Andy Warhol Was a Hoarder (4 page)

Without a stable inner being—Arthur Miller, Monroe's third husband, would later describe her life as “detached and center-less”—people with borderline personality disorder are exceedingly sensitive to how they are perceived, and often find self-worth by pleasing others. “They're a little chameleon-like, adapting themselves to different people,” says Dr. Joel Paris, a psychiatrist and borderline expert at McGill University. This was the thrust of Marilyn Monroe's life. As a child, she was forced to adjust to new family surroundings; on screen, she took on multiple identities; in the public spotlight, she played the seductress everyone wanted to see. It was her career that gave Monroe the only semblance of solid footing. “My work is the only ground I've ever had to stand on,” she said in an interview not long before she died. “To put it bluntly, I seem to be a whole superstructure with no foundation.”

All of this played out in Monroe's relationships, which were markedly intense and unstable. People with borderline personality disorder demand constant attention and reassurance, wearing out the people they turn to for support. “Many people who develop this disorder feel essentially alone and unlovable,” says Gunderson. “A lot of their relationships are compensating for that.” None of Monroe's three marriages lasted. She wed her first husband, a merchant marine named James Dougherty, in 1942 when she was 16, and divorced him four years later. Her second marriage, to baseball player Joe DiMaggio in 1954, was over in nine months. Among
other issues, DiMaggio was infuriated by Monroe's public displays of sexuality. This came to a boiling point during the filming of a famous scene in the movie
The Seven Year Itch
. Standing over a subway grate, Monroe smiled teasingly as her skirt billowed upward and swirled around her, an alluring image that would morph into an iconic photograph. Onlookers cheered and clapped. Later, there were reports of yelling at the St. Regis Hotel and of DiMaggio roughing up Monroe. “I've had it!” he shouted. Monroe accused DiMaggio of “mental cruelty.”

Monroe's third marriage, to Arthur Miller in 1956, seemed unlikely from the start: the intellectual playwright, the bombshell actress. Miller, who was still married to his first wife when he met Monroe, was intoxicated by her allure. She admired Miller's intellect and saw him, to some degree, as her savior. He accepted the role. But over the course of their five-year marriage, Monroe's insecurities and neediness wore on him. She probed the world for the slightest sign of hostility, Miller wrote in his memoir,
Timebends
, and constantly sought reassurance. Miller was unable to bear her emotional volatility, especially her ire. “Anger, relentless and unending, at last refused to give way to any ameliorating word,” he wrote. “In my trying to gentle her torment, she thought her cause was being trivialized.” Miller acknowledged that he had expected “the happy girl that all men loved” but discovered “someone diametrically opposite, a troubled woman whose desperation was deepening no matter where she turned for a way out.”

Monroe's intellect became a divisive issue. She had quit high school to marry Dougherty, her first husband, and struggled with her lack of knowledge about the world throughout her life. She tried to remedy it, signing up for art classes that introduced her to Michelangelo, Raphael, and Tintoretto, and collecting books by Milton, Dostoevsky, Hemingway, and Kerouac. She cultivated a
friendship with poet and historian Carl Sandburg and delved into his six-volume biography of Abraham Lincoln. She talked about admiring Eleanor Roosevelt and Greta Garbo. She even sent a telegram to playwright and novelist Somerset Maugham, wishing him a happy birthday.

But soon after marrying Miller, Monroe found an entry in his diary expressing his disappointment in her and suggesting that he was sometimes embarrassed by her in front of his intellectual friends. Monroe was said to be devastated and felt betrayed. Those feelings ran deep. Monroe's pattern in relationships was to experience exaltation initially and then defeat, because nobody could live up to her needs. People with borderline personality disorder, says Gunderson, “switch rapidly from idealizing somebody who's going to take care of them to viewing that same person as devalued—a failure who never cared about anybody.” By the time filming started for Miller's 1961 movie
The Misfits
, which starred Monroe as a young divorcée, “it was no longer possible to deny to myself that if there was a key to Marilyn's despair, I did not possess it,” Miller wrote. “With all her radiance, she was surrounded by a darkness that perplexed me.”

A
LTHOUGH BORDERLINE PERSONALITY DISORDER
is estimated to affect as many people as schizophrenia and bipolar disorder, it is far less recognized and often misunderstood. The very nature of personality disorders (there are ten total, including narcissistic, antisocial, and avoidant) is that they are deeply ingrained and long-lasting, which distinguishes them from other major mental health conditions. Symptoms of depression, for example, surge at one time and ease at another; the characteristics of personality
disorders, by contrast, persist over time. The key features of these disorders—impulsivity, an inability to sustain close relationships, and anger—are paired with an overriding inflexibility. As a result, people who have personality disorders don't do well adapting to new situations or, for that matter, changing their behavior.

Borderline personality disorder is strongly “heritable,” meaning it is likely to be passed down from one family member to another. One study found that a person's risk of developing the condition is three to four times higher if a parent or sibling has it, too. Monroe came from an unstable bloodline, and she connected her torment to her genetic roots. In her autobiography, Monroe pointed to “family ghosts” who struggled with mental health issues—in addition to her mother and grandmother, her grandfather died in a mental hospital, and an uncle killed himself. “I wish I knew why I am so anguished,” she once wrote in a letter. “I think maybe I'm crazy like all the other members of my family were.”

The biological underpinnings of borderline personality disorder are enormously complex and barely understood. Scientists have found that cortisol, the stress hormone, and oxytocin, which plays a role in social bonding and intimacy, both appear to be dysregulated in borderline patients. Brain scans may reveal additional features, including an overactive amygdala (the control center for modulating emotions) and an underactive prefrontal cortex (an area responsible for putting the brakes on impulsivity).

