#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:

#4 – 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.