Rich Girl Rehab

The “Borderline” Years

This is a guest post by Sorbie Richner, a renegade independent scholar from the Midwest who writes on her substack, Miss Apprehension. I admire the uncut brilliance and insights, hard-won from experience, that run through Sorbie’s work. The story she shares here has left echoes in my mind, and I suspect it’ll do the same for you. Give it your full attention. Awais Aftab.

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When I was 20, I got sent to rich girl rehab.

I was in a psychiatric hospital following the kind of scenario that gets you sent to a psychiatric hospital. This was not nearly my first time in a psych hospital, this was my second hospitalization in three months, and this time, the cops had driven me to the hospital where I was, like always, involuntarily committed. I had been getting sent to the psych hospital intermittently since I was 13. So a week before my release date from the hospital, I was given an ultimatum by my parents: either we ship you across the country so you can get permanently fixed, or we’re going no contact.

At this point I was on my second medical leave from music school at a fancy liberal arts college and was crashing with my parents. I had nailed down a part-time job washing dishes at a diner a few weeks before getting hospitalized; I lost the job when I got hospitalized. Things were pretty dark. I was feeling trapped and isolated; even before hospitalization, I had just been sleeping all the time. I knew that getting kicked out of my parents’ house would mean couch surfing at first and then, when I wore out the welcome of the few people who were likely to take me in, eventually winding up on the street. That sounded like a better option than going to rich kid jail. I initially told my parents and my doctors that I chose the street. A kindly and level-headed hospital psychiatrist dissuaded me over the course of several days. Though she didn’t use exactly these words, she could see clearly what I couldn’t see at that time: if you have a psychiatric history like mine, once you’re on the street, it’s nearly impossible to get off. You choose the street, you die in a gutter or under a bridge. Residential psychiatric treatment would at least give me a chance to escape that fate.

So I was discharged from the hospital on a perfect May evening and I got on a plane to Texas with my mother the next morning. I was in the stupor that new heavy duty drugs and the trauma of the psych ward put you in. I was significantly underweight. My mom bought me some shorts because I didn’t have any and she treated me to a haircut. Then we rolled up to the rich girl rehab.

I learned that the program I was going to was designed for girls with borderline personality disorder and similar. At the time I was admitted, I had the black mark of a BPD diagnosis on my chart. This “diagnosis” was not the result of any kind of rigorous evaluation, it was the result of getting hospitalized over and over again, and if that happens and you don’t have psychosis, the hospital just hits you with the borderline label. Borderline personality disorder, if you’re not familiar, is one of the most highly stigmatized DSM diagnoses. It’s characterized by rapid mood swings including explosive anger, unstable concept of self, relational instability, self-destructive behaviors like cutting and chaotic substance use, and suicidal gestures—and it’s much more frequently diagnosed in women. Basically, it’s “crazy woman disease,” modern day hysteria. There is much to be said about whether or not I think that BPD was the best framework with which to understand my symptoms or my suffering. For now I’ll simply say that I don’t really think it is, or was, and neither would most clinicians who knew my case well. I have come to find out in the intervening years that this kind of slapdash “diagnosis” of BPD is very common, at least anecdotally. Though some other young women in rich girl rehab with me were treated as “true” borderline cases while in the program, there were plenty who were in the same boat as me; more in-depth evaluations within the program evinced diagnoses like DID, autism, and, perhaps it goes without saying, PTSD. But I’m getting ahead of myself.

So yeah, we rolled up to the rich girl rehab. The facility was nice—ostentatiously homey, shabby-chic à la Texas. I didn’t see “But I’m A Cheerleader” until years after my time in Texas, but the welcome sequences are weirdly reminiscent of my welcome to rich girl rehab. We were welcomed by a smiling lady who gave us a tour of the grounds. We ran into a few other girls; some of them looked normal, some of them didn’t. We were then ushered into a cutesy office. The smiling lady explained a bit about the structure of the program. She explained that most girls completed it in about a year. My mom wrote the rich girl rehab a fat check, and then she left.

