Talking about mental health: borderline personality disorder

By Cara Croke

Cara Croke talks to Courtney Smyth about her life with borderline personality disorder.

Imagine having days where you’re too emotionally drained to get yourself out of bed and go to college or too anxious to go on a night out with your friends.

This is a daily struggle faced by people who suffer from borderline personality disorder (BPD) , described by the HSE as a mental disorder marked by an instability in moods, behaviour, self-image and functioning.

Among the 2% of Irish people who suffer from BPD is 22-year-old psychology student, Courtney Smyth. Diagnosed with BPD aged just 20, Courtney spent five weeks in St. Patrick’s hospital located in the Liberties. BPD is one of the most misunderstood and misdiagnosed mental illnesses in the world. For people with little knowledge of the disorder at all, it is described by Courtney as “a feeling of constant grief without there being any reason for it at all. Often it feels like you are not in control of yourself, you’re not in control of your own emotions and the world is kind of propelling you forward when you’re stuck in this state of not being able to manage anything at all.”

With symptoms very similar to bipolar, anxiety and depression, being diagnosed with BPD can be a long process of various tests. According to Courtney, the process of diagnosis is very interview based. “They go through your family life, asking general questions and if you say something that seems to signify a particular illness they latch onto it and ask further questions. I’ve had three assessments with three different psychiatrists because at the beginning my parents and I felt the diagnosis wasn’t really clear. We felt hypomania, where you go from being really irritated to really elated, wasn’t addressed. Finally, I was diagnosed with BPD and bipolar. They said I was on the spectrum of both.”



We all experience good and bad days in life, but for Courtney, struggling with BPD can mean that a bad day will consist of waking up and feeling sick with anxiety, being bedridden due to an overwhelming tiredness as her body signals that she’s too sad or too worthless for life. “A good day for me would be a normal day to most other people. It’s a day where I can get myself out of bed and make it through the day without having a panic attack or having to skip a lecture or leave work early.”

BPD has been proven to be very difficult to treat, the benefits of medication have been unclear, and psychotherapy or “talk therapy” is the main treatment for people with it. For Courtney, medication was not sufficient in treating her BPD. “I tried every medication before I finally said no. Xanax made me very sleepy and before long lithium was the only drug I hadn’t tried but I felt like I didn’t need it enough to risk the side effects.”

The type of treatment which showed the best results for Courtney was schema-therapy, an integrative approach to treatment that places an emphasis on the childhood origins of psychological pain.

Like many Irish people struggling with a mental illness, Courtney’s experience with the Irish healthcare system was not what she was expecting. To get into the hospital and be treated for a mental illness, one must receive a referral from a psychiatrist. When Courtney made the courageous decision to take the next step and admit herself to hospital, she encountered an unexpected problem. “I rang my psychiatrist’s office in bits and I asked the receptionist could I speak to my psychiatrist and that I was suicidal, only to be told ‘she’s not here, can you wait a week?’. She basically said that this had never happened before, which I don’t believe. It was just the lack of professionalism and humanity in the way she speaking. Another feature of BPD is the fear of being abandoned or rejected so, for me,that just felt like another rejection.”

Courtney was eventually admitted to St. Patrick’s Hospital on James’ Street after a 2-week wait, where she spent 5 weeks. Speaking about her experience in hospital, Courtney said; “I understand people being afraid of psychiatric hospitals, but people forget that these places are the scariest for the patients. I was put on a woman’s word with people who had similar illnesses to me. The nurses were fantastic. At first, I was overwhelmed with regret and I thought I wasn’t meant to be there and other people were sicker than me, but when you first get in they take a photo of you, and looking back now at how tired I was compared to how I looked when I finished was just an indicator of how much I needed to be there. They had a young adult programme and that was really interesting. It wasn’t so much an eye opener as it was a really unique way of getting to talk to people with different illnesses in a safe setting.”

Courtney now blogs frequently about her experiences with BPD after reading an article about it that she felt misrepresented the disorder. “I wanted to write from the perspective of someone who had it after seeing people who hadn’t even researched it claim to know what it was.”  It has been a year since she was first admitted to St. Patrick’s Hospital, and she’s gone to places and tried new things that she says she never would have dreamed of doing a year ago.

“It’s been a very slow process of getting better over the year. Looking back at this time last year and thinking about how determined I was to get into the hospital, I wouldn’t change a thing. I demanded I got the help I needed. I don’t care how I came across, I got it. If I could give advice to myself a year ago, I’d say keep trying. If me then could see me now, I’d probably hit me! People don’t recover that quickly but I was just so determined.”

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