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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by sar on June 1, 2001, at 21:14:41
The other day at work (I work at a bookstore) I saw a a book called *Stop Walking on Eggshells* about borderline personality disorder and flipped thru it because my main preoccupation for the past 6 months or so has been w/ psych issues and alot of ppl in my life seem to walk on eggshells around me (I'm terribly sensitive). I happened to flip open to a testimony from a BPD woman and felt as if I were reading my own feelings. The next day I had an appointment with my pdoc and asked if she thinks I'm borderline...she looked very surprised and said "What makes you think that?" then said that I probably meet 5 or 6 of the diagnostic criteria, but that she doesn't like labels too much. I know that is the reasonable thing, but I *crave* a diagnosis. I don't know why. A few nights later I had a few beers, drove to another bookstore and stole Walking on Eggshells, and I mention this here because the next day I thought about that objectively and thought "Damn, ___, you're crazy" but only from an objective point of view...it wasn't that bad for me.
Is BPD worth more research on my part? I read in the archives that it's a "ghetto" diagnosis...but what do yall think? I remember Nikki and Jah discussing BPD (Nikki dx'd and Jah skeptical) recently, but I'd like to open up the topic again...my pscyh was right, I do meet 5 of the criteria...& I also come from an abusive background. People close to me have called me "self-destructive." & I am.
I suppose I've been hiding for years...IF I do this & that & this I'll be Normal Happy Healthy...all of this putting-off kicked me in the ass with the blackest depressive episode in my life...I think it was the hiding & ignorance that did it...so now I'm at square one, one moment burying my nose in psych info and the next wondering if I'm fooling myself, that I'm making my problems more serious than they actually are and that if I get off of this psychiatric roller coaster parade *then* I can be healthy...what a dizzying maze.
thanks for listening.
sar
Posted by Rzip on June 2, 2001, at 1:13:56
In reply to borderline?, posted by sar on June 1, 2001, at 21:14:41
>A few nights later I had a few beers, drove to another bookstore and stole Walking on Eggshells, and I mention this here because the next day I thought about that objectively and thought "Damn, ___, you're crazy" but only from an objective point of view...it wasn't that bad for me.
Sar,
I would strongly STRONGLY urge you to bring this up with your psych. You could start with calling and leaving a message for her to call you back. When she does, tell her what happened. Start with first encountering the book in the bookstore, and reflect on how reading the excerpt made you feel. Followed with how her almost confirmation about the diagnosis made you feel. Eventually, tell her in however many words that you stole the book from a bookstore and you two should focus on coming up with some reasons as to why you did what you did. In my honest opinion, I would make this incident the focus of your therapy. The most wonderful element psychotherapy has to offer is self-awareness and insights, however painful they might be. I agree with your psych that you should not focus on labels...it'll block you from the self-exploration. Basically, psych. labels give you a reason to stop working on your issues. I, too was facinated with finding a label for my misery for the past two years. I did not get very far in therapy with that mindset.
Last note, self-destructive behaviors such as shoplifting will eventually lead you to prison time. That would be very sad. So, this behavior needs to be addressed in-depth immediately with a professional.
- Rzip
P.S. I will not be able to respond to these threads because I am going to be away doing something else. I sincerely wishes you the best of luck. I really hope that your psych is someone that you trust and I pray that you will find the courage to open up as soon as possible.
Posted by geekUK on June 2, 2001, at 7:46:07
In reply to Forget the diagnosis and focus on admitting » sar, posted by Rzip on June 2, 2001, at 1:13:56
I thought and still think the same thing as you about BPD. I too crave a label, something to fight against. I hate the Idea of docs trying to fix the way I think. (It does me no good to think like this). So I think its Label=ill, help=brainwashing! once again the docs did the same asking why, agreeing on criteria ect. Keep it in mind. It may help the therapist understand a Little more what you act like outside the little therapy room. I would stop the stealing though, I used to do it (never got caught) but I dont think the police will be a very nice experiance.
BPD is only a label, the usage of it has changed majorly 3 times over the past 50 years, its the symptom cluster behind the label that is important.
