know, like I
(34:53):
have this memory of like I was standing outside of
a hospital sobbing after trying to balance my insane war
stuff with my insane hallth stuff, and my dad saying,
this is what it does, Mall, this is what it does.
Is like exactly when you need it to not fuck
you up, it comes and it hits you like a truck.
And I think it's just like very similar to borderline,
(35:14):
the moving among these very extreme, very unstable moments and
desperately trying to get out of this, and it was
all very very intense. Everything was very intense.
Speaker 2 (35:32):
It would be easy for someone living with a borderline
diagnosis to internalize the idea that they're irredeemable and disposable,
but that hasn't been Malla's experience at all. Throughout her life,
her friendships have saved her and anchored her.
Speaker 3 (35:46):
Because I like hyper obsessed about my relationships. I really
understand why it's so hard to have stable relationships with BPD,
you know, Like it's not as though all my friendships
have survived all my stressed right, But I do have
a lot of friends who have been with me for
ten to fourteen years and have seen me go through
(36:09):
a lot and have experienced witnessed a lot of the
drama that it causes. I had dinners or got drinks
with like each of these friends individually to tell them
about my diagnosis. And obviously there's a part of me
that goes replaying my life in my mind and seeing
(36:31):
it differently and understanding myself. But also there was shame,
especially with my friend who, while I was raging at him,
it was always I'm right, you're fucked up because I'm
like I'm mad, right, and I'm right because I'm mad,
and just being like oops, like I don't think that's
exactly right now, like sorry, guys, that I've been an
(36:54):
agent to chaos. But they were like, moh, we're all here,
like nothing has changed about like who you have actually been.
What's paged is your framework for understanding it, and like
how you want to think about it going forward. We
know that you have intense emotions, But were the people
(37:15):
who were still here, No one was surprised. If anything,
it just made them have more empathy for me because
it was a framework for them too. So my best
friend told me this, if you could come to see
that you created this for yourself as a coping mechanism,
(37:35):
and so it was an act of self love to
develop it, even if it's not serving you, so you
should have compassion towards yourself. I think there's like, there's
so much there.
Speaker 2 (37:51):
Baska Case is a production of molten Heart and iHeart Podcasts.
The series is hosted, produced, and sound designed by ENK
Nicole Kelly. I co created the show with Jasmine J. T. Green,
who is also our executive producer. Production assistants by Siena
Petros and Ammani Leonard. Adrian Lillly is our mixed engineer.
(38:12):
Our theme is blue and orange by Command Jasmine. Our
show art was created by Sinnay Rolson. Fact checking by
Serena Soln. Legal services provided by Rowan Maren and File.
Our executive producer from My Heart podcast is Lindsay Hoffman
Hey there, I'm doctor Maya Schunker, and I'm a scientist
who studies human behavior. Many of us have experienced a
moment in our lives that changes everything, that instantly divides
our life into a before and an after. On my
podcast A Slight Change of Plans, I talk to people
about navigating these moments. Their stories are full of candor
and hard won wisdom, and you'll hear from scientists who
(00:22):
teach us how we can be more resilient in the
face of change. Listen on the iHeartRadio app, Apple Podcasts,
or wherever you get your podcasts.
Speaker 2 (00:31):
Hey, it's okay. Basket Case gets into some heavy topics
about mental health, and this episode contains references to self harm.
Please take care while listening.
Speaker 3 (00:41):
One analogy that I've given is uh to try to
explain it to people, is like, imagine that you felt
like you're being crushed to death. How much would you
do to escape that feeling? And I think that is
what's driving it so much. It's like you feel like
you've been crushed to death, Like how far would you
go to escape that feeling? But then what's terrible is
that if you cause destruction, now you have to deal
(01:03):
with that Wras's gonna want me, Mason's gonna want with
what person's gonna want me? When I have depression an anxiety.
