My boss, a vivacious blonde woman in her early sixties, loomed over my desk. “Why can’t you just….finish it?!” she demanded. “The website – like, what could possibly be taking so long?!”
I looked up at her, tears welling in my eyes. I was desperate to do well at this internship, to have a taste of success after years of floundering in college. “I just…can’t,” I finally blurted. The truth finally poured out in one long sob – “I’m really sick and I’m not dealing with it in healthy ways and I don’t want to live like this anymore.”
“We’re not leaving here until you get help. Call the hospital,” she said in a stern, motherly voice. She stood watch as I Google-searched for the number; I shakily dialed. Terrified, I imagined myself imprisoned under 24/7 watch, the laces taken from my shoes.
“They don’t have any inpatient beds, but they have space in a partial hospitalization program for women,” I told my boss, trying to hide the relief in my voice as I hung up the phone. At least I would be able to sleep in my own bed.
“Go,” she insisted. I promised I would, but I was secretly sure that it was pointless. The words started ringing in my ears – lifelong, incurable, no known effective medication – as they had since I was twenty, when the psychiatrist handed me the diagnosis pamphlet.
Despite my fears and doubts, I arrived the next day at the Loma Linda Behavioral Medical Center, a sand-colored building that looked more like offices than a mental hospital. After a battery of assessments and paperwork, the nurse put a bright blue band on my wrist and swung open the heavy security door to a maze of halls with bright overhead lighting. A tall and harried woman spotted me and hurried over, almost tripping in her clunky, worn-in ankle boots. “Hi-ii! My name’s Noelle, and I’ll be one of your group therapists,” she said with a wide grin consuming her face. She led me to a small empty room, a giant 3-ring binder labeled Dialectical Behavioral Therapy under her arm, and shut the door gently.
“Well, as you may be aware,” she began, “the goal here is to learn skills to cope with intense emotion. So, we need you to quit smoking alcohol and drinking at all while you’re in treatment. I’ll also be checking up on self-harm behavior every day.”
Excuse me? Oh HELL no, I thought. “Um, what?” I asked, wondering how much THC had shown up in the drug test – six years’ worth of daily smoking was probably a lot. Still, my initial distrust turned to resentment. Who was she to take away the only things that ever made me feel better?
“I can just like, leave. I’m not 5150 and I don’t have to do this,” I spat bitterly.
“Of course, you have every right to do that,” she replied calmly. My eyes narrowed as I stared back at her; she didn’t even flinch behind her wide, black-rimmed glasses. “In the meantime, let me show you what we’ll be working on together.”
She set the binder in front of me on the long plastic table. “So, what we do is called dialectical behavior therapy. Dialectical means that we look at the two extremes of a situation, then meet somewhere in the middle. This tends to help when people see the world in black-and-white terms and have difficulty coping with intense emotions.”
Well, that’s me, I thought. But they can’t really fix me here. No one can. Her face lit with excitement as she flipped to the Table of Contents. “Okay, so here are the five main subject areas: mindfulness, distress tolerance, emotional regulation, self-esteem, and interpersonal communication. For each one, we teach a bunch of skills to make life easier when we have symptoms, even suicidal ones. It helps a lot of people and it can even be really fun! But we’re just gonna get settled in for today. Anything I can get to make you more comfortable?”
Um, probably a joint. “No, thanks! So great to meet you,” I lied instead. She led me down the hall to a classroom with sickly green walls, and I felt the eyes of fourteen other women on me as I slunk into an empty seat. The rest of the day passed in a blur.
That night, emotions ripped through me like a tsunami. With nothing to numb the pain, the waves thrashed harder than ever before. But, I decided to endure it at all costs. As much as I hated her for it, Noelle was right – I hadn’t learned how to deal with my issues with weed and self-harm to rely on. She seemed to see things about my brand of crazy that I just didn’t. Her sincere enthusiasm gave me a shred of hope that treatment might help.
