Tag Archives: abuse healing

#19 – Hope, Meaning, and the Elimination of Borderline Personality Disorder

My goal for this blog has been to promote a new, more hopeful understanding of what is today called Borderline Personality Disorder. In writing this post – which will discuss hope for recovery from emotional trauma, but later argue that this hope might be better served by eliminating the diagnosis of BPD entirely – the following quote from Macchiavelli comes to mind:

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. For the reformer has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order; this lukewarmness arising partly from fear of their adversaries, and partly from the incredulity of mankind, who do not truly believe in anything new until they have actual experience of it.”
– Niccolo Macchiavelli (1469-1527), The Prince

For the purposes of BPD’s validity, this quote can be understood in terms of the “old order” of psychiatry – which profits both financially and via creating the illusion of scientific knowledge in psychiatrists – being opposed by those of us who argue as “reformers” that psychiatric diagnoses are invalid, unreliable and unhelpful. The reform position is that recovery from severe emotional trauma can be achieved without the need for psychiatric diagnosis. As the quote suggests, the idea that BPD does not exist as a valid diagnosis can initially be hard to believe.

Hope for Recovery, In All Its Forms

Today I’ll discuss what is among the most important topics for Borderline Personality Disorder: Hope. When a person is struggling with “borderline” symptoms – meaning intense difficulty managing their emotions and relationships, among other things – having realistic hope for improving one’s situation is critical. During difficult times, hope has felt as important for me as the oxygen a climber on Mount Everest carries for survival, or the fuel that a rocket returning from deep space uses, without which an astronaut would be doomed.

People may prefer to think of their hoped-for state as recovery, freedom, improvement, achieving goals, or something else; it is very individual. However their hope is defined, most BPD-diagnosed people express a strong desire to improve their situation.

Realistic hope

What makes hope realistic? I would suggest at least two things; 1) That hope is not taken for granted, and 2) That it is based upon convincing data.

#1, “Not taking hope for granted”, means realizing that improving one’s situation demands serious commitment and work, requires a willingness to confront oneself about difficult issues, and involves depending on other people for help.

#2, “Based upon convincing data”, means that realistic hope (for one’s desired outcome) must be based upon reliable and trusted information. To hold onto hope, a person needs a view of reality that is as accurate as possible in terms of representing the external world.

When I first searched for information about improving from BPD, a lot of what I found appeared pessimistic or even hopeless. Many publications said that the best outcome possible involved learning to better manage this painful lifelong “illness”, and some said that borderlines were untreatable or evil. Family members ranted about how difficult and unchanging their “borderlines” were. None of these things made me feel hopeful.

In earlier posts, stories and data were presented that, for me, provide realistic hope for recovery, healing, and achieving a “cure” of symptoms approximating what is described in the BPD diagnosis:

https://bpdtransformation.wordpress.com/2014/08/07/five-myths-about-bpd-debunked/

https://bpdtransformation.wordpress.com/2013/11/23/how-did-i-recover-from-borderline-personality-disorder/

The “Information War”

This data contrasted sharply with the earlier pessimistic, hopeless accounts about BPD I’d encountered. Sometimes it felt as though I was reading about two completely different conditions. For some time I fought an “information war” in my mind, trying to judge which of these conflicting versions of reality was right – or perhaps, whether both were correct, acting as self-fulfilling prophecies in different situations.  The increasingly numerous accounts I found of individuals with BPD diagnoses doing well, combined with my own life experience, eventually convinced me that realistic hope for getting better from what I then thought of as BPD did exist.

In my case, realistic hope meant that with sufficient support from family, friends, and my therapist, I had a very good chance of doing well, like many others who had encountered similar challenges before me. For other people, the hopeful narrative may be somewhat different; this makes sense given that we are unique individuals, and given my contention that BPD is an invalid, unscientific label which does not represent the same phenomenon from person to person.

Now, let us turn to look at some societal obstacles that impede realistic hope for BPD recovery.

The Failure of the American Mental Healthcare System

It can be useful to analyze the notion of realistic hope in the context of American psychiatry and its conceptualization of Borderline Personality Disorder. It is my position that psychiatry’s “medical model” approach to psychiatric diagnoses, its biological reductionism, its overemphasis on medication, and its oversimplification of an individual’s emotional struggles, all impede the spread of realistic hope regarding BPD (or more correctly, the hope for recovery from severe emotional trauma and/or the lack of healthy emotional development, in all its variations).