I was almost kicked out of the program in the first week. My suicidality was so acute that the rich girl rehab couldn’t accommodate it. I was given a stern talking-to by the therapist who had been assigned to my case. Suicidality is your only coping mechanism and it’s not good enough. Either you get your ass in gear, or you’re on the street. I didn’t get my ass in gear, but I was too tired to fight. (Except for later that same week when I got in a fistfight, but that’s a story to be told in person.)

I eventually emerged from my groggy post-hospital haze and got to know some of the other girls in the program. Like me, they were all rich girls whose rich parents were mad at them. And they had all absolutely been through the wringer. For many of them, this rich girl rehab was one of many they’d been to. All of us in the program were between the ages of 18 and 24; some of the girls had been bouncing from residential treatment to residential treatment since they were in middle school (many of them had been to the same rich girl rehab that Demi Lovato went to, which I just think is a fun fact). Some of them had been hospitalized even more times than I had, with even more significant medical vestiges of those times. Some of them were on upwards of 5 psych meds. Some of them were addicts, some of them had done sex work. Many had eating disorders. We all had the personality quirks that can arise when you’ve been through some serious shit. And a few of them became dear and lifelong friends of mine.

It was in this rich girl rehab that I was introduced to the concept of attachment styles. This was way before instagram heard about it. Attachment theory is just one way of understanding human development, but that wasn’t made very clear to us in rich girl rehab. The way that it was framed to us was as if an attachment style was some kind of biosocial reality. Today, I am definitely not what one might call an attachment theory realist, but I think attachment theory is as good a lens as any to look through from time to time (as long as you only look through it from time to time!). We are going to look through it for the purposes of this essay, because it’s the lens through which rich girl rehab viewed us.

The idea is that the way you were treated as a baby and a young child sets the template for how you are able to relate to others going forward in your life. If things didn’t go well back then, things probably won’t be going well for you now. According to the formulation that’s in vogue today, there are four clusters of behavior that indicate four attachment styles: secure, anxious-preoccupied, dismissive-avoidant, and fearful-avoidant (also called “disorganized”). People who have a secure attachment style have an easy time relating to others. They know what their needs and responsibilities are within relationships and have a relatively easy time expressing those. Other people aren’t generally seen as threatening. This pattern arises from having your needs met consistently as a baby. People with the anxious attachment style had some of their needs met as a baby, but the care was inconsistent. This can lead them to become very clingy in their adult relationships. They might need a lot of external validation and reassurance that the relationship isn’t going to disappear. People with an avoidant attachment style are people whose needs were met very inconsistently as a baby, they might have been lightly neglected. In adulthood, this can lead to being very remote and withdrawn in relationships; it might lead a person to not seek relationships at all; it can lead to a sort of “why try?” attitude toward other people. People with a disorganized attachment style are people whose caregivers were frightening, abusive, intrusive, or severely neglectful. This can lead to a lifelong feeling that relationships are inherently threatening: care equals pain. It’s often said that the disorganized attachment style comprises the more extreme relational strategies of the anxious and the avoidant styles. Practically, this can look like deep mistrust with a simultaneous deep need for closeness. It can look like ratcheted-up push-pull dynamics in relationships (“I hate you, don’t leave me”). People with the disorganized attachment style can be very hard to be in relationship with. All of us in this rich girl rehab were said to have the disorganized attachment style.

Remember, some of the hallmarks of BPD are mood swings, relational instability, unstable concept of self. Well, if you have a disorganized attachment style, your moods might be confusing or frightening to non-disorganized people. This might lead to unstable relationships. If you have trouble knowing who you are in relationships, you might have a hard time knowing who you are, period. In my case, feelings of isolation and alienation led to persistent acute suicidality. These are not new observations; plenty of people over the years have said that BPD is just the disorganization that follows developmental trauma; plenty have quibbled with what the borderline group even is, what counts as a borderline “symptom”. There’s plenty of discourse out there about how BPD in most cases could more accurately be called complex post-traumatic stress disorder, c-PTSD (which still isn’t in the DSM for a host of complicated, partly political reasons but which most clinicians recognize anyway). It seems in my experience that even among clinicians, “borderline” often just means developmental trauma but extra scary. It usually points to high levels of unpredictable anger, or sullenness, or basically any very difficult relational traits—like I said before, it’s crazy woman disease, modern day hysteria. Put another way, if your developmental trauma causes you to act out, it’s BPD.

