Monthly Archives: March 2014

#14 – How Risk-Taking Promotes Recovery from BPD

Reflecting on the last 10 years, several key decisions accelerated my recovery from Borderline Personality Disorder. In these moments, I took risks that moved me further along the road to becoming well.

At the time, these actions did not stand out as turning points. Today, their importance is obvious.

Below is a scene from the movie The Dark Knight Rises that illustrates this type of decision. Bruce Wayne has been imprisoned in a pit-like prison from which escape seems impossible. The jump to freedom is too far. Bruce Wayne fails on his first attempt to escape, but he eventually triumphs:

Short 1-minute version – http://www.youtube.com/watch?v=7BNW2By7ppo

Longer 3-minute version – http://www.youtube.com/watch?v=sdQFRf-KqNw

It’s notable that Bruce Wayne has to feel anger about his horrible situation before he can make the leap. The feelings of doubt, uncertainty, hope and determination which we can imagine in Bruce Wayne as he looks across the gap are feelings I often had before making the decisions below.

The dark, hopeless conditions of the prison are an apt metaphor for the unfulfilling, frustrating life in which many borderlines are trapped after a traumatizing, neglect-filled childhood. Continuing the metaphor for BPD, the open world that Bruce Wayne sees after leaving the prison could represent mature adulthood and all its possibilities for fulfillment (although in the movie, Bruce Wayne’s story is very different, and he was never a borderline!).

I had to take risks – the metaphorical leap out of the prison – over and over again in order to escape into the open world. Not all of my ideas worked; there were many failures and frustrations that are not mentioned below. But here are some of my ideas that did work:

Age 17 (2003) – Asking My Mom for Help

As an awkward, overweight high school junior, I became increasingly depressed and thought seriously about committing suicide. My parents’ relationship was falling apart, I had no real friends at school, and I hated myself. Other kids were dating and talking about colleges, concepts that felt alien and threatening for me. I desperately wanted to tell someone how I felt, but could not trust anyone. I remember listening to songs like Green Day’s “Boulevard of Broken Dreams” and feeling the songs were about me.  I felt totally alone through my sophomore and junior year of high school, not allowing myself to turn to anyone for help.

I decided I had to do something. Since my mother had not overtly abused me and had provided some support, she was the only person I dared open up to. But it was too difficult to go to her directly. So instead, I emailed her. That email read something like, “Mom, I am not feeling well. I feel really depressed and need help. Can we talk about this? Maybe there is someone I could see that could help me.” To my surprise, my mother came immediately and told me how concerned she was. She was healthier and stronger than I had realized. I was so emotionally weak that I could barely respond. But to know that someone cared was a great relief.

A week later, my mother took me to see a psychiatrist. Although he was a poor therapist who knew nothing about BPD, it was a relief to have done something to help myself. It made me feel less hopeless. And it set a precedent for everything that would come later. Interestingly, at this age, I had never even heard of Borderline Personality Disorder.

Key Point – If you have BPD and feel desperate and hopeless, look in your surrounding environment for others who might be understanding and supportive. Your splitting will likely cause you to doubt whether they really care. Once you identify a person or group that might help, fight past your fear and take the risk of asking them for help. In most cases, you have nothing to lose by asking.

Age 17-20 (2003-2006) – Making a New Trusted Friend

Toward the end of high school, I met an older man in our neighborhood, Gareth, who took an interest in me. We shared a common interest, tennis, and would meet at the local courts to play. At first, because of my great expertise at hiding my emotions, Gareth had no idea how hopeless I felt. Nevertheless, I often struggled to avoid breaking down and crying on the tennis court.

My vulnerable child-self identified Gareth as a potential helper. There ensued a great internal battle – should I or should I not make myself vulnerable and ask for help from someone outside the family? Should I risk rejection? Not asking for help felt safer.

I vividly remember the moments leading up to my opening up to Gareth for the first time. We were sitting in a steamroom at the local health club. The other people walked out, leaving us alone. After about 30 seconds of painful deliberation, I forced myself to haltingly tell Gareth how my father had physically abused me. I told him how school was a terrible struggle, how I felt depressed and suicidal most of the time.

Gareth responded very kindly. He empathized with how difficult and unfair everything was. He got me to tell him as much as I was comfortable about my family. Over the following months, he became a regular confidant. He went out of his way to be available to talk via phone, email and in person. For the next few years, I cried many times with him and worked through grief and anger surrounding my father’s abuse. He taught me that men could be trustworthy and safe, unlike my father.

My and Gareth’s relationship did not always flow easily. At times, I became provocative, manipulative, and withdrawn. A couple of times, Gareth became so frustrated by this behavior that we briefly cut off contact. However, each time we reconnected and made up, because each of us cared about the other.

Key Point – True friends are an invaluable support for anyone, but especially for those working to recover from BPD. Letting someone really get to know you can make a critical difference in recovering from BPD. Even if you don’t think you know how to form a real friendship, risk opening up to an acquaintance whom you think might be supportive.

Begin with telling them how you really feel, even if what you feel is terrible! Being honest with someone else about your negative feelings, while difficult, can be a freeing experience if they respond supportively. It can be the start of a long-term relationship that is transformative. In my experience, most people really do want to help – often more than we realize.

Age 18 (2004) – Beginning to Research BPD

In 2004, I read about Borderline Personality Disorder on the internet. It terrified me. I “knew” that I was borderline. I found online forums where family members of supposed borderlines complained about how difficult, manipulative, provocative, unchanging, frustrating, and wicked borderlines were.

When I first read about BPD, I had a visceral physical reaction where a lead-like despair overtook me. I felt sure that I had BPD, and that my chances of recovering were low to nonexistent. The pessimism of many writers who talked about BPD being life-long, severe, genetic, and untreatable greatly influenced me.  I was so distracted by the fear that I had difficulty walking around school, listening in classes, or having coherent conversations.

