Jenny is a professional model in her mid-twenties. She would sashay down the corridor at the out-patient department of the hospital, greeting hospital staff with a warm smile and a lilting “Good morning”, spreading cheer all around.
The outward cheer and bonhomie were an armour to protect the confused and hurt little girl within. Her childhood had been extremely traumatic, with unspeakable horrors heaped upon her by people, including family members. School had been a nightmare despite her obvious intelligence. At 15 she had realised she was dyslexic and not stupid, and got herself tested for learning disabilities on her own as she felt nobody else cared anyway.
Starting from her teens there had been a string of boyfriends, each abusive one replaced by an equally abusive one, every relationship entered into with much hope, trust and optimism. She just ‘wanted one special person who truly loved’ her, the way she put all of herself into a relationship.
She tended to see people in black and white, and dated boys she placed on a pedestal as ‘perfect’, often choosing to go out with charming boys with dodgy reputations. The white invariably turned to a disillusioning black when she became clingy and possessive. The boyfriend would then begin avoiding her and not respond to her calls and text messages. This would send her into tearful rages and she would smash to the ground whatever she could lay her hands on, like her cellphone, coffee mugs, books, anything at all. Then she would send him umpteen text messages asking if he was seeing someone else. This would happen a number of times in every relationship. After a couple of days they would make up.
She would never consider ending a relationship because her worst fear was of being abandoned and alone. Consequently relationships always ended with the boy walking out on her after a particularly nasty showdown, leaving her completely devastated and vulnerable.
She had tried every street drug that her friends made available, “to numb the pain” after each break-up. She had overdosed on her mother’s prescription drugs with an intention to die, and been rushed to hospital for a stomach wash twice before.
One day, in an introspective mood, she said that she felt happy only as long as she was having fun with friends, which usually included alcohol and weed. She could not tolerate being alone. When she was alone in her room at night she felt she did not really exist; she felt a sense of personhood only when she was interacting with others. By herself she had no stable identity, no sense of who she was.
Most of the time she felt devoid of feeling, what she described as “an emptiness in my soul”. With tears rolling down her cheeks she recounted how she had made razor-blade cuts all down her forearm in order to feel something: even pain was preferable to emptiness. When she still felt nothing she had broken down and cried all night. Sometime during those dark hours she had become aware of the pain and sadnesss deep inside her. By daybreak she had vaguely concluded that she had ‘depression’ and had decided to visit a psychiatrist to have medicines prescribed.
At the initial interview her depressed mood was obvious. A course of an antidepressent medication was started. Meanwhile, it was equally obvious that a diagnosis of ‘depressive episode’ did not quite cover her problem. I saw her once a week to support her till the medicines took effect, then referred her to a clinical psychologist for psychotherapy while continuing to see her once a month to check on the medications.
The prevalence of this type of personality is very much higher than one would think. It is more common in girls than in boys. Many of the girls whom other girls label drama queens - and worse - probably need an experienced clinical psychologist to help them sort out their confusing and terrifying inner lives, besides treatment of the psychiatric conditions that invariably exist in people with such fragile personalities.
In this series Dr Shyamala Vatsa highlights the fact that teenage changes can mask incipient mental health problems. These articles show how early symptoms of mental disorder can be taken for ordinary teenage behavior. As illustrated by the stories of young people who have suffered unnecessarily, it is important for friends and family to recognize when a behavior is outside normal limits, and seek help before things spin out of control.
Dr Shyamala Vatsa is a Bangalore-based psychiatrist who has been practicing for over twenty years. If you have any comments or queries you would like to share, please write to her at firstname.lastname@example.org