Dr. Carmen Wiebe, one of my group facilitators, has been working at the BPD clinic since 2002. After I completed the program, I asked her if moving to a new city would have been enough to trigger someone’s symptoms. “Moving is definitely one of life’s big stressors, so it certainly makes sense,” she tells me, though it’s not as clear-cut as that. It also depends on what the stressor represents and whether it overlaps with previous triggers.
“BPD tends to be a waxing and waning disorder,” Wiebe explains. “The symptoms intensify and de-intensity over time.” It’s true. Sometimes BPD feels like an ever-looming spectre.
When I ask if these symptoms will ever go away, Wiebe says it’s complicated. “It depends on which symptom,” she responds. “The behavioural symptoms like self-harm and anger outbursts and other impulsive behaviours can go away completely.” Having emotions that are easily prompted and take awhile to resolve can also go away, or at least become more manageable over time.
That said, the outcome of treatment varies greatly depending on the individual. And access to treatment is unfortunately less than ideal. Given the prevalence of BPD and that CAMH’s clinic is “kind of tiny compared to a lot of other services… we are completely unable to meet the demand.”
CAMH’s BPD clinic treats approximately 280 patients per year. These patients included my fellow group members, Chantel, 33, and Elliott, 23, to whom I grew close. I heard my story in theirs. Misdiagnoses, getting tossed around the system, wrong medication, invalidation. “I’ve always been told I’m broken, or sensitive, or wired wrong, that I’m dramatic or crazy, untrustworthy, because I’m ‘classic Borderline’,” says Chantel. After suicide attempts brought them to CAMH’s emergency room, Elliott and Chantel both entered the DBT program.
While we began treatment at different times, the first few months were challenging for all of us. “I had a lot of issues at first,” Elliott, who identifies as non-binary and uses the pronoun they, recounts, “especially concerning the fact that I was one of the few people of colour, and I felt very surrounded by white folks… it was very hard to open up and connect.” Chantel tells me that she’d struggled to get into the program for a year, during which time her then-girlfriend had become her caretaker. At the beginning, the program was “a band aid covering up too big a scar.” Her partner left her a month or two into Chantel’s therapy.
Things evolved for all of us, though. The “seemingly very easy skills” took some getting used to, but they eventually helped Elliott manage their emotions and symptoms “far more effectively.” Moreover, “the group started to become a place where I knew everyone understood what I was feeling,” they tell me. For Chantel, it was a matter of adjusting her focus inward. “It’s taken me a long time to do the program for me,” she says. “I can still be willful as fuck, but I can see myself trying… not to save a relationship, or convince my parents I’m not going to attempt to kill myself. For me.”
After my graduation in early January, I admittedly felt lost without my therapist, my group, my facilitators. I had moments of dark, troubling thoughts. I was surprised to find out that even though I’d finished my program less than two weeks prior, the most the clinic could offer me by way of support were recommendations to other services. I could not receive any more coaching.
I understood the possible rationale. Other people need help. The clinic needs to minimize therapist burnout. I was also angry and sad about it.
Then a funny thing happened. I noticed that I wasn’t hiding. I was reaching out to friends for help. I noticed that for the most part, I didn’t have any strong urges to self-harm, self-medicate, dissociate, or avoid my life. I noticed that somewhere in this 17-year tangle of trying to become a better person for others, I’d decided to start living.