regarding borderline patients

EricJRN, MSN, RN · Jun 16, 2006

So if we took borderline personality disorder out of the DSM, then these patients' families would stop calling 911, bringing them to the ER, or showing up in psychiatric offices?

hsieh · Jun 16, 2006

if you put a "borderline" on an airplane and dropped them in say - sudan - where there are no psychiatrists, no mental hospitals, no psych meds, and no laws stating that if you kill or harmself you can be "locked up", and there's no 911 to call - how are you going to be "borderline"? i might add - psychiatrists make a lot of money off "borderline". 'borderline" is like a business we have created. in fact i have a friend from malawi (can't spell) who worked at the psych hosp with me and said in her country if you say you want to kill yourself they give you a rope and say do it. the african employees at the psych hosp do not understand why our country has these "borderline". i might add when dealing with patients you need to take responsibility for they way you feel. if you are frustrated with a "borderline" that is your choice to feel that way.

Gompers, BSN, RN · Jun 16, 2006

Just wondering if you've ever met somebody with Borderline personality disorder. Or, better yet, had someone who is Borderline in your life, as a friend or family member? It's not a made-up thing. These people are very disturbed. They are still Borderline, whether they're in the USA or alone on a desert island somewhere.

Trauma Columnist · Jun 16, 2006

I guess I would question why I was working in psych if I didn't believe in the diagnoses. It would be like me working in the ER and not believing that drunks need medical care.

hsieh · Jun 16, 2006

yes i have taken care of many "borderline" patients. here's my point. you can't be alcoholic if there's no alcohol. you can't be addicted to nicotine if there's no cigarettes around, you can't get skin caner if you spend you life living in the arctic. you can't be in a plane crash if you don't fly on planes. you can't be "borderline" if there are no psychiatrists, no psych hosp, no laws making it illeagal to kill or harm yourself. when i look at a "borderline" i think i'm sorry you were born into an enviroment that enables your behavior which causes you so much pain. and i'm nice to all my patients. i have seen psych nurses treat "borderline" patients badley. and they get away with it because we live in a system which has no respect for "borerline". they are dismissed as "drama queens/kings" by many psych staff. my whole point of this discussion was don't blame the "borderline" blame the system that invents and enables it.

Editorial Team / Admin · Jun 16, 2006

Your logic is slighty skewered there.

If you do not awknowledge the dz, then it doesn't exist?

**canoehead, BSN, RN** · Jun 16, 2006

I get it, but I think the patients would still be borderline, they just wouldn't be a pain in my butt.

If someone says "I'm going to cut myself" and I tell them that's their choice, and have no liability or guilt afterwards when they do it...well that works for me for obvious reasons, and doesn't give them a return on the cutting that they are used to. If someone threatens suicide, but they know that if they do it no one will come running to their rescue, it would change the way and the number of attempts.

I think that if there was less rescuing there would be more injury and death (which makes it unethical to change the curent system) but it would certainly separate the wheat from the chaff as to who seriously wanted to die, and who had an actual compulsion to cut, as opposed to the attention seekers.

Trauma Columnist · Jun 16, 2006

I guess if we carry this logic further than if we completely do away with any and all psych care and meds, the survival of the fittest would prevail. Perhaps thats what the nurse in Malawi was saying. In a third world country, the scant medical dollar goes for treating the most basic of needs - food and water. So...of course their approach to inpatient psych care is going to be completely different from ours in the US.

VickyRN, MSN, DNP, RN · Jun 16, 2006

The way I look at it - Maslow's hierarchy at work in those countries. Most people in impoverished countries are just trying to survive from day to day and psychological issues are relegated to the back burner - often not considered nor addressed.

Meerkat · Jun 16, 2006

I kinda agree with Eric. Except I submit that Borderline is a judgemental, and money making dx. Is there anyone alive who hasn't had characteristics of borderline in their life? Can anyone claim to have never gone out of their way at some time for attention? In fact, 'personality disorders' on a whole seem very judgemental.

Gompers, BSN, RN · Jun 16, 2006

yes i have taken care of many "borderline" patients. here's my point. you can't be alcoholic if there's no alcohol. you can't be addicted to nicotine if there's no cigarettes around, you can't get skin caner if you spend you life living in the arctic. you can't be in a plane crash if you don't fly on planes. you can't be "borderline" if there are no psychiatrists, no psych hosp, no laws making it illeagal to kill or harm yourself. when i look at a "borderline" i think i'm sorry you were born into an enviroment that enables your behavior which causes you so much pain. and i'm nice to all my patients. i have seen psych nurses treat "borderline" patients badley. and they get away with it because we live in a system which has no respect for "borerline". they are dismissed as "drama queens/kings" by many psych staff. my whole point of this discussion was don't blame the "borderline" blame the system that invents and enables it.

You're getting awfully close to: If a tree falls in the forest, does it make a sound?

I also asked if you've ever had someone who is Borderline in your life. NOT as a patient, but as a friend or family member? The "system" has nothing to do with the fact that these people have a very serious, very REAL psychological problem.