But part of me wanted to fight the idea that borderlines couldn’t recover. I felt a fierce desire not just to survive, but to live. I searched on Amazon for books about treatment of BPD. At first, I ordered popular books like Walking on Eggshells and I Hate You, Don’t Leave Me. Since they weren’t addressed to sufferers, these books did little to help, and I interpreted them pessimistically.

Then I found Jeffrey Seinfeld’s The Bad Object. From it I gained a weapon to use in the battle against the negative thoughts. For the first time, I saw a writer clearly describe several borderline patients with similar abusive histories to mine. They recovered – fully, in several cases. They had the kind of good life that I desperately wanted.

I particularly benefited from Seinfeld’s “Four-phase” description of BPD. It fit me perfectly. I understood myself, at age 18, to be somewhere between the Out-of-Contact and Ambivalent Symbiotic phases. Seinfeld’s writing gave me a roadmap, making the origin of my problems clear. More information on his writing is here:

https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

The key point here is that I did my own research. If I accepted the status quo expressed by many writers 10 years ago – that BPD is a valid medical diagnosis that cannot be cured – then I would not be where I am today. These early readings were only the first among dozens of books on BPD and other personality disorders that I read.

Key Point – Education matters. Do not unquestioningly accept what any one person tells you about BPD, including me. No authority has all the answers on the disorder. Cultivate a healthy skepticism. Do your own research, think critically about what you learn, compare different viewpoints, and come to your own opinion about what is right. Trust yourself. How you define BPD and how you view the recovery process will evolve over time. There is no exact right way to think about BPD or recovery.

Early 20s – Confronting My Fears About BPD

Throughout my early 20s, I feared that BPD was a hopeless, incurable condition. I kept finding sources that espoused pessimistic, gloomy views of BPD sufferers. Their view of borderlines as people trapped in painful, inevitable destructive cycles from which they could not recover seemed cruel and terrifying. I had also read books like Seinfeld’s that asserted the opposite, i.e. that BPD, while challenging, but very treatable and even curable. But I could not trust the positive view or reconcile it with the negative. And what you don’t trust cannot reassure you.

I worked hard to overcome my fear about BPD with my therapist, who was positive about BPD, but could not fully trust her either. The authoritative-sounding writers of the pessimistic books continued to haunt me. I needed a way to more strongly refute them, to understand why these writers (falsely) thought that BPD could not be “cured”, and to convince myself that BPD could be fully recovered from.

Many things helped me to eventually believe that I could become well. One of the most important was my “systematic investigation” of BPD’s treatability. I decided to cold-call some of the most renowned therapists in the United States. I asked them their view of the “bad” writers, the ones whose views scared me Many of these therapists did not answer, but some did.

Among others, I spoke on the phone to Gerald Adler (author of Borderline Psychopathology and Its Treatment), Lawrence Hedges (author of Working the Organizing Experience), and James Masterson (author of Treatment of the Borderline Adult). Within the psychodynamic-psychoanalytic community in the United States, these are three of the “big guns” of writing about BPD and personality disorders in general. Their books are all on Amazon.com . Adler’s book on borderlines is even available for free download on http://www.freepsychotherapybooks.org

Between 2007-2009, I met Adler, Hedges, and Masterson in person, traveling to meet them in Boston, Los Angeles, and New York respectively. I told them how afraid I was about BPD being a hopeless, incurable disorder. Each of them described multiple borderlines they had treated who made great progress and in some cases recovered fully.

Adler, Hedges and Masterson also analyzed the “bad” writers, i.e. those writers whose pessimistic views about BPD scared me. They explained that these writers were inexperienced and/or poorly trained therapists whose personal failure at treating BPD had become rationalized into the mistaken view that the diagnosis had a poor prognosis.

They also described how the field of psychotherapy had become fragmented into different “schools”, and how many therapists were unaware of more effective models for how to treat BPD. They made it clear that the disorder presented serious challenges to therapists as well as patients, so it was not surprising that poorly trained, inexperienced therapists often failed to help borderlines. But they said that with good training, many therapists had had great success at treating BPD.

These three writers all encouraged me to continue treatment with my own therapist and to be optimistic about recovery. Hearing their optimism about the disorder in person made a big impact on me. They were very kind.

In retrospect, I over-idealized Masterson, Adler, and Hedges, seeing them as perfect, infallible authorities. But this all-good splitting served a useful purpose, as it allowed my fear about BPD to be gradually conquered by the belief that recovery from BPD was truly possible.

In the technical way I understand it based on object relations, I subjected the “all-bad” aspect of my anxiety-producing views of BPD to real-world analysis in a way that weakened my identification/attachment to those all-negative views. This allowed me to “correct” or make “less bad” those all-negative views, which in turn led me to stop splitting so severely. As I took in more positive ideas about BPD, I could eventually integrate the negative views with these new, more positive views. More information about object-relations and splitting is here:

https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/

Although I’m not a Christian, my great relief at the loss of the old fears about BPD caused me to think of this image from the famous novel, Pilgrim’s Progress:

pilgrimsprogress

Key Point – Anxiety is almost always related to specific environmental causes or lack of support. Whatever progress you want to make in your life, identify the fears that are holding you back. Brainstorm creative ideas in which you can challenge your preconceived beliefs and fears. Execute them. Do not be afraid to be take risks and be rejected.

Our fears are often like the ghosts in Super Mario Games. When you run away from them, they seem scarier. When you face them, they stop chasing you. Here’s a funny example:

http://www.youtube.com/watch?v=yqY7uFGroTo

Early 20s – Going to 12-Step Groups

At college, I began to overeat to cope with my depression, gaining 40-50 pounds. I mostly isolated myself from other students, having difficulty attending class regularly. As the twin problems of overeating and isolation intersected and reinforced each other, I realized that I needed something to address both of them.

