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By her own admission, Talya Lewis was a strange child – as early as kindergarten:
Lewis: Like I remember one day I came in with white sticky tape wrapped all around my arm, and I told everyone that it was a cast and I had broken my arm.
Desperate for attention, she convinced her mother she couldn’t see, and got prescription glasses. By age 8 – her behaviors were self-destructive:
Lewis: I had a game, and I called it TP, and TP actually stood for taking pills. I would rummage in my parents’ medicine chest and I would take their pills.
This was only the beginning. Over the next years, Talya knocked her front teeth out with a hammer, started taking drugs, cutting herself, her behavior out of control in school. Her parents, whom she describes as distant socialites, didn’t seem to notice. But then came the wake up call.
Lewis: I overdosed on a bottle of sleeping pills in my high school, in the front lobby, and that was the beginning of what ended up years of long-term confinements in a private psychiatric hospital.
Talya was diagnosed with Borderline Personality Disorder, or BPD. Philadelphia therapist Edie Mannion describes it as a severe and complex mental illness with many symptoms:
Mannion: Difficulty regulating emotion, like a broken emotional thermostat, and difficulty controlling impulses, and what I see as mostly a profound amount of emotional pain. Continue reading Understanding Borderline Personality Disorder from WHYY →
Here is a quote from Infinite Jest about “depression” or the “Great White Shark of Pain”. I think it helps illustrate the difference between the chronically depressed and those in emotional agony. I see that people with borderline personality disorder are more likely to be in the second category. I have bolded some key points here. The “suicide contract” is exactly the same as a “behavior contract”. With a person in this much pain, it ain’t gonna work.
That dead-eyed anhedonia is but a remora on the ventral flank of the true predator, the Great White Shark of pain. Authorities term this depression clinical depression or involuntary depression or unipolar dysphoria. Instead of just an incapacity for feeling, a deadening of soul, the predator-grade depression Kate Gompert always feels as she Withdraws from secret marijuana is itself a feeling. It goes by many names — anguish, despair, torment, or q.v. Burton’s melancholia or Yevtuschenko’s more authoritative psychotic depression — but Kate Gompert, down in the trenches with the thing itself, knows it simply as It.
It is a level of psychic pain wholly incompatible with human life as we know it. It is a sense of radical and thoroughgoing evil not just as a feature but as the essence of conscious existence. It is a sense of poisoning that pervades the self at the self’s most elementary levels. It is a nausea of the cells and soul. It is an unnumb intuition in which the world is fully rich and animate and un-map-like and also thoroughly painful and malignant and antagonistic to the self, which depressed self It billows on and coagulates around and wraps in Its black folds and absorbs into Itself, so that an almost mystical unity is achieved with a world every constituent of which means painful harm to the self. Its emotional character, the feeling Gompert describes It as, is probably mostly indescribable except as a sort of double bind in which any/all of the alternatives we associate with human agency — sitting or standing, doing or resting, speaking or keeping silent, living or dying — are not just unpleasant but literally horrible.
It is also lonely on a level that cannot be conveyed. There is no way Kate Gompert could ever even begin to make someone else understand what clinical depression feels like, not even another person who is herself clinically depressed, because a person in such a state is incapable of empathy with any other living thing. This anhedonic Inability To Identify is also an integral part of It. If a person in physical pain has a hard time attending to anything except that pain [(the big reason why people in pain are so self-absorbed and unpleasant to be around)], a clinically depressed person cannot even perceive any other person or thing as independent of the universal pain that is digesting her cell by cell. Everything is part of the problem, and there is no solution. It is a hell for one.
The authoritative term psychotic depression makes Kate Gompert feel especially lonely. Specifically the psychotic part. Think of it this way. Two people are screaming in pain. One of them is being tortured with electric current. The other is not. The screamer who’s being tortured with electric current is not psychotic: her screams are circumstantially appropriate. The screaming person who’s not being tortured, however, is psychotic, since the outside parties making the diagnosis can see no electrodes or measurable amperage. One of the least pleasant things about being psychotically depressed on a ward full of psychotically depressed patients is coming to see that none of them is really psychotic, that their screams are entirely appropriate to certain circumstances part of whose special charm is that they are undetectable by any outside party. Thus the loneliness: it’s a closed circuit: the current is both applied and received from within.
