Mental health diagnoses are a funny thing.
Categorization and organization of the world around us seems hard-wired into human nature. Everything labeled and grouped into sets and subsets from the natural world – plants, animals, colors, types of minerals, etc. – to the built world – vehicles, styles of houses, library books, etc, – to types of people based on a plethora of categories – occupations, social affiliations, social status, and country of birth.
So it shouldn’t be of any surprise that people have sought to categorize our mental states, particularly those that don’t fit into what is considered the elusive well-adjusted normal functioning individual, and put a label of this or that disorder on it. It has its uses. Falling into a diagnosis allows for treatment to be guided in a certain way, which can have a positive outcome. It sure makes medical billing easier (and the cynic in me suspects in this day and age, this is probably the most important reason behind having those diagnosis numbers in your chart – so that someone gets paid).
But I don’t feel it’s all that simple. Mental disorder can be more of a spectrum than a set of boxes where you go down the row checking off the contents listed on the outside and when you find the correct one you then crawl inside. The DSM seems a little weird to me with it’s “if you have 6 of these 9 symptoms, these 3 of which are MANDATORY”, then you belong here. Okay, but what if I have 6 of those symptoms, but only 2 of the mandatory ones or what if I have all 3 of the mandatory symptoms, but only 5 symptoms overall? Where do I fit then?
It’s hard to make room for all gradients of shading and degree of experience that exist in the real world of human experience.
And that’s the harmful side – people (including therapists) judge you, not based on you as an individual, but because you are seen as your diagnosis, no matter how typical or atypical it may manifest.
I have several categories of mental disorders that can be applied: anxiety and depression, social anxiety, PTSD, and borderline. They are all fluid and interact with each other in a unique way. If I isolate one, lets say social anxiety – how I experience it and express it may be completely different than someone else for a plethora of reasons. Yet, my diagnosis code simply says 300.23. But I know from being in an online support group years ago, that there is a huge range of experiences and behaviors among people with social anxiety. The way I experience it, on the more severe end of the scale, although it waxes and wanes over time, can be very different than the way it manifests in the life of another individual.
And so it is with BPD. And this is especially true when it comes to someone who falls under the label of “Quiet Borderline”. Go into any non-quiet BPD group and one thing that you see over and over again are people talking about their violent outburst of anger – throwing things, calling names, tearing another person down, exploding over trivial things. I honestly can’t relate to this at all. I am not saying the anger isn’t there, but it almost never expresses itself outwardly. It festers within – whether it’s part of BPD splitting when thinking about others (something I do quietly within my own head) or, more commonly, turning inward and destroying my own psyche. Self-harm and suicidal thoughts are a product of that anger. But I can’t even imagine flying off the handle regularly at other people. I am a tried and true conflict avoider. I don’t ever want to be around others who are arguing and raising their voices; that’s a survival “I need to get the hell out of here!” situation. Hell, when I was a kid, I couldn’t even be in the room when the Phil Donahue Show was on because people would disagree and argue with each other and it was too uncomfortable for me to even be safely in the living room with these people on the television. So I sure don’t want to be personally involved in angry conflict.
I’m also not particularly impulsive. I am not anywhere near what someone would consider a risk taker. I don’t have an addictive personality.
But all the other traits of BPD – oh hell yeah, I have all that in spades!
And I’m betting that others with the quiet form of BPD may not relate to those in the non-quiet BPD groups for the same reasons. But I would also bet that not all quiet BPD experience it just as I do. Because my life experiences, my genetic make up, and my other psychological issues all have an influence on how my BPD is expressed.
So here’s to all of us square pegs trying to fit in a round hole on something that is a spectrum. Don’t get too caught up in what you are supposed to be. Just be and try your absolute best to deal with the unique challenges living with a mental health disorder (or multiple disorders) brings.