In The Buddha and the Borderline, author and borderline personality disorder (BPD) advocate Kiera Van Gelder addresses her battle with BPD with frank poignancy: "I still wonder how you get treatment for something unspeakable." She traces her decline into this frequently misunderstood mental illness from her over-sensitivity as a child exacerbated by molestation at age six, repeated family relocation, and what was later termed "invalidation" of her needs. Only since 2007 have the biological and hereditary factors connected to BPD been identified.
After an early suicide attempt, hospitalization at age seventeen, and tumultuous years of substance abuse and promiscuity, Van Gelder's search for relief led her through an alphabet-soup of therapies and treatments: Alcoholics Anonymous (AA), Narcotics Anonymous (NA), dialectical behavior therapy (DBT), mood and anxiety program (MAP), cognitive behavioral therapy (CBT), and Internal Family Systems (IFS), ending, ironically, with her therapist-inspired "WTF." He told her, "The truth is, you'll never know all the reasons people do the things they do. That's when you can say to yourself, 'What the f***.' At a certain point, you just have to walk away..."
Walking away is something Van Gelder learned to do only after finding a measure of self-validation through her therapy journey and ultimately in her immersion in Buddhism. AA and NA helped her find and maintain sobriety. The BPD diagnosis itself in 2000 offered the relief of "a real illness rather than just being a terminal failure." In the DBT program designed by Dr. Marsha Linehan, patients learn coping skills such as emotion regulation, distress tolerance, interpersonal effectiveness, and core mindfulness, with a focus on fundamental wholeness and acceptance of change. Van Gelder's first time in the CBT-based MAP program came during hospitalization following a breakdown after ten years of sobriety. She describes the regimen as an effective linking of thought and behavior, with in-depth self-awareness exercises designed to "manage and control (your) thoughts as a way of modifying behavior and feelings."
At that point, Van Gelder ran into an inherent cruelty of the American managed healthcare system: after three weeks of steady improvement in the MAP program, her insurance benefits are withdrawn. "The more you need services, the less willing insurance is to pay for them," she notes scathingly. "'Managed care' providers...marking down a decrease in therapy costs...obviously don't need to pay for people who are dead." Buried in her medical file, she finds a diagnosis of BDP following a suicide attempt at seventeen which was ignored by professionals and her family. Van Gelder credits this discovery with empowering her, via righteous anger, to make necessary changes in her approach to treatment.
With the realization that she must "transform this despair and anger into power," and after a third hospitalization and stint in the MAP program, Van Gelder connected with a therapist working with a DBT consultation team and the cloud lifts. "With BPD, the rest of the world typically reduces the person to the disorder, which isn't fair or true," the therapist points out when he avoids the stigmatizing label. She is officially diagnosed with depression and anxiety disorder to appease the insurance companies. Slowly, painfully, the cloud of horror Van Gelder lived under for most of her life began to lift. She learned to reframe her tendencies to be sensitive, reactive, emotionally intense, and unpredictable as "inherent qualities" to be managed, not "symptoms to be cured" and found some relief.
Van Gelder's three-year ordeal, from official but hidden BPD diagnosis to what she reluctantly terms "remission," includes a series of relationships with men she finds through online dating services; emotional, panic-stricken family scenes; and humiliating public anxiety attacks before she finds a semblance of stability. With a new-found self-assurance, she began working as an advocate for BPD, appearing in two documentaries and speaking to numerous conferences and family groups. The Buddha and the Borderline is the written account of her heart-rending journey to what she calls a "transcendence" of the disorder.
"BPD has become my teacher," Van Gelder says. "While it's undeniable that (it) destroys people, it can also open us up to an entirely new way of relating to ourselves and the world." Her story offers hope to BPD sufferers, and to those who love them.
© 2011 Cynthia L. Pauwels
Reviewer Cynthia L. Pauwels holds an MA in Creative Writing and a BA in Humanities with a World Classics certification from Antioch University McGregor in Yellow Springs, Ohio. She works as a freelance writer with numerous short fiction, non-fiction and technical writing credits. email: firstname.lastname@example.org; website: http://cpatlarge.blogspot.com/