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Compassion for Annie: A Healthy Response to Mental Disorders

Compassion for Annie: A Healthy Response to Mental Disorders is a user-friendly book aimed at individuals suffering from borderline personality disorder (BPD) and those who love them. Dowell writes from the layperson’s perspective and covers many issues that affect those with the disorder, such as anger, boundaries, codependence and dissociation. It is a unique perspective that encourages compassion toward persons struggling with BPD.

The book explores the challenges of BPD through the interactions of a fictional married couple, Annie and Fred. Dowell uses them to educate the reader about BPD as well as to offer helpful suggestions in its management. Dowell stresses that BPD is “an affliction that can be healed.” She further emphasizes that knowledge and the assistance of trained mental health professionals is important to that healing.  

Dowell formats her book in a simple, understandable way. Each chapter is dedicated to a particular facet of BPD such as emptiness, identity, or narcissistic tendencies. She covers sixteen topics in all and follows the same format for each topic or chapter. She begins each chapter with a relevant quote and then uses a sample interaction by Annie and Fred to act out the topic. She then leads her readers to a more in-depth understanding of the issue and summarizes what was covered. For those who enjoy a touch of spirituality, she also includes a prayer at the end of each section. Each chapter concludes with a thorough list of pertinent books on the topic that she entitles “Bibliotherapy.” 

In the introduction, Dowell explains the use of Annie and Fred as a way “to illustrate the unstable relationships of borderline personalities.” For example, in Chapter 5, Annie and Fred demonstrate “emptiness.”

Because of her borderline personality disorder, Annie struggles with unbearable feelings of emptiness as in this episode.

Annie: “I’m sick of our boring lives, we never do anything.”  

Fred: “What would you like to do? Want to go to a movie?”

Annie: “No, I’m tired of movies.”

Fred: “How about a football game?”

Annie: “No, football is boring.”

Fred: “Then what would you like to do, Annie?”

Annie: “I’m going shopping, see you later.”

Three hours later, Annie comes back laden with packages. Fred, while going over the receipts, discovers that she has spent $2,000 — far more than they can afford.

Dowell then defines emptiness and how it connects to other maladaptive feelings and behaviors displayed in individuals with BPD. She also dissects the interaction between the characters and offers suggestions for how they could manage Annie’s BPD in a healthy manner.

Readers may find Dowell’s use of the DSM helpful to describe and break down the relevant topic. For example, Chapter 15 covers “splitting” and Dowell begins her discussion by quoting the DSM-IV:

The Diagnostic & Statistical Manual of Mental Disorders describes splitting as: A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

Dowell continues to describe the concept in more detail:

“Splitting” is a defense mechanism, a pattern of extreme thinking: all-or-nothing, 100–percent-good-or-100-percent-bad, no-shades-of-gray, black-or-white, for-me-or against-me, heroes-or-villains, good-or-evil, love-or-hate, 100-percent–in or 100-percent-out of relationships. Splitting bounces from love to hate, and there is no middle ground.

The book generally achieves its purpose “to encourage compassion … for those who suffer severe mental anguish.” However, in my opinion, the book is better suited for persons struggling with mild to moderate BPD, not suffering from severe symptoms such as ongoing suicidal gestures and self-mutilating behaviors.

In regard to Dowell’s use of the fictional characters to represent interactions that might occur with BPD symptomatology, the dialogue between her characters is a bit stiff and sometimes inauthentic. Nonetheless, Dowell still achieves her objective in using the characters as an example for the overall themes and issues that characterize the disorder.

Overall, Compassion for Annie: A Healthy Response to Mental Disorders is a book I would recommend to a general audience looking for more information on Borderline Personality Disorder. It is an easy guide to the basics of the disorder but I do not believe it gives mental health professionals any added insight into BPD. On the other hand, I do feel that it reminds mental health professionals to continue to be compassionate and patient with individuals struggling with this disorder. Most important, it offers a much-needed hope toward the healing of a very difficult and complex disorder.

Compassion for Annie: A Healthy Response to Mental Disorders

By Marilyn R. Dowell

Langdon Street Press: October 4, 2011

Paperback, 174 pages


Compassion for Annie: A Healthy Response to Mental Disorders

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Nicholette Leanza, M.Ed, PCC-S

Nicholette Leanza, M.Ed, LPCC-S is a licensed psychotherapist with a great deal of experience working with children, adolescents, and adults in a variety of treatment settings. She is a native of Cleveland and works as an adjunct instructor of Psychology and Sociology at the University of Phoenix, Cleveland Campus. She is a wife and a mother of two wonderful children and in her free time she enjoys yoga, reading, and traveling.

APA Reference
Leanza, N. (2016). Compassion for Annie: A Healthy Response to Mental Disorders. Psych Central. Retrieved on September 30, 2020, from
Scientifically Reviewed
Last updated: 17 May 2016
Last reviewed: By a member of our scientific advisory board on 17 May 2016
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