Speaker 2 (01:13):
This is basket case. I'm enke so. In the earliest
versions of the DSM, the ones most influenced by Freudian thinking,
people experiencing mental distress were sorted into one of two categories,
psychotic or neurotic. Psychotics were characterized by an unstable relationship
with reality, and neurotics were suffering from repressed anxiety and
(01:36):
a general melancholia. But some patients appeared to have characteristics
of both neurotic and psychotic personality. Their moods would oscillate
between melancholy and mania, and their perceptions of reality were
not considered reliable. They were on the borderline between psychosis
and neurosis. Between the nineteen thirties and nineteen seventies, this
way of being was given different names, emotionally unstable, care
(02:00):
character disorder or borderline schizophrenia. The label borderline personality disorder
or BPD was formally recognized by American psychiatrists in the
nineteen sixties, and it was included in the d S
III in nineteen eighty. Officially, BPD symptoms include emotional instability, impulsivity,
distortive thinking or distorted perceptions of reality, and a pattern
(02:23):
of intense and unstable relationships. From the beginning, BPD was
a somewhat controversial diagnosis, and its legitimacy is still being
debated today. Among mental health professionals, it's considered one of
the most difficult mental illnesses to treat, and it's also
incredibly stigmatized because borderlines are also known as unreliable narrators,
(02:45):
as manipulative and untrustworthy, as difficult to work with in
a therapeutic context, and for this reason, therapists sometimes refuse
to even work with borderline clients. But there is a
growing discourse at the intersection of gender studies, disability studies,
and philosophy that's based on the idea that a borderline
worldview is valid and that there is such a thing
(03:06):
as a borderline way of knowing, thinking, and feeling that
isn't necessarily disordered because it's.
Speaker 3 (03:12):
Really philosophically, really philosophically interesting. I was a big part
of why when starting to thinking right about mental philosophically interesting.
Speaker 2 (03:22):
This is Mala. She's a law professor who recently wrote
about her experiences being borderline for the LA Review of Books.
While I was researching this episode, I noticed that many
women of color, especially black women, seem to be disavowing
their BPD diagnoses. Instead, they attribute their symptoms to complex trauma,
the trauma of being black women and femmes in a
(03:42):
society that punishes them for it. But Mala embraces and
appreciates her diagnosis. For Mala, it's been a useful framework
and for her there's a clear dividing line, Mala before
BPD and Mala after.
Speaker 3 (03:57):
Yeah, it had incredibly tense emotions my whole life, Like
I have this best friend. I joke that he's the
person who has suffered the most from the outputs of
my VPD, because we would have fights and.
Speaker 2 (04:13):
I would Malla at Christen College when they were eighteen.
Chris isn't his real name. They were both philosophy majors,
and they both belonged to a community of weirdos, the
freaks that they're prestigious and otherwise very traditional and somewhat
conservative college. From the beginning, their friendship was rooted in
talking about the things they both loved. The music they
(04:34):
listened to, the movies they both liked. Malla loved all
kinds of psychedelic music and going to raves, and she
would take Chris with her. They got close, their friendship
felt deep, but then Malla started seeing Chris differently. She
felt that pull, that ache, a crush and because of
the crush, which for whatever reason, Chris didn't reciprocate, but
(04:57):
because of the crush, Mala was extra sensitive to the
way Chris treated her. That wasn't the issue, honestly, that's relatable,
but I felt.
Speaker 3 (05:06):
It so intensely, and what it moved me to do
was latch out, like send him a bunch of rage texts,
and I would feel shame about it, and I would
seek validation from like friends, like do we all agree
that like this was insensitive? And the answer to be, yeah, yeah,
that was for sure, but no one would say this,
(05:28):
But like, I also know it's the case that my
other friends like wouldn't respond that way to the same
you know, insensitivity, And the way that I did it
was almost like I thought the intensity of the emotion
was it self evidence that I was right about what
I was feeling so intensely about, And so that was
(05:49):
a kind of recurring phenomenon, particularly with relationships that were
especially close to me and that I most wanted affection from.
We didn't want to be abandoned by.
Speaker 2 (05:59):
But despite these relations flare ups, Chris stuck around. They
both did. They even kept studying philosophy together in the
same master's program. And then Malla introduced Chris to another
good friend. I'm gonna call her Naomi. Naomi and Mala
had been close since college. Naomi had also studied philosophy,
but where her friendship with Chris was intellectual and aesthetic,
(06:20):
Malla's friendship with Naomi was built on a deep emotional intimacy,
in ability to talk transparently about their feelings and experiences.
When Naomi met Chris, they vibed. Naomi felt that pull,
Chris felt it too. Chris and Naomi fell in love.
