Sasha Menu Courey wrote in her diary that dialectical behavioural therapy was “air” to her—no small metaphor for someone who, as a world-class swimmer, knew more than most of us about what it means to breathe.
She killed herself about three weeks later, in June 2011.
Sasha’s parents believe she decided to end her life, at least in part, because she couldn’t face leaving the hospital that was giving her that vital therapy.
Her illness, borderline personality disorder (BPD), isn’t well understood. If you’ve heard of it, chances are you have a distorted idea of it, thanks to shows like Criminal Minds or the sensational Jodi Arias murder trial.
When Sasha told her mother Lynn Courey she’d been diagnosed with borderline personality disorder, Lynn responded with hope, saying, “Oh it’s not bad, you’re on the borderline of a personality disorder.”
“I didn’t know anything then,” Lynn said, crying as she sat with her husband Mike Menu and daughter Kaya Menu Courey in the living room of their Toronto home recently. “I didn’t know.”
Lynn Courey and Mike Menu are now on a mission to educate people about their daughter Sasha’s mental illness, borderline personality disorder, and to promote dialectical behaviour therapy (DBT)—a treatment and form of communication they believe can help everyone.
They run the Sashbear Foundation and are holding its first Borderline Walk for borderline personality disorder awareness on May 26, beginning in Sunnyside Park in Toronto.
What is BPD?
“Borderline” doesn’t mean BPD isn’t serious. The name is outdated psychiatric jargon that erroneously refers to the disorder being on the border between two other diagnoses.
People with BPD have “emotion disregulation,” difficulty controlling their emotions and impulses. They’re sensitive and feel things intensely, explained Dr. Shelley McMain, head of the Borderline Personality Clinic at CAMH.
But unlike the impression given by murder shows and sensational trials, it doesn’t mean they’re violent toward others.
About one in 10 people diagnosed with BPD dies by suicide, said McMain.
Although BPD is not uncommon, affecting two to six per cent of the population, treatment is hard to come by. CAMH is the only hospital in Toronto with a clinic devoted to treating BDP, one of a handful in Canada.
When Sasha needed treatment after her second suicide attempt, even the CAMH clinic’s waiting list was full.
What is DBT?
CAMH treats BPD patients with dialectical behaviour therapy, a talk-therapy developed in the 1990s.
One key component is validation—a way of talking to someone with empathy, by expressing that you know their emotions are understandable and real, instead of saying they’re wrong to feel the way they do.
When Lynn and Mike look back on raising Sasha, they recall trying to help her when she felt bullied and alone. Following their best parental instincts they would try to comfort her and tell her she shouldn’t be sad, but their response would make her feel angry or misunderstood and she would worry that something was wrong with her.
Another component of DBT is learning to cope with emotional distress through mindfulness, which is “being aware of the current moment without judgment, being present,” said McMain.
McMain agrees with Mike and Lynn that everyone can benefit from learning DBT.
“You don’t have a mental health disorder to benefit from communicating effectively,” said McMain.
Mike and Lynn have begun teaching Toronto students and teachers about BPD and validation techniques. One day they’d like to see a mental health curriculum in schools that teaches everyone about mental illness, without stigma, and the basics of DBT.
Sasha Menu Courey
Sasha was born March 10, 1991, sensitive from the start but physically strong. “She was born with muscle,” said Lynn.
Sasha joined the Etobicoke Swim Club and set the 12-years-and-under record for the 50 free—previously held by Allison Higson, who went on to become an Olympian.
Sasha would cry if she didn’t beat her best time, even if she won the race.
Her parents would tell her that she shouldn’t be upset about that—and learned almost a decade later that there would have been a better way talk her through it.
Sasha left Toronto to swim at the National Training Centre in Montreal at 15. When an injury forced her to stop training temporarily, the sudden drop in endorphins and serotonin that come from intense exercise made her depressed, her parents said.
“Then, last but not least, she had her heart broken,” said Lynne. “And then she tried to kill herself, in May 2007.”
Sasha’s parents took her to Sunnybrook Hospital, but a psychiatrist didn’t diagnose her with anything other than teenage angst, and her parents didn’t feel they could challenge that decision.
“But my kid had just tried to kill herself,” said Lynne. “We left this place with shame and guilt. What did we do to our daughter for her to feel this way? We felt so bad.”
These days, Sasha’s parents wonder what could have been different if she’d received a diagnosis of BPD and begun therapy back then.
Instead, Sasha resumed her routine and went on to swim with the Junior National Team, then accepted a full scholarship at the University of Missouri.
But when a back injury forced her to stop swimming, the problems of 2007 returned.
Sasha checked herself into the psychiatric ward of a hospital in Columbia, Mo., and was diagnosed with borderline personality disorder.
The night she was released, she and another girl she met in the ward told her parents they were going out to let off steam.
Instead, they had a suicide pact.
Both girls survived. Sasha’s parents tried to bring her home to Ontario for treatment, but the only option—CAMH—had a waiting list so long it wasn’t taking new names. So, they took her to private hospital in Boston that cost $44,000 a month.
There, Sasha and her parents learned about DBT and dealing with her emotional pain. Sasha began keeping a diary, opening up about events in her life, including recently being raped at school. She was improving but the cost forced her family to arrange to take her home to Canada where she was to begin outpatient treatment.
Sasha didn’t make it home.
“She wanted to live,” said Lynn. “She loved life. She just couldn’t live with this excruciating pain.”