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Myra Anderson wants to know what the purpose of this article is.
In three long conversations, she's talked about living with mental illness and sexual abuse when she was a child. She's told of suicide attempts and court-ordered psychiatric hospitalizations, losing jobs and not being able to finish college. But she doesn't want people to feel sorry for her. She wants them to feel inspired. And she doesn't want to be thrown off track.
"The point is, I'm still here," she says in a voice that's friendly, but intense. "Everything that I've been through in my life has made me what I am today. … I'm thriving and wanting to live a full life just like everyone else."
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But to do that, she faces challenges from within as well as from the outside world, which she says tends to ostracize people with mental illness. Like others who contend with borderline personality disorder, Anderson strives to manage her emotions so they don't control her. One bad day at work can make her forget six months of good days; in the heat of the moment, she'll declare that she's always hated the job and wants to quit. With borderline, "You're all over the place," she says. "You might melt down anywhere." She recalls a recent incident when she was at a drugstore and something one of the employees said rubbed her the wrong way. "I started fussing and cussing in there," she says. "Then I called back later and I apologized to the pharmacists."
Anderson still fights self-destructive impulses that landed her in a Petersburg hospital for 14 days several months ago because she was feeling suicidal. She bears scars from razor cuts to her arms, chest and stomach — signs of her efforts to find release for inner turmoil.
"It is devastating to have a mental illness, but it is even more devastating to deal with the stigma of that, whether it's in college or work," she says. And to complicate things, "when you're mentally unstable, you're not in a position to advocate for your rights."
For many people, disclosing their mental illness can be dangerous. "A lot of people can't talk about a diagnosis without fear of losing a job or losing friends, losing family members," says Bonnie Neighbour, advocacy coordinator for the statewide mental-health network Virginia Organization of Consumers Asserting Leadership (VOCAL). "People get treated differently."
Anderson has learned to be careful about what she reveals and when. When starting a new job, for example, she enlists help from her therapist in determining what specific accommodations she might need to be successful and then asking for those in accordance with the Americans with Disabilities Act.
But after many years of going in and out of hospitals — and painful experiences as a student at three colleges, including Virginia Commonwealth University — Anderson, 35, has made remarkable progress. She works as a peer support specialist with Region Ten Community Services Board in Charlottesville, using her experiences to counsel other people who are affected by mental illness and teaching a recovery education class for clients, as well as an exercise class. She serves as a mentor for an 11-year-old girl who faces some of the same problems she did as a child.
She's engaged to Nathaniel Moore, whom she met at a conference related to mental-health recovery. He describes her as trustworthy, devoted and caring in her work and "real easygoing, easy to talk to and a great person to have a conversation with." She recently received a scholarship to attend Piedmont Virginia Community College, where she plans to continue pursuing a degree in social work.
Anderson, who says she has struggled with weight problems all her life, also lost 85 pounds since last summer, a result she attributes to daily Jazzercise classes.
Still, she says that for her, recovery is a journey, "something I have to pick up and bear daily."
Although borderline personality disorder is less well-known than mental illnesses such as bipolar disorder or schizophrenia, experts say it is more common. An estimated 6 million Americans, or about 2 percent of the population, are believed to be affected by it, and borderline patients account for about 20 percent of psychiatric hospitalizations, according to the National Institute of Mental Health (NIMH).
Dr. Robert O. Friedel, a Richmond-based psychiatrist who specializes in the disorder, says it is usually characterized by poorly regulated emotions, impulsivity, impaired perception and reasoning, and markedly disturbed relationships. If estimates are correct, one out of every 33 women and one of every 100 men have borderline symptoms, he says. The disorder usually becomes apparent in adolescence and early adulthood, says Friedel, who practices at the Family Institute of Virginia. When puberty hits, symptoms become more recognizable, he adds.
Research suggests that 75 percent of the risk of developing the disorder is inheritable, Friedel says, but life experiences also play a role.
Studies show that many borderline cases involve a history of abuse, neglect, or separation as young children, and 40 percent to 70 percent of people affected by the disorder have been sexually abused, according to the NIMH.
That may help explain why nearly half of the girls and young women treated at Jackson-Feild Homes, a residential mental-health facility in Jarratt, have the disorder. Most of the girls come from the foster-care system, says Debbie Mehl, the clinical director.
"A lot of times our residents don't have responsible adults to adequately care for them — helping them through life's trials and tribulations — and even getting basic needs met," she says. "At a very young age, these girls develop very distorted, false beliefs about themselves." Mehl sees this play out in substance abuse, chronic suicidal thoughts, self-injury, frequently changing moods and self-destructive behavior.
Anderson offers this explanation for why people with borderline personality disorder cut themselves: "When you feel overwhelmed with emotions and you want a release, you cut, and it soothes the whole emotional overload." And while observers might see it as a suicide attempt, she says, "actually, they cut because they want to cope and be able to live."
