Borderline personality disorder is mental disorder as defined by the American
Psychiatric Association's Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition. Like all personality disorders, it tends to be
an intrinsic style of coping and dealing with the world in a manner that is
not all that beneficial either for the person who has it, or those who interact
with that person. And when I say "not all that beneficial," I really mean "it
ain't working."
An example of this could be a person's relationships with others in their
life. In borderline personality disorder (BPD), the individual goes back and
forth in an emotional state, hating and loving the person depending upon
their feelings of dependency (or not) on another. These emotional swings
can often be intense, and therefore the person with BPD might feel a need
to let out some of these emotions. However, here's where the quandry begins...
If you tell someone you hate them, they aren't likely to like you very much and
a person with BPD, because of their dependency needs, fears that person leaving
them. So they cannot (or have not found adequate ways in which to) express
themselves emotionally.
So often someone with BPD will turn their intense emotions as much inward
as possible. This can result in self-harm behavior and suicidal attempts, as is
often the case when anybody is feeling very angry and depressed about themselves
at the same time. Sometimes, for some people with this disorder, some of the
emotions do get out, and they let people know they've harmed themselves
or need attention or the like.
Now the problem arises when mental health professionals put down individuals
with this type of disorder, explaining away every behavior and interaction with
another human being with, "Oh, her? She's borderline." Yeah, like that says it
all. As I've talked about here before, this demeans the individual not
only because it describes them merely in terms of their disorder ("Oh, he's
schizophrenic." You wouldn't say the same thing to someone with cancer, "Oh,
he's cancerous!") It's mean and unthinking to talk in terms like this, and rather
patronizing to boot.
But what's worse with people with BPD is that many mental health professionals
act as though the person with this disorder is a child. Or irresponsible. Or
that their emotions are somehow "fake" and not as felt as "real" emotions.
While this could be the case in some people with BPD, I'd argue this could
be the case in some people in the general population, regardless of whether
they have BPD or not. To dismiss or pretend to explain away a person's
feelings with such a label is doing a disservice not only to the person who has
the disorder, but more importantly the validity of their emotions and feelings.
If we start denying people their feelings, what's next?
If you're a mental health professional and you see yourself in the above, please
stop and consider this next time you're amongst your colleagues discussing cases.
I have sat in hundreds of case conferences and staff meetings where live human
beings were reduced to nothing more than their disorder and everything was explained
in that one or two words. It's dehumanzing and it can stop with you. If you're a client
in treatment now, ask your therapist why he or she might use that term to talk
about you and see where it leads to in a discussion. I'm sure it'll be interesting,
regardless of your or their views.
As more and more health-oriented sites come online, I'm beginning to see a lot
more of what I call the "medicalization" of mental disorders. I visited a new
Web site last week and found an article on depression where they stated time
and time again that it is a fact that depression is caused purely
by biological conditions and only medication is the real treatment. I thought,
"What a crock of horseshit," and promptly wrote them some e-mail telling
them so.
They promptly wrote back, and, in part, said:
"Thank you for your thoughtful and extensive comments on our www site. As
you recognized from our site, we take a very medical and biological approach
to the topic of mental illness. I will indeed review the site to make our
focus more clear."
Hmmm, that's interesting. Any objective reading of the entire literature across
disciplines clearly shows that a) we don't know what causes mental
disorders like depression and b) we do know that it appears that a number
of equally important factors are a part of almost every mental disorder, such
as biological, psychological, and environmental.
My point? Watch out for these sites as they come online and carefully
review their material and what they're saying with what the rest of the mental health
profession is saying. Just because you read it online by someone with some fancy
degrees after their name doesn't make it true.
I'm planning some sort of redesign of the home page soon. It's getting boring
and losing whatever originality it once (if ever!) had.
Also, check out the latest edition of the mental health magazine we publish
over at Psych Central every other month, Perspectives. It's our best one yet!
And, if you're a Prodigy member, check out my weekly mental
health chats there in the Health n' Fitness area in the Psych Central
room, Sunday nights, 9-10:00pm EST (-5:00 GMT).
