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.

[hsieh]

my boss told me that in the job interview. so have you gone to the search tab and typed in borderline personality disorder and read the other threads? if you don't like what i say you're definetly not going to like what you read in them. no i'm not narsisistic. what disorder involves name calling? and none of my african friends have said anything about fathers molesting their kids.

[LydiaNN]

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.

No one is saying that the threads to which you keep referring don't exist. I haven't read them because I'm not interested in reading them, but I do realize that all nurses are subject to venting when they feel frustrated, and few patients can frustrate a nurse as much as a patient with BPD.

[chris_at_lucas_RN, RN]

my boss told me that in the job interview. so have you gone to the search tab and typed in borderline personality disorder and read the other threads? if you don't like what i say you're definetly not going to like what you read in them. no i'm not narsisistic. what disorder involves name calling? and none of my african friends have said anything about fathers molesting their kids.

I'm sorry, did you take that as name calling? I certainly didn't mean it that way, I merely observed a behavior and linked it to a term that relates to a pattern in which that behavior is a major point.

As for your African friends, well, I do not know them. I know several Africans, and it doesn't come up in conversation very often, so I guess I cannot say I did a personal survey, but then I didn't say that, did I? No. I did learn about it from some fellow nurses, who happen to be from Africa, who were explaining some of the reasons African children of any means are usually sent away to boarding school, plus I did some research online and found out that yes, that is an African cultural issue and a clash with western culture as well.

I would guess that your African friends may not spend a lot of time talking about the belief prevalent among African males that if you have AIDS and you have sex with a virgin, it will cure your AIDS. But it is true, and it is responsible for the illness and deaths of many innocents who are raped, some at a very tender age.

But since you haven't heard of it? I'm off this thread now. I don't really need to read the others, I guess I could, but I don't think it's necessary. That wouldn't be my reason for posting anyway. Just because there are a lot of threads and a lot of opinions expressed doesn't make anything so. And why would I want to be upset by what someone else was written?

I only responded to this thread because it was in today's list of current posts, and I thought I might address the topic from the position of experienced psychiatric nurse and licensed therapist, because a huge and wonderful part of this board (and similar ones) is teaching and learning, but hey, everyone is entitled to their own opinion. It's just nicer if we recognize the difference between opinion and fact, like the difference between folklore or old wives' tales and science or prevailing professional opinion, and it's also nicer if we accept other people's posts even if they differ from our own.

Good luck in your endeavors, nursing and otherwise.

C Ya!

[chris_at_lucas_RN, RN]

hsieh, I went back and read your original post, since you referenced it, because I thought I had missed something.

No, I read it right.

You may be "on the same side" as the rest of us, but there may be some communication issue. So much is lost with the typed word rather than face to face spoken communication.

That aside, your posts, mostly the first, but the others too, seem replete with logic that does not follow, opinion purported to be fact, and a position of blame (whether the system or individuals) that may tend to make people want to get in there and argue with you.

That said, may I encourage any who read this who have not made this observation: this board is a wonderful, wonderful place to receive support, get answers to questions, learn stuff, vent, and probably some other activities that I can't bring to mind at the moment. However, neither it nor its posts and threads should never be taken as an authority on anything. Ever.

Rather than doing a search of the posts on this board and reading, for example, about borderline personality, why not use google or ask.com or a similar search engine and read posts which are written by professionals. (Note, watch out for those posts that have a lot of misspellings and poor grammar in them: they are usually written by lay people who, however well intentioned, are less than dependable authorities about the topic in question.) I do believe we can all agree that we want to make things better, and we want to do it the right way. No sense in attempting to reinvent the wheel when others are out there, making it work, with proven methods.

Now I'm outta here (and cutting off notification)....

Have a good day, all!

[LydiaNN]

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.

Do the people that hired you to care for borderline patients know of your... uh, let's be polite and say unconventional... viewpoint as regards this diagnosis? I can't imagine why one with your outlook would choose psych nursing. I don't ''blame'' anyone for the manifestations of mental illness, although I understand the inclination to vent at the resultant inherent caregiving frustrations.

[canoehead, BSN, RN]

Wow, it seems like the OP is getting slammed. He/she just floated an idea and asked what you thought. I think making inferences about his/her nursing skills might be premature.

[LydiaNN]

Inferences about nursing skills? Who drew those? The problem with asking people what they think is that they're going to tell you.

[hsieh]

yes my co horts think the same if not worse. like i said i was not trying to be evil and put people down i'm just saying i see hear a lot negative about borderline why not think of it differently so it is not so negative? i work in a non profit for the state (but not run by the state) mental health system so maybe i have seen the worse case senario. sorry if i offended anybody.

[NurseCard, ADN]

OP, I've been sitting here trying very very hard to wrap my brain around what it is you are trying to say.

You are basically saying that the illness, Borderline Personality Disorder (FORGET for one second what the *name* of the illness is, just focus on what it IS) exists solely because our culture allows it to. You are saying that we, as a culture, are feeding into these patients' illness and making it worse?

I... actually kind of understand your logic, but I think that whether or NOT there is a defined illness called Borderline Personality Disorder... in fact, let's pretend for a minute that the illness doesn't even exist. Never was "invented".

