alternate ways of treating borderline personality disorder

hsieh · Jun 28, 2006

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 · Jun 28, 2006

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 · Jun 29, 2006

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, BSN, RN · Jun 29, 2006

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, BSN, RN · Jun 29, 2006

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 · Jun 29, 2006

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, BSN, RN · Jun 29, 2006

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, RN · Jun 29, 2006

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.

rn/writer, RN · Jun 29, 2006

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.

Instead of pointing fingers at co-workers and complaining about how we waste money on other things, why don't you come up with some ideas?

You work with this population. Surely you have some thoughts on what might help them. You've outlined what shouldn't be done. Now go the extra mile and tell us what kinds of approaches you and others have been successful with.

I don't think this thread has run out of steam. I do wonder what you had hoped to accomplish with it. This far, no one else thinks shipping bpd patients to a third world country has much promise. Do you have any suggestions that might work within your facility? What have you learned about bpd patients that would help the rest of us in our approach?

It's easy to rip on unsatisfactory situations. It's much more of a challenge to propose something new and different that might make a difference.

Please share with us one positive thing that you have learned in dealing with the borderline population.

hsieh · Jun 29, 2006

like i said millions spent unsuccessfully on complicated treatments. let's say you have to catch a bus and you arrive at the bus station 5 minutes late and miss it. you learn that tommorrow you must get there early in order to catch it. or as dr. phil mcgraw said - if we can't figure this out in 2 days one of us is a fool. "borderline" are surrounded by people who enable them. if everybody and eveything (like mental health system) just dropped them then they would learn new ways. well if that's inhumane thinking than is not sending all your extra income that you use on vacations ect to starving people inhumane? remember at the end of the movie schindler's list he was upset because he thought if he sold his watch he could have saved another life.

rn/writer, RN · Jun 29, 2006

like i said millions spent unsuccessfully on complicated treatments. let's say you have to catch a bus and you arrive at the bus station 5 minutes late and miss it. you learn that tommorrow you must get there early in order to catch it. or as dr. phil mcgraw said - if we can't figure this out in 2 days one of us is a fool. "borderline" are surrounded by people who enable them. if everybody and eveything (like mental health system) just dropped them then they would learn new ways. well if that's inhumane thinking than is not sending all your extra income that you use on vacations ect to starving people inhumane? remember at the end of the movie schindler's list he was upset because he thought if he sold his watch he could have saved another life.

You know, I'm a big fan of Dr. Phil. I like the way he "cuts through the crap," so to speak. But he doesn't oversimplify complicated problems. Often, he will provide long-term therapy for someone who has deeply entrenched illness. The "figuring out" phase might take only a couple of days, but the "turning things around" phase is rarely that quick.

As for learning to come to the bus stop five minutes earlier, a bpd patient could very well decide to hitchhike and end up sleeping with the driver. Or beg a relative to lend them some money to buy a car. Or just stay home and lose the job.

If I understand what you're saying, borderline patients stay borderline because the people around them enable them. They should be sent to a primitive society where the culture shock, the poverty, and the urgency of their new situation with make them sink or swim.

Barring that, we should all "just say no" to their craziness and that will make them "snap out of it."

I don't get the connection between spending money on vacations and "dropping" borderlines, but that's okay.

I want to say with all kindness and compassion that I don't see even a basic understanding of borderline personality disorder in these suggestions. These people do not choose to be this way. We do not choose to have them act the way they do. Enabling can compound the problems but it doesn't create them. Not enabling may help motivate a bpd patient to get help, but in and of itself, the "just say no" philosophy does not cure what's wrong.

It is ironic to me that you were very hard on your co-workers' behavior--their insensitivity and labeling--and yet the only ideas you have come up with (ship them to Africa, just drop them and they'll learn new ways) seem more punitive than constructive. It's as if you are advocating an odd form of shock therapy that you expect to jolt them out of their illness. Your suggestions are akin to taking a two- or three-year-old child and abandoning her on an inner city street. She might somehow get by scrounging in garbage cans and begging for handouts, but she is much more likely to be exploited, further damaged, and terrified by this kind of betrayal.

Again, it saddens me to say that I don't believe you understand this disorder at all.

hsieh · Jun 29, 2006

i understand that millions are spent on it unsuccessfully. where i work the things that have been said in this thread are not taught. we are taught they are self centered, ect. one of my co workers was talking how a bpd was wanting attention for cutting on herself. the patient reported this and my boss told my co worker - you NEVER tell a bpd they're trying to get attention because they will do anything to prove you wrong. this statement tells me that bpd are nothing more than people who live to play games. you can't cure people like that. just like you can't cure people who like heavy metal music. wasting millions of dollars trying to cure them is ridiculous. my ideas are aimed at the point of the prob - go to an enviroment where you can't play games and maybe you'll learn you can live without playing games. this isn't an illness - it's a lifestyle. a lifestyle of playing games. and as for talking about the money - people were saying it's inhumane or not empathetic - if donald trump has gold furniture does that mean he's inhumane or not empahtetic becasue there are people starving to death and he buys gold furniture instead of feeding them? don't call people inhumane or empathetic when people starve to death and others drive suvs and live in large air conditioned houses.