Mehl and other mental-health professionals say that borderline personality disorder is not always the official diagnosis on paper, in part because symptoms overlap with other illnesses and less is known about effective treatments. But while someone may always have the propensity for a personality disorder, Mehl says, those symptoms can remit with the right treatment.
Cheryl Ann Bowman, a Nottoway County resident, would agree. She says she had a borderline diagnosis, along with bipolar and post-traumatic stress disorders, but is in remission for two of the three (she says medication helps her manage her bipolar symptoms). Now 46, she was diagnosed several years ago, but "I am sure I had this problem much longer because I was so very reckless with my life." She says that impulsiveness — often associated with borderline — led her into three "disastrous" marriages, as well as drinking, unsafe sex, and driving "like a bat out of hell."
After two years of intensive therapy, Bowman moved into recovery. Since then, she started a peer-to-peer support group in Amelia County, and she is undergoing training to become a peer specialist with the Crossroads Community Services Board, based in Farmville. "People really need to know that people with mental illness can recover," she says.
In an effort to call attention to the disorder, advocates succeeded in getting a congressional resolution passed declaring May to be Borderline Personality Disorder Awareness Month. The 2008 measure notes in part that the disorder often involves a pattern of unstable relationships, frequently occurs along with other conditions such as depression, substance abuse and bipolar and eating disorders, and "is a leading cause of suicide, as an estimated 10 percent of individuals with this disorder take their own lives."
The name, which refers to being at the "borderline" of psychosis (a loss of contact with reality, often involving delusions and hallucinations), fails to describe the disorder, mental health advocates say. Some have suggested changing the name to "emotional regulation disorder."
Neighbour believes that borderline personality disorder is sometimes used as a catch-all diagnosis for difficult patients. "So there's a stigma around it, that someone who has borderline personality disorder would be hard to live with or hard to work with. That becomes a public perception," she says.
The perception is not without basis, however. "What I see is a sort of vicious cycle when someone gets that diagnosis," Neighbour says. "The human condition calls for us to want to make connections. And for people who end up with a borderline diagnosis, their way of reaching out to make connections isn't effective, so they don't get the connections they want. … It's painful to watch.
In many ways, Anderson seems like a different person than the one Debra Knighton encountered six years ago at Region Ten's Blue Ridge Clubhouse, which offers rehabilitation and day support services to adults in varying stages of mental health recovery. Knighton, who herself has been diagnosed with major depression, was working as a staff member, and Anderson was a reluctant client.
"She'd stay home a lot of days," Knighton recalls. "When she stayed home, I called and said, ‘Where are you? We miss you.' " When Anderson did come in, she would just sit on a bench in the hallway. But Knighton persisted in inviting her to join group activities. "I could just see there was something in her," Knighton says. "She had such a spark and such energy when she got angry. I wanted her involved. She's so smart and so engaging. She just didn't want to be engaged."
Once Anderson started to interact more, her emotions sometimes boiled over. "I was in a room once when she started ripping and tearing apart paper because she was so angry," Knighton says. Other times, she'd show staff members where she'd cut herself. Anderson would also lash out at staff members, saying, "You hate me, don't you?" At times, she'd yell at Knighton, "I hate you," and later apologize.
Gradually, things started to change. "Once she realized that she could stay out of the hospital and stay involved and be a leader … it just took off," Knighton says. "I find, like I think Myra found, helping other people really helps you to move forward and stay grounded."
Anderson says that although she had always felt like she was different, her illness became apparent when she was 12. A next-door neighbor had been sexually abusing her for years, and though she told a counselor about it when she was 11 and her family moved away from the man, the abuse continued. Then, one day in seventh grade, a girl who shared the same terrible secret got hold of a gun and killed herself.
A distraught Anderson told a school guidance counselor that she was also thinking of suicide. That led to Anderson spending nearly a month soon afterward in an adolescent unit of a psychiatric hospital, where she recalls at one point being taken to a seclusion room and made to wear a paper gown. When hospital staffers — mostly strong men — dragged her into the room and restrained her, she fought, cried and screamed. "In my mind, I was reliving the abuse."
She left the hospital on a day pass to testify at a preliminary hearing for the man who had abused her. Having to testify about what happened increased her stress and anguish. But the man was convicted and given a 15-year sentence.
It was the first of what she says were more than 100 hospitalizations throughout her life. She'd get out, and things would be stable for a short time, then she'd be sent back, sometimes by court order, after fits of rage, suicidal threats or self-cutting.
Like many other people with borderline personality disorder, Anderson has multiple diagnoses. For her, they are post-traumatic stress disorder and dissociative identity disorder (also called multiple personality disorder).