The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death suddenly seems more appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise. Make no mistake about people who jump from burning windows. Their terror of falling from a great height is still just as great as it would be for you or me standing speculatively at the same window just checking out the view; i.e. the fear of falling remains a constant. The variable here is the other terror, the fire’s flames: when the flames get close enough, falling to death becomes the slightly less terrible of two terrors. It’s not desiring the fall; it’s terror of the flames. And yet nobody down on the sidewalk, looking up and yelling ‘Don’t!’ and ‘Hang on!’, can understand the jump. Not really. You’d have to have personally been trapped and felt flames to really understand a terror way beyond falling.
But and so the idea of a person in the grip of It being bound by a ‘Suicide Contract’ some well-meaning Substance-abuse halfway house makes her sign is simply absurd. Because such a contract will constrain such a person only until the exact psychic circumstances that made the contract necessary in the first place assert themselves, invisibly and indescribably. That the well-meaning halfway house Staff does not understand Its overriding terror will only make the depressed resident feel more alone.
By (author) David Foster Wallace
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An important article about the parents of Sasha Menu-Courey, who took her own life in June:
Parents hope to raise awareness of condition that took daughter’s life
Parents hope to raise awareness of condition that took daughter’s life. Sasha Menu-Courey, who took her own life in June after receiving a diagnosis of BPD, spent more than 25 hours per week pursuing her passion for swimming. Her parents will hold a celebration service for her Sunday to honour her life and raise awareness of BPD. Courtesy / Mike Menu
NOEL GRZETIC
July 8, 2011
When a person takes his or her own life, one would imagine it’d be an unbelievable challenge for their loved ones to function under the weight of the tragedy. In the case of Etobians Mike Menu and Lynn Courey, however, they’ve managed the courage to fight back against borderline personality disorder (BPD), the condition that took their daughter away.
The pair have teamed up with Mount Sinai hospital in Toronto to form a foundation to raise funds and awareness of BPD in honour of Sasha Menu-Courey. On Sunday, they will hold a memorial celebrating the life of their 20-year-old daughter at the Etobicoke Olympium, where the avid swimmer spent so many hours.
Popular, intelligent, athletic and creative, friends and family describe Sasha as a well-liked college student who had it all. She was attending the University of Missouri on a swimming scholarship, studying psychology with a minor in sociology. According to her father, she often said swimming was her life, noting in her journal that “her first scent was chlorine.” Sasha spent more than 25 hours per week training, and had a 4.0 academic average to match.
“She was an avid reader – she read for the whole family,” said her mother. Sasha was also a gifted writer who had already been published more than once in a local paper.
This was the Sasha that Lynn and Mike knew when they received a distressed call from her on March 21.
“She said ‘mama and papa don’t worry, I’m just not feeling good right now. I’m going to go to the hospital and talk to someone,’” her mother recalls.
This was not the first time her parents had seen her hit a low. In May 2007, 15-year-old Sasha was in Montreal for swimming and suffered a series of blows: she got an injury, had problems with a roommate and saw the end of a romantic relationship. The intensity of the circumstances was too much – she took a handful of Tylenol and later called an ambulance for herself. After the failed attempt to take her own life, her parents brought her to a Toronto professional but were not offered tangible help.
“They told us she was too young to be labelled with anything, that it was an adolescent scenario that could be worked out through therapy,” said her father. “Now that we know…we think she should have been diagnosed.”
Her parents are convinced that a diagnosis would have allowed them to get her the right type of help.
“[Adolescence] is the time when this disorder appears and affects so many friends, family, people at school. We need to be aware of when it gets intense – it should be a red flag, it shouldn’t be ‘oh well, it’s just a troubled teenager,’” said her father.
The phone call this March came amidst similar circumstances: an injury, a failed relationship and housing problems. This time Sasha was diagnosed with BPD and placed in a campus psychiatric centre for 10 days. She tried to take her life again weeks later.
“We didn’t know what was wrong because she called us 10 days before with the will to live, the will to fix herself. Suddenly all she wanted was to die,” said her mother.
