[DidiRN]

I didn't say anything about "locking them up"...in fact, I mentioned that they might be too non-compliant to go through with it, which means that I was not suggesting they were being forced into it. They could leave at any time.
Was just wondering if a controlled environment with staff particularly geared to treating this type of patient for a lengthy period of time might be helpful or not.

Originally Posted by hsieh

the goal of mental health is to keep people in the least restrictive enviroment possible. i would think locking up borderline would delay it's development even more. the best treatment is life itself not being locked up. another thing i just thought of is vidio tape people with their permission and have them watch it. then a professional can exam the video with the patient and explain how they are coping.

[EricJRN]

Originally Posted by DidiRN

Was just wondering if a controlled environment with staff particularly geared to treating this type of patient for a lengthy period of time might be helpful or not.

I like the thought of that. Specialty units exist for other mental health problems (such as eating disorders) and medical issues, so why not?

The only problem I see with videotaping/critiquing: Since people with borderline personality disorder can be particularly sensitive to criticism, would that be likely to place distance/friction between therapist and client? I know that limits have to be set, but I think reviewing videotapes might be carrying it a little too far.

[hsieh]

one of our state hosp actually has a unit for borderline only. as for borderline being sensitive about watching video of themselves the therapist can start off by saying with your disorder you may react by being over sensitive so we can deal with that along the way. and to meryteapot - there's nothing restrictive about going to africa to get better. when somebody goes off to college in another place are they being restricted?

[StuPer]

hsieh,
I seriously have to wonder about your ability to compare like with like, and then draw very poor comparisons as a result. You cannot draw any parallels between someone going to college and someone with a psychiatric illness being dumped in a 3rd world country, that to be frank is just mindboggling.
I'm aware that this post is not particularily constructive, but I am coming to the conclusion that a reasoned and well thought out debate is not going to happen, as I result I dont think I can add anything further to this thread.
regards StuPer

[hsieh]

i guess this thread has run out of steam. and our country spends millions to unsucessfully treat "borderline" every year. but i guess we have money to waste otherwise we wouldn't.

[multicollinearity]

Originally Posted by hsieh

i guess this thread has run out of steam. and our country spends millions to unsucessfully treat "borderline" every year. but i guess we have money to waste otherwise we wouldn't.

I remember from another thread you were asking if anyone has worked in Africa. You posted that you would like to go be a nurse there. I'm trying to understand how/why you think being sent to Africa would help a borderline, and what it is about Africa that draws your focus. What is it specifically about Africa? You didn't mention El Salvador or Indonesia for example.

[multicollinearity]

Originally Posted by hsieh

i guess this thread has run out of steam. and our country spends millions to unsucessfully treat "borderline" every year. but i guess we have money to waste otherwise we wouldn't.

I agree that treatment for borderlines is frustrating. Even if the ONLY success is preventing suicide because of hospitalization, isn't that an epic success? Even when the borderline patient is discharged and goes back to the usual chaos-making? They are alive, and the behavior and patterns does tend to burn out as the patient ages. I guess what I am getting at is we would all hope that treatment could accomplish more than keeping the patient alive - but if that's all it does - it's still a success. Do you agree that it is a success to prevent suicide?

[hsieh]

i have friends from africa and they impress me. the african friends i have that work at the psych hosp who all say they don't have these type of disorders in their country come from big citites and are educated - they aren't from 3rd world countries. "borderlines" don't kill themselves they treaten to kill themselves or try in such a fashion that they will be saved - for example in front of somebody or tell somebody who knows how to call 911. if you truely want to kill yourself you will do it you won't threaten it.

[multicollinearity]

Originally Posted by hsieh

i have friends from africa and they impress me. the african friends i have that work at the psych hosp who all say they don't have these type of disorders in their country come from big citites and are educated - they aren't from 3rd world countries. "borderlines" don't kill themselves they treaten to kill themselves or try in such a fashion that they will be saved - for example in front of somebody or tell somebody who knows how to call 911. if you truely want to kill yourself you will do it you won't threaten it.

I don't think the disorder is recognised in Africa. Also approximately 10% of borderline patients do commit suicide. I agree that much of the threats are for attention - but that alone shows great psychological pathology which needs attention. It's not quite that simple.

[rn/writer]

One of the major stumbling blocks in treating bpd patients is that they often do not think there is anything wrong with them. They think plenty is wrong with their family members and friends and employers and landlords and . . . well, you get the idea.

Sometimes, when they come in for help, it is at the "behest" of the people in their lives who have had it up to here and back with the irresponsibility and life-sucking neediness that pbd patients so often manifest. Occasionally, they are court ordered. Rarely do they come in on their own until their lives are in such a shambles that they see hospitalization as an opportunity to hide out and regroup.

Another obstacle is that there is no quick fix for bpd. Meds might help with mood, sleep stability, and co-morbidities (such as substance abuse) but the only "cure" for a developmental problem is good empirical treatment over time.

Just like there is an "autistic spectrum," I believe there is also a spectrum that fits bpd. At the far extreme is Radical Attachment Disorder or rad.

We come into the world unattached. We learn to attach emotionally when there is safety, consistency, and love. Kids with rad grow up to be what we know as sociopaths, completely devoid of conscience and empathy.

Borderline patients seem to be milder versions of this. Not completely lacking in empathy but much more able to feel their own pain than someone else's. They do develop attachments, but they do it indiscriminately at times and far too easily. In fact, some seem destined to walk around, umbilical cord in hand, look for a new person to plug into.

Because bpd patients have a hard time accepting that there is something unhealthy about their behavior, it seems that initial treatment would have to focus on any area where they are unhappy. As long as their problem behavior is looked at as an obstacle to their getting what they want out of life, if may be interesting enough and non-threatening enough to motivate them to want to change some of their strategies.

It also makes sense to bring in family members and friends, anyone who can provide a support structure, and educate them about the "toddler" they are dealing with. We could help them learn how frightening the world is to a bpd person and show them how behavior that previously looked only selfish and inconsiderate is really consistent with the way an immature child would handle things. Sometimes, the most important thing that we can do for these patients is to stop being so angry with them.

If we could help the patient's support people get past their own emotions, they might be able to learn some more effective ways of helping the patient take better care of themselves. Think what might happen if a patient saw people letting go of their frustration and providing a little bit of safety. The support person might be able to invite the patient to tell them how they feel about something instead of just watching them run headlong into yet another crazy-making impulsive relationship or financial wreck.

Over time, support people and therapists might be able to connect at greater levels and nurture and motivate the "toddler" into maturing to a higher functioning level. As the inner fear gradually dissipates trust will take its place. As anger is replaced with respect, boundaries will develop.

None of this would be easy, nor would it happen very quickly. But dedicated staff and family working together could actually help bpd patients grow up, incremental bit by incremental bit.

The mechanics of this are certainly open to discussion. But it has to beat the "stabilze 'em and boot 'em out the door" practice that takes place now.