[hsieh]

i thought this thread was dedicated to alternate ways of treating borderline personality disorder? i guess my views are shaped by where i work. we get the worst of the worst. we are a waiting room for the state hospital. the state hospital is no picnic. in fact you might say the state hospital is like a made up third world except they are locked up and not free.

[WhatNext?]

Originally Posted by mercyteapot

That would explain the lack of BPD in the third world. hsieh is taking things a step further, though, and is trying to sell the idea of sending westerners with BPD into these nations for treatment. Shall we also send people with morbid obesity to these nations? After all, there's not much of that in the third world either.

Are there studies that show that borderline personality disorder does not occur in third world countries? Does it only occur in industrialized societies? Haven't thought this through.

Throwing anyone into a third world country against their will or better judgement is simply duplicating the experience of violation and abuse. Particularly not beneficial to people with borderline personality disorder.

BTW, I spell it out because BPD means Bi-Polar Disorder in my practice and acronyms are confusing. And they are people with a disorder and are not simply the label!

[hsieh]

borderline people are thrown into state hospitals against their will. like i said - state hospitals are like made up third world countries.

[mercyteapot]

Originally Posted by WhatNext?

Are there studies that show that borderline personality disorder does not occur in third world countries? Does it only occur in industrialized societies? Haven't thought this through.

Throwing anyone into a third world country against their will or better judgement is simply duplicating the experience of violation and abuse. Particularly not beneficial to people with borderline personality disorder.

BTW, I spell it out because BPD means Bi-Polar Disorder in my practice and acronyms are confusing. And they are people with a disorder and are not simply the label!

WHATNEXT, I honestly don't know whether there are any such studies or not. What I was meant was that even rnwriter was right about what hseih is saying, her summation went only so far as to account for hseih's contention that borderline doesn't exist in the third world. I didn't mean to imply that I necessarily agree or disagree with that part of hseih's contention. I wanted to point out that even if it is true, the other part of the contention, that therefore, it would be wise to send our borderline patients there, is still impractical at best and inhumane at worst. I hope that makes sense.

[mercyteapot]

Originally Posted by hsieh

i thought this thread was dedicated to alternate ways of treating borderline personality disorder? i guess my views are shaped by where i work. we get the worst of the worst. we are a waiting room for the state hospital. the state hospital is no picnic. in fact you might say the state hospital is like a made up third world except they are locked up and not free.

It is a discussion thread. We are discussing your proposed alternative treatment, even though you haven't yet actually told us what the ''treatment'' would be. Yesyes, we understand you want to ship em all off to Africa, but what would happen once there? Just because we are disagreeing with what you propose doesn't mean we aren't following TOS or the rules you seem to feel you have the right to impose. No one is debating you personally- everytime I've responded to your posts, I've addressed your points. Apparently, what needs to happen for you to feel like we're following your rules is that we all agree with you and ignore the laundry list of reasons why your alternative should never and will never be accepted by the psychiatric community.

[rn/writer]

I posted a message asking for clarification. I haven't yet stated an opinion of my own because I want to be certain that I have (or don't have) an understanding of the ideas on the table.

What I was meant was that even rnwriter was right about what hseih is saying, her summation went only so far as to account for hseih's contention that borderline doesn't exist in the third world.

I don't know if I am right. That's what I'm trying to find out. Even if that summation is correct, it doesn't state that borderline doesn't exist in third world countries. Only that it might not be as noticeable and that there may be no reason and no means to give a formal diagnosis when there really aren't many treatment options available. I don't know if this is what hsieh was saying and that's part of what I'm trying to clarify.

i thought this thread was dedicated to alternate ways of treating borderline personality disorder?

Once I have a better feel for the thoughts that have already been expressed, I'll be happy to discuss pros and cons. And alternatives to present care, which does NOT have a very good track record.

hsieh, just out of curiosity, are you male or female? I don't have a bias either way. It would just make referring to things that you said a bit easier.

It would be interesting to see if we could put our heads together and look at the essence of what motivates borderline patients toward healthier choices, even if we didn't go so far as to replicate the actual circumstances. Is it fear, structure, urgency, immediate consequences, or something else? Are there practical ways to bring these principles into operation in a therapeutic milieu?