When Malla thinks back to this time in her life,
(06:42):
it says if she was two different people at once one.
Mala loved both Naomi and Chris and thought they were
good for each other. She wanted them both to be
happy together. Processing was a feature of this friend group,
also relatable, so there was lots of checking in about
Chris and Naomi's developing reallyationationship. Malla would talk to each
of them individually, and then the three of them would
(07:04):
talk together, very mindful. There was a lot of trust
between them, and curiosity and vulnerability as the three of
them really tried to understand and reassure each other.
Speaker 3 (07:15):
This.
Speaker 2 (07:15):
Mala did not want to ruin her friend's relationship, but
the other Malla couldn't stop thinking about the past, about
having feelings for Chris and what it felt like when
he'd softly rejected her. She couldn't stop thinking about how
she'd once felt neglected in their friendship, how he hadn't
always been careful with her feelings. That Mala also felt
(07:36):
betrayed by Naomi. How could Naomi, someone who claimed to
care about her, allow herself to fall in love with
the person who had treated Malla so insensitively.
Speaker 3 (07:49):
But then there would be moments my mind would fix it,
and I'd experience the swell of intense emotion, and I
would feel the need to express to her rage, like
I can't believe you could even be with this person
that like caused me pain in the past, and like
(08:12):
how I don't understand you know. And then and then
this person that this person that like caused me pain
in the past. And the thing that I remember very
distinctly is this was this was obviously very painful for
(08:34):
her because she felt very, very conflicted. He and I
would have my fulldoutful conversations where they would ask, is
it that you want us to not be together? And
like they were falling in love, and I said, no,
that's not it. You know, we're all trying to thoughtfully
navigate the situation.
Speaker 2 (08:51):
But most of all, she feared being replaced. That once
krist and Naomi had each other, there wouldn't be any
more room for her, and once that feeling, the fear
had grabbed her, it wouldn't let her go.
Speaker 3 (09:04):
You're kind of spiraling, and you feel like you're losing
grip and you're replaying stuff. You're going through it again
and again, making the argument again and again. You're fixating.
And I always felt I guess it's kind of two
sides of the same coin, one being sort of taken
(09:25):
by the intensity. The intensity of it, the sense that
it controls you. It drives you to do things that
don't feel like reason choices, even if the emotion like
the thing that you feel, I feel left out like
feel in that sense is something many people would feel,
but feel in the sense of like the phenomenal quality
(09:49):
of this emotion and the intensity of this emotion, the
crushing feeling, and the overwhelmingness, the all consumingness, that you
can't put it out of your mind and you have
to act on it.
Speaker 2 (10:01):
As her feelings intensified, as her hurt turned to anger
and then to rage, Mala couldn't escape that pressure.
Speaker 3 (10:09):
And it's because you're suffocating with the weight of this emotion,
and your instinct is to cause harm.
Speaker 4 (10:16):
To the source of the emotion, like it's yourself or
it's some person. But it's not because you want to
harm this person so much as you don't want to
feel this feeling anymore.
Speaker 2 (10:27):
Malla held her phone in her hands, thinking about Naomi.
She felt desperate to escape the force of her own emotion,
her fear of being left behind, of losing Naomi and Chris.
With every minute that passed, this swell of emotion inside
became more and more unbearable.
Speaker 3 (10:43):
And I just sent her a long text saying I
don't think we can be friends right now. And it
was just like a rage text in the middle of
the day, sort of out of nowhere, and it was
really sort of driven by like impulse and pain and
not mindful at all of the impact that that would
have on her, and it had a really really really
(11:04):
bad impact on her.
Speaker 2 (11:05):
And then setting the text, does it bring relief or
does it just bring like a different smell of emotions?
Speaker 3 (11:10):
Yeah, so it does bring relief, but then yeah, brings
different emotions. I think the best example of this kind
of a response is cutting. It's something that happens in
a moment of intense, intense, intense emotions and a desperation
to escape it. It's a desperation to feel something else
(11:30):
and to also release this rage. And so what happens
you cut yourself, You experience some relief, but then maybe
after your like, fuck now I have to contend with
this other thing that just.
Speaker 2 (11:45):
Happened, Naomi wrote back.
