When Sam agreed to meet up with me to talk about his
lifelong struggle with mental illness I thought I knew more or less
what to expect. I knew he was one of over one million people in the UK
diagnosed with Borderline Personality Disorder (BPD), one of “the
forgotten people in the Mental Health Services.” Dale Ashman,
co-founder of Borderline UK, only support network for BPD people,
described their collective predicament this way.

Yet
the round-faced 51-year-old man sitting opposite me in a café near
London Bridge gave a whole new meaning to life on the border; I walked
away with no straight answers about BPD or its causes, and a tiny step
closer to the living hell I would luckily never have to go through.

You’re
probably wondering what the deal is. Well here goes. BPD is “a
relatively rare diagnosis and a controversial one, as it can be seen to
imply that someone’s whole personality is flawed,” says Ruth Goldsmith,
spokesperson for Mind, independent mental health organisation. This is
what makes BPD so difficult to diagnose, and why it’s often confused
with other mental illnesses. Sam was diagnosed with schizophrenia at 28
until only six months ago, when his diagnosis was changed to BPD. This
is very common, as his symptoms include blackouts, paranoia and
hallucinations. “I imagine a gargoyle-like creature attacking me and
tearing out my arm. Then it hits me with it until I bleed, and starts
eating it.” This is just one of multiple nightmares he experiences. At
times he finds himself talking “to someone who isn’t really there,” and
is prone to bouts of anger when contradicted or misunderstood.

Why
‘borderline’? This is taken to mean you are on the border of a
psychosis, meaning you are having beliefs or experiences not shared by
others. Clinicians cannot make the diagnosis via medical or physical
tests, but by observing the presence of five or more of the following
symptoms: self-harm/suicide attempts, frantic fear of being alone,
unbalanced relationships, shaky self-image, extreme mood swings,
feelings of emptiness, inappropriate anger, paranoia/anxiety, impulsive
behaviour eg. drug/alcohol abuse, unprotected sex, reckless driving,
binge eating, accumulating debts.

Alice, a 24-year-old
student, agrees it’s like having a heightened sensitivity to life and
all its problems. “There’s no hard and fast dividing line between
normal and pathological,” she says. That’s why “normal” people find it
so hard to deal with Borderlines. Alice went through a painful cycle of
anorexia, depression, refusal to socialise, and self-harm and a suicide
attempt from the age of 11 until she was diagnosed with BPD at 19.

Sam
is adamant that knowing he has BPD has changed “absolutely nothing.” He
lives on welfare, and he cannot hold down a job due to severe learning
difficulties since childhood. “I have had no friends, and no social
life for 23 years. I have no hope for the future.”   

He
clenches and unclenches his fingers continuously. “Sometimes I stand
for hours by the side of the road wondering what it would be like to
just walk in front of a bus… like how soon it would be until I felt the
pain.” It surprises me how direct he is about it, but then maybe he
doesn’t get the chance to talk a lot. “I’ve been labelled a freak all
my life,” he says, “People stay away from you when they see there’s
something wrong with you.”

What causes BPD? An hour
into the conversation, I manage to squeeze in this question. Sam
doesn’t hesitate. “My father was a paedophile. I was raped by men since
I can remember.” What was I expecting? Over 50% of Borderlines have
been physically or sexually abused in their past. The main theory is
that poor nurturing and a genetic predisposition do the trick. Yet a
small number of researchers, mainly in the US, believe it is in fact a
“neurological illness” that can be treated with medication and
psychotherapy (see links).  Memories of his past have left Sam
severely traumatised; his mental problems started at 28 when he moved
to London and escaped the abuse. He cannot relate to men at all, and he
has had only one significant relationship with a woman.

Alice
is hesitant to attribute the causes of her BPD, but then hopefully the
worst is over for her now. Sam sees no end to them. Around 75% of
people with BPD can be said to recover after 15 years after the initial
diagnosis. Technically, Sam was diagnosed six months ago, but he’s been
living with the monster for 23 years now, so in practice he’s still in
the “untreatable” 25%. 8-10% of Borderlines will commit suicide.

Borderline
UK is the largest national support network run by Borderlines for
Borderlines. It aims to provide understanding and support, and help
fight discrimination and prejudice. It is funded and run entirely by
volunteers. Dale set up the network in 2000 with a few other
Borderlines and a grant from Mind’s Award Scheme. BUK addressed a
significant gap in the system, and now “there is a growing realisation
that BPD is a national health issue.”

I found there’s a
lot of distrust of “normal” people. “Mental health professionals fall
especially foul of the instinctive distrust. They’re in such a position
of perceived power,” says Alice. This is what leads BPD sufferers to
turn to their “fellow sufferers”, hence the function of support
networks, chat rooms, and several websites set up by Borderlines about
themselves, BPD and how they cope with it (see links).

“To
clinicians [a BPD diagnosis] will mean someone more difficult to
treat,” says Dr George Fieldman, Lecturer in Psychology at BCUC and
psychotherapist, who treats around two cases of BPD each year. He
highlights the difficulties faced by Borderlines; they react
aggressively to people in positions of authority; around 70% of
Borderlines are women, yet there seems to be no explanation for this
yet.

What’s certain is the way BPD is still highly
stigmatised in society. Alice has not told any of her new friends about

her BPD. “BPD destroys people… It still has the power to take a lot
away from you even when it’s largely history,” she says. I tell Sam
good luck. He shrugs and walks away. One of the worst things in life is
losing the possibility for hope. BPD can totally destroy it.

*Some of the names in this article have been changed.