Posted by JAMMER on June 2, 2001, at 10:12:44
In reply to borderline?, posted by sar on June 1, 2001, at 21:14:41
> she doesn't like labels too much. I know that is the reasonable thing, but I *crave* a diagnosis. - sar
sar, Labeling is a part of diagnosis, which in turn allows proper "treatment", in my opinion. And maybe labeling is the wrong word to use.
I think Rzip and geekUK are correct in thier response about comming clean on why you think you fall into this catagory, how you learned about, and why you stole the book...To me, a "label" or diagnosis, helps begin the task of working on the problem, as then there is a path identified which will lead to self-improvement. Keep in mind it is honesty that will lead to true understanding, and help in identifying a proper response to symptoms.
Good luck,
James
Posted by shelliR on June 2, 2001, at 10:36:54
In reply to borderline?, posted by sar on June 1, 2001, at 21:14:41
Sar,I think everybody so far has given you good advice. Assuming you are over 18, shoplifting, is stealing--theft, which is a fairly serious crime.
I think you need to focus on what you want to change about yourself. Maybe make a list. What would make you happier and make your life easier for you? Then you and your therapist can take your list and make it into a treatment plan. If you want to stop drinking, what stands in the way for you? What scares you? How can you take one step toward that goal. What emotional things have to be worked out even before you take that first step.
At the same time that you are developing these goals with your therapist, you are also developing trust with your therapist. That she will support your efforts to change and be there for you.
I think also we all want to understand who we are, and perhaps knowing our diagnosis helps to give us a place that we perceive that we belong. I actually do think learning my diagnosis was helpful in understanding that I was not a failure, but a person with a specific disorder. But the real work still came down to what do I want to change about myself and my life and how to I go about doing that.
I do hope you share your story with your therapist.
Shelli
Posted by JAMMER on June 2, 2001, at 15:02:15
In reply to Re: borderline? » sar, posted by shelliR on June 2, 2001, at 10:36:54
> I do hope you share your story with your therapist.- Shelli
Shelli, Outstanding feedback!
-James
Posted by sar on June 3, 2001, at 9:18:17
In reply to Re: borderline? shelliR, posted by JAMMER on June 2, 2001, at 15:02:15
Thanks for the great responses! I see my psych on Tuesday & I plan on telling her the story...good point that she needs to know more what I'm like outside of her office.
for what it's worth, 2 of my friends have urged me to accept my craziness. They say that the alternative to craziness is to be normal & boring. I've spent all my life *trying* to be normal & boring but I think that maybe it's only made me crazyer.
what a conundrum!
blah.
thanks again yall & many hugs,
sar
Posted by Noa on June 3, 2001, at 9:36:06
In reply to thanks everyone, posted by sar on June 3, 2001, at 9:18:17
I think that to whatever extent a label helps you understand the problem, it is useful. Ultimately, many psych diagnoses (especially the personality disorders) are somewhat arbitrary. They are, afterall, man-made constructs to try to sort out clusters of symptoms.
If it helps you to conceptualize it as BPD, then use that. But ultimately, the treatment needs to address building more effective coping strategies to help you deal with your feelings and sensitivities, so that you can start feeling more in control, and so people don't have to tiptoe around you, but can be real with you.
I think it is a fantastic idea to fill your therapist in on how you interact with the world outside her office.
Good luck.
Posted by Cam W. on June 3, 2001, at 13:41:41
In reply to Re: thanks everyone, posted by Noa on June 3, 2001, at 9:36:06
As some of you know, I have done some research on stigma. I'd like to add some to this talk of stigma (which has most recently cost me a job and, for a while, I thought a career).
The use of scientific principles has uncovered universal laws in the physical and biological sciences; in which experiments done in identical conditions yield the same results, again and again. However, in the social sciences the outcome is based usually less on science and more on social aspects. Then normative cultural values (what is normal or abnormal) are thrown into the mix. Thus, nondiscrete behaviors are pigeon-holed by science into discrete categories, most often flavored by Western cultural norms.
When taking the world as a whole, what Western cultural norms consider right, moral, rational, healthy, and legal, may be wrong, immoral, irrational, sick, and illegal in another (more often vice versa). Much of DSM-IV appears to be moral and political judgements of the U.S. psychiatric community (thus, opinions of Western science) rather than part of any diagnostic nosology. For example, a bacterial infection can be cultured and an appropriate antibiotic can be prescribed; but in psychiatry, we attempt to take a set of symptoms and try to fit them to the symptoms of a disorder. When a psychiatrist thinks that he/she has the closest fit, a diagnosis is made. This method of classification is much more subjective than the objectiveness of, say, microbiology.
