The Subject is BPD–That’s Borderline Personality Disorder–not Bipolar Disorder

 

Ruth at Off Label, and Polly at polarcoaster both take on this issue in the last few days. I’ve decided to join the bandwagon. This will be my first post on BPD, too, Polly.

While  this label has been never been used to describe me  I know that if I had been in psych wards today instead of 25 years ago, I would have certainly been labeled with it. It was not as commonly used when I was frequently hospitalized. I did, however at the time, not make doctors happy. I, indeed, as Ruth writes in her post, perpetrate the “bitch pisses off doctor” sin. I pissed off all the staff . I couldn’t stand being treated with so little respect when I was hospitalized, so I did not “behave” well.

I’m going to write about the label from a slightly different perspective. I’ve not said much, except in passing, that I was a social worker in mental health. I no longer identify with the role that took front and center stage in my life for so long. I was a social worker dammit, not a psych patient! In any case, in truth, I was a social worker and a psych patient and in my practice I really did behave as both, though my employers never knew it.

Looking back I now see I may have gotten burnt out for a reason. I identified with my clients. You are always told not to identify with “them”. To have empathy instead? What does that mean? Really. I have no idea. If you identify does that mean you might catch something? Was that my problem–is that what in the end brought me to my knees? That I dared consider those I was meant to serve as fellow human beings?   I may have not done myself a favor, but I think I certainly may have done my clients a favor. And just so you know–I’m just wondering aloud here–I really don’t believe it hurt me at all. The time simply came when the drugs I was on beat my ass. I was tired and stretched to my limit. I couldn’t work anymore–and not just as a social worker–I couldn’t work at anything. I needed to get off the drugs.

Anyway, as a social worker, I had the habit of volunteering for all the people all the other clinicians refused to work with. All those damned borderlines as well as a host of the other so-called personality disordered (the bulk, of course, were labeled BPD.) I loved them. And I loved them because I identified with them…they dared to show their pain in a way I found honest even if not always straight-forward. And they liked me.  I never got harassed and no one ever knew why I so emphatically fought for their rights and needs when everyone else wanted to just let them slip into oblivion.  If you respect these folks, I argued, they respect you back. And it was the truth. It’s pretty simple.  It was true for me too. I behaved like a shit in the hospital because that was how I was treated. You know, my colleagues, more than a few times, suggested I was being manipulated by these clients. That was why I supported them. Sadly, I simply understood what it was like to be subject to my colleagues care.

Anyway it’s not like I actually have deep insight into the so-called borderline personality. I know I have some traits, but they are minor. No one outside a psychiatric ward would have ever labeled me that. My behavior in psych wards was out of control simply because those “treating” me were out of control. Hence, the reason I’m sure I would be labeled borderline today in a psych ward and hence the reason the same “borderlines” who behaved so well with me could not work with my colleagues who simply could not empathize with them let alone identify–the clinicians were out of control–perhaps angry and scared, certainly condescending. I think identifying with a client is actually a good thing? Yup, a fellow human being. I’ve never given it a lot of thought, but I imagine that peer counselors are effective for exactly that reason. And wasn’t I, though in the closet, just a glorified peer counselor?

I’ve always had respectful relationships with providers outside of hospitals–no risk of being labeled outside, even if I now view the relationships as completely messed up because the power balance was so skewed and I lapped up all their advice to my great detriment.

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Author/Editor Beyond Meds: Everything Matters

6 Responses

  1. Ruth

    I guess your colleagues would have said that the patients were ‘splitting’, right? That they were making a point, consciously or otherwise, of dividing the staff into two camps – those who were the good “kind, supportive, identifying” ones and those who were bad and who just wished they’d go away. Little consideration appears to be given to the possibility that this is two-way dynamic process, not just a manoeuvre instigated and perpetuated solely by the designated borderline. Given the contempt directed at those BPD by those in the psychiatric profession, this should barely even need stating.

    Anyway, it should hardly be surprising if people with BPD – who are somewhat more likely to have been abused in various ways as children – are distrustful and dismissive of those who seem unsupportive in any way. After all, why waste time examining the various hues of grey to their antagoniser’s behaviour, if you think you’re running the risk of getting ‘more of the same’? If they do respond positively to those who do treat them well, I’d be inclined to view that as a healthy substrate to build on, given the tendency of people with histories of abuse to allow themselves to be repeatedly drawn into similar situations.

    Splitting is an ego defense mechanism – that is, a protective device – and some people require more protection than others. So in some contexts it might be fair for psychiatrists to describe as ‘primitive’, but in other contexts, it’s just a matter of self-preservation.

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  2. Gianna

    yes…if providers are brought to odds with one another as a result of interaction with a “borderline,” “splitting” behavior on the part of the client is always blamed. That is not what was happening most of the time with me an my colleagues…they just couldn’t figure out why I liked working with people they had completely dismissed. There weren’t any real arguments. My colleagues tended to be grateful they could dump the people on me.

    I kept “splitting” from being a problem in that if someone I was working with (a client) tried to make one of my colleagues a bad guy–I just wouldn’t go there…with them or the colleague)I had good relationships with my colleagues and my clients. It’s kinda hard to imagine now. During my last hospitalization right before I quit working I had insight into my colleagues like I never had before. Most of them were condescending much of the time and I hadn’t even realized it because I was more identified as social worker than patient. That came to an abrupt end upon my hospitalization. I finally saw who I had been working with. (there are people in mental health who do truly respect their patients/clients but they are not the majority)

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  3. Gianna

    and certainly…when the client “tried to make one of my colleagues a bad guy” they could be right on! I simply chose not to get involved on either end–I might bitch about it at home with my husband–sometimes blaming the colleague–but it didn’t cause strife in the workplace or with my client. I did a mighty fine balancing act! God knows how.

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  4. flawedplan

    Ya threatened the haters, good for you

    Interesting how those who Other try to take the moral high ground. You empathize, they other; and they pressure you to do like them, which is odd, it shouldn’t matter what you think and feel about borderlines.

    But it does, because how your colleagues think about borderlines is wrong, and who wants to be reminded what they do is wrong?

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  5. Gianna

    Yeah, thanks Marissa, I had seen that article. I don’t doubt that one can have empathy without the experience. I am asking though, is it possible that identifying with empathy is as good as or even better than empathy alone. Some professionals say one should not identify. I think that is silly as I mention the effectiveness of the peer counselor. Peer counseling programs are being promoted all over the country now, so I imagine the caution to not identify among professionals is more about fearing being like the client than it being a problem for the client. It is an attempt to keep the client as “other.”

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