Speaker 3 (11:47):
She responded saying, like, I'm so hurt that you would
send me a message like this. We've been working so
hard and having all these mindful conversations and just like
just throw in the towel, And I think the break
needs to be in death it and it took us
a long time to actually feel our friendship. If you
(12:07):
cause destruction now you have to deal with that, and
probably now you have other emotions that further crossed to you,
and it's a terrible feedback loop that you end up in.
Speaker 2 (12:23):
That loop was the overwhelming emotions requiring relief, relief that
came in the form of lashing out, and the shame
that followed, which would eventually require its own outlet, repeating
the cycle. That loop was not something that Mala before
BPD could see, and admitting that maybe she was the
source of someone else's pain was terrifying, but.
Speaker 3 (12:45):
Then also kind of wanting validation because the intensity just
made me feel crazy. I would feel a kind of
need to talk through whatever I was upset about with
my friend runs a lot and say like, am I right?
Speaker 2 (13:01):
Am I?
Speaker 3 (13:02):
Right? Am I crazy? Like isn't this so bad? Isn't
this fucked up? The reason that it had to be
that I was justified is that if I wasn't justified,
I just caused so much pain. The narrative has to
be that I was justified in doing that, because the
alternative is that I'm a toxic, fucked up person.
Speaker 2 (13:26):
I've told you that Mala attended a prestigious university and
that she's a lawyer and the philosopher, and lately a
published author. She's now a law professor at a different
prestigious university, and that's because she's channeled her intensity into
academic and professional achievement. It's like an engine that propels
her upwards, keeps her head above water, keeps her from
(13:46):
sinking back into what she calls the darkness, the darkness
that's been there since she was a kid. But a
few years ago, Mala slipped in her bathtub and wound
up with a concussion. For a period of time, she
wasn't able to move much or do much of anything.
She spent weeks at home on her couch in a
major depressive episode, reading the same book over and over.
(14:08):
Without the engine of her ambition pushing her forwards, she
struggled to justify her own existence. She thought about ending
her life a lot.
Speaker 3 (14:18):
Took a bottle of pills or whatever, and then I
sort of that moment, I had the wherewithal to text
my friend, and then she took me the emergency room.
And this emergency room doctor, it's like random dude is
asking me some questions. Spue's like thirty seconds with me,
and all he knows is that I tried to kill myself.
(14:38):
He says, you might have borline personality disorder and then
just walks away. We didn't go through the criteria. It
just says this and just walks away. Obviously, I'm like
what And this became this very dark, like a darkly
funny moment in my friend room because apparently in my
state of being drugged, I said, does he know who
(14:58):
I am?
Speaker 2 (15:00):
You were familiar with borderline though, like that label meant
something to your.
Speaker 3 (15:03):
Yeah, the label did mean something to me. I associated
it with this image and the media, the villain image,
just the toxic, manipulative girl by antagonist, very very erratic emotion,
very unstable who in my mind, there was no vision
(15:25):
of herterier life. And that is the image that I had,
not the person that anyone wants to be.
Speaker 2 (15:35):
We're going to get into that image of the toxic
borderline woman after the break. At the same moment that
(16:00):
the BPD was added to the DSM in nineteen eighty,
the DSM's authors finally removed another long standing diagnosis, hysteria,
a maybe physical and maybe mental affliction that only affected
cis gender women. Accounts of hysteria date back to ancient
Egypt and ancient Greece. The word hysteria actually comes from
the Greek word for uterus. Greek physicians believed that the
(16:23):
uterus could wander around the body, disrupting a woman's emotions
and physical health in the process. Early hysteria treatments involved
dangling pleasant smelling substances near the genitals or foul smelling
substances at the mouth in order to lure the uterus
back into its proper place. And that's sorry, but that
(16:44):
is funny. Later at medieval and Victorian doctors also believed
it was caused by malfunctioning reproductive organs, but they opted
to treat it with hysterectivies and sometimes also with medically
induced orgasms. And I really urge you to google Victorian
vibrators if you are not already familiar. Symptoms of hysteria
included irritability, insomnia, anxiety, water weight, and having sexual desires
(17:10):
and being crazy enough to talk about them. Then, in
the early twentieth century, Daddy Freud located the cause of
hysteria not in the bodies, but in the minds of
women and in the experiences they were having as women
in society hysteria was ultimately discredited in nineteen eighty, deleted
from the DSM and considered a bygone Victorian relic, and
(17:30):
at the same time VPD was added, though I should
say that there were psychiatrists who opposed that decision. But
it's kind of hard not to see the connection between
borderline and hysteria, especially because today around seventy five percent
of people diagnosed with BPD are CIS women. People who
question whether BPD is even a legitimate disorder think that
(17:52):
the diagnosis plays into paternalistic stereotypes about women, that they
were erratic and overly emotional by pathologizing what they considered
to be a reasonable response to living in a society
that is hostile to women.