Finally, in the previous thread, hsieh expressed dismay at the way psych staff members often refer to borderline patients negatively and engage in put-downs and derogatory talk about them. I believe this is the result of having to deal with a population that presents with an extremely challenging profile WITHOUT having effective methods to handle them. Frustration builds and it sometimes does result in making the patient (and not the illness) the enemy. This is especially likely in cases where the borderline patient appears to be happy while everyone else is ready to tear their hair out. Awfully difficult to remember, at such times, that the patient may feel very different behind the scenes.

By the time we see them in an inpatient setting, they have often used up family and friends and are begging for some kind of safe boundaries. Unfortunately, we are quite limited in setting those boundaries, even though doing so would benefit everyone.

This is not an easily discussed or changed topic. I hope we can keep going because there are questions that need to be asked and answers that need to be sought, for the sake of all involved.

[hsieh]

i think it was the last thread i did i talked about how a psychiatrist said about a revolving door boderline at the hosp "this is one of those patients you want to euathanize". somebody said well he was just venting. have you ever heard an oncologist say about a revolving door chemo therapy patient - this is one of those patients you want to euthanize? i doubt it. the fact that he would make such a statement shows that he thinks of this particular kind of patient in a bad way. and does anybody else have alternate ways to treat borderline patients. and to mercyteapot - once they're in africa or the amazon then they will live like the people there do.

[andreadrea]

Well to answer the original question, Dialectical Behavior Therapy can be effective with borderlines. Marsha Linehan wrote 2 books: Cognitive Behavior Therapy for Borderline Personality Disorder and Skills Training Manual for Borderline Personality Disorder. They are EXCELLENT. I'm looking into training so that I could do skills training groups at my hospital. Although the books emphasize that the best way to treat it is not in the hospital, but in intensive therapy/skills training outpatient. The books also give a great view into the mind of a borderline, and have a great deal of empathy for the very real pain these people are in. I highly recommend them for someone who is interested in learning more about treating borderline patients.

[rn/writer]

Originally Posted by hsieh[B

]i think it was the last thread i did i talked about how a psychiatrist said about a revolving door boderline at the hosp "this is one of those patients you want to euathanize". somebody said well he was just venting. have you ever heard an oncologist say about a revolving door chemo therapy patient - this is one of those patients you want to euthanize? i doubt it.[/b] the fact that he would make such a statement shows that he thinks of this particular kind of patient in a bad way. and does anybody else have alternate ways to treat borderline patients. and to mercyteapot - once they're in africa or the amazon then they will live like the people there do.

Chemo patients don't usually present with the relentless behavioral challenges that borderline patients do.

Borderline patients are one of the most frustrating populations on earth to deal with. Because they are often intelligent, their behavior SEEMS to be willful. And because their disorder is so entrenched and our methods for dealing with them are often so ineffective, the grim prognosis adds to the frustration. That doesn't make negative attitudes right, but it certainly does make them understandable.

Any meaningful discussion about alternative treatment has to acknowledge the intense frustration now present on the part of many caregivers. It may be that this extreme discouragement is exactly the proof needed to say that current treatment is not working for most borderline patients. In order to make real progress, both the caregivers and the care recipients need new ways of looking at old problems.

Hsieh, I would really appreciate your response to my earlier post asking for clarification. That would be Post #29. Thank you.

[hsieh]

to rnwriter post #29 - yes that is exactly what i'm saying. and as far as making nasty comments about patients - cancer is very difficult to treat and sometimes not curable - but even though cancer is difficult you still don't make nasty comments about people with cancer. that's because you know it's not their fault. when a practitioner makes nasty comments about a diseased person that means the practitioner holds that patient responsible for their disorder. we had one sad pt who was sent to state who had cut both arms so much they were nothing but 99% red cut marks on her arms. somehow she also got razor blades on the unit and swollowed them. i can't help but think what would happen to this person if she were dropped in a third world country where nobody would have the time or money to pay attention to her. how is it inhumane to put somebody in an enviroment where they get better? a place where people have to put all their energy into keeping themselves and their kids alive. and don't have any energy left over to take care of somebody who says they want to die.wouldn't we ALL be changed by going into such an enviroment?