Her parents tried to bring her home but were warned by CAMH of an eight- to 12-month waiting list. So her parents took matters into their own hands. They found a place for her in a community house at McLean Hospital in Boston. At the cost of $50,000 a month, her parents began to see improvements as Sasha followed the course of Dialectical Behavior Therapy (DBT). After two months, her parents could no longer afford the costly treatment and began to speak with Sasha about bringing her home. It proved too much for Sasha, who took an excess of 100 Tylenol and went to sleep. She died later in hospital.
“She was not supposed to die. She had such a bright future,” said her mother. “I want her to be remembered as a great kid – social, that always wanted to help out others.”
The foundation – the Sasha Menu-Courey fund – will be used to fund DBT treatment for other teens in similar situations. Bracelets will be sold on donation at Sunday’s service, and health care professionals from MacLean Hospital will be there to help raise awareness.
Service runs from 5 to 8 p.m. at Etobicoke Olympium, 590 Rathburn Rd., and is open to the public.
Donations can be made to Mount Sinai Hospital Foundation Sasha Menu Courey Fund will at http://www.mshfoundation.ca/fonds-sashamenucourey or call the foundation at 416-586-8203, ext. 3936.
Article about a University of Missouri swimmer who committed suicide. She had BPD. Sad, sad.
Missouri swimmer’s suicide might draw attention to disorder
By DAVID BRIGGS
Sunday, July 3, 2011
Sasha Menu Courey loved college life at Missouri.
She was a swimmer with Olympic ambitions but rarely missed a chance to set free a laugh so booming that it seemed to rattle the ceiling of teammates a floor below at Johnston Hall. The sophomore greeted friends — everybody counted as one — as if they were just the person she was hoping to see.
“It was always, ‘Heyyy!’ ” said MU swimmer Caitlin Connor, who met Menu Courey before a home football game their freshman year when she and her roommate from 233 Johnston searched out the source of the bursting cheer in Room 333. “She would talk to you like she had known you her whole life.”
In the classroom, Menu Courey earned a 4.0 GPA her first semester and was already planning for graduate school. The aspiring psychologist had lined up a prestigious internship this summer researching treatment for alcoholism.
“Everything she touched,” said her mother, Lynn Courey, “she was doing great.”
But this spring, Menu Courey fell into the grip of an illness she had kept hidden from the world.
Menu Courey committed suicide June 17 in a suburban Boston hospital. She was 20.
When a series of events one friend described as the “perfect storm” reached a crest, she slipped into a deep depression from which she would never escape.
Menu Courey left the team on March 21. She spent the next 10 days under watch and treatment at the MU Psychiatric Center, where her parents said she was diagnosed with borderline personality disorder, an illness characterized by extreme emotional instability.
Lynn flew in from the family’s Toronto home to be with her daughter when she was released. By then, however, she said she no longer recognized Sasha. Though Sasha often put on a cheerful front to keep friends and family from worrying, she bore an emotional pain too great to endure.
“We have difficulty understanding, as well, what happened,” Lynn said. “My daughter really had a great will to live, and suddenly she had a will to die.”
Now, Menu Courey’s family is celebrating a life that brought joy to so many while searching for answers and striving to raise awareness of a disorder they knew little about until it was too late. Continue reading Missouri swimmer’s suicide might draw attention to disorder →
In a recent article/review of Borderline Personality Disorder treatment options and management methodologies, the author quotes the Dr. John Gunderson in the New England Journal of Medicine May 26 issue:
“…BPD is present in about 6% of primary care patients and persons in community-based samples and in 15 to 20% of patients in psychiatric hospitals and outpatient clinics,” writes John G. Gunderson, MD, from the Psychosocial and Personality Research Program, McLean Hospital in Belmont, Massachusetts. “Patients with BPD usually enter treatment facilities after suicide attempts or after episodes of deliberate self-injury. Such episodes result in an average hospital stay of 6.3 days per year and nearly 1 emergency room visit every 2 years, rates that are 6 to 12 times those among patients with a major depressive disorder.”
As you can see BPD has a major financial impact on the health care system, not to mention the distress for the patients and their families.