Speaker 3 (18:05):
Borderline has these roots in female hysteria, in this condition
that physically only women could have that doesn't exist, right,
and then more women get diagnosed with it, and then
we keep associating it with women, and then more women
get diagnosed with it because we keep associating it with women.
This kind of like feedback loop, you know, roughly similar
(18:26):
symptom inhabiting individuals. If there are women, they get diagnosed
with borderline more, and if they're men, they get diagnosed
with complex PTSD.
Speaker 2 (18:33):
More it's been suggested that when CIS men exhibit classic
BPD symptoms, they may be more likely to receive a
diagnosis other than borderline, like antisocial personality disorder, and one
recent study in the academic journal Transgender Health found that
trans and gender not conforming people are even more frequently
diagnosed with BPD than cysgender women. But in the popular imagination,
(18:58):
the borderline diagnosis continues to be most strongly associated with
CIS women, who are at best tragic and at worst
vindictive and inconvenient, out of control, erratic, needy, hysterical. In
pop psychology books like nineteen eighty nine S I Hate You,
Don't Leave Me Understanding the borderline personality or nineteen ninety
(19:19):
eight s Stop Walking on Eggshells, Taking your life back.
When someone you care about has borderline personality disorder, borderline
women are talked around or about. They're rarely spoken too,
through the villains and someone else's story, which tracks with
the images we find in pop culture where borderlines are
rarely depicted as complex subjects. Girl Interrupted a BPD memoir
(19:43):
is perhaps a notable exception, and that story the main
character narrates her own experiences of being treated for BPD
in a psychiatric facility, but the borderline woman is usually
cast and the role of the antagonist someone more like
Alex in the nineties erotic thriller Attraction, hurt and angry
and insistent. After the end of her affair with Dan,
(20:05):
a married man, Alex transforms from a person to an
obstacle for the previously happy and stable family to overcome
spoiler alert, they kill her at the end. Like Malla
said earlier, Alex is not the person that anyone wants
to be. This popular image of the toxic borderline woman
(20:26):
and the stigma she reflects, is one of the reasons
that people who suspect they might be borderlined don't seek help.
They don't want to see themselves in that image. But
as Mala wrote in her essay, stories like these are
not describing what BPD is.
Speaker 3 (20:41):
But rather the shadows that it casts, the outward reverberations
rather than what seeds inside.
Speaker 2 (20:49):
And when what sees inside fails to be recognized, not
just seen, but held and witnessed, the isolation and anger
that borderlines feel can lead to the very rejection and
abandonment that they fear.
Speaker 3 (21:01):
The most lack of any understanding or representation of voice
given to what the borderline is experiencing makes all of
the focus on how we affect other people and the
people that are affected by us and what it suggests.
And maybe it's not conscious, or maybe it is like, oh,
(21:22):
we've given up hope on the borderlines, like they're never
going to be anything other than toxic and manipulative and whatever.
All that matters is like people who have the ill
fortune of knowing them, right, I think there's kind of
a self fulfilling prophecy in such a sad way.
Speaker 2 (21:43):
After the er doctor's casual and unsolicited diagnosis, Malla went
home in a kind of daze and told her boyfriend
what the doctor had said. Mala's boyfriend, Brian, now her partner,
was sensitive and thoughtful like Mala. Before they started dating,
other people had told her that he was unfathomably kind.
Mala loved that with her. He was so empathic. He
(22:03):
had been close to someone with the mental illness before,
and he's like.
