regarding borderline patients

[hsieh]

i read on the forums nurses resentments toward "borderline" patients. look at it like this. our country enables "borderline" behavior. if you scream suicide or self harm yourself we have built hospitals and paid health care prof to take care of them. we also have laws that say if you cry suicide or self harm we can "lock" you up. we also have laws if you cry suicide or self harm and a health prof doesn't "take care" of you you can sue them. i know many people from africa. they don't have "borderline personalty" disorders there. so next time you get "resentfull" of a "borderline" patient remember if we didn't live in a country that makes laws saying you have to "take care" of these people, or build hosp to house them, or pay health prof to take care of them, then we would not have this prob. so it's not the patient to blame but the "system". basically our "system" has invented "borderline" patients.

[Gompers, BSN, RN]

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.

There is a lot more to Borderline personality disorder than just wanting attention. The skewed mindset of these people, the manipulation of others, the self mutilation, etc. There is a lot more to this disorder than just crying out for attention!

[caroladybelle, BSN, RN]

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.

Actually your analogies are quite incorrect. Many in the artic do indeed get skin cancer, as they are exposed to a great deal of reflected light, and the facial exposure is intense.

If you driving along below, and airplane crashes, hitting you, -you are still in a plane crash.

People who dip snuff or chew tobacco, are addicted to nicotine, despite not smoking cigerettes. So are those that are on the patch.

Borderlines will be out there whether they are called borderlines or not. And if they are not presenting as a borderline, they will present as an OD, a suicide attempt, homicide attempt, as an abuse victim, as a victim of a car accident (or perpetrator), and in many of these cases they will leave more "victims" in their path than if they had been treated as merely borderline.

[hsieh]

to caroladybell - the things you described in your last paragraph - they will leave more victims if they aren't treated borderline. are you saying borderline means a bad person? if that's the case why not just call them a bad person and don't make up some dx like "borderline". what's a bad person? somebody who breaks the laws? somebody who's mean to others? i guess i don't like the fact that i work in a specialty that can be unkind to some of it's patients. schizophrenia is a brain disease so i don't know why it is handled by mental health. the point is if you're going to have a dx of "borderline" then treat it like it's a real disease and not just "a pain in the butt" as one member wrote earlier. it's demeaning to everybody when you make a dx like "borderline" then you treat these people like they're bad or a pain in the butt.

[Lisa CCU RN, RN]

Personality disorders are real! I've been dealing with one for nine years--I just didn't know it. You can't tell me that they aren't a pain in the butt because they are. I just wish there was a cure for them.

[chris_at_lucas_RN, RN]

.... 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....

Wrong, wrong, wrong, wrong, wrong, wrong, wrong.

Ever hear of a "dry drunk?" That would be an alcoholic without alcohol (and no program, either).

Ever see someone going nuts looking for a cigarette? They don't have the cigarettes around, but they are most definitely addicted.

Persons with personality disorders get that way to avoid pain, early on, intensely. They don't have a choice about it, because it develops when they are too young to manage what they have to manage, any other way. The "disorder" aspect is because it doesn't work, even if they think it does.

They are miserable most of the time, and very lonely.

Yes they can irk the socks off you, but the difference (supposedly) between you and them is that you understand their internal dynamic and know how to help them make some changes and develop some insight and begin to trust enough to work out what they have to work out.

If you aren't doing that, you aren't doing psychiatric nursing, you are there for a shift and filling out paperwork while diverting your patients away from you and any help they might get.

I certainly hope you a) develop some empathy and b) learn something about psychiatric nursing.

While you are at it, look up lack of empathy and see which personality disorders that's a characteristic of.

Persons with personality disorders aren't "bad people," either. They may do things that are bad, but basically, there isn't much difference between them and us "normals," except that they experience more chaos, more fear, less satisfaction and less joy. Can't imagine anyone needing more help than people with personality disorders.

Have you considered med surg? Or ambulatory care?

'Nuff said, hopefully.

[RENAISSANCE RN]

I think the poster doesn't take in to account that even before psychiatrists existed, mental illness existed.. Look at King Henry the 8th... killing his wives, ( how wacko is that). So yes, he wasnt labeled, but nuts he was. Suicide was committed before the time of Jesus until now. NO mental hospitals, but the same acts committed.

The ICD9 codes and the axis labels have a lot to do with health insurance and treatment procedures. Psychiatry and mental help isn't perfect but it is all we have for now.

[Gompers, BSN, RN]

the point is if you're going to have a dx of "borderline" then treat it like it's a real disease and not just "a pain in the butt" as one member wrote earlier.

The problem is that personality disorders are very hard to treat. Many do not respond to medication because they are not a problem with brain chemistry, like say depression or schizophrenia. The other problem is that trying to treat someonen with a personality disorder is challenging because many of these indivuduals don't agree that they have a problem. The only treatment is usually pschotherapy, and that is not successful unless the patient participates with the therapist. This is at least for Borderline personality disorder, maybe it's not the same as the others...

[chris_at_lucas_RN, RN]

IMHO, the OP doesn't express or demonstrate an understanding of how to treat people, period, much less those with a mental disorder.

Personality disorders are disrupted relationships with oneself and with others. Part of the problem is an inability to take responsibility, so why get treatment if the problem is everyone else? It takes years, and like all the light bulb jokes, the patient has to want to change. That in itself is a huge success in treatment, because it represents acknowledgement of one's part in the system of dysfunction in one's life. This does not happen in acute care. It happens in therapists' offices and community mental centers over a period of years.

