I was 17 when I was diagnosed with borderline personality disorder. I’d flown to Bangalore with my parents for a couple of weeks to be evaluated at the largest mental health facility in India. Somewhere between excursions to labyrinthine bookshops, towering malls, and all manner of delightful restaurants, we squeezed in visits to the outpatient department where I’d practice my story on a different psychiatrist every day. It developed in the telling, that story, each version more concise than the last as my attention drifted in the April heat wave to thoughts of tangy lassi and the art books waiting for me back in my hotel room. I finally received my sentence three days before we had to fly out. We gathered for the verdict in an impersonal waiting room with our serious faces on, looking every bit like the family we’d ceased to be by then. I never knew the name of the trainee psychiatrist who delivered the judgment, I never cared to remember his face either. All I remember are the flowery yellow curtains which draped that funereal chamber, and the feeling of being marked as a monster for no reason that I could understand.
At the time, I thought BPD made me a monster, a sociopath. My closest frame of reference for this condition was the boy who’d recently broken my heart, and who’d once made an offhand reference to his diagnosis. It wasn’t a burden I was ready to take on. It would mean that I was someone like him: someone to whom cruelty was casual and deliberate, someone who had rarely shown me kindness or empathy. After the initial bewilderment, my first urge was to resist and somehow convince the psychiatrists that I was something other, someone better than what they’d pronounced me to be. For their part, the evaluating team seemed rather in a hurry to wash their hands of me—a reaction I’d later learn is all too common in the medical community toward patients of a similar nature.
When it comes to personality disorders, the four which fall in “Cluster B”—antisocial personality disorder (ANPD or ASPD), histrionic personality disorder (HPD), narcissistic personality disorder (NPD), and borderline personality disorder (BPD)—are held together by a common thread of dramatic, emotional, and erratic behavior. That is what medical literature will tell you. However, more than anything, what these disorders are all characterized by is an embarrassing dearth of reliable information and a shameful amount of stigma.
Commonly held beliefs on Cluster B individuals by everyday people and clinicians portray us as violent and manipulative, emotional trainwrecks careening toward a bitter end, remorseless abusers who must be avoided at all costs. The first time I took the advice of a psychiatrist I trusted and ran a Google search on BPD, I broke down in tears. If deep down I’d always known that I was a monster, now I had the words spelled out in front of me. Page after page of results, all echoing the same prognosis, all detailing the abuse I could deal out so easily and the hurt that my victims would never recover from. Resources of empathy and succour intended solely for those victims—my long-suffering family members and loved ones, every individual who’s come in contact with my destructive self and been burned—and a clear warning across it all that read: Avoid this person because they will end you.
What should I have done then? Should I have locked myself away from the world so as to minimize the damage, or should I have pushed for the understanding and medical treatment I so desperately needed? In the end, I did neither. I saw a different psychiatrist, convinced him that I was bipolar, and waited eight whole years before coming to terms with the reality of who I am. I was lucky in my friends and chosen family, almost unusually so for their understanding and love, and the lengths they went to to ensure that I always received help when I needed it. Neurodivergence wasn’t a word in my vocabulary then, but some time in the middle of recovering and relapsing and recovering only to find myself back in the psych ward with its familiar haze of mood stabilizers, needles, and antipsychotic drugs, I realized that this is who I was. It wasn’t a one-time illness that could be cured. This was my default state, my brain’s natural configuration.
In psychiatric terms, neurodiversity is a relatively recent concept developed by individuals on the autism spectrum to describe themselves without stigma. As it has grown in use, the term has also been reclaimed by people with ongoing mental health difficulties like bipolar or personality disorders, which usually need lifelong management. Unlike pathologizing labels of the past, neurodiversity acknowledges that there’s no one “correct” or “proper” state for the human brain to default to, and that every individual has their own unique way of relating to the world around them. For neurodivergent folk, this could vary significantly from that of neurotypicals—people who don’t have to make significant efforts to be accommodated socially—because social structures are designed with neurotypicality in mind.
If there’s one thing that unites all of us neurodivergents, it’s that those of us who need the most empathy rarely end up receiving it. Cluster B personality types have been known to be abusive; so have just as many neurotypical people, except that they don’t have to carry the burden of stigma that mental illness inevitably brings with it. To put it simply, when a neurotypical is abusive, their violence is attributed solely to them as an individual. However, for a person with difficulties linked to mental health, any such behavior is immediately seen as a fault of their errant minds, though the two might be completely unrelated. And when entire sets of psychological conditions become stigmatized for little other than the crime of correlation, all of us who live through those conditions are forced to carry that mark of stigma as well.
Naturally, this does nothing to make the conditions any easier to deal with. In branding certain groups of people as monsters, more often than not we end up creating monsters out of individuals who might otherwise have gone on to live stable, nurturing, fulfilling lives. In the past couple of decades, a commendable effort has gone into destigmatizing the most common of mental illnesses, like depression. Sadly, the world of Axis II disorders (personality disorders as a whole) continues to lag far behind. The sole exception is BPD, which has recently emerged as some sort of a star in the cluster following research showing it to have higher rates of recovery compared to others in the group. As a result, there are several more empathic resources dedicated to understanding BPD available than there were even a few years ago.
Still, using a model based on successful treatment to divide mental health conditions into a “good” and “bad” binary is a terrible idea: Neurodivergence is not a disease to be cured, not even when it manifests in forms that are hard for others to stomach. Plus, research has shown that treatments that take neurodiversity into account, and that involve a long-term plan of therapy and learning healthy coping mechanisms, are far more successful than those geared toward “curing” mental illness. People are not diseases, and even the most “difficult” and “resistant” among us deserve compassion and help. A lot of the time, however, that help isn’t forthcoming from the world around us, but we can help ourselves.
If there’s one thing that I believe about mental illness, it’s this: If you’re having difficulties managing your mental health, no matter how negligible or insurmountable the problems might seem, your greatest responsibility to yourself is acknowledging that issue and taking steps to get help for it. You don’t have to do it for your family, or your loved ones, or the world you’re forced to navigate—you have to do it for yourself. You have to help yourself, even if no one else is, because that’s an essential part of living. Getting that help can sometimes be a drawn out, expensive, and even dangerous process because of financial, environmental, and stigma-related circumstances. If, in 2016, it’s possible for me to get online and find at least a handful of resources on managing my BPD; for NPD, ANPD, and HPD individuals, that number goes down to practically zero.
The internet, and even psychiatrists, will tell you that clinical narcissists never commit suicide; they only threaten it to manipulate the people around them. The truth is that NPD—just like other Cluster B disorders,—presents a far greater risk of suicide when compared to the median. (According to The BPD Survival Guide, the risk is as high as 10 percent, which makes a person with BPD twice as likely to commit suicide as the rest of the population.) So where can we Cluster Bs get the help we need, and more important, how can we help ourselves if no other kind is forthcoming? Like many of us, I learned to cope the hard way, from experience and putting that experience into action. I learned how to deal with dissociation, to put aside labels, and think of Cluster B disorders on a spectrum. I figured out ways to express empathy, and went on the long journey to find the medication that finally worked for me. Here’s what I’ve gathered along the way.