When reviewing the various treatment options, the author says this about mentalization therapy:
Mentalization-based therapy is a cognitive or psychodynamic therapy including individual as well as group therapy. While assuming a “not-knowing” stance, the therapist insists that the patient “mentalize,” or examine and label his or her own experiences and those of others. This emphasis on thinking before reacting may be a process central to all effective therapies.
That “not-knowing” stance is what I tell the nons that I know: Be a detective, not a judge.
I’ve had conversations with several BPD “experts” about borderline behavior. There seems to be an assumption that many people with BPD are “silent” or “high-functioning” and do not engage in dangerous and/or ineffective behavior often attributed to the “typical” borderline.
In my group recently, a non-BPD was questioning his own “sanity” (I put it in quotes because I don’t believe that people with BPD are insane) and speculating that he was the one with BPD. One of our longer-time posters replied:
If you’re not throwing full-blown temper tantrums, freaking out because EVERYONE is out to get you, threatening to hurt or kill yourself, running away from those who love you because you’re afraid they’re going to leave you first, complaining that NOBODY loves or respects you AND popping pills and guzzling alcohol all at the same time… then, I think, you can go ahead and disqualify yourself.
Based on the polls that I have conducted over the past few months, I believe that she is right on the money. Here are the poll results from the last few polls about borderline behavior:
 Borderline Behavior Poll Results As you can see by these polls results, more than 73% responded that their borderlines (or themselves if they have the disorder) indicated that they have engaged in self-injury, suicide attempts and/or substance abuse. While these polls are certainly not scientific and it’s pretty much impossible for me to understand the profile of a person that responded, they results are, for me, striking. If 7 out of 10 (or more) individuals engage in these “low functioning” or ineffective borderline behaviors at some point in their lives, what should that tell us?
I believe that it tells us that the “typical” profile of someone with BPD is the “low functioning” or “classic” borderline. While I am sure there are others out there that operate in pretend mode (and pretend everything is ok while they “white-knuckle” their way through life), the vast majority of people with BPD seem to be caught in a spiral of ineffective and often dangerous behavior. They seem to me to be sending the message that they are in a great deal of emotional pain and are suffering greatly – that they will do anything to stop the pain that they feel. It also indicates to me that it is vital for parents of child with borderline-like traits and feelings do their best to get the child into appropriate treatment before their teenage years.
Each day, I check my Amazon Associates account to see what has been purchased the previous day. Amazon is a day behind – it’s not “real-time” reporting – so I get the purchases of books, eBooks and other products that have been linked into my Recommended Reading List or by people who click out of the list and buy something else. Yesterday, one of the people who clicked through on my website bought a copy of Final Exit: The Practicalities of Self-Deliverance and Assisted Suicide for the Dying, which is a fairly well-known guide to suicide and how to make sure that suicide is successful. I suspect you all can see why this purchase disturbed me. As has been show in my poll conducted a few months ago, 70%+ of people with Borderline Personality Disorder (BPD) attempt suicide some time in their lives. Reports have shown that about 8-10% are successful in killing themselves. That is a rate 400% higher than the general population. What really disturbs me about this purchase is that many times a suicide attempt by a borderline will be impulsive and not planned. The purchase of Final Exit may indicate that a person out there is planning his/her suicide. If you’re the person who bought that book from a link on my site, please contact a mental health professional immediately or go to your nearest emergency room. You can also call the national suicide prevention hotline at: 1-800-273-TALK (8255)
How DBT saves lives and how to accept the label borderline. I stumbled upon this interview with Stacy Pershall, a woman recovered from Borderline Personality Disorder (BPD). The interview itself is fascinating and can be found here. She has also written a memoir entitled: Loud in the House of Myself: Memoir of a Strange Girl. Here are some highlights from the interview:
Stacy on the label Borderline Personality Disorder:
When I first heard of BPD, it was in a magazine article given to me by a college roommate. That was back in the early ’90s, and the article said BPD couldn’t be cured, so I either had to resign myself to being crazy forever or dismiss the diagnosis as a way of marginalizing women who refused to be meek and subservient.
My initial reservations about the diagnosis, with which I continued to struggle until I found DBT and, therefore, hope, centered around the question of whether you could diagnose any strange, artistic, outspoken girl with the disorder. I had a lot of legitimate anger over growing up marginalized, and I had a hard time separating that anger from the maladaptive rages that derailed my life for so many years.
