People often take psychiatric drugs because there’s something about themselves they don’t like—extreme low mood, threatening voices, or panic attacks. But many who’ve been diagnosed with borderline personality disorder (BPD) take drugs for the sake of others. They’re repeatedly told that their very personalities are disordered, pathological or just intolerable. This message is profoundly stigmatizing. It can contribute to isolation, loneliness, and even suicidal thoughts.
I talked with Dr. Shay Welch, a philosophy professor at Spelman College. Welch, who’s been diagnosed with BPD, truly writes from an insider’s perspective—a perspective that’s nearly absent from the academic literature.
Her recent paper, “Am I Safe Enough for You Now? BPD and the Forced Erasure of Personal Identity,” describes how people with BPD often feel forced to erase who they are to make others feel safe. We discuss ways of promoting more positive messaging around BPD, and creating a more tolerant and accepting society.
The title of her paper captures a theme that ran throughout our conversation: “treatment” for BPD is often less about alleviating the diagnosed person’s suffering than about making them more tolerable to other people. She describes medication levels that kept rising to make other people more comfortable, and a research literature built almost entirely around people in crisis. She also describes what would make life better: a cultural shift that would see, in BPD, not a defective kind of person, but just a different kind of person.
Justin Garson: There’s this idea that people take psychiatric drugs to manage parts of themselves that are inherently distressing, like being depressed or anxious. But as you point out in your paper, people with BPD often take medications for the sake of others. You describe how other people want to “erase—literally—who we are for their own comfort.” Can you say more about this idea of taking drugs to erase one’s personality?
Shay Welch: It’s true that you have these categories of social anxiety, panic attacks, and chronic deep depression, and those can interfere with somebody’s ability to thrive. But then you have these “identity” disorders, like BPD and bipolar and schizophrenia, which make other people very uncomfortable. When it comes to bipolar, or BPD, or schizophrenia, the institutions or the medical field itself will try to medicate it completely out of them. And then you just completely eliminate the person. These people are like, “I’m not a person. I am so medicated, I don’t exist as an individual.”
So, we are constantly trying to back off the medication to hit a point where we’re still satisfying other people, but reclaiming more of our actual identity. But that’s when people say, “you’ve come off your meds too much, and now you’re not functioning well in society and you need to go back on your meds.” And then people like us are like, what do I do? I’m terribly unhappy, but it’s me versus all of them. That causes many people to isolate themselves.
For example, a lot of bipolar people really love their mania. They accomplish so much, and their lives are so colorful, when they’re in the manic state. Then they have to go into the depression state. But sometimes they’ll tolerate the depression for the mania—especially if your manic state is longer than the depressive state. But other people don’t like that. For others, it’s too intense or erratic.
Garson: That makes sense. My dad was bipolar and he was on medication mainly because people didn’t like his manic episodes. In general, he didn’t like medication—he enjoyed having those emotional extremes.
But it seems to me—and this is something you get at in your paper—that for schizophrenia or bipolar disorder, there’s a sense that “we’re treating your symptoms,” like hallucinations or manic episodes. Whereas for BPD, the “problem,” as it were, is you. The message is that your very personality is at fault.
Welch: Right. What makes these “personality disorders” is that there’s a problem with your personality. I’ve often been told that I’m too boisterous for other people. Even when I medicate, I project my voice. I’m very straightforward and very blunt, but I’m always enthusiastic, like, let’s go. I’m driven. Before I was medicated, people didn’t like that.
And it’s true that when you’re not medicated for borderline, you do have these spillovers. I spent my whole life having random episodes where my affective regulation—the top just blows off. When you go off that big, you don’t come back without a whole lot of negative consequences and personal damage, and maybe damage to other people.
So, I’ve spent a lot of time trying to find the least amount of medication that would make me interact with other people to their satisfaction. And I thought I had succeeded, and I had found the right level of medication that made other people happy—but it turned out that wasn’t enough. I finally medicated to a degree that I lost interest in everything. I’ve lost 80% of who I was.
Garson: If it’s not too personal, what would be an example of going over the edge?
Welch: I would get super amped up, and I’m like, it’s time for an adventure. I would go out into the world and approach strangers and be like, “Let’s have an adventure.” And it would just roll. I could grab people and snowball it and make it bigger and bigger. As with all snowballs, eventually it hits something and bursts, and I’m left with the fallout.
One of the things I mention in the paper is that everybody loves the ride. Everybody wants to jump on that train, especially because 80% of the time it doesn’t hit that point where it goes crazy. People are like, “This is fun. This is exciting. I want to live vicariously through you.” And then if they happen to be with me when I went over the edge, all of a sudden they’re like, “You’re a terrible person,” or “You’re irresponsible.” And I’m like, you’re the one who wanted to play this game. You’re the one who enjoys this part of me when it doesn’t go over your limit.
I’ve had a lot of people purposely come into my life and then purposefully leave my life, which is sort of why I stick to myself for the most part.
Garson: When it comes to BPD, what would a more ideal society look like? I know that for my dad’s bipolar, a more ideal society would be one in which people are more tolerant and accepting of differences. How would you prefer people interacting with you?
Welch: There are people who are very tolerant toward BPD people. I know that people get really concerned about dangerous things. For example, people are concerned about suicide. But my suspicion is that a lot of the suicides and self-harming behaviors are responses to other people. Maybe a better world would be where people don’t look at people like me and think that we’re bad people, but that we’re just a kind of person. So, I’d like to see more of a recognition that this kind of person is this kind of way.
For example, there are autistic people who are very blunt and straightforward; they don’t chitchat. I’m that way. And that makes a lot of people uncomfortable. With autism, you usually have to have a highly recognizable form of autism before people say, “OK, we need to let this person be that way because of their autism.” I would happily wear a little tag. If I walked around with BPD, and I was acting my sort of way, people would say, “Yes, that all translates well, I understand this person.” And people try to adjust to each other. When people police me, it makes me much more resistant to interacting with them in the way they want to.
Garson: If you lived in a world where people were more tolerant of your personality, do you think you would have any reason to continue taking medication?
Welch: I think it was a good thing for me to take some medication. I started after something had gone very wrong in a social situation, during a time when I was going through something in my personal life. Somebody said something very, very specific to me, and I was like, people don’t want me here. That was when I attempted suicide.
Then I got my little medication—75 milligrams—and I was like, this is good. It got rid of 70% of the snowball. But it just wasn’t enough for other people, and I had to keep going until I got to 300. And then I just completely lost interest in everything.
My nickname used to be Super Shay. It was on my car, on my work name tags. I killed off Super Shay when I was 36, 37, when the suicide attempts happened. And now if I just have to knock off Shay to make sure that I don’t end up homeless or something of the sort, have at it. If I just have to chill and coast for a while, fine. I was getting tired anyways.
Garson: As you mentioned, one of the most concerning things about BPD is suicide. Estimates (here and here) hold that between 5% to 10% of people diagnosed with BPD die by suicide, and up to 70% make suicide attempts. To what extent are suicide and suicide attempts responses to other people not being able to accept their personalities? Do you think that rate would drop if people were more accommodating and accepting?
Welch: I can’t speak for the history of people with BPD, but I can say that for every single person in my life that I know who has BPD, suicide attempts are 100% a result of other people’s reactions to them. And I’ve never read a single thing in the academic literature that says this—that BPD people act out this way or have these responses or engage in self harm or suicidal behavior because of the way they are treated, either by other people with whom they’re in relationships, or by the medical institution itself. That is one of the reasons I’ve been writing about it.
The research is done on a very small sample of people. Say somebody is a really successful scholar in psychiatry. The only people they’re really writing about are the people in their practice. Let’s be generous and say 100 people—100 people who are in crisis—and then they make a standard canon of research about what BPD is.
My psychiatrist, who I adore, recognizes that my testimony is completely reliable. She lets me make all of my medication decisions. No other therapist or psychiatrist has ever interacted with me in that way. I can message her and say, “I really almost committed suicide, and I think we need to talk about a new medication,” and she’ll call me on the phone at 8 o’clock at night and say, “So what happened?” She never thinks that she needs to call the police on me, because she knows I’m responsible enough to tell her. And she’s like, “This is 100% not your fault.”
Garson: As a society, we seem willing to talk about BPD in ways that we would never talk about any other mental disorder, or any other marginalized group. People with BPD are described as manipulative, attention-seeking, calculating. Why do you think that is?
Welch: I think it’s because sometimes we can engage in really degrading behavior. We’re the ones who can really go off the deep end and violate a lot of social and ethical norms. But when people think that we’re manipulative, that’s just crazy. People navigate each other. Normal people do that in relationships.
I have been a go-to person to run things because of my disposition. I make things happen. People can rely on me. Those are all aspects of my BPD. But nobody wants to give me credit for those things. They just want to see my marginal spin-out behavior and say, “We don’t want that.”
People with BPD do need that assurance of safety, that assurance of acceptance. I’ve run things at FEAST [the Association for Feminist Ethics and Social Theory] for years, and never have I had a spin-out there. Never. Because I’m with people who I know genuinely love me. Maybe it’s a big ask, to need people to be with you in a loving way in a professional environment. But that’s the way I stay grounded. What would the world look like? It would be somebody who knows me really well just sticking with me and saying, “I’ve got your back. You’re with me. It’s safe.”
