"There I stood, in a hole, deep in the ground. Did I dig it or just get in? Did I fall into it? Did someone else dig it and throw me in?"
These are questions my daughter Pamela asked herself as the heartbreaking effects of borderline personality disorder consumed her life.
Trying to piece together the circumstances that landed my sweet child into this abyss, I recognize some things were not quite right as she was growing up. On the other hand, nothing was terribly wrong.
From the time Pamela was a small toddler, she was somewhat shy and seemed unusually attached to me, but that was balanced by normal behavior – reciting nursery rhymes, jumping into the pool with giddy abandon and doing cartwheels on the lawn – so my husband and I felt she was going through a stage she would eventually grow out of.
When she reached adolescence at the all-too-early age of ten, Pamela became painfully uncomfortable with her body-image. A sudden growth spurt made her taller than most of her fair-haired friends: she developed pimples, dark body hair and needed eye glasses. As a result, Pamela had very low self-esteem. We told her she was beautiful, which she was, but that is not what she saw when she looked in the mirror. In an early diary from that time she wrote that she was depressed. But, during this same period she regularly played basketball, baked cookies, took up the saxophone and swooned at concerts for teeny-boppers.
As a teenager, Pamela developed a moodiness that we thought was again, typical for her age. She had many friends, including boy friends, and was an honor student and a key player on her school's volleyball team. However, she seemed to be a reluctant participant in group activities and always needed an extra amount of encouragement to take part in social events. Within our family of five, she was the least talkative at the dinner table yet she sang at the top of her lungs in the shower.
In relationships with her peers Pamela regularly attached herself to one person at a time and, in a sense, became that person's alter-ego, as if she lacked her own. She always worried about what others thought of her, and perceived slights were magnified a hundred-fold. Yet, she had a sense of humor that poked fun at herself, generating mixed-messages to those in her company.
While all of these quirks of Pamela's personality were noticeable, none of them at any one time were unduly alarming. My husband and I had gotten through some bumpy periods with our two older children, and thought she would find her way as she matured as well.
The first indication that we were wrong was when Pamela came to us after her freshman year at college and told us she was suffering from depression. We sent her for therapy and on the surface, at least, it seemed to help. After a rocky first year, her second year went smoothly. She even joined organizations that helped counsel others, she made the Dean's list and was happy with a steady boy in her life.
It wasn't until the summer of her junior year that the jigsaw puzzle of Pamela's existence – held so tightly together under wraps for 20 years -- began to break apart. It surfaced with intense headaches and ended six-months later, in an all-consuming, life-shattering nervous breakdown.
What followed is a story that would test any human's soul.
Where do I begin? With numerous hospitalizations at very well known and highly respected medical institutions across the country.
Why? Basically because she was depressed and even after the borderline personality disorder (BPD) diagnosis was made the antidepressants weren't working fast enough to end her anguish. Thereafter, she underwent twelve sessions of Electroconvulsive Therapy (ECT).
Then, as if her ego shut down and her id took over, Pamela began to exhibit impulsive behaviors far beyond her control: self-inflicted cutting, burning, two overdoses (Ativan and Excedrin), for which she had her stomach pumped, the shame of being abused by another teenager, admission of drug and alcohol use and promiscuity as a result. Two rapes – one of which was brought before a grand jury opting not to indict even though she was a patient at a mental health facility. AIDS tests. Anorexia. Bulimia. Tattoo. Tongue ring. Hair chopped, dyed purple. Psychogenic seizures, initially diagnosed as epileptic, but proved otherwise after electroencephalogram and videotaped monitoring. And the more subtle effects of anti-social behavior: low self-esteem, inability to express her feelings, splitting relationships among friends, family and care givers. Thinking only in black and white. Through it all, depression was impervious to those psychopharmacological agents prescribed for her. Anxiety and post-traumatic stress filled her days and nights.
Pamela worked very hard in her recovery. She valiantly endured the three month cycles of going on and then off every imaginable class of antidepressants, but her depression was unyielding.
In the end, Pamela's death was attributed to a reaction between her antidepressant medication and the lunch she ate on an ordinary day in 2001. We never envisioned that the pizza she ate that day would result in a lethal brain hemorrhage.
Pamela did not want to die - her diaries reaffirm how much she wanted to live. Her doctors told me and my husband how hard she tried to pull herself out of the inescapable hole she found herself in. She didn't want to have this illness. Nobody does. But it happened to her as it continues to happen to others.
The burden we carry in the aftermath of this tragedy is that we never knew much about borderline personality disorder (BPD.) As Pamela was growing up, we never read or heard about it. During her illness, it was a vague definition.
We now realize that BPD and other personality disorders are identifiable, and can be as deadly as physical diseases that consume the body and mind. We now realize that with more information, we may have been able to recognize her symptoms, had the support of other families in similar situations, sought earlier or different treatment for her, and possibly changed our daughter's outcome.
The hole may still be there for others, but Pamela, through her life story, has extended a hand to help lead others out. It is our hope that this Resource Center will be a resource for others who are similarly affected by this disorder.
Pamela's Mother