A Story: Emma

Let us discuss these ideas with a fictional example. Emma is a 21-year-old woman who grew up with an alcoholic, abusive father and an overstressed, emotionally neglectful mother. As a young girl, Emma was sexually molested several times by her father. Since finishing high school, Emma has lived at home with her mother, who works two jobs to provide for Emma and her younger sister. The father abandoned the family several years before, increasing the stress on the remaining family members.

Over the past three years, Emma has felt increasingly depressed and anxious most of the time. She is unsure how to make meaningful relationships with other young people. Never socially confident, Emma has become increasingly socially isolated as her old high school friends move out of town.  Due to her depressions, she cannot keep a regular job, and she goes through a series of short-term boyfriends who use her for sex and then abandon her, reminiscent of her father’s behavior. Unable to tolerate her increasing feelings of aloneness, and frustrated with her mother’s lack of understanding, she begins binge eating and purging, and also cuts herself when feeling particularly hopeless.

Finally, Emma overdoses on psychiatric medication in a desperate gesture that is really a call for help, leading her to be hospitalized for the first time. When evaluated by a doctor, she is seen as fearing abandonment by her mother, having an unstable self-image, practicing self-injurious behaviors, being unable to regulate her feelings, seeing others as all-good or all-bad, and so on. Obviously, she would be a prime candidate for receiving a BPD diagnosis according to traditional American psychiatry.

However, I want to focus on two possible ways that the hospital doctor could respond to Emma, and how these approaches might or might not promote realistic hope in Emma’s mind.

The Medical Model’s Diagnostic Approach

In the traditional psychiatric (medical model) approach, the treatment provider might communicate something like the following, “Emma, you’re suffering from a psychiatric illness called Borderline Personality Disorder. We don’t know what causes this condition, but it’s believed to result from a combination of genetic, biological, and environmental factors. BPD causes people to have problems regulating their emotions, and that is what is creating your symptoms like depression, anxiety, and rage. This is a tough condition to have – there’s no cure for it – but if you take medication and attend therapy, the symptoms can be managed.”

Usually, such an approach involves the doctor asking Emma what her symptoms are, but not going into detail about possible causes for these symptoms based on her personal history. Several emotional messages are conveyed by this approach. The first would be that there is something innately wrong with Emma. Emma would probably feel that she has a mental “disease”, that she is stuck with this illness for life, and that her prospects for finding personal fulfillment are poor.

The second message is that Emma’s past history and relationships are unimportant in relation to her “diagnosis”, or perhaps not related at all to her present problems. Rather than her current feelings and actions being understandable reactions to the deprivations she has experienced throughout life, she is told that a “disorder” is mysteriously causing her symptoms. Paradoxically, getting diagnosed with BPD does not give Emma any deep insight into why she is behaving or feeling the way that she is. The last, related message is that Emma is seen as a label, rather than as a person.

In my view, the ideas presented to Emma in the above example – i.e. “you have a psychiatric disorder called BPD, this mental illness is causing your symptoms, there is no cure for it” – are examples of outrageous lies coming from the pseudoscience that is psychiatry. In the posts below these distortions are expanded upon:

https://bpdtransformation.wordpress.com/2014/03/16/the-science-of-lies-psychiatry-medication-and-bpd/

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

https://bpdtransformation.wordpress.com/2014/01/16/a-unicorn-the-paradox-of-the-bpd-label/

In this last article – “A Unicorn: The Paradox of the BPD Label” – I originally wrote that BPD has value as a label allowing people to find help and support. My thinking here has changed, such that I would now strongly endorse only the second half of the article – i.e. starting with “Why I Do Not Believe in BPD.” As I’ve read more about how psychiatric diagnoses oversimplify people’s stories, fail to meaningfully address the causes of people’s problems, and lack scientific validity, I’ve become increasingly reluctant to attach value to the label “Borderline Personality Disorder”.

Formulation: An Alternative to Diagnosis

Returning back to Emma’s case, if labeling her with BPD is not helpful, how might she be understood instead?

The Formulation approach, which has been pioneered by mental health workers in the United Kingdom, would offer something like the following:

“Emma, you’re obviously in a lot of pain right now. From what you’ve told us, things have been incredibly hard over the past few years, and you’re not able to rely on your mother for emotional support. The way your father treated you has also had an incredibly powerful negative influence. Given your history, you must feel incredibly alone, and it’s no wonder that you feel hopeless, scared, and abandoned. Your behaviors of purging and cutting yourself make sense; after the trauma you’ve experienced, anyone might react this way to manage their overwhelming feelings.”

