There is an old joke that summarizes psychiatric disorders thusly: A neurotic builds a castle in the air, and a psychotic moves in. In early editions of the American Psychiatric Association’s Diagnostics and Statistics Manual (DSM), the pathologies known as personality disorders were a level of magnitude below the neuroses in severity, and the individual classifications were typically used as convenient labels with which to describe abhorrent – yet not necessarily debilitating – personality characteristics, which frequently went untreated. The DSM defines a personality disorder as “an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it.”
Unfortunately, when the psychiatric effects of drugs such as crystal meth are added to the dynamic, a person who had previously exhibited a simple personality disorder can easily experience an exaggerated form of the disorder, even to the point of psychosis. Put simply, adding meth to the mix is a lot like dousing a fire with gasoline.
While I make no claim to expertise in the human psyche, the ordeal I have gone through with my ex-wife has given me a crash course in one aspect of human psychology. I’ve seen first-hand how a moderately insecure but benign individual can be transformed into a violent criminal. Perhaps the saddest part is that people such as Lucille aren’t actually freed of the constraints of conscience; those moral guideposts that make us civilized are merely pushed back in line, hidden behind the hungers, fears, and ersatz confidence that are the by-products of addiction. Remorse, I am certain, still lives within the addict, and continues to gnaw at his or her sense of self, but is for the most part overwhelmed by the demons of addiction and psychosis that are part and parcel of the meth experience.
In particular, borderline personality disorder seems to be quite the prevalent diagnosis applied to meth addicts, Lucille among them. Borderline personality disorder (BPD) is a serious mental illness. To give one perspective on the degree of that seriousness, the individual has built the metaphorical dream castle, but it is a time-share, rather than a permanent residence. People with BPD typically have severe mood swings, often jumping from near-elation to rage or even despondency for no apparent reason. They can be giddy as a child on Christmas morning one moment, yet turn angry – even violent – at the drop of a hat, be it a seemingly innocuous comment, a minor event, or even a response to their own thoughts jumping from some pleasant subject to one that they find uncomfortable. As you would expect, a relationship with such a person is alternately a garden of delights and a minefield. No matter how delightful the garden might be when the person is in his or her “happy place,” it is impossible to see the boundary where the garden ends and the minefield begins, and the sweet moments spent together are inevitably overshadowed by the bad times. I can attest – from personal experience – that no matter how much love you feel for the person, it becomes impossible to accept those tender feelings when you know that the hammer is going to fall at any moment.
Though personal relationships seem to be the first casualty of BPD, the true ground-zero victim is the sufferer’s self-image. Imagine feeling intense love toward another person one moment, only to have that sense of tenderness evaporate instantaneously, replaced by a sense that the object of your affection is your most vicious enemy, bent upon bringing misery and destruction to your life. Then, as the cloud of paranoia passes, you realize the pain you have inflicted on one for whom you care so deeply. It is difficult to even imagine the self-loathing that must arise from such a violent emotional arc. And after going through these polarized love/hate cycles, how must people with BPD view themselves in their more lucid moments? The toll on the individual’s self-esteem must be phenomenal. Yet even understanding and empathizing with the person’s pain, the human instinct for self-preservation – both physical and emotional – ultimately forces a “healthy” partner to abandon the relationship. And no matter how well justified the abandonment, it is still incredibly painful to both parties, with plenty of guilt to go around.
The instability that destroys loving relationships has the same effect on the sufferer’s work life. Co-workers begin to avoid the person, supervisors are frequently torn between sympathy and anger toward the employee, or even fear of the person’s reaction if confronted with the inappropriateness of his or her behavior. Naturally, people so afflicted have little success at making long-term plans of any kind, since their priorities are likely to change over the course of a few hours or minutes, leaving their best laid plans feeling like a trap to them. The lack of any progress toward an orderly life becomes part of a vicious cycle, further eroding their sense of self-worth. And when that happens, they are even more motivated to turn to the one “friend” who consistently gives them what they crave: the yellow powder that is always ready to tell them that things are all better, and that life will be fine.