In almost every case, borderline patients suffer tremendous emotional pain and are prone to the worst possible outcome: suicide. More than half of all emergency room patients admitted for suicidal behaviors have borderline personality disorder, according to one report; 10 percent of patients will succeed at killing themselves. Because of their frequent ER visits, borderline patients are known in medical circles as “frequent-fliers,” and their illness has
long been considered toxic and unbeatable. Many patients do not, however, intend to die, and this may well have been true of Monroe, who made numerous attempts at suicide. Their actions are impulsive, rather than decisive, says Gunderson. The thinking is “If somebody saves me, then life is worth living, and if nobody is there, I'll be dead.”

Proper treatment can save patients, and this is where a radical transformation has taken place over the last 50 years. Monroe did seek psychological counseling, and she was seen by leading practitioners of the day, including Dr. Ralph Greenson, a prominent Beverly Hills psychiatrist; Dr. Marianne Kris, in New York; and even Anna Freud, Sigmund Freud's youngest child. All were trained in psychoanalysis, the established treatment approach in the early to middle part of the 20th century. A classical psychoanalytic approach is grounded in listening, rather than active dialogue. Therapists often begin by asking patients, “What's on your mind?” and then wait quietly for a response. A patient's thoughts, dreams, and reactions are used to help interpret how experiences of the past might be influencing behaviors of the present. Psychoanalysis is still used in some circles today to treat a number of mental health conditions, and some people seek it out simply to better understand themselves—how their lives were shaped by early experiences, how they perceive the world, how they interact. Talking allows patients to uncover old wounds, pick at the scabs, and help their damaged cores heal.

But patients with borderline personality disorder are primed for battle mode, and when the therapist is more passive, fears and insecurities can become aggravated. Although no one is privy to the dialogue Monroe had with Greenson, her longest-running therapist, it is likely that she spent a great deal of time reliving her childhood—her absent mother, the loneliness, the isolation, and perhaps, the
abuse she says she suffered. Inez Melson, Monroe's live-in business manager, once wrote a letter to Greenson saying that she was concerned that Monroe was spending “too much time thinking about her problems” and “languishing in her misery.” Arthur Miller questioned Monroe's treatment in his memoir as well: “Psychoanalysis was too much like talking
about
something rather than doing it, which was the only thing she had ever believed in anyway—her life had all been put up or shut up.” If only Monroe could “step out of herself and see her own worth,” he wrote.

Greenson seemed to struggle with how best to handle his patient and, at some point, he decided to radically alter his traditional therapy. Because of her losses in early childhood, he tried to help create the family she never had. He invited Monroe into his home—a no-no in the therapeutic world, where the patient-therapist boundary is sacrosanct. Greenson became Monroe's surrogate father, making himself available at all times of day and night. Monroe became completely dependent on him, often extending her sessions by several hours and eating dinner with Greenson and his family, even washing the dishes. Throughout her treatment, Monroe continued to receive copious prescriptions for drugs, not just from Greenson but from other doctors as well. For years, she drowned herself in sleeping pills and sedatives—the very drugs she would overdose on the night she died—to help quell the emotional pain. “You have to say that her treatment failed her,” says McGill's Joel Paris.

Greenson has been roundly criticized for the dynamics he set up with Monroe—not just because he corrupted the sacred relationship between patient and therapist but because his methods may have made her condition worse. Still, the reality is that he had to rely on the skills and tools available to him at the time. Today, therapists use radically different treatment approaches that
are rooted in the conviction that patients must be active participants in their own recoveries. One of these, dialectical behavior therapy, was pioneered by the borderline expert Marsha Linehan of the University of Washington, who realized it was crucial to develop a therapy for patients at high risk for suicide with difficult-to-treat disorders. She would know: After a patient inquired if she was “one of us,” Linehan went public with her experience with mental illness in 2011 and spoke out about her severe distress and the suicide attempts that came with it. Institutionalized, often in seclusion, at a Hartford clinic at the age of 17 in 1961, Linehan burned her wrists with cigarettes, cut her arms and legs, and banged her head against the wall. Linehan now suspects that the symptoms she exhibited in the hospital and for some time afterward were similar to borderline personality disorder. But she was given a diagnosis of schizophrenia—one she finds highly unlikely—and was prescribed drugs, psychoanalysis, and electroshock treatments. None of it helped. “I was in hell,” Linehan told the
New York Times
. “And I made a vow: when I get out, I'm going to come back and get others out of here.”

The approach Linehan devised starts with having patients acknowledge their traumatic pasts. Rather than dwell on their emotional injuries, however, they learn skills to help them move on. Rooted in problem solving, the method focuses on establishing a balance between acceptance and change. Through a series of exercises, patients are taught how to regulate their emotions and control their impulsivity. Learning how to reduce self-destructive behaviors linked to the disorder, like abusing drugs and alcohol and cutting arms and wrists, is critical. Patients are also encouraged to try soothing activities to calm their powerful and erratic emotions, like taking a deep breath, going for a walk, or calling a friend for a chat.

Unlike the psychoanalysts of Monroe's day, therapists who practice dialectical behavior therapy and other related approaches take a hands-on approach to their patients. They talk to them, they give them direction, they don't allow them to stew. “It's become much less about either living through the past, à la Freud, or trying to replace the missing mother,” says Paris. Instead, “you have to go forward.” Patients often find much needed relief and affirmation when they discover that their clinicians are willing to not only validate their suffering but also believe in their ability to get better. In general, people tiptoe around borderline patients, says Neacsiu, so when clinicians treat them as equals, “they find it incredibly rewarding.”