Try “The Objective Route”
If unemotional responses toward other people can be honed to develop clear thinking against panicky times, you can use the same reasoning in situations where you find yourself stuck in an idea and unable to change your position. Sometimes, I’ll be so convinced of something that it won’t even occur to me that other points of view exist, even when they’re jabbing me in the face. I describe this as my on/off switch being flipped deep. Here’s an example: For the best part of last year, my partner and I kept getting into drawn out arguments about our drastically varying ways of expressing love. While he drains his time and energy into giving me the emotional support I need, I’m an emotional turnip and prefer to convey my appreciation by giving him presents. Sometime last month, I was scrolling through Instagram, when I came across a post about materialist-capitalist nature of Valentine’s Day. It was nothing groundbreaking (I’ve been confronted by that sentiment about five thousand times before), but it flicked a switch in my head, and suddenly I could understand my partner’s point of view as clear as rain. Where months of tearful imploring had failed to make the slightest headway, a stray photograph had miraculously succeeded.
I hate that switch: I hate that I have no way of accessing it or even knowing when it’s going to turn itself on, and I hate how it influences my personality and thinking despite my complete lack of control over it. But that’s the essence of BPD, that black/white, good/bad, always/never dichotomy that lies at the heart of all my actions, interactions, and relationships—including the one with myself. I’m trying to make my peace with that switch, and I’ve found that talking about it helps. If you’re facing the same sort of difficulty with your on/off switch, tell your loved ones that sometimes you might know something without understanding it. Ask them for patience, ask them to hold on, and in the meantime, try little things like replying to a message in good time, or remembering to text a friend you haven’t heard from in a while. For larger issues, try stepping away from an argument and being aware of your own limitations when taking on a task. It might feel tedious, unnecessary—unpalatable even—but if you succeed even once in 10 tries, that’s progress.
Rethinking Binaries and Labels
When discussing Cluster Bs, clinicians will often mention “affective empathy” and “cognitive empathy.” The difference between these two ways of experiencing empathy can be difficult to wrap your head around, depending on where you are on the narcissistic-borderline spectrum. If you think of the poor soul who fell down a couple of paragraphs ago, there it was my cognitive empathy which helped me figure out that they were hurt. But since my affective empathy is negligible and expressed only in fits and spurts, I didn’t feel affected by their pain, and wouldn’t even if they were someone close to me. While borderline personality disorder classically means a person has high emotional but low cognitive empathy, and narcissistic personality the opposite, it’s possible to have any combination: BPD with low emotional empathy, NPD with low cognitive empathy, somewhere in between with average amounts of both etc. All four Cluster B disorders, and the way they affect us, exist on a spectrum.
If you tried to create a visual representation of a person’s psyche, you’d eventually end up with a series of overlapping spectrums, more of a Venn diagram than a bullet-pointed list. A map of my own mind, for instance, would comprise a series of overlaps between BPD, bipolarity, depression, seasonal affective disorder, anxiety, and a history of disordered eating. All of these are conditions I have either suffered from or continue to suffer from, but they’re also a heavy burden to carry if I consider them piecemeal.
A couple of years ago, I had five or six odd sessions with a therapist whose words have stuck with me ever since. I’d brought up my difficulties in having to identify with so many disorders as well as my history of abuse, and how that made it impossible for me to address any of those concerns. In response, she suggested that I stop thinking in terms of one disorder or the other, and see myself instead as a person with a constellation of symptoms. All of which flow into one another, interact with my personality, and modify my responses to make me who I am. Some of these symptoms require management but that doesn’t mean they define me. Neither do any of the labels, all they can is create points in that constellation. For some reason, I felt that I’d been relieved of an enormous weight. And on the whole, I’d say that I’ve been less hard on myself since then.
Labels can be useful to get a sense of what’s bothering you, but don’t let them dominate if they’re impeding your ability to treat YOUR specific symptoms. Few people conform exactly to any single diagnosis. Increasingly, psychiatrists are moving away from diagnosis based treatment. Always remember that it’s your call and not your therapist’s whether you choose to accept a label or have nothing to do with it. Mental health practitioners who insist on a certain label and a certain course of treatment based on that particular label should, in my experience, be given a wide berth. For example, people diagnosed with BPD are often steered toward dialectical behavioral therapy (DBT) as the preferred course of treatment. However, a huge number of BPD individuals (like ME!) find medication to be equally, if not more helpful in managing their constellation of symptoms. When it comes to mental health, there’s no one-size-fits-all treatment. So if your current treatment is not working for you, talk it over with your psychiatrist and explore a different avenue.
The overlap that exists between all the Cluster B disorders often make diagnosis impossible, if not futile. From BPD on one end to NPD at the other, the spectrum traverses all the grey areas between high and low empathy, its affective or cognitive variants, a sense of self that’s compromised either by its absence or an overweening presence, and emotional responses ranging from indecipherably muted to bursting at the seams. Most Cluster Bs fall somewhere in between all these ranges, which means that any diagnosis can only give you a probability of how susceptible you are to each of these disorders. I scored high for BPD, moderate for HPD and ANPD, and low for NPD. These days I prefer to think of myself as a person with a constellation of BPD-related symptoms.
Medication in particular can be hard to get right at the first try or even the fifteenth one, and feeling like a lab rat as one pill after another fails to achieve anything more than side effects can be quite defeating. But I’d always say, hold on. The right medication or cocktail of medications is out there—you just haven’t come across it yet. Research into brain chemistry is still so nascent that all a psychiatrist can do is have an educated guess about which medicines might work. It took me 10 years to find the one antidepressant that did everything it promised, and it turned out be a variant of the very first medication I’d done a steady course of, a variant that didn’t even exist until 2007. For me, medicines took time to get right, but once they were right, the results made up for the wait.