I researched online and found something called 12 Step Groups. The vulnerable, dependent part of me quickly realized that 12 step groups might be helpful. But my antidependent side, being identified with my abusive father, feared that I would be rejected and disliked. I eventually fought past this fear and forced myself to attend a meeting of Overeaters Anonymous.

I walked into a small group filled with men aged from about 35-65. I was 20 years old. The first meeting intimidated me. But at the end, an elderly man came over and made a point of welcoming me. He told me how hopeful it was that I came to get help at a young age with my whole life ahead of me. This idea had never occurred to me. Over the next few years, I made many friends in 12-step groups, benefitting greatly from the fraternal, warm, encouraging nature of the group. I also disagreed with some aspects of the program, which eventually caused me to leave. But overall, it helped. Here is more about my 12-step experience:

https://bpdtransformation.wordpress.com/2014/01/11/addiction-recovery-12-step-groups-and-bpd/

Key Point – Look for support groups, whether 12-step, group therapy, Meetup.com groups, or other networks that might help you. Especially if you are socially isolated, these groups can be a great way to safely learn how to trust and be intimate with other people. Such groups are usually free or very low-cost.

Mid-20s (2008-2009) – Leaving a Therapist Who Wasn’t Working

By my early-to-mid 20s, I had made significant progress, getting a regular job and developing some meaningful friendships. I still got depressed and had problems with splitting, handling anger, and maintaining my self-esteem. Since I had found my first regular job, my mother required me to start paying for my own therapy.

Once that happened, I suddenly “discovered” that my therapist of three years, with whom I had been making quite good progress, was charging me for sessions while I was on vacation or if I couldn’t attend the regular time. My therapist had a rigid policy that patients had to pay for the same weekly time 50 weeks out of the year. There were no early cancellations. I thought this was outrageous, and I confronted her. She agreed to change the policy for me only. However, I lost my trust in her, feeling that she was not treating her other patients fairly and that she mainly cared about money.

I tried very hard to come to trust this therapist again, but it didn’t work. So I made the difficult decision to seek someone new. It made my life really unstable for a while, because the loss of the old therapist created a void, and who knew if I would find a good replacement. I searched extensively for a new therapist who had successful experience treating borderline patients, using the criteria described here:

https://bpdtransformation.wordpress.com/2013/12/15/what-to-do-if-you-are-diagnosed-with-bpd/

Eventually, I found someone who proved to be a great fit. Shifting therapists involved a lot of research and some discomfort in the short term, but it had great value in the long-term.

Key Point – If a given relationship or work situation is not working, be open to making radical changes which give you a better chance of feeling good about the situation. That may mean ending a frustrating relationship or job, seeking a new one, or fundamentally changing how you deal with a person or situation. Don’t be afraid to experiment and to take calculated risks –the idea of taking a leap of faith is again important.

Mid-to-late 20s (2010-2014) – Dating and Getting My Own Place

Over the last few years, my independent functioning and relationships continued to improve. While I felt better, my problems did not all suddenly vanish. Instead, I confronted new challenges. Two of the most important were dating and moving out from living with my parents. I will discuss each of these topics briefly.

Many healthy, non-borderline men have anxiety about asking out attractive women. This was certainly the case for me, even after my self-esteem improved a lot and I was no longer borderline. Drawing on my earlier risk-taking experience, I forced myself to ask women out and go on dates.

In my early 20s, I had been so shy that I had barely dated, and had thought that women found me unattractive. But the real issue was my lack of confidence.Once I talked to more women and starting asking them out, I found there was no shortage of women willing to date a decent looking, athletic, friendly guy with his own job and house.

As for moving out from my parents, this is another phase that even healthy young adults can find challenging. In my early 20s, I became more and more frustrated at living at home with my mother. I was working and saving money, but didn’t like bringing friends to my mom’s house, or being on top of her all the time (although I do love my mom!).

Although it cost more to move out and rent, the potential benefit to my psychological wellbeing justified the added expense. I rented in two places, and finally bought my own house. Being a homeowner and having to manage my own place has only been a good thing!

Key Point: Challenging situations and the need to take risks do not suddenly disappear after we recover from Borderline Personality Disorder. Life is full of challenges, not in a bad way, but in an enlivening, interesting, meaningful way. To prevail through these challenges, it helps to stay open to the value of risk-taking and trying new things throughout life.

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I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or would like to more effectively help someone who is borderline, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes

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#13 – The Science of Lies: Psychiatry, Medication and BPD

Disclaimer: This article is not a recommendation for others to come off psychiatric medications. Any decisions about taking, continuing, or discontinuing psychiatric medications should be made in consultation with a medical professional. This article should not be construed in any way as professional advice – it is one person’s opinion and experience only.

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Seven years ago, I made a decision that would define my future. Against my psychiatrist’s advice, I began tapering off three different psychiatric medications. Within three months, I had stopped taking them entirely.

At age 21, I had already been taking multiple medications for four years. These included antidepressants, antipsychotics, mood stabilizers, and antianxiety pills. At different times, I took Lexapro, Effexor, Xanax, Wellbutrin, Prozac, Seroquel, Paxil, Zoloft, Depakote, Zyprexa and Lamictal. For brief periods, they made me feel less anxious and depressed. For the most part, they did nothing to reduce my overwhelming fear, rage, and hopelessness.

At this time, my core problems had barely begun to be addressed. These problems included being completely unable to trust others, having no identity or self-esteem, and never having had a secure dependent relationship with a parent figure. Nevertheless, my parents were spending thousands of dollars each year on psychiatric medications that barely influenced my symptoms.

Finally, I realized the futility of continuing to take the pills and acted accordingly. I stopped taking them with full awareness of the risks involved. Since I stopped seven years ago, life has only gotten better. I have not missed the medications for one day.

