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,
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.
12/14
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
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