Sunday, October 15, 2006

Borderline Personality Disorder and My Friend Letitia

When I was 20 years old, I met a woman in a poetry group I had joined who became one of my best friends. She was much older than I was, a mother, but she was also an athlete and a poet, as I was. She taught me to play racquetball, beating me easily for the first year or so. She was the toughest critic of my poetry, forcing me to consider every word, every sound.

We shared a proclivity for misanthropy, for depression, and for smoking. We both were fond of the idea of suicide at that point, although Letitia was very practiced in failing to suicide, having tried several times before I had known her. She tried and failed several more times during the years we were friends. During a dark period of my life when I was very depressed, we had made a pact never to interfere if one of us chose to die.

I broke that pact.

One gray day in the summer of 1991, we sat on the stones beside a bend in the Rogue River just west of Grants Pass, Oregon. The air was warm and humid, the river’s roar lulling us into a sense of calm. A blue heron stood on one leg in the shallows at river’s edge. We said little, just sat and watched and listened.

The spell was broken by the blare of a tourist boat forcing its way upstream. The heron quickly took flight. As the ugly red boat plowed through the rapids, many of the tourists waved at us, unaware of how unwelcome they were. We flipped them off with both hands.

That brief disturbance sent Letitia into what she called “the bubble,” the dark space in which she was no longer in this world, longing only to free herself from a body still rooted in time. All of Letitia’s suicide attempts took place while she was in the bubble, and paradoxically, she had no control over when it would occur. She could court it, seek it out, but it happened outside of her will to make it so.

Saying nothing, she quietly walked up to the car. When she returned, she had two bottles of pills in her hand. I tried to pry them from her fingers, but I was unable to loosen her grip. For the next three hours, maybe more or less, I tried to talk her out of the bubble. As I write these words I hold a small red pebble, a bead-like stone I fingered throughout those hours, a reminder, now, of a wound healed in me that afternoon.

I succeeded in preventing Letitia’s suicide (or merely postponed the inevitable). She did not talk to me for several weeks, angry that I had broken the pact. In the struggle to prevent her death, however, I realized my own incredible desire to live.

I would still considered suicide after that day, but never with the serious intention of doing it. In forcing me to decide between letting her die or preventing her death, she helped me find my own will to live. Each time I hold the small red stone, I feel the power of the life-force, the radiant Eros that was awakened in me that day. And I am compelled to remember the words of another friend who said that in our greatest pain is our greatest gift.[1]

*****

Letitia had been diagnosed as having borderline personality disorder. She had been given all sorts of medications, but she didn't like they way they dulled her feelings, so she hoarded them for the times when the urge to die became an insistent voice in her head.

The whole thing was made worse by a lifelong clinical depression. She had an emotionally manipulative mother and a sexually abusive father (though all family members denied this). Her father suicided when she was a teenager. She saw in herself the wounds of her father, and her attempts on her own life usually clustered around the anniversary of her father's death.

In 1996, Letitia had somehow gotten her hands on a gun. Late that year, she finally succeeded in taking her own life.

*****

I think about Letitia from time to time, but this morning I saw an article that talked about a new treatment for borderline personality disorder, which was thought to be essentially untreatable.
For the first time, a major outcome study has shown that a high percentage of patients with Borderline Personality Disorder can achieve full recovery across the complete range of symptoms. The controlled study, appearing in a recent issue of the Archives of General Psychiatry published by the American Medical Association, shows that a new approach -- Schema Therapy -- is more than twice as effective as a widely practiced psychodynamic approach, Transference Focused Psychotherapy (TFP). Schema Therapy was also found to be less costly and to have a much lower drop out rate. Borderline Personality Disorder (BPD) has until recent years been considered untreatable, with little scientific justification for longer-term therapy.

This study demonstrates that schema therapy leads to complete recovery in about 50% of the patients, and to significant improvement in two-thirds. The success of the therapy is strongly related to its duration and intensity (two sessions a week for 3 years). The results clearly contradict the prevailing opinion that BPD cannot be fully cured, and that longer-term psychotherapy is ineffective.
This is great news for those who know and love someone suffering from BPD. The hardest part for those of us who loved Letitia was that she was incapable of feeling that she was loved. Her own warped view of her self-worth left her feeling that no one could ever love her or care about her. When she was clear, she could get it intellectually, but she could never feel it emotionally.

I wonder what might have happened if Letitia had the benefit of effective therapy. I wonder if she would have lived, if she still would have written poetry. I wonder if she would have been less driven as an athlete.

None of that matters. All who loved her would have wanted her alive, especially her family.

Letitia's poems were collected into a book, The Wings of Black Birds, for which I wrote the Afterward. Here is a part of one poem:
from "THE WINDMILL"

I'm a girl, but Daddy doesn't care.
I've an Ithaca shotgun, too,
And we're going hunting.
The old blue truck stops on the country road;
There's no shoulder, just a deep weedy ditch.
Fine yellow sand slides underfoot
As we climb from the truck, quiet,
For no purpose,
Though neither is there purpose in speech.

We buckle on cartridge belts,
Break our shotguns, cross the ditch.
We part barbed wire for one another,
Standing on lower strands, holding the upper.
When through,
We slip shells into the chambers of our shotguns.
Single file we set off along a narrow cow path
Through long prairie grass.
Still quiet, contented,
We follow the trail to the water hole.
I hope that schema therapy will keep a few more people alive who might otherwise choose to suicide. I am grateful for having known Letitia, for the gift of life she gave me, but I would trade it all for her to still be kicking my ass at racquetball.


[1] Some of this text is from the "Afterward" to The Wings of Black Birds.

2 comments:

Ruth said...

Thank you, Bill, for sharing your powerful story about Letitia.

Gabby said...

Thank you for this post.