Tragic Borderlines on Web Forums

On forums for Borderline Personality Disorder that I frequent, individuals with BPD sometimes list their current diagnoses and medications beneath their username. Reading their posts is often saddening, since many of them are struggling with overwhelming life problems.

It is rarely apparent that the medications make a great difference to these individuals’ experience of themselves or others. They will sometimes ask for recommendations of medication that work better. There is often the sense that if they could just find the right medication, their situation would improve dramatically.

Many such borderlines appear to be trapped in a Kafkaesque nightmare. They are on many medications, but not in effective long-term therapy. They have been told that their diagnosis (BPD plus other “comorbid” conditions) involves biological and/or genetic factors that all but require them to take medication. The medications may slightly reduce their suffering, but at the cost of painful side effects and an inability to feel positive emotions.

They do not realize that they are missing the most basic ego functions, are using primitive defenses like splitting and projection, and that their terrible emotional struggles stem from a crucial lack of nurturance and support in childhood. Without awareness and insight, these borderlines keep repeating the same ineffective, self-destructive strategies. These strategies allow them to survive but keep them chained to BPD symptoms. Their borderline personality structure based on splitting endures, being immune to any effect from the medication.

Such borderlines usually accept what their psychiatrists tell them without questioning:
1) The scientific validity of mental health disorders and the DSM,
2) The validity of biological and genetic causes of “mental health disorders”,
3) The real long-term effectiveness of medications for these supposed disorders, and
4) The potential risks of long-term medication use.

Psychiatry: The Science of Lies

There are many well-researched books on the unscientific, fraudulent, and patient-damaging practices of psychiatry. Here are my recent favorites:

The Book of Woe – Gary Greenberg
Mad Science: Psychiatric Coercion, Diagnosis, and Drugs – Kirk, Cohen, and Gomory
Anatomy of an Epidemic – Robert Whitaker

In brief, these books assert that psychiatry is the biggest scam going. It manufactures fake diagnoses through the DSM, then creates medications with questionable efficacy and dangerous side effects to treat them (and yes, there are an incredible variety of real human emotional problems – just not in the pseudoscientific way that the DSM defines them).

(Psychiatric drugs can cause dangerous, irreversible side effects, including tardive dyskinesia. Tardive dyskinesia is an often incurable disorder characterized by chronic involuntary muscle spasms of the face and tongue. About 20-30% of long term users of antipsychotic drugs, which are sometimes prescribed for BPD, develop it.)

These books present studies showing that the majority of mental health patients, including those with depression and schizophrenia, do worse over the long term with medications. Yes that’s right – long-term medication use makes the average person with emotional problems less likely to recover. Patients who only take medication for short periods or don’t take it at all do best. I have no doubt that this also applies to Borderline Personality Disorder.

This does not mean that a borderline individual who has taken medication for years cannot recover. Good therapy and the support of family and friends can greatly outweigh the negative effects of years of medication use. I am an example of that.

My View on Medication and BPD

My opinion is that medication has very little use in the long-term recovery process for Borderline Personality Disorder. The extent of its usefulness involves management of extreme short-term symptoms such as overwhelming anxiety, depression, and suicidal thinking. For a period of a few weeks or months, medication can be effective in damping down these symptoms. It can make other interventions possible, and in some cases even save lives.

However, beyond a few months, the scales shift. Long-term medication use reinforces the myth that BPD is a biologically-caused condition from which the individual cannot fully recover. It dulls down and limits access to negative and positive feelings, both of which need to be worked through for recovery. And medication works against a feeling of agency and personal power, two qualities which borderlines are desperately lacking.

Why Is It Impossible For Medication To Cure Borderline Personality Disorder?

Let us assume that BPD is a reliable diagnostic entity, as ridiculous as that notion may be. Why shouldn’t we create a medication that can alter chemicals in the brain in the exact way necessary to cure BPD?

One problem is that our understanding of the brain is very primitive and poor. There are about 100 billion neurons, or nerve cells, in an average human brain. If they were stretched out end to end, they would span about 620 miles. One million of them would be about 33 feet end to end. These neurons are connected by about 100 trillion synapses, or specialized connections between cells. Therefore, neurons interact in trillions of subtle and complex ways with each other, exchanging chemical signals constantly in ways we understand only superficially.

Not only do neurons interact with each other, but they interact in a dynamic, unpredictable way with the external environment through the sensory organs and physical intake mechanisms of the body. Our 100 billion neurons are uniquely influenced trillions of times daily by internal and external factors trillions of times every day.

Obviously, the brain is incredibly complex, and we understand relatively little about its workings at a molecular level. What our psychiatric medications are good at is dulling down certain chemicals that we know to be genereally associated with emotion. Medications affect dopamine, serotonin, and norepinephrine in blunt ways that prevent a person from feeling their negative (and positive) emotions as strongly. That is why they may usefully reduce symptoms like depression, anxiety, and suicidal thinking.

However, medications do nothing to cure the causes of these symptoms. In BPD, the central problem is a massive predominance of negative past experience that is encoded in the brain through many thousands of memories of neglect, trauma, and/or unsatisfactory relationships. The dominance of negative memories and the relative lack of positive memories is crucial. This dynamic creates defenses like splitting, and generates all the borderline symptoms contained in the DSM.

Therefore, a borderline personality structure affects a person’s every waking moment, stretching back in time to their early childhood. The only escape is a long-term positive dependent relationship with a new person or group in the present.

Since medications cannot replace bad memories with good memories, they are hopeless at curing BPD. Curing BPD via medication would require some kind of ultra-advanced nanotech treatment that would rewrite a person’s entire personality. It would erase their old identity and encode new positive “memories” to suddenly give them all the ego capacities that come with a healthy childhood. It would trick them into believing they were a totally new and different person.