Back to rich girl rehab. I won’t get too much into what the treatment actually looked like because it’s not the point of the essay. Suffice it to say that real treatment actually happened there. There are rich girl rehabs out there, especially addiction-specific ones, that are very coddling. This was not one of those. We were doing some kind of therapeutic intervention on a nine-to-five kind of basis. And there are rich girl rehabs out there that are pretty universally traumatizing and abusive, like in those netflix shows. This was not one of those, either. A lot of girls felt like their time at our rich girl rehab was transformative and they went on to live full, healthy lives afterward. Some girls didn’t; some girls wound up on the street after all. As for my treatment, it ran the gamut from asinine and ineffectual to very stunting to pretty useful. I finished the program in 9 months, which was unusually fast.

My therapist at rich girl rehab had a pet theory that what was really wrong with me was not only not a personality disorder, it was not developmental trauma at all. She thought it was autism. I was formally assessed for autism by a professional diagnostician of autism and, if you can believe it, she found that I had autism. (Something about hammers and nails.) I believe that I really met the DSM-5’s expanded diagnostic criteria for autism spectrum disorder. I also believe that if I were assessed today by a different clinician, I might but very likely might not be diagnosed as autistic. You know how what people really mean when they say “BPD” is “crazy woman disease”? I think that these days what we mean by “autism” is basically “weird person disease.” And I definitely had weird person disease back then, the same way I sometimes had crazy woman disease. I still have weird person tendencies and sometimes a touch of crazy woman ideation. One thing I guess my rich girl rehab therapist didn’t appreciate was that some manifestations of developmental trauma are practically indistinguishable from the symptoms of high functioning autism under the expanded criteria. Even if she had, there wasn’t really room for that kind of thinking in this rich girl rehab, where disorganized attachment reigned supreme.

I’m a lot healthier now. But my healing was no thanks to RGR. The things that I think were most helpful about rich girl rehab were 1) I didn’t wind up on the street, 2) getting space from my family and others that had open contempt for me, and 3) the autism diagnosis made my family treat me a lot better. For most of my life my parents were eager to attribute my confusing and upsetting behavior to a desire to manipulate or punish them, instead of the natural expression of excruciating pain and overwhelm that it really was. The BPD diagnosis gave them license to blame me even more: if I tried to kill myself, it was just an attention cry and they should just ignore it unless it was very medically significant. If I was failing out of school, I was acting out, being oppositional, and I should be punished. If I was acting in a way that was interpersonally jarring, I was provoking a reaction. If I was angry, it was just scary borderline rage. The autism diagnosis helped my parents not blame me for my own distress. It helped them see me as disordered instead of monstrous. I didn’t have an evil heart, I just had a brain that was permanently sick with weird person disease. It’s much easier to treat a person with compassion if you see them as disabled and pitiable than if you see them as a chronically untrustworthy menace.

If I ever talk in real life about my time at rich girl rehab (which I rarely do these days), I usually tell people that the thing it mostly did was make it easier for other people to be around me. I don’t mean that it gave me better relational skills; it didn’t. I mean that it made me obsessed with acting normal. My rich girl rehab therapist made it an explicit treatment goal to accept that I would just always be weird and there was nothing I could do about it. This made me hypervigilant for any trace of weirdness in my behavior. Believe it or not, obsessively checking your behavior to make sure it’s normal does not make you seem very normal. I grew out of that in a few months after leaving rich girl rehab. But the obsession with my abnormality remained. Instead of always checking myself, I just felt crippling shame anytime I realized I had done something out of the ordinary, and I still felt the niggling paranoia that I was probably acting weird all the time and just couldn’t tell. Over 7 years later, I am still recovering from the shame that stuck to me after rich girl rehab. But hey, at least I know I’m fucking weird now. I went back to music school thinking I could do it because I was fixed, and then I realized I couldn’t and I dropped out. It’s true that I don’t any longer do the scary or self-destructive behaviors that led to my getting shipped off to rich girl rehab. That doesn’t mean that the feelings went away or became easier to manage while in rich girl rehab; they subsided for a while commensurate with my parents treating me better, then they came back again in full force when my parents inevitably started treating me badly again. The feelings have subsided over the course of these past several years due to a host of other factors that I’ll get into in a bit.