“Although it’s difficult, we feel that your situation is far from hopeless. But to feel better, you’re going to need help. You may benefit a lot with support from someone who can understand your story, assist you in managing your current feelings, and help you find practical ways to improve your current life. We have therapists who have successfully helped people with similar family histories to yours, and when you come to feel better and leave the hospital, we can refer you to an outpatient therapist who can continue to help you.”

Differences Between Diagnosis and Formulation

Obviously, this approach is starkly different from the traditional psychiatric approach. Firstly, Emma is not diagnosed with anything – the terms “Borderline Personality Disorder” or “BPD” are never mentioned. Rather, her symptoms are understood as perfectly logical reactions to the trauma she has experienced. In that way, Emma can start to make sense of what has been happening to her, and she will be less likely to feel crazy or defective. Emma’s past history and present circumstances are used to create a narrative explaining her present problems.

Secondly, a message of hope is strongly promoted, with the idea being that recovery is likely if Emma receives effective support. “Illness” and “disorder” are never mentioned as causes of her problems; therefore, Emma is not led to feel that there is something innately and irreparably wrong with her brain. Instead, Emma is told that her personal history matters, and that understanding how it relates to her presenting problems can help in managing her distress and improving her life.

Obviously, these approaches are poles apart, and might be considered black and white examples of how an actual mental health worker would deal with a patient such as Emma. Nevertheless, I have read about many people who are treated similarly to the first example, in which a psychiatrist diagnoses them with a mental “disorder”, while completely failing to understand the individual as someone with a history contributing to their problems. In my opinion, this traditional psychiatric approach is destructive to and precludes realistic hope.

Lucy Johnstone and Formulation

I must give much credit here to Lucy Johnstone, a British clinical psychologist whose writing on formulation inspired me. Here is an excerpt of her viewpoints on traditional psychiatry and the destructive effects of psychiatric diagnoses:

“Psychiatric diagnosis underpins the whole biomedically-based model of mental health. Any science needs to be able to demonstrate that it is based on a reliable and valid classification system, in order to develop testable hypotheses and hence the general laws that constitute a body of scientific knowledge. If this cannot be established, the whole model breaks down and all psychiatry’s other functions – indicating treatment, carrying out research and so on – will be fundamentally undermined.”

“ ‘Diagnosing’ someone with a devastating label such as ‘schizophrenia’ or ‘personality disorder’ is one of the most damaging things one human being can do to another. Re-defining someone’s reality for them is the most insidious and the most devastating form of power we can use. It may be done with the best of intentions, but it is wrong – scientifically, professionally, and ethically. The DSM debate presents us with a unique opportunity to put some of this right, by working with service users towards a more helpful understanding of how and why they come to experience extreme forms of emotional distress. We already have a situation where the strongest defence of DSM is: ‘We know it’s flawed, but it’s the best we have – what could we do instead?’ The simple answer is, ‘Stop diagnosing people.’”

These quotes come from the following source: http://www.madinamerica.com/2013/01/time-to-abolish-psychiatric-diagnosis/

Lucy Johnstone’s positions are very close to my thinking on the pseudo-diagnosis of Borderline Personality Disorder. To promote hope in people who have been severely traumatized and have great difficulty managing their emotions, perhaps it would be helpful to stop diagnosing them as “borderline.” Instead, we could understand them as individuals with unique histories that have contributed to their current problems, while encouraging them that they have strengths that can lead to recovery.

And here are some of Johnstone’s thoughts on “Formulation” specifically, in this case related to a person labeled as “psychotic”:

“In Britain, formulation is considered to be the core skill of the profession of clinical psychology… Formulation can be defined as the process of co-constructing a hypothesis or ‘best guess’ about the origins of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It draws on psychological theory and evidence in order to suggest the best path to recovery.  Unlike diagnosis, it is not about making an expert judgement, but about working closely with the individual to develop a shared understanding which will evolve over time…”

“We can see that the formulation is personal to (the patient), and helps to make sense of her experiences… It suggests an individual pathway forward, which will probably include developing a trusting relationship with a worker or therapist, learning ways to manage and cope with her voices, perhaps gaining support from others with similar experiences, and talking through her past. All of this is in stark contrast to the messages of shame, damage, hopelessness and despair that are conveyed by a diagnosis, and that too often lead with tragic inevitability to medication, admission and a lifetime career as a psychiatric patient.”

