Her brain tormented her, and doctors could not understand why

The young woman — and her family — were exhausted and confused by the barrage of treatments and medications. How were they supposed to cope with her nightmarish outbursts, her self-mutilation and suicide attempts, her destructive behavior?

Her brain tormented her, and doctors could not understand why
By Aleszu Bajak September 14 at 2:38 PM

“I hate myself, and my brain,” Pam Tusiani wrote in her journal while under 24-hour watch on the fourth-floor psychiatric ward of Baltimore’s Johns Hopkins Hospital. “Nothing is worse than this disease.”

When Tusiani wrote those words in 1998, doctors had little understanding of the disorder that was troubling her, and all these years later they have little more.

Trying to understand how the illness works — in hopes of finding a cure — strikes at the heart of psychiatry, indeed medicine in general. How does one replicate at the basic research level what one sees in a patient? How do you find the chemical root of a disease, especially one as complex and multifaceted as borderline personality disorder, or BPD?

Just as a smile takes dozens of facial muscles to execute, a particular emotional response to a stimulus requires a web of brain activity. The brain isn’t a series of one-way streets. It’s a hive of superhighways, and we can barely make out the cars, much less figure out where they came from, where they’re headed, what they’re carrying and why they’re on the road. We barely understand a healthy brain, so how are we to understand one haunted by psychoses?

Some days Tusiani, a New Yorker who was attending Loyola University in Baltimore when she was hospitalized, would cut herself, usually on the arms and hands, not so much to inflict pain but rather to relieve inner turmoil. “Bleeding enough that I felt good,” she wrote. One day she’d be curled up in the fetal position, unable to eat or speak; the next, she’d be pacing her house, berating anyone within reach and seeking drugs and alcohol — or a razor — for relief.

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