The history of psychiatry has many, many instances where clinical observations of deviations in prevailing social, cultural, political, and ethical standards of Eurocentric conduct have received inappropriate labels of disorders or disease. These include things as mundane as the vitamin B deficiency pellagra and syphillis being deemed psychiatric disorders to categorizing "deviant acts" such as homosexuality, child abuse, masterbation, polygamy, prostitution, lying, and lacking a mainstream religion, as illnesses. It is in this way that psychiatry can, itself, be lumped into a category with religion and politics. Thus, psychiatric categorization, is no more than a measure of the political success of the dominant ideology.
The classification of many psychiatric disorders are influenced by the ability of special interest groups to effectively organize and lobby decision makers. For example, DSM-I (1952) and DSM-II (1968) classified homosexuality as a "sexual orientation disturbance", but a campaign by the Sexual Preference Rights Movement, including disruptions of APA meetings, had homosexuality removed as a disorder. The APA trustees voted unanimously for this change. In 1974 nearly 60% of 10,000 votes cast in an APA member referendum to formally approve the change, were in agreement, but in a separate survey of about 2500 responding psychiatrists nearly 70% opposed the change (ref. Greenberg DF. The Construction of Homosexuality. University of Chicago Press, 1988). Thankfully our social fabric has been, more or less, reweaved in 25 years.
Furthermore, what is the difference between a cult and a religion? Answer: about a hundred years. Seriously, the difference between a cult and acceptable religious beliefs is often based on the number of members and reflects the milieu or social environment of the evaluator, including current cultural norms. J.Gutman noted that when certain practices appear strange or unpopular: "A religion becomes a cult; proselytization becomes brainwashing; persuasion becomes propaganda; missionaries become subversive agents; retreats, monasteries, and convents become prisons; holy ritual becomes bizarre conduct; religious observance becomes aberrant behavior; devotion and meditation become psychopathic trances." Waco anyone?
This sort of thing can also be shown in a nonreligious bent, where the collective deviance exhibited by a particular group has been called hysterical or sick, based soley on the assessment of these acts by scientists (or lay public or media) as being at variance with Western standards. For example, many social scientists claim that the Nazi movement was a form of mass psychopathology among the German people, ignoring the literature on conformity and cultural context in shaping Nazi beliefs.
I guess what I am trying to say is that when it comes to determining what is acceptable and what is not, the remains a fine and ever-changing boundary that more often reflects the social world of the interpreter than the mental state of those being interpreted. The difference between which side of the line one stands on often depends on who is holding the chalk.
Yes, stigma starts even before one is pigeon-holed. This is why many people do not seek help for mental illnesses. How do battle stigma? I really don't know. Perhaps the medicalization of mental disorders as biochemical disorders may help some, but ideologies and stereotypes are deeply entrenched in our cultural fiber. Perhaps the first step is for the sufferer to realize that they are not alone and that 1 in 4 people will at some point in there life suffer from a mental illness that will require professional help. Also, the "coming out of the closet" by such people a Kay Redfield Jameson and Ted Turner does help, but it is not a painless emergence. Until such time as the cultural mores drift in a positive direction for us, all we can do is to hold our head up high and say, "This disorder will not run my life, I will!"
Just some meanderings - Cam
Posted by Helen36 on June 4, 2001, at 16:49:18
In reply to stigma, posted by Cam W. on June 3, 2001, at 13:41:41
Great musings, Cam.
Borderline, ahhhhhaa! I have done a *lot* of research on BPD, being 1) an academic and 2) engaged to a man with BPD until quite recently.