Speaker 3 (22:06):
Yeah, that was really fucked up. And then he says,
but also, you might you might look into it before
I say with what he's like, Yeah, I mean, you
just feel so much pain, Like obviously when he said
was fucked up, and like he didn't have any day
of saying that. But you do go through so much
(22:27):
and it happens really fast, and it's so intense. And
I think, Betty is what borderlines experience is really really
intense emotions that suddenly come on. Maybe there's a dish
at all help that you can get. And then he
just like changes the subjects. I'm looking at him like
what the fuck? And I started spiraling a little bit
(22:48):
in my mind. I had literally never heard anyone describe
borderlines before as people in pain. Ever, I was like,
to other people not feel controlled by their emotions, and
he was like, yeah, people bury their emotions all the time.
And I was like, that feels literally impossible to me.
(23:12):
I actually have no idea how that is even possible.
If you are in boiling water and you've just never
felt you have never felt the other water, it's really
difficult to glean that without help.
Speaker 2 (23:28):
And the stories about borderline that Mala was familiar with,
no one ever talked about the source of the intense emotion,
what was at the heart of it. So this observation
became a wide open door. Malla felt curious and she
stepped through it.
Speaker 3 (23:44):
I just started to notice by reactions more like him
saying this. Dropping this framework in my mind was what
enabled me to have a little bit of space to
clock my emotional responses to things. The big day that
(24:05):
I saw it in me, I was walking to the subway.
The sun was shining, and I was having one of
those moments of like euphoria where I was like, Wow,
everything is great. I feel so much better. Life is fabulous.
All my problems are solved forever. And I even send
a text to like my girlfriend's group chat because I
had been talking to them the night before about how
(24:27):
I was depressed, and I was like, ugh, I'm doing
so great right now, guys. The sun is shining, like
it's all good, everything is fixed. I'm vibing.
Speaker 5 (24:37):
And and then like literally later that day, I.
Speaker 3 (24:48):
Come back home and I lie down on my bed
and I feel overcomp with like the most intense depression.
It's like intense isn't like psychedelic intense, like you know
when depression is really bad, it's like you're tripping. It
was like that where I just felt swallowed, and then
(25:12):
Brian comes over my partner, and I'm trying to talk
to him. I feel that feeling of like I'm in
a prison right now, Like I'm the tripping I'm in
a prison, Get me out of here. And I'm just
kind of looking at him and he's looking at me,
and I have this sense that this person doesn't care
(25:33):
about me. He's presenting this, he's questioning everything, like just
overcome with what I think. We're truly paranoid thoughts. I
go to bed, I wake up, and I like look
back on the arc of this day, and it really
does feel like like I just went on this insane
journey and it doesn't make sense to me. And so
(25:54):
I'm really seeing like this happens a lot, but this
was the first time I really saw that it didn't
make sense.
Speaker 2 (26:06):
A lot of the discourse about Borderline suggests that its
impact is most felt on the level of interpersonal relationships,
but privately alone, Mala was also experiencing a kind of
emotional whiplash. She was constantly being pulled from one reality
and then smashed into another without warning.
Speaker 3 (26:25):
These episodes happen like multiple times a day, and then
you are trying to make sense of the you that's
like persisting over time in these episodes, and it's extra
puzzling because you can feel really alienated from yourself an
(26:46):
hour ago, like multiple times in one day. But when
you're in it, it's like, this is the most important
thing in the world. I was wrong all along when
I didn't feel this way. When you're in it, you
believe that it's the real you. I can feel I
was in one world five seconds ago, and like now
I'm in a different world and I have to make
(27:07):
sense of what just happened.
Speaker 2 (27:09):
Interesting can't necessarily explain or predict when that shift will occur,
but you are aware when the shift has happened.
Speaker 3 (27:17):
So this is the trippiest thing. So my favorite book
is Infinite Jest. I think it's like the best book
that I have read exploring mental illness. And it gives
this analogy and one then Yette, a kid wakes up
from a nightmare, looks on the floor. I sees a
face on the floor, a terrifying face on the floor,
And as he sees the face, he comes to believe
(27:37):
like this face has been.
Speaker 2 (27:38):
There all along.
Speaker 3 (27:40):
And this idea of when you're in it, you believe
now I'm seeing the truth is so overwhelming that to
be able to from within tell yourself, no, you're having
a distress episode is the great Jedi mind trick. You
(28:01):
need to be able to pull off in order to
just get out of the distress episodes.
