Diana in Search of Herself (71 page)

Whenever the subject of Diana’s emotional disturbances came up in the British press, she was invariably derided as “loony,” “potty,” a “
basket case,” or “
barking mad.” Time and again, journalists and their sources implied Diana was to blame for her behavior, refusing to accept that mental
illness is neither a moral failing nor a character defect. “
Diana should not get help,” wrote Lesley White of
The Sunday Times
in November 1995. “She should simply get over it.”

The harshness of these characterizations prompted allies of Diana to issue misguided denials that she needed
any
professional help. Stephen Twigg, the massage therapist whom Diana relied on for several years in the early 1990s, told the
Sunday Express
in 1992 that Diana’s suicide attempts “
could happen to anyone … the idea that she is ill, unstable in some way, emotionally unbalanced, is nonsense.” Such statements reinforced Diana’s aversion to being labeled and must have pushed her further from seeking proper care.

Diana herself had an ambivalent attitude toward psychiatry. She turned to alternative therapists largely because she could control them. She initially resisted psychotherapy and was deeply mistrustful of antidepressants and tranquilizers—although she depended on prescription sleeping pills for many years. Even after discussing her self-mutilation and bulimic bingeing on television, she derided the royal family and Charles’s friends for stigmatizing her as mentally ill. Diana also claimed at various times to be “finished” with her bulimia. But the underlying causes persisted, as evidenced by her reliance on colonic irrigation and obsessive exercise.

Even when her symptoms were acute—and dangerous—her position as Princess of Wales precluded her checking into a clinic, as her sister Sarah and her brother’s wife Victoria had done to treat their eating disorders. “
In a sense, she was finished on the day of the royal wedding,” said Michael Colborne, former aide to Prince Charles. “Nobody saw the basics with her, that she had to be looked after.” As a result, Diana’s psychological problems festered and grew.

Diana underwent psychotherapy on several occasions and mastered psychological jargon along the way. But Diana’s treatments were short-lived until she enlisted the help of Susie Orbach, a fellow sufferer as well as a therapist who kept Diana engaged for several years. The treatment did not seem to have lasting effects. As her friend Richard Kay wrote, Diana “
was as unsure of herself at her death as when I first talked with her [in the spring of 1993].” Her behavior grew more chaotic, not less, and she repeated her mistakes rather than learning from them. She ultimately denigrated Orbach in particular and psychotherapy in general, telling the patients at Roehampton Priory they were unlikely to find much help from “
some psychotherapist or someone just reading from a book.” The press, which Diana looked to for approval, applauded these remarks. Writing in the
Evening Standard
, Melanie McDonagh saw a hopeful “
backlash against therapy … this very modern infantilism.”

Given the range and severity of Diana’s symptoms, it’s not surprising that outpatient psychotherapy failed her. A number of psychiatrists and psychologists have debated Diana’s condition in the British press, offering diagnoses ranging from addiction to obsessive-compulsive disorder to narcissism. But none adequately explains Diana’s disordered thinking, behavior, and relationships. Nor does pinning everything on her bulimia, which was commonly done by both her friends and journalists. In fact, her eating disorder was a manifestation of her illness, not the illness itself. “Don’t make a mistake by focusing on bulimia,” said a psychologist familiar with Diana’s case. “Bulimia is a window.”

To a striking degree, Diana’s disturbances conformed to the
borderline personality disorder.
Neurotics may experience anxiety but still have a clear sense of themselves, while
narcissists tend to be self-important and disdainful.
Borderline personalities feel inferior and dependent and are typically confused about their identity. They are self-destructive, easily depressed, panicky, and volatile. But on the surface they are apt to be charming, insightful, witty, and lively. As in Diana’s case, they tend to be perceptive about other people, and
many work as counselors, doctors, and nurses, providing the kind of care they would like to receive. One hallmark of the borderline personality is the ability to appear “
superficially intact” while experiencing “dramatic internal chaos.”
Among other notable figures who exhibited borderline behavior was Marilyn Monroe, who, like Diana, was obsessed with finding her identity, harbored a terror of solitude, and suffered from crushing despair.