Rich girl rehab didn’t fix me. I’m not sure how much it helped me in the long run. There are some significant ways that it harmed me. It did keep me off the street, though, I’ll give it that. If I had wound up on the street, I would likely be dead by now.

So, if rich girl rehab didn’t help me, what would have? People love to ask this. People are also usually not prepared to hear my answer. I’ll tell you some of what I think, but I’ll take a winding road to get there.

After finishing rich girl rehab, I was as adrift as you might imagine. I was 21. I was very poor. My parents allowed me to move back in with them. The diner where I had been washing dishes before rich girl rehab somehow agreed to hire me back, this time with more hours and more responsibilities. I reconnected with some friends from the past. I was doing things. But I was still absolutely debilitated by shame. I had it in my head that I was so fucked up that I would never be able to live a normal life, because I had received that message implicitly and explicitly for many years up to and including rich girl rehab.

In July of that year, I returned to a rural area I’d visited with my family as a child and got a job in a shop. It was the first time in my life I was truly alone. It was awesome. In my spare time I swam in the lake, walked, cooked, wrote, and made art.

My family is very clannish; we usually kept to ourselves when I was a kid. By dint of working in a public facing job, I got to know some of the other locals I’d never met before. These locals didn’t know anything about my history of insanity. As such, they had no reason to treat me any differently than anyone else. They weren’t afraid of me, they didn’t hate me, they didn’t talk to me like a retard or coddle me in any way, and they also weren’t insanely shaming and cruel to me. My boss was tough on me in a way that was enormously generative. She knew something of my history but didn’t care that much; she wanted me to do my job and do it well and was extremely clear about her expectations, and when I didn’t meet them, she let me know, but she didn’t punish me, didn’t threaten to fire me (or give me a failing grade, which was the fear that was freshest in my mind).

I know these things all sound really basic. But these were modes of relating that I was not accustomed to. Within my family I had been the “identified patient” for so long that the only way my family knew how to treat me was like a crazy person. I was so sick for so long that I didn’t have any close friendships at this time in my life, so there was no real counternarrative. I had of course had contact with teachers and schoolmates, but I was a very bad student with a lot of “natural talent” but poor social skills and a “poor work ethic,” so the message I received there was that I was simultaneously an insufferable know-it-all and a lazy, oppositional piece of shit. I had no way of knowing that people who didn’t know my family or in the context of school would treat me like I was normal. I had no idea that most people thought I was normal, if a bit quirky, a bit undersocialized. I didn’t know that most people thought I was capable to a normal degree. This was all revelatory.

I liked rural life so much that I tried to stick around for the winter. When the shop closed down for the season and all the tourists cleared out, I got a job in a hotel 45 minutes away. Living alone in a rural area in the winter and spending all my time commuting, working, or completely alone proved to be as isolating as my pre-rich-girl-rehab life had been, and that was too painful to bear, so I crashed with my parents back in the city from March to May of that year. I worked at the old diner again during that time.

Then I moved back to the rural area and picked up my shop job and a few other odd jobs. That summer was the most magical time of my life so far. It helped me develop a vision for my future that I hold to today. I was integrated in the community of my little rural town; that summer I made new friends that will stick with me for life. I was busy with work and play and spending time outdoors, but I still had plenty of time for quiet contemplation and moody thought thinking. I learned how to drink alcohol and do drugs (neither of which I had done before because of the heavy-duty psychotropics I’d been on since I was a kid); that was a steep learning curve. I was really internalizing that I was actually pretty normal and as such, some semblance of a normal life individuated from my family might be possible after all. At this point I had actually accrued some savings for the first time ever. I decided that I was going to move back to the city in the winter and try to strike it on my own, then come back to the rural area next summer and try to figure out how I could strike it on my own there, too, more permanently. I knew that was where I wanted to build my life.