Unfortunately, such a magic bullet is not on the horizon.

The other problem is, of course, that Borderline Personality Disorder does not exist in a medical sense. It is a fictitious, non-scientific “non-diagnosis”. It is ironic that I mention the “disorder” so often in this blog, but don’t believe in its validity. In truth, there is no sharp dividing line between “borderline” and “normal”, nor can anyone reliably diagnose BPD. Human beings are so complex, the varieties of our problems so individual, that “disorders” like BPD simply cannot be scientifically applied, let alone “treated” via medication.

It does not make sense to even discuss how medication might cure BPD, given that BPD is not a unitary condition. As noted elsewhere, Borderline Personality Disorder finds better use as a metaphorical term, describing a spectrum or range of psychological difficulties, rather than as a medical diagnosis.

Why Do Psychiatrists Overprescribe?

Most psychiatrists working today in the United States have little training on how to do depth psychotherapy. They do not broadly understand emotional problems in terms of developmental experience. Rather, they are taught that mental health conditions are biologically based diseases needing to be medicated and managed, rather than understood and cured.

Why do psychiatrists prescribe so many pills to so many people, and increasingly to borderlines?

Reason #1 – Money

Underlying psychiatrists’ training is the profit motive. Psychiatrists – and the drug companies with which they are intertwined – have learned that seeing patients for “medication management” for 15-30 minutes at a time, one or twice a month, results in much more money than seeing the same patients for talk therapy 45-60 minutes at a time, multiple times a week. Psychiatrists often charge outrageous sums ($180-250 or more on average in my area) for these occasional, half hour or less sessions. They are making several hundred thousand dollars a year.

The move away from depth psychotherapy toward short-term treatment and heavy use of medication is therefore simple to understand. When hundreds of thousands of dollars per year are at stake, it is easy to convince oneself that psychiatric disorders really are valid, that psychiatric medication really is doing a lot of good, and that one is doing a service to society by promoting long-term medication use. Most psychiatrists are not bad people. However, many psychiatrists use defenses like denial, confirmation bias, and avoidance of contradictory information to maintain their belief that what they are doing is good for most people. It is amazing what people will deny when hundreds of thousands of dollars depend on it.

I am fully aware that there are good psychiatrists out there. There are psychiatrists who focus on therapy, on understanding the patient as a person, and on minimizing medication use. These practitioners are to be commended. The problem is, there are not enough of them.

Reason #2 – Simplicity

The other reason for psychiatric overprescription is that it’s easy. Working with a borderline patient in long-term psychotherapy, understanding their overwhelming pain, and helping their fragile inner self emerge is extremely challenging. It requires great patience and tolerance for managing negative emotion within the therapist.

Many less talented and committed mental health workers have unconsciously decided it’s easier to sedate difficult patients rather than understand them as complex individuals. How simple is it to give someone a pill and pretend that that is the best that can be done? Or to pretend that their problem is mainly genetic or biological, a simple matter of misfiring brain neurons, rather than a result of the individual’s unique personal history?

This situation is unfortunate, but it is incumbent upon borderlines to avoid these charlatans and find truly effective help.

Should Psychiatrists Be Blamed?

Should “bad” psychiatrists be blamed for overprescribing medication?

No.

Psychiatrists are able to overprescribe (meaning prescribe too many medications for too long) partly because consumers accept their practices. If we want the situation to be different, we need to look at ourselves and ask why we continue to buy their poisoned offerings. If more borderlines did what I did – stop taking endless medications, find ways to get effective therapy no matter the sacrifices involved, and reject the prevailing biological-determinist model of mental health disorders – then many more current borderlines would fully recover to become non-borderlines like me. None of this is easy, and in reality I am far more sympathetic than I sound in this paragraph.

In making these controversial points, I am fully aware that for a few mental health patients, long-term medication use is absolutely necessary. A few conditions like bipolar disorder have a proven biological component. However, that is not the case with Borderline Personality Disorder and many other so-called mental health “disorders.” As hard as drug companies are trying to increase their profits by to linking these conditions to genetic and biological causes – thereby legitimizing the prescription of more and more medication – they have so far abjectly failed. T

It is critical to understand the lack of any proven genetic basis for Borderline Personality Disorder, because that undermines a central argument of those who advocate medication. This topic is discussed in more detail in earlier articles on this blog including this one:

https://bpdtransformation.wordpress.com/2013/12/09/is-borderline-personality-disorder-caused-by-faulty-genes/

What Would a Good American Approach to BPD Look Like?

An effective approach to BPD in America would involve a massive increase in the number of therapists specially trained to treat BPD intensively via long-term therapy. It would include a massive decrease in the average cost of treatment, or the provision of greater subsidies, to allow the many poor and disadvantaged abused borderlines to fully participate in intensive treatment. It would also include a massive decrease in the number of psychiatrists treating BPD with medication, and an equally massive drop in long-term medication use (meaning medications used for more than a few weeks or months at a time).

Paradoxically, these changes would probably save our economy money in the long run. If good therapists treated more borderlines at lower cost using less medication, many more borderlines would recover. After several years of treatment, many former borderlines would become productive members of our economy for decades. They would generate much more money for employers, earn more money, and spend more money. The number of borderlines working part-time jobs in fields far beneath their capacity or interests would lessen. The number of borderlines not working at all, or on disability, would likewise decrease greatly, resulting in huge savings for our welfare system.

This scenario is a huge contrast to our current practices, which involves medicating borderlines (or not treating them at all) such that their symptoms remain muted but essentially the same. For these unfortunate people, their independent functioning and ability to contribute to the economy remains weak or nonexistent, and they are a continuing burden on the economy.