The term “borderline” has been around since the late 1930s as a catchall category for people who are more severely ill than neurotics but lack the distortions of reality that incapacitate psychotics. The condition exists on the “border” of long-recognized mental illnesses such as manic depression, anxiety disorders, and schizophrenia.
Two leading American psychiatrists, Dr. Otto Kernberg of Cornell and Dr. John Gunderson of Harvard, came up with a definition that was officially recognized by the American Psychiatric Association in 1980 and subsequently by the World Health Organization.

The possibility that Diana suffered from borderline personality disorder was discussed by a few people close to Prince Charles. One of them consulted a psychologist and a psychiatrist, each of whom told him that Diana’s behavior “fit the description of the borderline personality in quite extraordinary detail.” The suggestion was made publicly as well, most notably in a 1995 column by Nigel Dempster, who reported in the
Daily Mail
a “
growing feeling” Diana’s symptoms pointed toward a borderline disorder. Yet Dempster undercut the potential helpfulness of his suggestion by
using it as evidence of Diana’s “predatory,” “manipulative,” and “egocentric” approach to men. “It can only be hoped that she is not allowed to sink further into the indulgence of the victim or the aggressive manipulation of the predator,” he wrote.

While one cannot say with certainty that Diana had a borderline personality disorder, the evidence is compelling. The most important factor setting the borderline personality apart from those with other disorders is early parental loss—in Diana’s case the departure of her mother and the emotional withdrawal of her father for several years following the Spencer divorce.
Even the timing of the usual appearance of borderline symptoms in late adolescence fit Diana’s profile, as did the trigger of intense pressure, which in Diana’s case was brought on by her royal marriage and the lofty expectations of the public and the press. Borderlines can frequently maintain a facade of normality “
until their defense structure crumbles, usually around a stressful situation,” according to psychiatrist Richard J. Corelli of Stanford University.

The borderline personality is also more prevalent than one would expect. According to the
Harvard Mental Health Letter
, an “
estimated 2.5 per cent of the American population suffers from borderline personality disorder—six million persons, or three times the number with schizophrenia.”
From fifteen to twenty-five percent of all patients seeking psychiatric care are borderlines. It is by any measure a major mental health problem, although it remains little known and largely misunderstood.

Many people have the traits of the borderline to one degree or another, but someone with the disorder experiences them severely and chronically, as Diana did. The traits are “
intricately connected, interacting with each other so that one symptom sparks the rise of another like the pistons of a combustion engine,” wrote Dr. Jerold Kreisman, a leading expert in the study of borderline personalities.

At the core of a borderline’s psychology is an uncertain self-image. In his eulogy, Diana’s brother Charles referred to her “
deep feelings of unworthiness.” Diana spoke of her self-hatred to Andrew Morton, James Hewitt, and any number of friends. She constantly sought ratification from friends, the press, and crowds of strangers. Her preferred source of approval was the public, but even after mingling with adoring fans, she felt inadequate. As she once explained to
Evening Standard
editor Max Hastings, she cried after public events “
because of the strain of feeling that so much is expected of me.”

Diana couldn’t accept that her attributes were a fixed part of her personality—a typical borderline reaction. Instead, she relied on the most recent judgment she had heard, whether from her husband, her friends, the press, even people she met in hospital wards. This tendency largely explains
why Diana felt she was “never praised.” If someone had applauded her two weeks earlier, it didn’t matter, because she required continuous encouragement to avoid plunging into depression over her imagined deficiencies. James Hewitt felt worn down by Diana’s need for praise about her beauty “
to the point where he had repeated it so many times that he feared his words had lost their meaning.”

Lacking any firm identity, Diana frequently felt lonely, empty, and bored—another marker of the borderline. She often started up relationships to fill the vacuum. Since she frequently felt victimized, as most borderlines do, this urge to find relief in new friends or lovers was paradoxical. But for Diana, the possibility of a disappointing relationship was preferable to solitude.

The comfort Diana sought from bulimic bingeing and purging was also an example of the impulsive behavior characteristic of a borderline.
A number of studies have shown that as many as a third of bulimics suffer from the borderline personality disorder. Diana’s well-documented episodes of self-mutilation, as well as her suicidal gestures and threats, were related forms of impulsiveness consistent with the disorder. As Kreisman observed, “
self-mutilation … is the hallmark of borderline personality disorder … more closely connected … than any other psychiatric malady.”