While there is less media coverage of BPD than there is for other disorders, such as schizophrenia or bipolar disorder (manic-depressive illness), BPD is much more common, affecting two percent of adults, mostly young women. Many of these people have a tendency to engage in self-injury, such as cutting themselves (or perhaps kicking a family dog until it finally bites them). Such self-injury is typically inflicted without the intent to commit suicide, although the rate of suicide attempts and completed suicide is much higher in people suffering from BPD than in the population as a whole.
Patients often need extensive mental health services; yet, with help, many improve over time and are eventually able to lead productive lives. Thankfully, both awareness of and treatments for BPD have improved in recent years. Where once personality disorders were little more than labels, used to describe a “difficult” individual’s behavior, the emergence of patients at the more severe end of the scale have resulted in increased focus upon their pathology, and an ensuing increase in efforts to treat them. Nowadays, individuals diagnosed with BPD account for 20 percent of all psychiatric hospitalizations. Antidepressant drugs and mood stabilizers are frequently prescribed for patients who are depressed and/or exhibiting severe mood swings, and antipsychotic drugs (major tranquilizers) may also be used when the individual suffers from severe delusions. Group and individual psychotherapy have proven to be at least moderately effective for many patients.
In the late 1980s and early 1990s, a treatment regimen called dialectical behavior therapy (DBT) was developed by Marsha M. Linehan, specifically to treat BPD, although it is now used for patients with other diagnoses as well. DBT is a behavioral-based treatment, which leans heavily on cognitive therapy, with a little Eastern/Zen thinking mixed in. In essence, the patient is taught, via one-on-one sessions with the therapist, as well as group sessions, to perceive the illness as being a biological dysfunction that affects his or her behavior, rather than a psychologically-based “flaw.” The sessions with the therapist focus upon the most critical behaviors, which the patient is responsible for documenting, while the group sessions focus more upon acquiring and implementing skills in four distinct modules: core mindfulness skills to assist the individual in remaining aware of their thought processes; emotion regulation skills to help the person consciously choose how to react internally to events and circumstances; interpersonal effectiveness skills to assist in choosing the most appropriate behavior in a social situation; and distress tolerance skills to assist the person in dealing effectively with stressful stimuli.
Although it is unknown whether the actual cause of BPD is organic (biological and/or genetic), or environmental (caused by traumatic experiences, especially in early life), it is generally believed that a combination of the two commonly predisposes the individual to exhibit BPD symptoms and traits. Many, but not all, people with BPD have a history of abuse, neglect, or abandonment/separation as young children. A majority (up to 71%) claim to have been victims of some form of sexual abuse. Adults with BPD are also more likely to be the victims of violence, including rape and assault, frequently as a direct result of exercising poor judgment in their own behavior and selection of partners and lifestyles.
Ongoing research funded by the National Institute of Mental Health (NIMH) is revealing specific brain mechanisms that directly affect the impulsiveness, mood swings, aggression, anger, and other negative emotion seen in BPD. This research has revealed that a small, almond-shaped structure inside the brain, called the amygdala, responds to signals from other brain centers, and regulates the emotions of fear and arousal in response to threats or other significant stimuli. The function of the amygdala is thought to be more pronounced under the influence of drugs like alcohol (or meth), partially explaining why the vast majority of methamphetamine addicts also fit the description of an individual with BPD.
With further research, perhaps it will eventually be possible to effectively reverse the effects of meth abuse and addiction with a simple prescription. Unfortunately, the primary focus of the “designer drug” industry is on keeping one step ahead of regulators, maintaining a constant cash flow by providing an evolving stream of drugs that keeps the customers coming back, even as it keeps the lawmakers and medical community scrambling. Far too many people nowadays are seduced by the promise of immediate pleasure that is the essence of meth’s seduction. Unfortunately, many of those people, like Lucille, move into their fantasy “castle,” only to find that it stands in the middle of a place called Crazy Town. And the “realtors” have proven more adept and adaptable than have their opponents in law enforcement and medicine.