On a glaring July day in 2001, having just received a breakup email from my boyfriend, I walked into the bathroom and tried to kill myself. I remember hearing my cat meow at me as I downed every pill in the medicine cabinet and the room faded to gray, then black. What I do not remember is the paramedics breaking down the door to save me, but the webcams took pictures of that. Fresh out of art school and thinking I was making an important statement, I'd become one of the first "camgirls," young women who broadcast our lives to the world.
Three days later, I woke up in the intensive care unit with an IV in my right hand and my mother holding my left. I was angry I had lived, overcome with guilt and shame about what I had put my loved ones through, and desperate to call my ex and beg him to take me back. In other words, I woke up with the same raw desperation, the same lack of skin.
It was the latest in a long line of suicide attempts, after 17 years of having an eating disorder. I was terrified of and exhausted by the world. I no longer trusted myself to be around people; I inevitably scared them off with my rage and self-loathing. Never-ending chaos is no way to live, and I had been living it for as long as I could remember. So much so that I had a literal drama degree; constantly filling myself with another character was the only way I survived college. (Then I got a spiky haircut and an M.F.A. in performance art, because the guy I'd convinced myself I couldn't live without told me Laurie Anderson was the only woman he'd ever marry.)
The day I came home from the hospital, I was greeted by dozens of websites featuring images of me swallowing pills, passing out and being rescued. There I was slumped on the floor with my head in the toilet, surrounded by prescription bottles. There were the paramedics, hauling me out of the bathroom. In my email was a massive web hosting bill and notice that my account had been canceled. I couldn't afford the bandwidth used by all the people who'd tuned in to watch me die - my biggest audience ever, for the performance I'll never live down.
I had known for years I had a mental illness; that much was blatantly obvious. For years, I'd been diagnosed with rapid-cycling bipolar disorder. I was as comfortable with the label as one can be; bipolar disorder was, after all, just a chemical imbalance, a few neuronal switches flipped the wrong direction here and there. Borderline personality disorder, on the other hand, the whispered thing I'd heard, was a wicked jungle-bred stepchild of a diagnosis. Borderline was Glenn Close in "Fatal Attraction." It was a shameful, incurable thing to be.
But I continued to flagrantly be it, until the day when my latest therapist (I was always firing them in a huff, or being fired because they didn't want the liability of dealing with a suicidal patient) gave me a piece of paper with the phone number for the dialectical behavior therapy program at New York-Presbyterian Hospital. "You have borderline personality disorder," she said. "D.B.T. will help you. This is where you need to be."
Dialectical behavior therapy can be summed up as cognitive behavioral therapy meets Zen Buddhism. Marsha Linehan, the University of Washington psychology professor who created it, was influenced as much by Thich Nhat Hanh as by established psychology. Linehan theorized that the emotional growth of borderlines is stunted in childhood by an "invalidating environment," in which their feelings are minimized or punished. Emotions with no acceptable outlet, especially anger, are then channeled into whatever coping mechanism is available -- eating disorders, self-injury, substance abuse, suicide attempts. B.P.D., said Linehan, is a disorder of chaotic emotions, which can only be tamed through mindfulness. Once a person becomes mindful, she can accept a gray area, a dialectic, a place where human beings are neither all good nor all bad.
D.B.T. is divided into four modules, the first of which is "Core Mindfulness." Every group therapy session begins with meditation. No way could I meditate, I thought; no way could I give up my crises and focus on my breath. My therapist insisted that I could. My job, she said, was to admit that my emotions were ruining my life, and to stick with her for as long as it took us to fix things. She promised, in return, to stick with me. This simple revelation, a pact between two women, was enough to contain me as I grew.
The second module of D.B.T. is "Distress Tolerance," or "getting through a situation without making things worse." Borderlines in crisis may, as I did, shift from happy to suicidal within minutes. Linehan's suggestions, which sound corny at first but actually work, involve substituting a temporary intense sensation that won't hurt you for one that will. Examples include gripping ice cubes in both hands, ripping all the pages out of a phone book, or eating a big spoonful of wasabi. In the case of impulse control disorders, temporary distraction is sometimes all it takes to avert a crisis. And those who have spent any amount of time in psych wards know that eating wasabi by the bucketload all day long is generally preferable to spending any more time in one.
The third module, "Emotion Regulation," focuses on limiting the amount of time you spend in what Linehan calls "emotion mind" and gradually coming to spend more time in "wise mind," a place where you are your best, healthiest, most compassionate self. The idea that emotion is not something that must be acted upon was another tremendous revelation to me. Feeling attracted to someone didn't mean I had to jump into bed, feeling lonely didn't mean I had to accept just anyone into my life, and, most importantly, feeling angry didn't mean I had to destroy myself.
It was the fourth module of D.B.T., however, that presented the greatest challenge. "Interpersonal Effectiveness" first required me to confront my judgments about any therapy that would use the words "interpersonal effectiveness." It sounds so '70s, I thought, so est, so like something that would end with participants bashing each other with those big padded mallets from the opening credits of The Jeffersons. But by the time I found myself in DBT, my life was a complete disaster, so I was willing to try anything. After all, the biggest reason I couldn't handle the world was that I couldn't handle individual people.
I stayed with D.B.T. for a year, watching the seasons change as I learned Marsha's recipes for surviving in the world. I recited her acronyms in my head constantly, her mnemonics for remembering the skills, and whispered myself through the steps of successful interactions with other human beings. Learning to use D.B.T. is like learning to surf -- only by diligently practicing balance can you learn to stay upright. There is a lot of wiping out before it starts to feel like dancing.
I haven't had a psychiatric hospitalization since 2005. I don't think of myself as a sick person anymore, because I found a therapy that turns chronic psychiatric patients into an army of compassion. In teaching me the value of unconditional acceptance, D.B.T. instilled in me a desire to go out into the world and unconditionally accept other people. It is, in many ways, the therapy that keeps on giving -- after all, only by connecting can you create a life worth living. Only then do you have a reason to stick around.