Yes, mental illness has existed for as long as human beings have. Historically people with mental illness have been seen as evil, possessed, ill by choice, hopeless, unhelpable, and a pain. Diagnoses are a short hand way of communicating specific recognized patterns of symptoms, not identifying people. So just referring to "borderlines" as such is a big part of the problem. Doing away with the diagnostic term does not eliminate the illness. (How stupid would that be?)

These people really are ill, they really do deserve help, and if there is a third party payor and a provider of services who are willing to get together and do something about it, why on earth would anyone, much less a nurse, advocate that that not happen? And let me tell you from personal professional experience, very, very few are making very much money from the treatment of the mentally ill, including persons with personality disorders.

Again, IMHO, the OP is pretty clueless about how human beings' personalities work, how human beings interact in health and in dysease (and no I didn't make a typo or a misspelling), and how one appropriately functions as a helper of people with these kinds of dysfunctions. He or she needs to do something else, where they won't be pouring kerosene onto the internal fires of miserable people.

First do no harm.

[hsieh]

to chris lucus rn - i do have empathy for my patients. the reason i started this thread was i was reading other thread where people were putting down borderlines. i have also seen at work co workers putting down boderline. if you don't have empathy for all psych patients you should get out of the specialty. instead of writting thread about how much one hates about taking care of borderline i'm saying don't blame them blame the system. maybe a more fitting "label" for this group of people is "child abuse syndrome" because basically that is what it is. i think a "label" makes all the difference. borderline congures up negative definitions. where as if somebody is labeled "child abuse syndrome" care takers are going to react to them better. but enviroment does enable some behavior. in africa where they don't have this disorder a lot of the people suffer all kinds of abuse but they don't develope borderline because their enviroment doesn't enable it. and i might add my boss who has been in mental health for over 20 years has told me from the begining - you are not going to change these people (that means all pt not just borderline).

[LydiaNN]

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.

I believe that your reasoning is fallacious. A diagnosis- any diagnosis- is based on accepted clinical criteria, not the area of the world in which a person is located. So while there may not be treatment widely available in certain parts of the world, there can (and I'm sure are) people with this, and many other, disorders. Also, I hardly think it is professional or ethical to be looking to hospitals that supposedly hand people a rope and encourage suicide as anything to which to aspire. If that does happen, then shame on them, not ''hey, let's do that here!''

[hsieh]

hey i'm not trying to be an evil person. go to the search tab and type in borderline personality disorder. then read the threads. you will find many of them have bad opioions of borderline. so i started this thread to say hey don't have bad feelings about the borderline, blame the system. or better yet take responsibility for your feelings and recognize it's your choice to feel this way.

[chris_at_lucas_RN, RN]

to chris lucus rn - i do have empathy for my patients. the reason i started this thread was i was reading other thread where people were putting down borderlines. i have also seen at work co workers putting down boderline. if you don't have empathy for all psych patients you should get out of the specialty. instead of writting thread about how much one hates about taking care of borderline i'm saying don't blame them blame the system. maybe a more fitting "label" for this group of people is "child abuse syndrome" because basically that is what it is. i think a "label" makes all the difference. borderline congures up negative definitions. where as if somebody is labeled "child abuse syndrome" care takers are going to react to them better. but enviroment does enable some behavior. in africa where they don't have this disorder a lot of the people suffer all kinds of abuse but they don't develope borderline because their enviroment doesn't enable it. and i might add my boss who has been in mental health for over 20 years has told me from the begining - you are not going to change these people (that means all pt not just borderline).

There is no relationship between child abuse and personality disorder, so I don't really know where you are getting that. Child abusers do not usually have personality disorders, and those abused do not usually grow up to have personality disorders.

Have you read your earlier posts? You will see that what you are writing here and what you wrote there (unless you have edited in the meantime, and I obviously would not be able to respond to that at this point) do not mesh very well.

Well good for your boss who has been in mental health for 20 years. So have I. And I don't think anyone ever changes anyone else. But I do think that caring, intelligent, educated, experienced people help others to make their lives better (uh, change) all the time. ALL the time.

So no, you aren't going to make them better. One wonders what you were doing that your boss felt the need to tell you that, and then if your present attitude and your persistence in referring to individuals by their diagnostic terms is the result of some resentment because they wouldn't change for you? We all go through this, it is a part of development into an effective helper, if the right combo of caring and insight and desire are present.

When I read your last post, it sounded to me like there was a little projection going on. Read up on narcissism. You may find it illuminating. It is a fascinating pattern of behaviors (which includes thoughts) and emotions.

Referencing "don't blame them, blame the system." I have never seen blame do anything productive. And "the system" such as it is, is a huge, huge benefit to many.

Referencing Africa and mental illness, they have some of their own unique stuff in other cultures. Why? Because it is about interactions with others, which is about culture, and theirs is very different from ours. Do you know that in Africa, children are molested by adult heterosexual males so often that they are thought (usually with cause) to be unsafe with their own fathers?

I'm not sure where you are getting your info, maybe from personal opinion, but I'd encourage you to do a little googling, maybe meet some people from Africa, and learn a little about the culture. You cannot compare care of the mentally ill, EXCEPT where it is a biochemical issue such as schizophrenia or bipolar disorder, between two cultures, and even with those, because of the manifestations in interaction with the community, and therefore the influence of culture, it is apples and oranges.