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Dr, Did You Do Your BPD Homework?

Dr. Irene: Did You Do Your BPD Homework?

Sent: Monday, December 13, 1999 12:12 PM
Subject: Re: Dr. Irene, have you done your homework?
Dr. Irene:

Hello.  I came to this site to read a friend's column, and I'm sorry to say that it will be my last visit.  Have you done your homework lately?

I am a former social worker, and am disappointed to see that in your synopsis of the borderline, not only did you not appear to have fully understood the diagnosis of BPD, but you are also not familiar with the most successful therapy for them to date, DBT (dialectical behavioral therapy).  This therapy is remarkably successful with borderlines as much as 5-15 years down the road, so I think it worth your time to check it out - particularly when it comes to suicidal gestures. 

Before I begin discussing the gestures, I think it important to discuss Marsha Linehan's research on "where BPDs come from".  After extensive case studies, she discusses that there is a balance of what makes a borderline between biological and environmental, with the weight of it falling along environmental factors.  As for the biological predisposition, she has conducted studies on perceived reactions to stress, and found that in borderlines, their central nervous systems have a difficult time returning back to baseline after stress.  Combine this with an extremely controlling/invalidating parent who invalidates or ignores their own thoughts and feelings and who may or may not participate in some form of abuse and there you have it.  In fact, the common denominator in all case studies was invalidation of thoughts or feelings of the child by the primary caretaker;  anything from feeling thirsty to not allowing anger after abuse. 

The suicidal gestures seen by many borderlines are no longer seen as an attempt to merely manipulate you (though there are those out there, usually who received the damage at an earlier age or more preverbal state), but stem from real or often perceived feelings of deep-seated invalidation of their thoughts and feelings, or in other words, a trigger reminder of how they got to be the way they are to begin with.  In not having enough coping strategies to deal with this type of stress, they want to self-harm and/or escape.  They CAN use this strategy as a manipulation, such as instead of stating that they don't feel cared about, they say, "I feel suicidal" to get the concern.  However, most borderlines legitimately feel as failures at their lives, as they are very aware of how maladjusted that they can be, and they have no readily available coping strategies to help them with these feelings.  That's where DBT steps in.   

DBT is taught in a group setting and in individual counseling, and combines coping skills, grief management, anger management, social and communication skills, boundary issues, and other forms of cognitive therapy.  The biggest component to DBT is the issue of the dialectic, or how to avoid "splitting".  Instead of seeing issues as "black and white", they are taught to allow both sides of an issue to be true, and accept a percentage of responsibility without self-loathing.

In my own DBT group, I, along with three others are more successful and functional than we have ever been in our lives.  I had a personal meltdown three years ago, with a very private plan to end my life.  This was unknown to everyone, including my therapist at the time (who I had had for 5 years). She viewed borderlines primarily the way that you appear to, and I sank deeper and deeper in a pit of shame for my diagnosis, to the point that I stopped going out with others at all, for fear that I would manipulate them, etc.  Now I realize that I was attributed all sorts of characteristics to the disorder that I don't even have such as lacking in motivation, frequent changes in therapists, rageful actions, and "clingy" behavior.  Though I never missed an appointment, I was told by her that I had, even though it was her that had canceled several times.  (I later received an apology).  I never called between sessions, and did not have a pattern of becoming clingy in relationships.  I had never gotten violent with ANYONE (physically).  In fact, being a borderline is more about the chronic lack of a sense of self, not these other "symptoms" of  poor coping strategies for this issue.

Feeling more and more "defective" and realizing that the current therapy was not working but causing further shame, I became suicidal, unbeknownst to anyone.  I made a plan that I would try any therapy that came around for Borderlines, and if I didn't see any improvement in myself in one year, that was it. 

After hearing of DBT, I said good-bye to my long-term therapist, and switched to DBT in a last stitch effort, and was finally seen as an individual, not as a diagnosis.  I am happy to say that since this time, I have gone back to functioning (for 2 years I have been at the same subcontracting employment without missing more than one day of work), with very happy clients.  Another member of our DBT group just received her PhD.  Two others were removed from disability.  The amazing thing that among these four who were diagnosed, not one of them ever threatened suicide, but later admitted to having a plan about these feelings.  It can be a very private struggle, and it can be very discouraging for those who are given a therapist with just such an attitude as yours.  We are immediately labeled with qualities and attributes that we don't even carry. (Just ask my DBT therapist of 3 years).  The underlying diagnosis is based mostly on a lack of a clear identity, not the sideline criterion (of which their are too many for one diagnosis), and often those seeking treatment are put "on watch" for these behaviors anyway. 

I am curious, when you are speaking of the suicide being "accidental", where do you get the information?  Are you certain that it wasn't after a lifetime of ineffective and maladjusted behavior failure in relationships? Until you are certain, it might be best to reserve judgment. Whatever happened to "positive regard" in therapy? Thank you for your time, -WDB
Dear WDB,
If you take a look at the BPD links, you will find that a dialectic BT link is included, and for readings, one of Linehan's DBT books is (most highly) recommended.
Please do your homework.
Dr. Irene

Ps: Lighten up. I published your letter not because I found it at all endearing, but because I think you gave Linehan's DBT work the excellent review it deserves in the treatment of BPD.  


Dr. Irene:  I am sorry that I missed that information.  The blaring one on the "front page" about the manipulation tactics that are supposedly used by BPD was the one that I found so offensive, and I jumped the gun - you're right about me not searching enough on your site. 

HOWEVER, I see that I'm not wrong about your attitude towards them, even though they have been emotionally abused victims themselves (and true enough, can become abusers).  

I see that we're a little biased and touchy when it comes to differing opinions.  Lighten up? Hmm, gosh...I've never thought of that before!  WOW, I'M COMPLETELY CURED!  THANKS, DOC!!!  I guess that nothing's ever struck a chord with you before and you wrote a response. I guess that sensitivity isn't your strong suit, then, is it? WDB

I'm not sure I know what you think my attitude on BPD is, but I doubt you understand it. How could you? This its not a BPD site!  I have not written extensively on the subject! Please understand that I am fully aware of the invalidation experiences that often give rise to the BPD's suicidal gestures, and fully agree with Linehan's perspective in the treatment of BPD. But, this site does not focus on the treatment of BPD and the BPD's experience. From the point of view of the BPD's victim (e.g.), the gestures are manipulative and meant to elicit caring. 

I'm sorry if my straight-forward position offends you.  I call a spade a spade to empower the person to change his/her act, if they choose.  I do same with victim and abuser, seeing each adult as fully responsible for his or her actions, no matter what.  While my position is highly empathic, it does not excuse or justify mis-behavior, for any reason - which is what I think outrages you in terms of how I see BPD.    -Dr. Irene