Source: http://www.madinamerica.com/2013/01/thinking-about-alternatives-to-psychiatric-diagnosis/

When Belief in the System Fades

In my view, psychiatry and its zoo of imaginary diagnoses militate against hope, personal meaning, and understanding. Psychiatry’s diagnosis-based ideology could be likened to a precariously perched house of cards. As more people understand that diagnoses like “Borderline Personality Disorder” are scientifically invalid, they may increasingly question the medical model underlying them. Over time, increasing numbers of patients and professionals may become unwilling to accept these labels. At a certain point, belief in the current system – the ideas that psychiatric diagnoses are real entities, that they can truly explain a person’s emotional problems, and that medication should be the first line of treatment – may fade and then collapse.

The vested interests of psychiatry will inevitably resist these changes because of the threat they pose – to making billions of dollars for drug companies, sustaining psychiatrists’ high incomes, and maintaining the fiction of psychiatrists as authorities who can diagnose emotional “disorders”. As Macchiavelli implied, the old order profits from defining reality in a way that benefits it, and some people may have trouble even considering that emotional problems could be understood in a radically different way.

Nevertheless, it is my hope that people will be open to the following idea: that promoting hope and restoring meaning for those suffering from the symptoms associated with “Borderline Personality Disorder” might be better achieved in many cases without labeling people as BPD. If some people still find benefit from being labeled as borderline, then so much the better. People ought to be free to use what works for them. But if other people are helped more by a “formulation”-like approach, one which connects their symptoms to their personal history and life circumstances without labeling them as having an “illness”, then perhaps we should shift our mental health practices in this direction. There might be still other approaches that work better for some people than formulation.

These ideas, some of which may seem confusing, relate to the arguments I have repeatedly made in previous articles: that BPD is an invalid and unreliable diagnosis, that no biological or genetic basis has been found for BPD, and that the medical model approach with its emphasis on medication is not useful for many people. For more information, the reader is again referred to the articles linked to above and their links to other websites.

The Idea of a Borderline Spectrum

However, part of me remains sympathetic to the idea of a borderline spectrum of emotional problems, which does not mean that BPD is a literal psychiatric illness. Instead, it means that people with similar-appearing emotional struggles as adults can be understood as using similar psychological defenses (e.g. splitting and projection), resulting from related histories of neglect and/or abuse. In this model, people and their problems are understood as existing along a continuum of functioning and symptom severity, and they are not understood to have the same “disorder”.

This spectrum-based model may have some value in allowing people to relate their emotional problems to other people’s (similar) problems in a meaningful way, and in allowing treatments to be developed for similar-appearing emotional problems that might be called part of a “borderline” spectrum. However, this idea conflicts with some of what I have written earlier about the lack of validity of the borderline concept per se. As can be seen from the trouble I’m having writing about it, it can be quite tricky to discuss emotional problems without using labels!

To conclude, it is fascinating how the words we choose to describe emotional problems, along with the theoretical models we base them on, are such powerful influences on our thinking and feeling about what is possible for us. I would be interested in what others think about what makes hope realistic, about formulation as an alternative approach to diagnosis, about the (lack of) validity of the medical model of BPD, and about the idea of “borderline” symptoms as occurring along a spectrum. Please feel free to share your views in the comments!

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#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.

———————-

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

#2 – How Did I Recover from Borderline Personality Disorder?

People reading this page are probably searching for hope and encouragement, either because they have problems related to Borderline Personality Disorder or they care about someone who does. Or, perhaps they are simply curious and wonder whether BPD can be recovered from.

On this page, I will describe what allowed me to move from being an emotionally immature young person, suffering from many painful borderline symptoms, to being the relatively mature, functional, and symptom-free adult that I am today.

When I Was “Severely Borderline” – Teenage and Young Adult Years

From approximately ages 13-23, I was severely emotionally ill. I had the following symptoms, most of which are in the DSM-IV definition of BPD:

– Severe anxiety and depression most of the time, with little ability to comfort myself.
– Constant feelings of emptiness and low self-esteem.
– Acting out in various ways, especially overeating.
– Viewing other people and myself as all good or all bad, accompanied by childlike clinging toward the “good” people and extreme rage against the “bad” people.

