I Swear You Will Be Fine

Dear Josh,

I watched an interesting video recently that hooked me with the opening line, “The brain science behind one of the most misunderstood and stigmatized conditions in all of psychiatry.” I didn’t realize it was going to be a video about borderline personality disorder (BPD). I wanted to stop watching after that big reveal, but I thought it might give me a better understanding of what went on in your brain.

As we know, BPD is influenced by environmental factors, genetics, and trauma. This doctor shared that it’s like having a brain that experiences emotions at max volume with no way to turn it down. He gives examples like, “Real BPD (meaning, not the BPD clouded by myths) is being terrified that someone you love is going to leave you even when there’s no evidence of it,” or “It’s like loving someone so intensely in one moment, but then feeling betrayed by them in the next.” He says that people with BPD have brains that flip like a switch they can’t control. I could see aspects of these in you and your actions at times. I could see the switch one especially clearly in some instances. In one moment, you could be feeling really, really bad. It’d be so bad that I would be worried you’d hurt yourself, but something can immediately change your mind, like a switch, and you’d be laughing and joking about the way you were a second ago.

This doctor shares that 65 to 80% of people with BPD hurt themselves. He explains that this happens because the emotional pain can become so great that physical pain is one way to quieten it. The neuroscience explanation for this urge is that the emotional thermostat is dysregulated – the amygdala in BPD brains “explode” instead of firing a “normal” amount, and because the prefrontal cortex is underactive, it does not regulate these heightened emotions. I didn’t know this before, that the amygdala is hyperactive in people with BPD causing every emotion to hit harder, last longer, and fluctuate faster. When you told me that you were self-harming, I kept trying different ways to get you to stop. I think I was underinformed back then and didn’t know how to properly help. Sometimes I wonder the use of having such information now.

There’s another part of the brain that’s wired differently in people with BPD – the part involved in social cognition that helps in reading faces, interpreting intentions, and determining if something is safe or not. Apparently, BPD brains have a negativity bias, which kind of means that neutral faces can end up looking angry, or ambiguous social situations can feel like rejection. I didn’t notice this in you from our interactions. But when I listened to your family’s stories, I heard it. It sounded like you would misinterpret information and at times think some things happened when they didn’t. Now I understand that it wasn’t something you could control.

The video goes on to talk about the genetic component (40-60%), mistreatment or trauma as a child, recovery rates, and treatment options. It was advertised as a treatable condition. I wish we could relate to that too. I stopped watching after he started talking about the recovery rates, so I can’t give you any statistics – not that it matters since we didn’t.

The video intended to bust some myths about BPD but the comments showed me that people barely understood. Someone said that people with BPD rather hurt others than themselves. Some said that they are little psychopaths and can never get better. I also stopped reading after a while because of the lack of empathy. There were some nicer comments though, thanking the doctor for trying to destigmatize a misunderstood disorder. Oh, I almost missed something out! He also said that BPD should be renamed to Complex-PTSD. I thought that was interesting.

I understand this letter is getting a little long so I’ll wrap it up. We once talked about whether diagnosing someone is helpful or harmful. We were both on the side of “helpful” because it would be easier to guide treatment and some might feel better knowing that there is a “concrete” reason for their feelings and experiences. But some days, I think diagnoses aren’t helpful. I sometimes wonder if you would have coped better thinking of the symptoms as symptoms – dealing with what it is instead of what it adds up to. Nearing the 31^st, you said you were tired of having cancer, and I’m sure you meant it was tiring to deal with the symptoms, but I’m also wondering if you meant it was tiring to carry that label.

I can’t wait to see you again. I’ll love you forever, I’ll like you for always, and I’ll miss you more than you can imagine.

Love always,
Sha