I moved back to the city that November to get the ball rolling. I was determined to do some service work to pay the bills and try to use the half a music degree I had in my spare time. I was going to become a piano teacher and do some classical music gig work, I was going to get established in the classical music scene. And then I was going to hit the bar scene and try to meet someone to take back to my rural town with me. That good old diner took me back. I started going to church again. I signed my first ever lease on an apartment, and I moved in on… March 1st, 2020. Our city went into lockdown two weeks later.

So my plans were thrown off course a bit. I never became a piano teacher. I didn’t hit the bar scene, I didn’t meet someone. But I did keep working in that diner for a while, except when our city went into lockdown for a few months. Early COVID was great for me. Where other people were freaking out about how shit wasn’t normal, I was doing fine, because my life had never been normal the way theirs had been. I was accustomed to loneliness; the isolation didn’t cut as deep for me as for others because it wasn’t as fresh, and it wasn’t as pure as the loneliness I had known. I got a part-time job on a farm, I walked around outside. The pace of life was slow, and I couldn’t have been happier about that. When the pace of work got too fast at the diner again, I quit and just did the farm thing.

Things did eventually get bad for me again. In the summer of 2021 while on vacation with my family, I had a full-on freakout, and thus began a year of deep darkness. My symptoms were so severe that I remained unemployed for almost 3 months. I probably should have been hospitalized. My therapist didn’t hospitalize me because she knew that all the involuntary hospitalizations in my past had done more harm than good. I was in real danger; my therapist got very lucky in her roll of the dice, and I’m ultimately grateful—I don’t know what I would have done in her shoes. My parents helped me with my rent a little bit during that time, but I quickly ran out of money anyway. My family and I had a series of talks that eventuated an estrangement that lasted over a year and which we are still recovering from. The things that kept me afloat were these: 1) By this time, I had learned how to make friends and I had robust friendships—real friendships, not the pale, flimsy imitations that I had mostly had in the world I grew up in. 2) The old diner sometimes called me in to help when they were understaffed, and that made me feel useful, valuable, and competent, even when most other signs in my life pointed to the contrary. 3) Church. 4) I got a job as a nanny. I probably wasn’t a very good one given the circumstances, but I loved those kids, I loved that family. 5) I spent all my spare time outdoors, touching plants.

I made it out of that dark year through the love of friends and because I was a meaningful part of something(s), of my community. I had people and things I had to care for, real responsibilities and real reciprocal relationships. And I had a rich, embodied connection to the divine, in the form of congregational worship and in meditative and devotional forms, including being out in creation everyday. On the other side of that dark year came the healthiest years of my life, even in spite of some significant challenges.

I’m doing well now. I’m happy and steady. I have dear friends and loved ones and a partner, none of which I could have dreamed of having back in the rich girl rehab days. I have a somewhat strained but functional relationship with my parents. I got off my psych drugs many years ago, as I said, and have never looked back. I dropped out of college, and as such, I’m cut off from working many of the kinds of jobs that pay high wages. I have done only manual and service work for my whole adult life—dishwashing, cooking, farming, nannying, barista-ing, the like. I live alone in a pretty comfortable if shabbily-maintained apartment in the town I grew up in; I’m going to get priced out soon. Most of my income goes to my rent. My parents did help me with rent years ago; now they do not. I just got approved for Medicaid (still waiting to hear about food stamps), but my parents have offered to pay for my therapy if I ever choose to go back. In other words, I’m living a working class life with a few extra (therapeutic) perks. I’m much happier than I was when I was trying to do the upper class thing, and a lot of my material needs are met. And I think I’m a lot more fulfilled than I would be if I was working at some kind of fucking nonprofit or consulting firm like I was supposed to. But my body is a lot more worn out than it would have been in that case. My life is a far cry from what was laid out for me. It’s very different from that of my peers in my extended family and the people I grew up with. I’m happy that way. I have been forced to make meaning out of my life path in a way that I think most people from the same socioeconomic origins as me will never have to do. So for that, thanks, rich girl rehab.

