A Girl in Need of a Tourniquet

Johnson, Merri Lisa. Girl in Need of a Tourniquet: A Memoir of Borderline Personality Disorder. Berkeley, CA: Seal Press, 2010.

“Stories are the self’s medium of being” writes Arthur W. Frank.[ref]Frank, Arthur W. The Wounded Storyteller: Body, Illness, and Ethics. Chicago: University of Chicago Press, 1995.[/ref] Illness narratives do not simply recount someone’s life experience, according to Frank; they enact selfhood, bring a version of identity into being, and as a result, have the potential to undo the stigmatizing prejudices that attach to many forms of illness and disability. Storytelling thus acts in revolutionary and empowering ways, allowing the memoirist to present a version of self that might directly counter the authority of medicine. Personal stories also individualize, offering discrete perspectives against the anonymity of symptoms or etiologies.

With raw honesty, Lisa Johnson tells of her lived experience with borderline personality disorder (BPD) in Girl in Need of a Tourniquet. She recalls her path through a dysfunctional and destructive relationship with a married colleague, recounting the experiences that brought her to her breaking point. In recognizing her struggle with BPD, Johnson is eventually able to reach out and seek help. She embarks on a soul-searching, psychological healing process. It’s a process that is painful, difficult and, at times, heart-wrenching, but ultimately makes her better able coexist in healthy relationships with others.

For the majority of this text, Johnson focuses on the confusion, panic, and chaos that characterizes an affair with a woman, Emily. Johnson recognizes this relationship as co-dependent and unhealthy yet she finds she is unable to break free. Somewhere along the way, Johnson conducts a Google search on her issues of self-mutilation, relationship drama, estrangement from her mother, her addictive personality and is directed to a page on BPD. Johnson immediately recognizes her symptoms are consistent with this diagnosis. Her diagnosis is later “officially” affirmed by a therapist.

In an effort to understand herself and her behavior, Johnson immerses herself in research on BPD, drawing heavily on psychological research in her text. Her writing is spliced with excerpts from various scholarly sources on BPD and personality development, citations from major works in both psychology and self-help literature, various relevant definitions, song lyrics, quotations, poetry, and graphic black slashes (likely representing self-injury, which is often a feature of this disorder). Johnson’s style choices reflect the disorganization of the borderline experience. Chapters are highly fragmented, comprised of chunks of text with frequent interruptions in different fonts and type sizes, capital letters, indentations, and alternating spacing. Overall, this makes for a unique reading experience about a very serious illness. Her writing is figurative and lyrical. This is a very artful memoir.

Despite this being a text about BPD, it takes Johnson about two thirds of the book to start divulging any real information on the disorder. When she does so, she begins with the criteria for a diagnosis of BPD from the Diagnostic and Statistical Manual (DSM). She then goes on to conceptualize the illness as:

A form of madness made of mood disorders and neurological malfunctions. People with borderline personality disorder heat up fast and have trouble cooling back down. Emotions run high. Impulse and inhibition run together like hot and cold water from a tap. Once the borderline body reaches this place of hypervigilance and despair, every day presents new evidence of apocalypse and new opportunities for hysteria and resignation (p. 159).

Johnson pays a lot of attention to the stigma attached to BPD, describing how the media portray women with this disorder as “beautiful sociopaths.” According to Johnson, most therapists and people in general are afraid of those diagnosed as BPD. She recounts an experience that gives a clear indication why there is such a negative connotation with the term:

I had heard of borderline personality disorder when I worked in the university counseling office as a undergraduate English tutor. A woman walked in one day, a streak of dark hair and an open black raincoat. She asked to see one of the graduate-student counselors. No one would tell her anything. Everyone just wanted her to leave. When she left the office, the student worker staffing the front desk turned to me and said, “She’s a borderline. They’ll stalk you.” That’s the start and finish of what most people know about borderline personality (p. 138).

She writes that a diagnosis of BPD “is medical shorthand for patients who make their doctors uncomfortable. Unstable, mercurial, self-injurious, contradictory, seductive, clingy, the term borderline personality has borderline personality. It is in crisis. It is poised to self-destruct” (p. 197). Johnson’s memoir is something of an open invitation to readers to change how they think about people with BPD. Many people have called for the name of the disorder to be changed to “emotion regulation disorder,” renouncing the label of borderline as insult, injury, and outdated bias on par with hysteria. Madness is a word that has been historically used to tie a woman’s arms and legs to a bed in an asylum. There is a radical tradition in psychoanalysis with its roots in the work of R. D. Laing, who questions the social construction of mental illness believing that we sustain a fantasy of being whole if we set apart those who are sick. The idea that anyone is mentally well all of the time is a delusion that may get in the way of asking for help when we find ourselves falling away from our stable minds. Marsha Linehan, the brains behind Dialectical Behavioral Therapy and once a sufferer of BPD, describes this as the borderline patient’s first dilemma: Am I vulnerable and sad or undisciplined and bad? I believe that proposing that the label of BPD is inaccurate or artificial is very risky. It may further undermine the very real needs for therapeutic support and corresponding eligibility for medical insurance claims. Johnson writes that such “pragmatic concerns cannot be overstated, yet as psychiatric knowledge steadily evolves, identity categories give way to more subtle models that conceptualize mental illness as dimensions—continua or spectra without clear separation from normalcy, and with less separation from each other than we think” (p. 201). It’s important to point out that Johnson does not use the term “disorder.” She believes that while BPD is a serious condition, it also seems to be a collection of unhealthy behaviors that many people exhibit at some point in their lives. She writes:

A personality disorder is not the foreign presence of demonic possession or a cancerous cluster of cells spreading among the internal organs. It is a pattern of cognition and reaction that impairs the capacity to be productive, happy, and generally at ease. It is a fractured sense of self giving way to the weight of stressful interpersonal dynamics (p. 203).

In other words, personality disorders are “as common as dirt” (p. 203).

One of the most intriguing things about this memoir is the trustworthiness of the author. I think this comes from her intense self-reflection and compelling honesty about her fractured relationship with Emily as well as her behavior in subsequent relationships (including a fling with one of her students). Johnson also delves deeply into her family life, describing how she was raised by a serious of stepmothers after her father left her “careless and selfish” mother. She focuses much of her attention on her two younger sisters who had the misfortune of being raised by their neglectful mother after Johnson and her father left the household. She describes the guilt she feels for not being there for her sisters, who both also have the diagnosis of BPD. As she gets better, she describes how the illness has manifested itself in different ways for them. She describes her attempts to reconcile with them and help them through their diagnosis. It becomes painfully clear that Johnson has a better handle on her illness than either of her sisters do.

A criticism of this text is that Johnson abruptly shifts from her breakup with Emily to a scene where she is at peace with her new wife, leaving the reader to wonder how she got from Point A to Point B. Johnson makes it clear that even in the her newfound stability, she will always continue to struggle with the instability that comes along with being borderline. However, she does not make it explicitly clear how she reached this stability and I think that is of interest to the reader. Overall, I found the book to be an engaging read with a fast flowing and interesting narrative. This book is clearly written with the intention of offering solace to others diagnosed as borderline and understanding to those who are not.