So the next morning, I dragged myself to the hospital an exhausted train wreck, hair in a greasy bun and heavy bags under my eyes. I never wanted to feel as wretched as I did the night before. So, I threw myself into learning DBT. I took copious notes and asked questions, eager to absorb each skill. Yet, for almost a week, the chaos peaked over and over again. One night, as the urge to self-harm grew unavoidable, I realized that no amount of rote memorization would make it go away. I was scared to try the skills – what if they didn’t work and I lost all hope? Still, I took a deep breath and thought back to what I had learned that day. “Opposite Action”: replacing a maladaptive, disproportionate emotion or behavior by a healthy, opposing one. Courage opposes fear; love opposes hate. “When you start feeling that self-harm creep in, show yourself some love! Harness that energy into an act of self-care. Maybe giving yourself a gentle wrist massage, applying your favorite scented lotion, or brushing your hair,” Noelle had said. It seemed too simple, almost dumb. But after a few minutes of kneading the sore spots in my wrists, I was surprised to find that my body had seemingly tricked my mind into settling still.
Noelle, as my mentor through the learning process, became someone I deeply trusted and respected. Unbearable days gave way to tolerable weeks as I kept going, adding more coping skills to my repertoire with enthusiasm. Some skills, like “Assertiveness,” were downright terrifying to learn at first. Others, like “Opposite Action,” seemed to work despite their simplicity. “Self-soothing with the Five Senses,” a skill to cope with distressing, inescapable situations, seemed too easy to work at first, too. But I found that a pleasant experience, such as lighting a scented candle or taking a bubble bath, was surprisingly effective at relieving emotional pain in tough situations. The “Mindfulness” skill was similarly helpful in this straightforward way. With just ten minutes of daily practice, I was more aware of my body, my surroundings, and my emotions than I had ever been before. The exercises ranged from spiritual to silly – loving-kindness meditations one day, pipe cleaner crafts the next. But with each, I improved at focusing on the present moment. As I learned more and more skills, though I barely dared to believe it, I was getting better.
Towards the end of my time in treatment, I encountered one skill that just seemed too objectively ridiculous to accept at all. I adored the therapist, Kimi, a pleasant, churchy lady with a laugh as delicate as a wind chime in a cool, spring breeze. But I almost laughed aloud when she lectured with the utmost sincerity, bless her heart, about “Positive Affirmations.”
“I am kind and beautiful and everyone sees me that way,” she told us to say three times in the mirror at home. I could suspend my disbelief for things that seemed corny or dumb, but not things that were just plain false. Some people think Gandhi was a jerk, some people think Marilyn Monroe was ugly, and some people definitely think both of me.
“No need to repeat affirmations out loud in the mirror three times; we’re not trying to summon Beetlejuice here,” Noelle laughed later. She then imparted some game-changing advice: “If something doesn’t work, throw it out! But before that, try to find a way to make it meaningful for you.” Of the 100 positive affirmations in the handout, only a handful seemed to make any kind of sense. She suggested that instead of chanting these to myself aloud every day, I could write them on an index card and put it somewhere I would see it regularly. Sure enough, that helped. By modifying the skill to my individual needs, Noelle taught me that even positive affirmations could have significance if I was willing to look for it.
A short while after, the seven weeks of treatment came to an end and I resumed my regular life – a life that I presently, three months out and sober, find worthwhile and meaningful. In coping with the daily struggles of living with borderline personality disorder, Noelle’s advice to find personal meaning in DBT skills has been indispensable. I can now ask, “Where is the meaning for me in this experience? Is there insight that can be gained, or a silver lining on these storm clouds?” While it’s difficult, I also have the choice to throw out the things that don’t have meaning in my life – self-destruction, avoidance, apathy, and resentment.
Recovery has ups and downs, but I’ve learned that taking even imperceptibly small steps in the right direction is better than taking none at all. When one skill doesn’t work in the moment, I modify it or try another, and sometimes even a dozen others, until something helps. The most ridiculous skill of all, in the end, has helped me the most to keep going. Tucked in my wallet, the beat-up and dirty index card of positive affirmations declares: “I haven’t tried all possible ways, so I refuse to give up.”