The positive scenario described above is extremely unlikely, due to the uniquely capitalistic and competitive ethos that characterizes American corporate culture, and due to the ease with which many people are tricked into believing its lies. Drug companies and psychiatrists have realized there is little profit in treating borderlines as complex people needing long-term psychotherapy and short-term medication. Instead, many psychiatrists, and almost all drug companies and their shareholders, are invested in prescribing as much medication as possible regardless of the damage done to the patient.

Borderlines as Collateral Damage

The current treatment of BPD means that many less borderlines are recovering than would be if psychotherapy were emphasized over pills. To drug companies and psychiatrists, these “non-recoveries” are essentially the collateral damage that is necessary as part of their profiteering operation.

In this way, the continued suffering of borderlines because of drug companies’ promotion of pills (relative to how much better borderlines could do under non-drug approaches) is loosely comparable to the environmental destruction wrought by industrial companies as they extract natural resources. Many oil, gas, timber, and mining companies have happily profited by damaging rivers, forests, and oceans in ways that only become apparent much later on. In their short-term worldview, it’s fine for others to bear long-term costs while they make off with short-term profit.

In a similar way, the CEOs and shareholders of drug companies are either unaware or unconcerned about how medications are hurting borderlines in the long run. The key thing for drug companies is that they are making money, not whether the patient is being cured. A carefully cultivated illusion of efficacy, built up around medication’s short-term symptom-dulling effects, supports the profit-making process. If the patient can be deceived into thinking their “disorder” is biological and into taking medication for a longer time at high cost, then so much the better.

In this view, borderlines and other mental health disordered patients are the “tragedy of the commons” of the psychiatric industry. They have to bear the costs of the long-term negative effects of overprescription and ineffectiveness of psychiatric drugs. Meanwhile, psychiatrists and drug companies are long gone with billions of dollars in profits.

Conclusion: Becoming An Educated Consumer

If you have been diagnosed with BPD or have a family member with BPD, do not let yourself become another victim of the psychiatric establishment. Educate yourself. Read books like the ones mentioned above by Greenberg, Whitaker, and Cohen which lay bare psychiatry’s lies. Read the emerging studies referenced in these books, which show that people taking long-term medications do less well on average than those who take them short-term. Question whether biological-genetic explanations of BPD are founded on solid scientific research. If you talk to your friends and neighbors about mental health disorders, discuss with them what you have learned about psychiatric drugs.

The only reason drug companies and psychiatrists continue to survive and profit is because we let them. If we stop buying their products in, they will mostly shrivel away, leaving a much smaller industry providing short-term, acute-need medication. The only weapon against these corporations is an educated consumer.

I am a mortal enemy of our present-day psychiatric industry, being focused as it is on the long-term prescription of medication alongside elaborate cover-ups of the long-term effects. I hope that people reading this article will open their eyes to the biggest ongoing scam in our society, that of American psychiatry. People that can see through their lies are an existential threat to the entire industry and the thousands of jobs that depend on it. I only hope that its house of cards will come tumbling down sooner rather than later.

#12 – Cracking the Borderline Code

In this post, I’ll explain the concept of Borderline Personality Disorder as an emotional programming language. While recovering, I developed emotional strength and insight which allowed me to consciously redirect destructive thought patterns. This formed part of a long-term plan by which I reversed the early course of the disorder.

Here I’ll explain how my plan worked, and provide some suggestions for current borderlines and their families to consider.

I’ll begin with the idea of BPD as a destructive code and the sufferer as a spy who must break and reprogram that code. While struggling to recover from BPD years ago, I often imagined myself in metaphorical roles. The most prominent was as spy or code-breaker.

Today, having more of a neurotic personality organization, I can mentally play with such roles without taking them seriously. However, when I was severely borderline, they felt real – I almost believed myself to be a real-life espionage agent or warrior, trying to outwit and defeat the sinister forces arrayed against me. My lack of a strong observing ego caused me to have difficulty distinguishing fantasy from reality.

Recently, memories ran through my mind about these difficult days. I remember the keenness of the desperation, how getting through each day presented a titanic struggle. I was deathly afraid of never “making it,” meaning not succeeding in work and relationships as an adult. And I did not know how I was ever going to fully trust another human being.

The Bourne Identity

I loved watching movies about characters who played soldiers or spies. Doing so gave me a powerful feeling of motivation, of being alive and active. One of my favorite spies was Jason Bourne. In the clip below, Matt Damon demonstrates the intensity and coolness under pressure which define Bourne. He uses expert planning and deception to outmaneuver the Central Intelligence Agency, which is attempting to kill a witness who knows too much:

http://www.youtube.com/watch?v=DUd5RPVDjPY

I related to this scene because I too felt persecuted and pursued by a heartless, inscrutable adversary. In my case, it was the past memories and present-day projections of my abusive father that haunted me. Since I did not know love as a child, I could not perceive the goodness in other people as an adult. I always expected people to ignore and abuse me like my father had done. For years, it did not dawn on me how unrealistic these (mis)perceptions were. Right before my eyes, people were far kinder than I could ever have imagined.

Fighting through the maze of persecutory misperceptions to reach human help was, for me, emotionally equivalent to the desperate escape from murderous persecutors shown in this Jason Bourne scene. For my college-age self that watched it years ago, Jason Bourne represented my evolved, adult-self, and the victim represented my vulnerable child-like self, which the adult self sought to protect from persecution. Today, I watch this clip with a tremendous sense of pathos toward my past self.

Jason Bourne also personified a determination, focus, and ruthlessness that I admired. Since I was entering the adult world without the necessary emotional equipment to navigate it, I felt that I had to be absolutely committed to finding help at all costs. There was an element of ruthlessness to my personality at that time, and I did use people.

Today, I am much kinder and gentler, but there is still a lingering dark aspect to my personality. When I occasionally feel threatened in some real-life situation, my “protector” side, the inner Jason Bourne, will come rushing back. But it doesn’t dominate my mind like before, since I now know that I’m re-experiencing the past in the present.