Sorbie Richner

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Epilogue

Sometimes when people find out that I have an intense psychiatric history, that I have “struggled with mental illness,” they ask me what I think caused it. Though I have some narratives I like to cling to, I still don’t know exactly. I think some aspects of the answer are best gleaned by looking carefully at what got me out of the darkness. So just to review, here are the things I identify as healing agents:

• getting away from the bad environment; gaining stable, safe living conditions

• meeting new people and finding out they thought I was normal: having a normal version of myself reflected back to me in my interactions

• steady employment/something to fill my time

• having time to create

• keeping my body active outdoors

• lots of unstructured leisure time outdoors

• being treated like I was capable: not stupid and not a genius, just a normal amount of capable

• being treated like I was valuable

• financial stability—not excess, just enough to meet my needs

• a vision for the future—one that I formulated myself, NOT one that was handed down to me from on high

• religion

• being integrated into my community: having a variety of relationships of varied depth, but most crucially, having several emotionally intimate connections

• caring for and being cared for: relationships of mutuality and reciprocity

If you look at this list, it reads like a list of the things that make life worth living. These were also things that were mostly not present in my life until my early twenties. It’s very easy to understand why I didn’t feel like my life was worth living before. A lack of these things is enough to drive anyone crazy.

You may have noticed the absence of two expected healing agents, psychotropic medication and psychotherapy. You noticed rightly. I don’t take psych meds. I was put on heavy duty psych drugs at age 11 or 12 and stayed on an intense cocktail until I was 21 (at which point I got off them with the help of a doctor). I’m of the opinion that psych drugs kept my symptoms at bay to the detriment of deeper healing earlier on. A person could make the argument that the drugs helped me get into a stable enough place to do deeper healing. It’s impossible to know if that’s true or false, whether something else might have stabilized me equally well or better. Psych drugs also wreaked havoc on my mind and body in myriad ways, and I think they also made me stupider. As for psychotherapy, I was first taken to a behavioral psychotherapist when I was 9 and it was very traumatic, and I think that, combined with general pervasive mistreatment by adults in my life, spoiled me for therapy for the rest of my life. I have had some effective therapists and therapies since then (and some idiotic ones, and some absolutely insane ones, IYKYK), but I have never fully trusted them, and I don’t think I ever will. In recent years I have sought out some specific modalities, particularly EMDR and sensorimotor psychotherapy, and they helped a little bit with some specific things. Good therapy can help some people with some things; sometimes it can even be truly transformational. But the kind of healing I needed and need was not and won’t be done primarily or even secondarily within a therapeutic relationship.

Anyway, the themes that emerge from the list above are these:

1. security, both material and relational

2. agency; some control over my circumstances, both material and psychological

3. a balance of active time and resting time

4. depth of meaning, including arts/creativity, nature, love, and God.

A person looking in on my life pre-rich-girl-rehab would almost certainly not have conceived of it as lacking security, agency, or meaning. I grew up in a two-parent household in the top income tax bracket, after all. I’m a rich girl from a high-achieving family! Of course I had security, of course I had comfort. If anyone has agency, it’s rich kids! Rich people can afford access to all the things that make life worth living and more, plus I even went to rich kid church. I have no right to be mediocre, let alone crazy. There is plenty of evidence that two parents and financial stability correlate with all kinds of metrics of success: if financial stability and having a mommy and a daddy are guarantors of health and a life well lived, then what the fuck did I do wrong?

That’s a clean narrative and I understand why people cling to it, why people make sense of stories like mine in this way. It’s also just not the whole picture. Remember, all the other girls in rich girl rehab with me were rich girls, all of them from two parent households. And I actually think those factors contributed to our psychopathology. Money, mommy and daddy helped make us sick.