..... there is STILL something terribly wrong with persons who have been given this diagnosis... and they have to be treated! People who behave in the way that borderlines behave... they wouldn't DO the things that they do if they didn't have terrible problems.. if they weren't unhappy... if they didn't suffer from extremely poor relationships with others... they wouldn't even DO things like cut themselves, try to kill themselves for attention, manipulate others. You know?

Saying that, ignore the suicide attempt and ignore the skin cutting and boom! No such thing as Borderline Personality Disorder!!

Is like saying, ignore the sweating and ignore the confusion and ignore the excessive hunger and BOOM! No such thing as hypoglycemia!

Am I making any sense? The behaviors that borderlines engage in... their are symptomatic of bigger, underlying problems that are making these poor people miserable, and making their loved ones miserable. You have to treat the *REASON* why they are doing these things!!!!

[hsieh]

in our country we would laugh at the thought of people praying to an ostrich in order to get rain which is what one african tribe does. they truely believe this works. in malawi and kenya (just 2 places where my african friends at work are from) they laugh at the fact that there are people who cry suicide and cut on themselves and people react (with hospitalization etc). so what do you say to that?

[LydiaNN]

in our country we would laugh at the thought of people praying to an ostrich in order to get rain which is what one african tribe does. they truely believe this works. in malawi and kenya (just 2 places where my african friends at work are from) they laugh at the fact that there are people who cry suicide and cut on themselves and people react (with hospitalization etc). so what do you say to that?

I say that one has nothing to do with the other and there is no valid way to compare the two propositions. I also say that in this country, we aren't about to look to the practices of which you speak as being those to which we aspire as concerns treating patients who need our help.

[Thunderwolf, MSN, RN]

Oh, what an excellent thread. The Wolfie can't resist to respond.

Personality disorders DO exist. In this, I have no doubt. For 10 years, I had worked inpt and outpt psych...as a licensed counselor and as a psych CNS. In my little warped sense of humor, God sprinkles the Earth, from his Cosmic salt shaker, all the Personality Disorders to keep life on Earth interesting. Borderline is no exception. These folks do exist. In the US, they may be dx'd more because the dx has...let's say...a more established acceptance and relevance to our culture....where other countries, it may not. I hear folks' arguments here back and forth, but it comes down to the cultural acceptance of the label/dx. Regardless of country or culture, the PD still exists....one country is more accepting and one is not; culturally it fits in one, in the other, it has little relevance...but, the diagnostic pattern/criteria still exists nevertheless. Personality disorders, in my belief, are developmental disorders of personality. The stressor has to do with relationships, and how that person sees him/herself in relation to self and to others. So, in saying that, the energy has both an internal and external source of onset. Treatment needs to connect the two together (improving self knowledge) and learning new and better ways to adapt as a person in order to get their needs met. Responsibility, as a term, is often used as my structure of approach. Responsibilty equates to "Response" and "Ability". When in reference to interacting humans, it is to get our basic needs met in a satisfactory way AS we relate to others. So, the direction of progress is often measured by me as "how have you met your basic need for _______ in a satisfactory way for yourself in relation to __(add person's name)_." Many folks...no problem. Folks with PD, a major problem...for quite often they become stuck in an established pattern of behavior which either thwarts getting the need met satisfactory and/or impacts their relationships with others as they are trying to meet those same needs. Maslow's hierarchy is often a good place to start. I see a member placed it here on the thread. Very appropriate. So, as a clinician, each PD has its "certain" dysfunctional pattern....hence the different diagnoses. Each are dysfunctional, each get in the way of getting the basic needs met, and each disrupt relationships around them. We all have personalities...it is what we are come to be known by. One's personality is how we perceive and respond to one's concept of self, one's concept of others, and one's concept of the world. Healthy personalities are able to adjust with change and adapt to stress. PD personalities are not flexible, more rigid, and attempt to force or blame other's and the world for their mishap and life frustration (unable to self adjust and adapt)...failing to see for themselves that the cause of grief is often found within. The direction of treatment is to help the PD to turn their vision back towards him/herself or pattern and why life is so frustrating. The direction is also to begin learning Responsibility once again without guilt assigned or shame. Most folks with PD fail or relapse in their progress because their patterns are so entrenched. A clinician helps them to understand it, even to predict dysfunctional outcomes without blame/guilt, in order to enlighten the person just how predictable their pattern is. Before change can happen, Awareness has to be present...first step. Much of the work with PDs is spent there. The second step, is coming to Acceptance of their pattern (the pattern stinks, makes me miserable, and not only do I see it and not like it but I also wish to to be happier...I just don't know how). A lot of time is spent on the second step as well...because denial and motivation often wax and wane. The third step is Action. "So, you know it in your head and accept it in your heart that you have been making yourself very unhappy, especially when getting your basic needs met through others...let's examine your pattern again and make some changes. Let's actually start DOING a few things differently which is unlike your pattern and see what happens from there"...is a good starting point. So, in understanding and treating PDs, a clinician needs to understand the patterns objectively in order to help the client to do so as well. Objectivity is key in PD work. Folks with PD are challenging to work with because quite often they do not see their own patterns clearly. As a clinician, you are in a unique position to assist them in this. Most folks with PD tend to mellow out with age...many well into their 40's and 50's....with Histrionic PD sort of being the exception where they tend to have a more difficult time as they age. Again, an interesting thread. Lot's of debate...this topic always does. The key thing is to be respectful in how we relate to each other as we debate it. All points of view are valid if respectful and contribute to the discussion. Again, good topic.