I always had some sense of the great challenge facing me after enduring repeated physical abuse and an unloving childhood home. It would take every bit of ingenuity, cunning, courage and endurance I possessed to create a good adult life. And that is why I identified so strongly with creative, fearless characters like Jason Bourne.

Taken

Bryan Mills, the father played by Liam Neeson who seeks to free his daughter from ruthless kidnappers in Taken, became another of my favorites.

I always identified with fearless, intimidating male protagonists who endeavored to save a weaker, vulnerable character from a heartless persecutor. This, of course, represented what I had been unable to do for myself in the face of my father’s abuse. It also signified my failure, at that time, to work through the feelings created by my father’s abuse or to forgive him. Here is an example of Liam Neeson playing the father-spy-protector in Taken:

http://www.youtube.com/watch?v=wcjY-VN8_l4

It may be disturbing, but my old self loved the confidence in Liam Neeson’s voice as he talked about tracking the criminal down. He exhibited such absolute certainty that he would punish the bad guys and recover his kidnapped daughter. It represented the strength and freedom to take action that I wished I had when my father abused me. Although I did have murderous thoughts toward my father sometimes, I never would have followed through with them as Liam Neeson’s character does in this movie.

How Splitting and Projective Identification Recreate Past Experience in the Present

My identifications with Matt Damon and Liam Neeson in their spy-soldier roles demonstrate important aspects about how splitting and projection in Borderline Personality Disorder.

In earlier essays, I discussed Fairbairn’s object-relations model, and four phases of BPD recovery derived from that model:

https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/

https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

The reader is referred to these essays for more detail on these topics, which will form the foundation of the current discussion.

In my life at the time, I was constantly reliving my past abusive experience in the present. I always feared that other people would reject or abuse me like my parents had, and so I could never feel safe or comfortable in relationships. Even after leaving the family home to go to college, I felt unsafe, alone, and threatened.

Intra-psychically, I was constantly projecting “all-bad” (negatively split) images onto other people. This occurred regardless of whether the people were nice or not-nice in reality. In fact, if they were kind, the all-bad splitting happened even more, because I was afraid of intimacy and therefore wanted to create distance. In this way, I unconsciously prevented myself from perceiving their actual kindness and good intentions. The strong observing ego that is writing this post was not there then, so I was truly emotionally blind to my own self-sabotage.

Therefore, I was “transforming” any new person (in my mind, as I saw it at the time) into uncaring, mean people like my parents. The defenses that did this were splitting – or viewing people unrealistically as all-bad, based on my internalized parents – and projection / projective identification – meaning putting these images onto new people in the outside world, and relating to them in provocative ways which made them respond negatively. These defenses serve to distort the external world and to confuse the emotional past and present.

My identification with Jason Bourne and Bryan Mills occurred in a roundabout way. In my own life, I was continually recreating threatening, all-negative scenarios with new people. For this self-perpetuated reason, I continued to feel alone, unsafe, and unloved. This gave rise to the need to save myself by finding someone to help me. Therefore, I identified with strong movie characters, like these spies, who personified the strong male savior that I wanted to be. If I had not been borderline, I would not have identified with them in the first place.

BPD Deconstructed

For me, the essence of Borderline Personality Disorder is that it involves, 1) An inversion of the normative developmental process, and 2) A constant, nightmarish reliving of the past in the present. What does this mean?

1)      An inversion of the normative developmental process: This means that the borderline individual pursues unsatisfying relationships and rejects satisfying ones. Borderlines are continually focused on, is sensitive toward, and addicted to bad, frustrating, persecutory interpersonal relationships. By contrast, they reject or are relatively unaware of loving, good, supportive relationships. This represents the “attachment to the internal bad object” that Fairbairn discussed, with the concomitant “rejection of the internal good object.”

2)      Reliving the past in the present – Most people diagnosed with BPD have severely traumatic histories filled with neglect, inattention, and abuse from inadequate parents. The borderline adult recreates this childhood experience in their present-day life. They do so by continuing to view the external world, no matter how different it really is in the present, as filled with mainly bad, frustrating, and persecutory people. And they do it by rejecting and remaining oblivious to those who try to help. In other words, the inversion of the normative developmental process, described above, represents a continuation and present-day reliving of past traumatic experience in the present day.

In my case, as a teenager and college-age boy, I constantly preoccupied myself with the ways in which other people ignored me, disliked me, thought I was weird, and/or directly rejected me. Emotionally, I kept reliving the feeling of being ignored and rejected that I felt at home. I repeat this point again because it is so important for understanding common borderline processes.

It is important to see that people in the outside world did not usually set out to treat me this way. Rather, I unconsciously looked for only the bad aspects of the outside world and rejected the good aspects.

In this way, I “created” what became my felt reality – that I was rejected and worthless, and other people were uncaring and mean. Healthier people would have experienced their peers at my high school and college very differently. But, since I had had very little loving, emotionally close experience growing up, I lacked “receptors” – or positive memories – which would have helped me to recognize good things when I saw them. In that sense, I was emotionally blind.

This is something I find that non-borderline individuals often misunderstand about BPD. They think the borderline’s lack of receptivity to positive gestures and their inability to trust is intentional. Hopefully, my experience demonstrates that the issue is far more complex. For the most part, borderlines would like to trust and take in more help, but they simply don’t know how to.

The Paranoid Position

This constant negative psychic activity – of clinging to bad perceptions and people and rejecting good ones – creates the emotional ground where the outside world seems dangerous and threatening. It generates the nine symptoms of Borderline Personality Disorder that are listed in the DSM, and it is the very heart of what perpetuates the disorder.

Technically termed the “paranoid-schizoid” position, this is the earliest period of emotional development in psychoanalytic theory. It describes the position of the young child’s ego or self when they have just come into the world. It represents the young child’s emotional position before they become able to trust outside people and to view them ambivalently as mixtures of good and bad.