The most poignant aspect of the borderline personality is the inability to sustain close, mutually gratifying relationships. Diana brought a ferocious intensity to her relationships, pleading for attention and time, and demanding complete loyalty. She showered people with affection and gifts, then cut them off with little or no explanation. “
If you have been rejected by your mother and then rejected by your husband,” Rosa Monckton explained, “you feel that as soon as people get to know you they will reject you.” Diana “was so incredibly insecure, and whenever people got close she got frightened.” Diana actually alternated between fears about intimacy and anxiety over separation. If people came too close, she felt suffocated; if they kept a slight distance, she felt abandoned. These problems were invisible to the public. Only intimates saw her worries and erratic behavior.

In her closest relationships, Diana showed the borderline’s frantic effort to avoid abandonment. Jonathan Dimbleby described numerous examples of this behavior, beginning early in her marriage when Diana repeatedly insisted on Charles’s presence “
to the exclusion of all else in his life.” When Charles went off to work, Diana interpreted his departure as a lack of love. James Hewitt, Oliver Hoare, and Hasnat Khan all were the objects of the same pattern of urgent dependency. To the end, when Diana talked about her ideal man, she envisioned someone “
who would be there for her twenty-four hours a day,” according to energy healer Simone Simmons.

When Diana was alone, she felt trapped and isolated. After a close friend or lover left Diana’s presence, she reacted in a childlike fashion, as if she feared the other person wouldn’t return. She also experienced what psychiatrists call the “
paling effect of time”: When she was cut off from someone to whom she was intensely attached, her favorable memory of that person would be quickly eroded by feelings of doubt. It may have been to assuage these misgivings and fears that Diana would call people repeatedly or spend hours with them on the phone. “
She had no governor that operated,” said her friend David Puttnam. “If you said, ‘This is the sixth time you’ve called,’ she would say, ‘No, I’ve only called once,’ ”—a form of denial also typical of the borderline’s occasional disconnection from reality.

Always distrustful, Diana listened in on phone conversations, opened mail, and lingered in hallways to catch comments that proved her worst suspicions. In some cases, Diana had reason to be wary; plenty of people took advantage of her. But most of the time she overreacted, mainly because she tended to see people in black or white, a defense mechanism known as “splitting.” It is a classically juvenile response frequently seen in borderlines who “
cannot tolerate human inconsistencies and ambiguities” or “reconcile another’s good and bad qualities into a constant coherent understanding of that person.… At any particular moment, one is either ‘good’ or ‘evil’ … idolized one day, totally devalued and dismissed the next,” a behavior pattern often exhibited by Diana.

At the outset of close relationships, Diana usually screened out negative characteristics in the other person. But, inevitably, the object of her affection would let her down, perhaps by failing to praise her enough. Then she would see only the worst in that person. Virtually everyone was destined to fail her, because Diana couldn’t accept the fact that every relationship has its ups and downs.

Diana’s sudden mood shifts typified the borderline personality’s “
emotional hemophilia,” an absence of “the clotting mechanism needed to moderate spurts of feeling.” As her friend Clive James wrote, “
Clearly on a hair trigger, she was unstable at best, and when the squeeze was on, she was a fruitcake on the rampage.” Even her sunny side had a slightly manic edge. “I never thought she was unstable when I first met her,” said one of her friends. “But I noticed as I got to know her better the inconsistencies in her behavior. She was a tremendous giggler, but her laughter had a touch of madness, almost uncontrollable. Her giggles were always faintly hysterical—like a combination of tears and laughter.”

By her own description, Diana had felt a sense of detachment (“in the wrong shell”) since childhood, another trait of the borderline, especially in times of severe stress. “Diana seemed to look at the world through a glass, and was unable to form relationships while seeing others form relationships,
and she was tormented that she couldn’t do it too,” said a man close to Prince Charles. As is often seen in “high functioning” borderline personalities, tied into Diana’s sense of being an outsider were instances of “
magical thinking”: her belief in premonitions of events in her life such as her father’s stroke, her reports of hearing voices that instructed her, and her conviction that she possessed healing powers.