Speaker 2 (28:06):
Looking back on that day, Malla realized that she couldn't
always trust that what she was feeling was reality. But
the experience also taught her that, with help, she could
learn to separate her feelings from facts. That's after the break.
So there was Malla before and Mala after. Right, What
(28:29):
distinguishes Mala before from Mala after is a framework. Her
official diagnosis of BPD allowed her to see herself as
separate from the symptoms and the behaviors that borderline caused,
and her new narrative that a borderline woman was simply
a woman in pain, that she was a person in
pain that was something she could work on.
Speaker 3 (28:50):
It was kind of like a mind's blowing experience. I
think one way that I also describe it is like
it simultaneously both validated and debunked my intense emotions and
like this suffering that they caused me, Because on the
one hand, it's telling me, like, yeah, you have really
(29:11):
intense emotions, like you're not imagining that, Like you you
experienced really really tense emotions. I'm much more intense, not
with people's that's real. But at the same time, like
you experience really a tench emotions, like they're not the
same with other people's, and like that should give you
pause with acting on them. So it both gave it
(29:31):
empowered me to both feel validated and liberated about my emotions.
Speaker 2 (29:38):
The diagnosis gave her a way to make sense of
her past experiences and a new way to understand herself
and the present. It also gave her the language she
needed to articulate her experiences, her pain to the people
in her life most impacted by her actions.
Speaker 3 (29:51):
It was interesting, actually to talk to my friends about
it post diagnosis. One thing they said is it never
struck any of us that you were being on reason
about this was wrong or this was insensitive. It was
always just that the emotions were so intense.
Speaker 2 (30:09):
The main mode of treating borderline personality disorder is called
dialectical behavioral therapy or DVT. It's a talk based therapy
designed by an American psychologist, Marshall Lenihan. Lenihan was borderline
herself and she saw a need for a therapeutic modality
that would be effective for people who suffered because of
their emotions, especially people prone to self harm and thoughts
(30:31):
of suicide. The d and DBT dialectical describes the process
of combining two contradictory ideas into one cohesive new idea.
In the case of therapy for borderlines, Lenihan wanted to
guide patients to hold both the need for self acceptance
and the need to change.
Speaker 3 (30:49):
It's very effective because when you're in it, you're thinking, oh,
I need to burn everything down, I should quit my
job and my relationship, I want to hurt myself. And
what deact will be ever will he tries to do
is say, okay, well, if those things are true, they
will still be true after you're out of the distress episode.
Speaker 2 (31:09):
Distress tolerance is one of the primary DVT skills, a
strategy to help people navigate painful feelings in the moment
and cope with them.
Speaker 3 (31:17):
Distress tolerance is about like helping people who like me,
when in distress their instinct is to hurt themselves or
hurt other people, to be able to not do that.
That's literally what it's about. It's about don't hurt yourself
and don't hurt other people.
Speaker 2 (31:33):
It's not, And in that way, DVT can be literally
life saving, since around one in ten people who receive
a borderline diagnosis eventually turn to suicide for relief from
their pain. But like almost of therapy, DVT isn't without critics,
some who say that it doesn't focus enough on the
broader social conditions that can cause mental distress in the
first place. And that critique might sound familiar to regular
(31:58):
listeners of this program, but Mala hates that argument.
Speaker 3 (32:04):
One reason that I get really irritated by these sort
of like quote unquote leftist critiques of like behavioral therapies.
It can be true that all this stuff is the
product of all kinds of unjust conditions, but also we
should give people who don't have the ability of like
not hurting themselves instinctively when they're in distress. If there's
(32:27):
a tool that can help them, we should let them
have that tool. It's a recurrent like argument that I
think comes from privilege of like being able to intellectualize
about how, oh what we should really focus on is
like not dialectal behavioral therapy, but like a Marxist revolution
or whatever, and it's like, dude, that's because you maybe
(32:48):
don't need dialectical behavioral therapy in order to save your life.
In hindsight, I see it so much like I see
it so clearly in hindsight that it going on all along.