Cracking the Code of BPD

In both Taken and the Bourne series of movies, the leading characters must penetrate an initially-mysterious and threatening network of criminals. Jason Bourne turns the tables on his pursuers and discovers the truth about his identity from a time before the CIA brainwashed him. Bryan Mills penetrates a shadowy network of criminals to recover his beloved daughter.

In both cases, I learned from the way in which the main character defeated their adversaries. Both Bourne and Mills already knew or learned everything they could about their enemies before turning the tables on them. In Machiavellian fashion, they did whatever was necessary to overcome the obstacles, without concern for anything outside themselves and their loved ones.

In my case, the past “enemy” was the emotional abuse from childhood that I internalized and kept re-inflicting on myself in the present. My present-day opponents were splitting, denial, projection, and projective identification. These defenses distorted the external world, and caused me to constantly repeat bad relationships while rejecting good people who wanted to help me.

How I Used My Understanding of BPD to Recover

My weapons were my intelligence and my unwavering motivation to improve. I realized that I would have to learn everything I could about Borderline Personality Disorder, understanding it in much greater depth beyond DSM descriptions.

In fact, the DSM-allied psychiatrists who said that BPD was untreatable (or treatable but not cure-able) became a new enemy. Their pessimistic, medicalized views, which advocated symptom management and medication, represented capitulation and defeat. I wanted to understand WHY borderline symptoms happened, and I wanted to recover fully and live a great life as a non-borderline. And that is why I taught myself the “code” of object-relations theory, which for me best explains why borderline symptoms occur.

Once I understood how my mind had been “hacked” by my past abuse, implanted with relational “code” that made me to endlessly repeat bad relationships, I realized that I could change the pattern. I needed to specifically address my inability to trust other people, and to devote time and energy to cultivating new positive relationships.

That process began with my therapists, who were able to confront the many ways in which I distorted them into “bad” people so as not to trust them. I am extremely grateful to my therapists for their help in confronting my projection and splitting. I learned from that process and continued the work of perceiving others more realistically with new friends and family members.

After several years, my positive images (memories) of myself and others became strong enough that I could fully trust other people and develop deeper, intimate relationships. As this happened, the borderline symptoms all gradually lessened and faded away. I developed the abilities to control previously destructive behaviors, to regulate my own feelings, to distinguish past from present, and to tolerate frustration. I came to feel alive, real, and happy most of the time.

Today, when I watch movies like Taken or the Bourne Supremacy, I no longer identify with the main characters personally. But, I wistfully remember how attached I was to them years ago.

Borderlines Starting in Recovery

Many recently diagnosed borderlines who share their story on web forums have, understandably, not yet come to deeply understand the genesis and causes of their problems. These borderlines and their families are the primary people that I hope will take something away from this site.

In my view, our society’s approach to Borderline Personality Disorder is shallow, symptom-focused, and often unreasonably pessimistic. How many therapists truly understand the causes of BPD in the ways I describe on this site? That may be a bit arrogant of me, but there are many poorly trained and incompetent therapists out there.

I recommend that sufferers and families do not simply trust one therapist or psychiatrist, but instead do their own research and reading about the disorder. Self-help, self-education, and self-therapy can make a huge difference. If I hadn’t taught myself about what BPD really is and what causes it, I would probably still be on three medications, not working full-time, not in good relationships, and not happy.

Looking Beneath Symptoms

The key point that I would like borderlines and their families to take away from this article is to look beneath symptoms. There is so much more to gain from looking at the object-relational causes and patterns that drive BPD symptoms.

Focusing on BPD symptoms alone, i.e. how to reduce or control them, can only be palliative. This means it will reduce symptoms but not treat the underlying causes. Medication used for years on end and superficial therapy focused on symptom management are examples of these approaches. It is because of unthinking treatments like these that many borderlines continue to suffer, year after year after year, with no real long-term improvement in their emotional wellbeing. It’s time for that to change.

If borderlines do not understand and take action to change their attachment to internal bad objects, then their self-abusive cycle, the pattern of recreating bad relationships and rejecting good ones, repeats endlessly.

A Dramatic Example of Repeated Self-Abuse

I recently watched a horror movie that illustrates this phenomenon, Triangle. Its trailer is here –

http://www.youtube.com/watch?v=SQk2NpfQm7k

In this movie, a woman gets stuck in a time-loop where she must survive a nightmarish situation on board a cruise liner. The nature of the time loop is such that her past self always confronts her present self and kills it just as it is about to break free. Her job is to realize, as the trailer states, “It’s starting over again, that’s what going on…. Everything that happens to you, happened to you before!” The solution is “to change the pattern… if we change the pattern, we’re not trapped!”

As the reader should see, this movie’s plot is reminiscent of the way in which borderlines can endlessly repeat negative pas experiences. It is only by understanding what one is doing to oneself, and by taking responsibility for change, that it can get better. Near the end of this movie, the woman gains insight into how she is contributing to her own repeating problem, and this leads to hope about changing the outcome.

An Optimistic View of BPD Recovery

I would like to repeat that I am very optimistic about full recovery from BPD being achievable, as stated in earlier articles on this site. To be more exact, it’s not whether or not BPD recovery is achievable. I know that it is. It’s that I’m optimistic that the resources needed to recover are reachable, and the work doable, for motivated people who are diagnosed with BPD.

 “Cracking” the borderline code is not impossibly difficult; but it takes a significant amount of time and work. I encourage those with BPD to look beyond shallow, limiting, symptom-focused descriptions of BPD. Instead, focus on learning how the disorder works in depth in order to break the destructive cycles that cause the symptoms. In this way, transformation and full recovery are real possibilities.

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I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or would like to more effectively help someone who is borderline, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes