Sabotage or Saving Grace? Psychiatric Diagnosis Can Be Both

By Amy Higgins

Many of us have met nurses who put their own health last, doctors who ignored their own neon-bright warning signs of heart attack until the crisis came. I empathize with these caring professionals because I have been a hypocrite to my own caring profession. Until today, I was a creative writing instructor who refused to take her own best teaching to heart: Write about what terrifies you.

But here goes, because in the three years since my mom died, NAMI’s training and support have shown me that telling my story and hers is the greatest gift of care I can give to others who live—as I did for 52 years—in support of a parent, child, or partner with mental illness. I tell our stories believing it may free some of you who read it from an outsized burden of shame, guilt, or despair you carry. A burden I knew so well, I mistook it for a part of me, until the day my mother’s psychiatrist said the words that let me set that burden down. 

I was in my early forties, visiting my mom on a mission to help her apply for disability, when she shocked me with her casual words, “My shrink says he’d like to meet you, and I’ve granted my permission.”

I took a deep breath and blurted out, “Of course! Oh, Mom, that would mean so much to me. Are you sure you’re okay with this?” Mom had always rigidly opposed my meeting any psychiatrist, therapist, or caseworker. I had tried to persuade her—I’m your daughter and I love you. If you let us talk, we can work together to support you. Her refusal had always stung, but I’d grown to understand. Mom had a strong sense of privacy and dignity; her policy regarding me and her mental health professionals—never the twain shall meet—was something I’d come to accept. 

I called Dr. B’s office to set up an appointment the very next day. I was surprised when the secretary said, “He’s right here, Amy, and he’d like to talk to you.” 

“Hello, Amy? Mary Kay told me you might be in town this week. I’d be delighted if we could meet.” Mom had been right about his gentlemanly Southern drawl. I hoped she was also right about him being one of the good ones, the highest compliment she’d give any shrink—even the good psychiatrists were shrinks in Mom’s lingo. 

Late the next morning, I stepped from the torpor of a North Carolina July afternoon into the blessed cool of Dr. B’s office. The décor was that of an old-style parlor. I sat in a Queen Anne chair with curved cherry legs and admired the embossed pineapple pattern on the waiting room wallpaper. 

Dr. B greeted me in a seersucker suit and bow tie. He shook my hand, and when I hesitantly moved toward the couch, he directed me to the chair across from his desk. I had been to therapy, but here I was the ally, not the patient, and I appreciated Dr. B. making the distinction. Dr. B leaned his elbows on his desk and touched his fingertips together to make an airy cathedral. “So, what can I do to help both of us help Mary Kay?”

“I’d like your professional diagnosis of my mom. She’s been denied Disability twice, and we’re going into DSS again tomorrow. I have documentation of Mom’s treatment for alcoholism, but having a doctor’s official mental health diagnosis will help me advocate for her.” 

“Did Mary Kay ever tell you why she quit seeing Dr. S and started seeing me?” 

Surprised by the question, I sifted through the complaints Mom had made about Dr. S—from He’s d***less to He won’t be satisfied until I’m locked up—neither of which seemed worth repeating. “No. Why?” 

“Because she rejected his diagnosis. It sent her into a very bad episode, you may remember. Your mom never talked to you about this?” 

“No. Wasn’t it bi-polar illness? Or major depression?”

“Those are the diagnoses on your mom’s record; she and I base her therapy and medication on managing symptoms of those conditions.” Dr. B leaned toward me with a meaningful look. 

 I didn’t know where this was going, but I knew that look: The main point is what I’m not saying, and may not say.

“I don’t understand.” 

“Dr. S thought your mom had Borderline Personality Disorder. This is a diagnosis that smart, sensitive patients like your mother rarely will accept.” 

“Doesn’t borderline mean schizophrenic?”

“No, schizophrenia—borderline or otherwise—is a different beast. Amy, does it make sense to you that sharing some diagnoses—however accurate they may be on some level—may do harm and actually set the patient back if shared frankly?” 

I thought about Mom’s terror of schizophrenia and nodded. 

“Well,” Dr. B spoke as if it pained him, “Borderline Personality Disorder, in my opinion, is one such diagnosis.”

“But even if it’s hard to hear, isn’t it best for her to know the truth? What is . . . this disorder?” 

Dr. B made a go at a reassuring smile, but winced instead, “I won’t sugarcoat this. BPD—almost by definition—defies treatment. The single most defining symptom is splitting ideation, a worldview that sees everything, everyone, as good or evil; flawless or hopelessly flawed.” 

Dr. B paused, perhaps at my flash of alarmed recognition, then went on, “It’s not uncommon, for instance, for a parent with BPD to cast one child as the angel and one as the demon.” His eyes met mine. 

The empathy I saw there was profound, and it was for me, the demon child, the bad seed, the bully. He knew. As the doctor described the other two characteristics of BPD—anger out of proportion to its cause and threats of suicide—I barely registered his voice against the pumping of my own heart. My vision blurred. I felt like I was about to dissolve or drown. 

If I’m not the demon child, the jealous one, the torturer . . .who am I? If my brother isn’t the angel—sensitive, pure hearted, good—then, who is he? 

Years of therapy had repaired one distorted lens after another, but my belief in mom’s insights into my character and my brother’s was immutable. She said I was the stronger sibling, fearless and assertive to my brother’s passive temperament. I must face, along with this, the dark side of the coin—I was strong at my brother’s expense. His timidity was a response to my cruelty. His nature was selflessness, mine was selfish greed. 

I’d always believed that Mom told me hard truths about myself because she loved me, because it was her job as the person who knew me best to tell me the truth. But what if Mom’s truth about me wasn’t true? I could not imagine a life that was not built upon making up for being the bad child, like trying to fill a bottomless hole with fistfuls of sand. What if there was no hole to fill? What if—like the rest of the world—like my own two children, my brother and I were just a mixture of virtues and flaws? What if splitting ideation—a symptom of illness—was what caused Mom to cast us as good child and bad child? 

 I continued to nod as Dr. B gently spoke, as he collapsed and re-erected his airy hand cathedral. His words had set off a chain reaction, the beginning of an epiphany that would leave me finally free to reject the stigma of being “the bad child,” and move toward the freedom of self-love and healing. 

Dr. B did give me a document to take to DSS the next day. It stated his professional diagnoses of my mom were bipolar and major depression, and his professional opinion that Mom’s symptoms made her unable to maintain steady employment. But I left knowing that the meeting had been for my sake as much as for hers. Dr. B achieved his primary goal, even if his loyalty to my mom, his patient, required him not to speak it, nor I to acknowledge it. He sought to free me from the pain and damaged sense of self my mother’s splitting ideation had caused. I will be forever grateful to Dr. B for his deft and compassionate delivery, in a single appointment, of what my mother and I both needed.