Meeting my DBT therapist and reading Marsha Linehan’s work helped me make peace with the diagnosis and to see it as valid. When I read the DSM criteria and realized I was nine for nine, I had to admit there was some truth there. It really was like seeing an outline of my life. By that point, I wanted so desperately to get better, to build a life not punctuated by constant bingeing and purging and starving and suicide attempts, that I was willing to call my illness whatever I had to call it to get treatment.
As for what borderline means to me today, it is an accurate description of a disorder from which I feel mostly recovered. I encourage anyone who feels the diagnostic criteria ring true to pursue an official diagnosis and seek out the treatment for which they qualify.
Stacy on relationships as triggers (a study by Dr. Paul Links showed that relationship events are the #1 most important trigger for borderlines):
Relationships were my primary triggers. I wanted so desperately to be loved, validated and saved from my loneliness that I latched onto a string of partners who showed intense initial interest, and I promptly scared them off with the depth of my neediness.
I also had a propensity for seeking out emotionally abusive or withholding lovers. Relationship after relationship ended in emotional flameouts and trips to the emergency room for overdoses. When I entered DBT, I realized this was something I had in common with most of the other women in my treatment program, and I was able to let go of some of the shame I felt about it. Learning that this particular brand of self-destruction was a hallmark of my disorder gave me hope that I could use my DBT skills to avoid forming unhealthy attachments in the future.
Stacy on DBT (and mood stabilizers):
It’s a totally different world! Life before DBT seemed hopeless, and now it seems exciting and full of possibility. I trust myself to navigate the storms of day-to-day existence. Thanks to the DBT distress tolerance and emotion regulation skills, I even weathered a breakup without a suicide attempt, and know that if I ever see my ex again I can hold my head up and feel no shame or guilt over my behavior. I’m really proud of that.
The mood stabilizer Lamictal has also been a godsend. My moods now swing between happy and sad, not ECSTATIC and SUICIDAL. Needless to say, I’m a fan.
By (author) Stacy Pershall
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Article showing that teens with eating disorders have more suicidal thoughts:
Teens with eating disorders more likely to harbor thoughts of suicide, study finds
By Amina Khan, Los Angeles Times
7:21 AM PST, March 8, 2011
Teens suffering from anorexia, bulimia and other eating disorders are more likely to suffer from suicidal thoughts, anxiety disorders and substance abuse — but how much they suffer may depend on the type of eating disorder they have.
That’s according to an analysis published online Monday in the Archives of General Psychiatry that, with 10,123 adolescents surveyed, is the largest and most comprehensive study of eating disorders in teens in the United States.
About 0.3% of the teens surveyed reported suffering from anorexia nervosa, and 0.9% from bulimia nervosa. A full 1.6% suffered from binge-eating disorder. Ethnic minorities were more likely to report binge-eating disorder, and white teens tended more toward anorexia.
Those who had one of these three eating disorders often suffered from other issues as well. For example, those who were anorexic were 1.6 times more likely to have problems with alcohol – but bulimics were 3.1 times as likely, the study found.
As for phobias, people with anorexia were 1.8 times more likely to suffer from a social phobia. Those with bulimia were at 3.9 times the risk, but even that jump was dwarfed by those with binge-eating issues, who were 5.9 times as likely to suffer a social phobia.
Sound scary? It could be worse than we think: The researchers write in the paper that some of these numbers may actually be “a lower bound of the true prevalence of eating disorders.”
Follow me on Twitter @LAT_aminakhan.
Copyright © 2011, Los Angeles Times
I am closing the BPD and suicide attempts poll. The results were quite interesting. The last poll I ran was BPD and substance abuse. The basic results of the suicide poll were Yes 66%, No 25% and Don’t Know 9%. However, if I remove the “Don’t Know” group, the results are Yes 73% and No 27%. It is interesting to me that the substance abuse poll was Yes 76% and No 24%. The majority of people with BPD having substance abuse problems and having attempted suicide makes me wonder… are they generally the same group? If so, I think it indicates that people with BPD (generally) will do anything to stop the pain.
 Suicide Attempts Poll
Here are the results with the “Don’t Know” choice removed:
 Suicide Poll with Don't Know Removed
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