– Very poor personal relationships in terms of their emotional depth – I had no real friends and tended to use people for my needs and then quickly lose interest in them.
– No clear identity or long-term goals – I usually only planned a few days or weeks ahead.
– A tendency to be paranoid and fear that other people were “out to get me”.
– Intense fear of losing important family members (fear of abandonment).
– Suicidal thinking when I became very depressed.

These symptoms persisted relatively constantly for 10 years starting in middle school. It is difficult to describe in words how painful or frustrating they were. Externally, I tried to appear normal and to function in school and work, but internally it was a constant emotional nightmare. I felt myself to be cursed, a walking example of Murphy’s Law, existing in a personal hell on earth. When first working on recovery, I had no idea where to go. Emotionally, I felt like a cork caught in the waves of a stormy sea.

My Progress Toward Being a Mature Adult Today

However, here is how I would describe myself today, at age 28:

– Able to regulate my feelings– I can comfort myself and rarely become anxious or depressed.
– Able to think in an ambivalent way, and to see others and myself as good and bad at once.
– Have confidence in myself, possessing a clear sense of what I want to do in work and relationships. I think long-term, able to plan months and years ahead.
– Able to feel genuine concern and interest in others, rather than only using them to satisfy my needs.

– Have had a good romantic relationship and several meaningful long-term friendships.
– No paranoid thinking, suicidal ideation, or fear of abandonment.
– Able to function independently in a job I enjoy; no need to cling to other people to function well.
– Have a strong core identity which persists through difficult times.
– Much reduced acting out – I still do occasionally overeat when under unusual stress at work, but it’s much less of a problem than before.

I am pretty happy with how my life is going today, and proud of myself for the work I did. How did I make these changes to develop a good life, and to lose almost all of my borderline symptoms?

What Helped Me Become Healthy and Non-Borderline

1) Long-term psychotherapy

Starting in my late teens, I was fortunate to be able to attend psychodynamic, psychoanalytically-informed psychotherapy. At first, I went once a week, and then for several years I went an average of twice a week, sometimes going three times a week during difficult periods. It was extremely expensive, and I was fortunate to have parental financial support to go to therapy (I later financed myself, sacrificing in other areas of my life so that I could go to therapy). Essentially, I used psychotherapy as a reparenting process in which I worked to be able to deeply trust someone else for the first time. My various therapists – I had four significant ones – provided me with crucial emotional support that allowed me to become independent in my job and to develop better interpersonal relationships. They were the substitute mothers for my emerging true self.

In other articles, I will discuss more extensively how and why therapy helped me, my views on therapy vs. medication, as well as options one has if one does not have the money to go to therapy initially (therapy is certainly not the only path to getting better, although it can be very valuable).

2) True friends

Starting in my late teens, I was fortunate to develop a close friendship with a man, Gareth, who knew about my history of physical abuse (my father beat me throughout my childhood). He was an older, middle-aged family man who I met via the shared interest we had in tennis. I took the risk of opening up to Gareth about my problems, and we developed a friendship that has endured to this day. We spent hundreds of hours talking through my past and present problems. There were many times I cried with him, as well as some periods when I became angry or paranoid and misunderstood his kind intentions. However, most of the time his support was extremely helpful, coming during a period of my life when I desperately needed love and understanding. I will be eternally grateful to Gareth for his decision to help me.

From about age 15 until the present day, I developed three other close friendships, with two men and one woman, all of whom helped me tremendously and gave me hope that life could get better. My relationships with Julian, Andrew, and Helena were similar in quality to the first one described above, in that I took the risk of opening up to these people, telling them my life story, and asking for help. However, they were not as deep or intense as the first one.

Today, I also have a number of other important friendships, but they are more “normal friends” that I enjoy for themselves and can share my present-day sense of self with. These friends do not know my history of being borderline in nearly as much depth as the four people I opened up to in my teens.

I will write more in another article about how genuinely opening up to another person for help is one of the most important risks a borderline person can take.

3) Family – My mother

Despite her faults, my mother supported me financially to go to psychotherapy, and she did genuinely care about me although it was difficult for me to feel that fact early on. She had a very difficult relationship with my father, and her decision when I was 18 to divorce him and live alone provided me with a stable, safe place to live for several years. As I became a young adult, I came to trust my mother more and risked talking to her openly about some of my problems. This occurred in parallel with my trusting and opening up to the friends noted above. To my mother’s credit, she matured along with me, becoming a supportive listener and a cheerleader for my developing independence. I owe much of what I am today to her heartfelt efforts to help me.