I've were in Arizona, then we moved to India for
a year and a half, then New Jersey for a
year and a half. Then Colorado, which is the second
(33:10):
place that I lived the longest. I mean pictures like
a lily white suburb and like pretty like well to
do there's two non white people, like in my entire
elementary school, my entire middle school, and then my high school.
Speaker 2 (33:23):
Compounding this feeling of alienation, Mala was chronically ill.
Speaker 3 (33:27):
I have these autoimmune conditions and when I was a
child they were extremely debilitating. So it was very sick,
but no one believed me. My teachers all thought I
was faking sick and treating me like shit. I was
like suffering constantly. Trying to just like graduate from high
school was like a battle. I was in pain and
I wanted to go home, and like I have memories
(33:48):
of a teacher yelling at me saying like I'm not
going to be able to succeed in life because I
can't do anything. And I was pulled that again and again,
and then all of a sudden learning that I have
two weeks to finish an entire class because my teacher
has decided that I can't make it up. Then you know,
a week later, I'm in the hospital for a week
because I have like an infection. My pain ahorance is
(34:10):
so high that often I end up in the hospital
with a doctor being like, Mala, what the fuck you
should have come to the hospital a long time ago,
because now you're in an emergency situation, And like what
was happening was I was ignoring my pain, and I
think that is a product of being told that my
pain isn't real and I'm weak, and actually, like it
(34:32):
turns out that like, no, actually it very much was real.
And so I think, you know, like to question myself,
to question my pain, to question everything, to you know,
it's very much fueled by this stuff. My whole life.
It would just be a freight truck that just came
in and torpedoed everything, and like, you know, like I
(34:53):
have this memory of like I was standing outside of
a hospital sobbing after trying to balance my insane war
stuff with my insane hallth stuff, and my dad saying,
this is what it does, Mall, this is what it does.
Is like exactly when you need it to not fuck
you up, it comes and it hits you like a truck.
And I think it's just like very similar to borderline,
(35:14):
the moving among these very extreme, very unstable moments and
desperately trying to get out of this, and it was
all very very intense. Everything was very intense.
Speaker 2 (35:32):
It would be easy for someone living with a borderline
diagnosis to internalize the idea that they're irredeemable and disposable,
but that hasn't been Malla's experience at all. Throughout her life,
her friendships have saved her and anchored her.
Speaker 3 (35:46):
Because I like hyper obsessed about my relationships. I really
understand why it's so hard to have stable relationships with BPD,
you know, Like it's not as though all my friendships
have survived all my stressed right, But I do have
a lot of friends who have been with me for
ten to fourteen years and have seen me go through
(36:09):
a lot and have experienced witnessed a lot of the
drama that it causes. I had dinners or got drinks
with like each of these friends individually to tell them
about my diagnosis. And obviously there's a part of me
that goes replaying my life in my mind and seeing
(36:31):
it differently and understanding myself. But also there was shame,
especially with my friend who, while I was raging at him,
it was always I'm right, you're fucked up because I'm
like I'm mad, right, and I'm right because I'm mad,
and just being like oops, like I don't think that's
exactly right now, like sorry, guys, that I've been an
(36:54):
agent to chaos. But they were like, moh, we're all here,
like nothing has changed about like who you have actually been.
What's paged is your framework for understanding it, and like
how you want to think about it going forward. We
know that you have intense emotions, But were the people
(37:15):
who were still here, No one was surprised. If anything,
it just made them have more empathy for me because
it was a framework for them too. So my best
friend told me this, if you could come to see
that you created this for yourself as a coping mechanism,
(37:35):
and so it was an act of self love to
develop it, even if it's not serving you, so you
should have compassion towards yourself. I think there's like, there's
so much there.
Speaker 2 (37:51):
Baska Case is a production of molten Heart and iHeart Podcasts.
The series is hosted, produced, and sound designed by ENK
Nicole Kelly. I co created the show with Jasmine J. T. Green,
who is also our executive producer. Production assistants by Siena
Petros and Ammani Leonard. Adrian Lillly is our mixed engineer.
(38:12):
Our theme is blue and orange by Command Jasmine. Our
show art was created by Sinnay Rolson. Fact checking by
Serena Soln. Legal services provided by Rowan Maren and File.
Our executive producer from My Heart podcast is Lindsay Hoffman
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