The stigma of the diagnosis is slowly changing, and much of that is due to some great new research being done in the field (new studies that find, for instance, that NOT all folks with this disorder were sexually abused, or that at least 30% of them are male, or that certain SSRIs work much better than others for containing the specific symptoms, or that Dialectical Behavioral Therapy as developed by Marsha Linehan of UofW shows vast improvement over other therapeutic strategies, or even that the diagnosis is NOT a 'life sentence').So ultimately, YES, I agree wholeheartedly, treat the person, not the illness! (I know I'm preaching to the converted here, but what the heck ;) )
Sometimes the Dx IS important, though, such as in my fiance's case; he is classic BPD (meets all 9 diagnostic symptoms) yet because of a psychiatrist who didn't 'believe' in 'stigmatizing' folks with the label BPD, he was diagnosed Bipolar II and treated with lithium for over a year with absolutely no improvement. Traditional talk therapy repelled and alienated him (although to his credit he kept at it).
Ultimately, he almost successfully attempted suicide while still on massive doses of lithium, depakote and risperdal. Why? The acquired thought patterns of BPD had simply not been addressed in his treatment. Had his psychiatrist been willing to address the topic of BPD, he could have gone straight to a DBT clinician and begun the proper therapy regimes.I urge anyone who is interested in BPD as a diagnosis to check out a brand-new website I've created: it's a HUGE compilation of internet resources relating to BPD. It's geared mainly for family and loved ones of BPDs, but has lots of resources for those wondering if they are BPD themselves, too. I've collected all the latest internet-available information, and many books, pertaining to life with BPD in all its many permutations.
There are sections on treatment/clinics, general introductions, support groups for both nonBPs and BPs, links to all the latest discussions of etiology, relation to other mental disorders, etc etc.Check it out!
http://home.hvc.rr.com/helenbpd
I am particularly interested in any materials relating to these cross-over diagnoses, such as: BPD, Adult Reactive Attachment Disorder, PTSD and Bipolar II, which can all read very similarly on paper. Yet the treatment regimes do vary considerably, as in my ex-fiance's case. Had he not been labelled Bipolar, more attention might have been paid to his very real disordered learned coping mechanisms.
Very frustrating! And indubitably even more so to the folks seeking help themselves.I welcome comments on my site, just drop me a line at the address on the intro page of the site.
Strength and courage!
Helen
> As some of you know, I have done some research on stigma. I'd like to add some to this talk of stigma (which has most recently cost me a job and, for a while, I thought a career).
>
Posted by Zo on June 9, 2001, at 4:07:44
In reply to BPD resources!!, posted by Helen36 on June 4, 2001, at 16:49:18
I'd also like to distinguish between borderline - or any other - traits, which come out under stress, for example, and disorder, which is, unfortunately, far more "hard-wired" in the character and in the brain.
When I was young, I stole, shoplifted, and was eventually caught and arrested. Even now, with all the work I've done and having raised two healthy children to adulthood, every now and then the urge to just *take* something will arise, ever so slightly. . .And I can connect it to the longing that overwhelmed my childhood, and how I must have hoped I could "steal" my mother's love. Which she gave to my siblings, but never bonded with me, her firstborn. Instead, I was her goat - and slave. For many years, I thought I was Borderline - and for many years, it was a sexist diagnosis, encompassing much of the real grief of women. The terrible aspects of psychiatry, the very psychiatry that has saved my life, is its power to marginalize and make "sick" people who are suffering from real, sociological dilemma.
It's all in how your wound possesses you, or whether you possess it. I know I am broken, I know I will never be at home in the world as are, for example, my children. But I know myself to *be*. I have the crucial awareness, that which mediates the space between trait and disorder, the observing ego.
It's a painful life either way you cut it, no pun intended. . .and my wish is for wholeness, as we are, for us all.
Posted by Fred Potter on June 10, 2001, at 21:44:48
In reply to stigma, posted by Cam W. on June 3, 2001, at 13:41:41
Cam change "reweaved" to "rewoven" and you have a masterpiece
Posted by Cam W. on June 11, 2001, at 8:03:11
In reply to Re: stigma, posted by Fred Potter on June 10, 2001, at 21:44:48
Thanks Fred - But < blush > the ideas aren't all totally mine. I did steal other people's works without referencing them, but I did try to put the articles together into a whole. As I do not have access to my files, I did do this from memory (ie. from one of my lectures) so I don't have the proper references handy. I am probably using "reweaved" in my lecture, as well (thanks again, I will change it). Alas, I should have paid more attention in the one and only English class that I had to take for my degree. :-) It's not easy to make the other half of the brain work, at my age.
- Cam> Cam change "reweaved" to "rewoven" and you have a masterpiece
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