When she left home for college, she continued to bounce between studies and hospital treatment. At VCU, where she studied social work between 1996 and 2000 on a reduced course load, she says that one semester, she failed a class because she was in the hospital the day of exams. Another time, Anderson says, she sought help from Richmond Behavioral Health Authority after she began hearing voices telling her to do harm to one of her suite mates in the dorm where she was living. "Even though that is being out of touch with reality, I still had enough of a reality base to know that what I was hearing was the wrong thing."
She says a counselor with the authority called her courageous for coming forward — then obtained a court-ordered hospitalization and contacted VCU police. When Anderson returned to her dorm more than a week later, she found a letter from the coordinator of residence education posted on the door to her room telling her she was suspended from university housing. In a later incident, Anderson recalls that police were waiting for her when she arrived on campus; someone had made a threat to the president's office, she says, and she was questioned about it. "Why, I don't know." Finally, she left VCU. "I didn't see myself being able to be successful there," Anderson says.
For a while after that, Anderson worked in a teenage-pregnancy prevention program. But she says that although she received a glowing evaluation for her work there, she was unable to return after yet another hospital term. Agency officials asked to speak with her doctor, who told Anderson they were afraid to have her work around children. "They hired a temp and paid me to stay at home," she says. "After that, they laid me off."
At Ferrum College, where she enrolled in the fall of 2003, she wound up in the hospital twice. The second time, she says, a college official took her to the emergency room and obtained a court order for psychiatric treatment. After that, she says, she was told by an intermediary that she would not be allowed to return. "They didn't think I was stable enough to continue."
The last college she attended was the small Mountain State University in Beckley, W.Va., in the spring of 2004. Despite being hospitalized five times, she made the dean's list. The school assisted her in keeping up with assignments and tests while she was in the hospital. But after one semester, she decided not to go back. "My family is a big part of my support system," she says. "I didn't make one friend on that campus, and my family was three hours away." Anderson says she arrived in the middle of the semester, when most students had already established friendships. It was wintertime, so she tended to stay indoors, and she says, the small campus had limited opportunities for socializing.
It was around that time that Anderson met Knighton at Blue Ridge Clubhouse. Depressed after her college and work experiences, "I was at a point where I was sleeping 18 hours a day," Anderson says. "I didn't feel like I was capable of doing anything."
She recalls being annoyed by Knighton's calls and appeals for her to take part in activities. "She was communicating to me in a way that she still had hope for me," Anderson says. "I didn't get that at the time, but I get that now."
When Anderson transitioned from client to staff member, the two became friends. Like recovery, the friendship has had ups and downs. Knighton, now a counselor with the Charlottesville League of Therapists, says she and Anderson once went eight months without talking after a big blowup. But they've since worked out their differences. In recent months, they've been participating in a program called "Stand Up for Mental Health," which teaches people living with mental illness to use comedy to help relieve stigma and promote healing.
"You couldn't ask for a better friend," says Knighton. "She's funny and sensitive, honest, open and direct. She genuinely wants to work through things."
Anderson says that Dialectical Behavior Therapy (DBT), a treatment developed specifically for people with borderline personality disorder, has been helpful in reducing behavior that's harmful to herself and to her ability to relate to others.
Dr. Grace Hadeed, who works with borderline patients as clinical director of the Family Institute of Virginia, describes DBT as "a cognitive behavioral intervention paired with empathy, which aims to change the person's destructive thought patterns." She emphasizes that family involvement is crucial to a positive outcome.
Anderson has learned to use deep- breathing techniques to help calm herself. And she has an agreement with her therapist. "When I'm really upset about something, I don't deal with it for 24 hours, and that gives me a chance to cool down."
She also has support from her family, her church, and work supervisors who appreciate her and who aren't put off by her occasional flare-ups.
Anderson's mother, Karen Anderson, says she's never given up on her daughter. She acknowledges that it's been disappointing when Myra seemed to be making a lot of progress and had a setback, but adds, "I'm right there beside her and when she's ready to climb, I'm right there beside her, open arms. … A mother has to have the stronger upper hand. If I let it pull me down, then I'm not helping her."
Faith is important to both of them, Karen says, noting that Myra attends a nondenominational church in Charlottesville. "God has never turned his back on us." And Karen does think her daughter has come a long way. "She's not looking back. She's involved in so many activities and meetings. There's really not a lot of time to dwell on [having] a mental illness."
What's been most helpful, Anderson says, is finding people who believe in her. "Sometimes you don't have any hope for yourself. Sometimes someone else has to hold the hope for you."
Above all, she is determined not to give up. She talks about how New Orleans is still rebuilding from the wreckage of Hurricane Katrina. "That's what my life is. I'm still rebuilding," she says. "The devastation was sexual abuse and all those things. Now I need to heal from that and work to improve the quality of my life — to decrease behaviors that destroy the quality of my life and increase behaviors that make my life worth living."