4) My passion – tennis

The one thing I always liked as a young child was the sport of tennis. I took group classes at the local club and viewed the coaches as substitute father-figures. The process of hitting the ball and running around with other children became addictive, and I developed an obsession with the pro game and players like Roger Federer. Perhaps surprisingly, this interest endured during my teens and early twenties even when I was struggling with all the horrible emotional symptoms associated with Borderline Personality Disorder.

Tennis had great value as something that distracted me from my emotional suffering during the most difficult periods, and had meaning for me in its own right. It also led me to work with children as an assistant coach in college, which eventually led to my present day job, in which I work with kids.

5) My own study of Borderline Personality Disorder

When I first learned about BPD, and later was diagnosed with it, I was terrified because of all the pessimistic descriptions about how difficult it was to help people with the diagnosis and how many therapists did not want to treat them. Online web forums were filled with horror stories about manipulative, evil, hopeless borderlines.

Over time, I researched BPD extensively and came to a more nuanced understanding of it. I understood it from a developmental perspective, meaning how traumatic childhood experience shapes later adult problems, as well as from an object-relations perspective, referring to how the traumatized individual uses psychological defenses and modes of relating that distort the external environment based on pathological internal views of themselves and others. More on that in later posts.

I studied the writing of many therapists who had successfully treated individuals with BPD, including Harold Searles, Vamik Volkan, Otto Kernberg, Heinz Kohut, Gerald Adler, James Masterson, Peter Giovacchini, Jeffrey Seinfeld, and others. I met Gerald Adler and James Masterson in person and interviewed them about their views on the treatability of BPD. From this research I developed an overall picture of what was necessary in the “big picture” for borderline individuals to become non-borderline. In essence, the traumatized person needed to learn to trust and accept support from another person, and to be helped via a therapeutic alliance to develop healthy adult ego functions that they never developed as a child. By around age 20-21, I understood BPD in more depth than many therapists do. Understanding it taught me what was necessary for a successful recovery process.

I will write much more about these issues in later articles, but for now, the point is that having a map of where to go when struggling with BPD helped immeasurably.

6) Eventually abandoning the concept of BPD

Paradoxically, I now no longer believe that Borderline Personality Disorder is a valid diagnosis. This is despite the fact that I was diagnosed with it, and have recovered from having almost all of its symptoms.

As I improved, I continued to be periodically worried or depressed by the idea that I was still a borderline. I would often fear that maybe the writers who said borderlines were untreatable and hopeless were right, that I would always be a borderline, and that if I did improve I would inevitably relapse.

Today, I view BPD as an archaic, outdated term, one fabricated by psychiatrists to (mis)label a wide range of severely abused and neglected people. To me, a more realistic view is that “borderline” symptoms exist on a continuum of severity, i.e. that there is no firm line that divides borderline from non-borderline. Looking back, it is obvious that as I recovered there was no past time at which I suddenly no longer “had” BPD, if I ever had it at all. Of course, I did have (and gradually stopped having) all of its symptoms, which were real and extremely painful.

Once I realized this, I experienced a paradigm shift in which I was no longer worried by the diagnosis of BPD, since I regarded it as invalid.

7) My curiosity, resilience, and aggression

By my nature, I have always been curious. This helped me when dealing with BPD, since it spurred me to extensively investigate the disorder and how it could be treated, as well as to eventually question its validity as a useful diagnosis.

Even more important, I am one tough cookie (I was going to use another word, but want to keep this blog’s language clean!). Starting in my early teens, I promised myself that I would get better or die trying. After reading about how borderlines often failed to improve, I defiantly predicted that I would recover. I weathered the long, slow storm of many years of depression, anxiety, rage, and uncertainty, never giving up despite times when things seemed hopeless.

Lastly, I can be a pretty direct and blunt person. Aggression is often regarded as a “bad” thing in our society, but aggressively seeking out the truth or defending oneself when under attack can be good things. My aggressive rejection of those who are pessimistic about BPD was important in my recovery. I’m not afraid to say what I really think, as you will see on this site!

These qualities are partly genetic. They certainly helped me with my challenges. Each person has their own strengths, and there are other ways in which I’m not as gifted as others. For other people working to recover from past trauma, it may be these or other strengths that are most useful on their journey.