Just because all of us in rich girl rehab were rich girls with two parents doesn’t mean all our biographies were alike. We came from diverse cultural, religious, and social backgrounds. There were more than a few girls who grew up very strictly religious. We all had something in our childhoods that went really wrong. For some of us it was something truly horrific, the kind of thing you think of when you hear “severe child abuse” or “acute, repeated trauma.” For many of us, the things that went wrong were painful, but an outsider looking in might write them off as quotidian, as “not that bad,” as “little-t trauma” at most. Most of us had some of each. But the things that went wrong went wrong enough that we acted insane enough to get all of us sent to rich girl rehab.

Something else we all had in common was parents who were desperate, parents who didn’t know how to help us. We all had parents who cared about us enough to spend a huge chunk of change on helping us feel better. Our parents didn’t know what else to do. Our parents were at their wit’s end. Our parents had tried everything!

Recall now what I said about attachment styles earlier: all of us in rich girl rehab had a disorganized attachment style, and that, at least in part, was responsible our symptoms. Recall also what I said about what leads to a disorganized attachment style: when you are a baby, you have caregivers who are frightening, abusive, intrusive, or severely neglectful. Now, I want to be clear. I’m not saying all the parents of rich girl rehab girls were violent abusers (though some were). The things that can frighten, intrude upon, and constitute neglect of an infant are not always malicious. Parents who are consistently very depressive, rage-filled, or erratic, even if they don’t physically harm the baby, can be enough to disrupt the baby’s development.

I’ve told myself that I don’t mean to blame parents in this essay. And as I write, I’m realizing that’s not true. I do blame parents for making choices that harm their children. But what I don’t blame them for is their lack of better choices. I don’t blame parents for their own upbringings, their own lack of relational skills, or their class position and the psychosocial baggage thereof. And you know what? I’m still allowed to be fucking mad at them.

I believe some things that would have had the best chance of preventing my need for intensive psychiatric interventions my whole childhood and adolescence are these (minus a few extra-personal details):

• my parents waiting several more years to have me

• my parents having a robust, tight-knight circle of friends and loved ones with whom to share support and emotional intimacy

• my parents having strong relationships with loving, warm, supportive families of origin

• my parents getting couples counseling for the years before my birth and during my early childhood

• my parents getting their own individual therapy for many years during my childhood

• my parents choosing an entirely different career path and timeline

• my parents choosing to raise me in a different geographical location

• my parents making a thousand small childrearing choices differently

• my parents making a few large childrearing choices extremely differently

If I were to fixate on these bullet points, I would drive myself doubly crazy with bitterness and rage, because these things didn’t happen and there’s no way they could have. My life is already irrevocably changed by what I went through as a child, teen and young adult, and no amount of theorizing about my family of origin will change that.

The more important question is, “what would keep people from getting sent to rich girl rehab?” If all the girls in rich girl rehab had disorganized attachment that generated their symptoms, then the question becomes about creating the conditions for secure attachment.

The only truly healthy, well-adjusted people I know from my social class of origin are people who had at least one parent who was consistently present in the home most of the time. They also had access to a wealth of other kinds of relationships, like kids to play with down the block, aunts and uncles and grandparents that came to visit often, mom and dad’s friends, schoolmates, and much more. I believe that this kind of social integration of the family unit is as close to a magic bullet as we have. I believe that the ideal of the American nuclear family doesn’t deserve the cultural hegemony it has, because the nuclear family in isolation is bad for people.

Communities have life forces that can be nursed back to health. We can do that if it’s important enough to us. And there are plenty of people for whom it is. I know and love many such people. And my experience of rich girl rehab and the precipitating incidents have given me the wisdom to know that dedicating my life to knowing and loving those people is the best thing I can do to help build a world where what happened to me won’t happen to anyone else ever again.

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This post is an edited version of an essay that was originally published in two parts on Miss Apprehension. Read part one and part two.

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See also:

• Miss Apprehension — On suicidality

• Psychiatry at the Margins — Borderline Personality and Self-Understanding of Psychopathology

• Psychiatry at the Margins — A Memoir For the Iatrogenic Age