 ——————

I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, 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

#1 – The Goal of My Website About Borderline Personality Disorder

The main goal of this website is to show that meaningful recovery from Borderline Personality Disorder is possible, and to illustrate one way of getting there.

My Life Today

My name is Edward Dantes, and I’m 28 years old. I am a teacher working in an academic institution in the Eastern United States. At age 18, I was diagnosed with Borderline Personality Disorder by a psychiatrist. I have spent the past 11 years working to recover from severe childhood abuse and neglect, and have now reached a place where I can definitively say that I am better.

By “better”, I mean that for the most part I’m emotionally healthy – I like my work, enjoy several hobbies, have good intimate relationships with family and friends, can regulate my self-esteem, and can handle difficult emotions without acting out. Most days, I feel real, alive, and excited about what I’m doing.

I still have periodic struggles and doubts. But my core self is so much stronger than before. Or rather, I have a core identity where there was none previously. As one of many people who have recovered from severe childhood problems, I hope my story will encourage other survivors who want to do the same.

My Past Struggle

In my late teens and early 20s, I was severely borderline. My life was a living hell dominated by severe depression, constant anxiety, terrible self-esteem, suicidal thinking, acting out of various kinds, a lack of any intimate relationships, being unable to sustain full-time school or work, and the horrible feeling that things would never get better. As a young adult, I often despaired of ever succeeding at a job, having real friends, or having a successful romantic relationship.

However, slowly but surely, I did get better. I educated myself in great depth about BPD, and discovered what had helped others with the condition. I sought therapy and found friends to support my recovery. I rejected the prevailing societal view of the disorder as a biologically-caused, life-long condition that can only be managed rather than fully recovered from. This shift in my thinking became critical. I found out the truth – that meaningful recovery is possible, and that many people diagnosed with BPD have recovered enough to live good, rewarding lives.

Today, I have 0 of the 9 symptoms of BPD, whereas 10 years ago I had at least all 9 symptoms listed in the DSM-IV definition of BPD. I trust my progress and have every reason to believe that it will continue.

Confronting the Pessimists

Apart from promoting this positive vision of recovery, another purpose of this site is to confront those who say that Borderline Personality Disorder cannot be effectively treated. Many people on internet forums and the therapeutic community believe that BPD is a life-long condition. They believe that it can only be managed and “lived with”, but not deeply recovered from.

Nothing could be further from the truth. Getting better from BPD is possible, although it requires hard work over a period of years. Recovering to the point where one is essentially healthy and “normal” in the sense of enjoying work and relationships has been achieved by many former borderlines. Unfortunately, many borderlines and their families are not aware of the resources that are needed to recover, nor do they understand the disorder in depth.

On this site, I will present a powerful counterexample to pessimism about BPD. I will explicate the disorder from a variety of viewpoints, and present strategies which were useful in my recovery.

Additionally, this site will confront the American medical view that seeks to cast BPD as a genetic or biologically-based disorder, one that needs to be treated primarily with psychotropic medications. It will expose the lack of strong scientific basis for such claims, and will analyze the emotional and financial factors that might motivate supporters to hold this viewpoint.

The Validity of the Borderline Disorder

Lastly, I wish to radically challenge the notion that BPD is a valid scientific diagnosis as it is defined in the DSM. From my own research and life experience, and despite being diagnosed with it myself, I now believe that the DSM version of borderline personality disorder has little validity. That is not to say that the symptoms BPD represents are not profoundly real and that people do not suffer from them greatly – they are, and people do.

However, my viewpoint is that BPD is more useful as a metaphorical or symbolic term that encapsulates a range of severe problems in functioning and relating. In other words, BPD represents a large, nondistinct area of severe psychological distress, rather than a discrete syndrome. Psychodynamic theorists would call this region “preoedipal” and “preneurotic”, but not “psychotic”. Re-conceptualizing BPD has been a useful step toward recovery, since it allowed me to view myself as existing on a subjective continuum between sickness and health, rather than as having a discrete “disorder”. For me, this was freeing.

Disclaimer

Lastly, this website should not be taken as the advice of a medical professional, but rather as the opinion of a layperson. However, coming from the “inside out”, I can give a viewpoint of BPD and how to recover from it that is fundamentally different from any professional opinion.

It is my hope that this website will prove useful both to those who have been diagnosed with BPD and to family members of such people. If it does nothing else, it will hopefully challenge people to think differently about BPD, both in terms of what the disorder actually is, and in considering how much people diagnosed with it can change for the better.