Mental Health Month “Personality Disorders”

The first day I was interning in a crisis center, I heard two women talking, and one said; “Whatever you do, don’t ever see a client who has Borderline Personality, they’re the WORST”

Shamefully I had studied but didn’t know very much about BPD yet, as I was only a year into my studies. I went home that night and read up on it and subsequently read some books devoted to BPD including the well-known book “I love you / I hate you.”

Shortly afterward I found out a friend of mine was BPD (BPD often goes hand-in-hand with Bipolar, as we often see Anxiety and Depression co-morbidly). She educated me significantly in a first-person account of what it was like to suffer from a personality disorder.

The very words ‘personality disorder’ strike me wrong. It’s not really giving someone a chance is it? If we label them as being disordered in some way?

It is thought personality disorders ‘grow’ in childhood and upon reaching maturity can be responsive to treatment or not, depending on the depth and extent they were reinforced in childhood. They usually have triggers such as the link between BPD and being sexually abused in childhood.

Why this is – isn’t so hard to understand if we consider, we all have personalities that are shaped by our experiences – any wonder then that certain experiences will commonly shape certain personalities and responses/reactions. If we take this to an extreme, a ‘disorder’ is a disorder of that personality caused by something wrong and traumatic that occurs to a child.

Why then doesn’t every child who is sexually abused BPD?

Because BPD and other personality disorders must be reinforced. If you are abused as a child but someone finds out, the person is taken away, you are told it was not your fault, the trauma is made better by a rectify and love and lack of shame, then you may well be affected by that abuse but not altered by it in terms of your personality.

If however, the opposite occurs and that trauma is reinforced, then by its very nature of reinforcement, the personality ‘disorder’ forms and every bad thing that happens afterward goes to continue that reinforcement.

It can work something like this;

Child A gets raped by her step-father. Child A tells her mom. Her mom calls her a dirty little liar and beats Child A. Child A is then raped repeatedly by her step-father who threatens to kill her if she ever talks again. Child A remains silent to her abuse for years and it goes on, unpunished. At 15 Child A goes to a party, gets drunk and is raped by a friend. Child A is told by her friends she is a slut and deserved it. Child A internalized all of this and develops BPD which among other things is characterized by a profound lack of trust in others.

Phrased like this, are any of us surprised?

In other words, a personality disorder is a consequence to abuse. As such I find the use of ‘disorder’ punitive because we’re saying the person has something wrong with their personality we are focusing on that, without really considering how this occurred.

Why? Because BPD can be very destructive, both to the person with BPD and those who know them. When you are dealing with someone who is capable of throwing everything into flux, it’s hard to make time to consider the background. You are too busy putting out the fires. And that is why BPD is so feared by therapists and wrongly, stigmatized as being a personality disorder people dread. Whether people dread it or not, any health care worker should aim to help those under their care and treat everyone equally. Perhaps that is easier said than done, but this is why more time should be spent learning about the formation of personality disorders.

Later on in my training I was warned again about BPD folk and told that they can be highly manipulative and destructive, they can and will always try to bring you down. I recall thinking ‘I can’t see how anyone could do that’ but later on I saw several colleagues have to defend their licenses against false accusations by BPD patients who were ‘testing’ them or flexing their muscle.

It appalled me to think anyone, even someone mentally ill, could deliberately go after someone with the sole purpose of trying to ruin their life. I found it hard to understand and empathize with them on that. Which is why I now understand why mental health workers can fear certain diagnosis in people. But despite this, I believe, given the right training and awareness, people can find ways to help those who even lash out at them.

BPD is characterized by a pull-push approach to relationships, an intensity, followed by a rejection, both of which are extreme, due to an inability to trust people shifting from intense attraction/like, to repulsion and hate. For most of us, this extreme is not impossible to imagine, perhaps if we have fallen out with a friend who back-stabbed us or a relationship went wrong because someone cheated on us, we went from love to anger at very least. With BPD those emotions are amplified and far more aggressive, with anger as the source. BPD individuals stoke the flame and are among the most angry and vitriolic of the mental spectrum.

For this reason when befriending someone with BPD it’s important to secure firm and unwavering boundaries. Ensuring the BPD knows the ‘ground-rules’ in other words, don’t flirt one day, and be cold the next, don’t be close one day and distant the next, because by doing that, you are feeding into their fears that nobody is trustworthy, and that will only bring on an extreme response.

Many BPD’s confess that the hardest part of the illness is the social disapprobation and isolation. They do not maintain long-term friendships or relationships, they are at high risk for suicide and self-harm, they vacillate between self-incrimination and feelings of persecution. In short, it’s an instability of their psyche due to being fractured in childhood.

This is among the myriad reasons I condemn child-abusers unreservedly. It is not just rape and abuse, it is messing a child’s life forever when you take someone and you fracture them. If we can take child abuse more seriously and catch more of them before they go on to ruin more people’s lives, this will have the knock-on effect of reducing the numbers of people who grow up to develop BPD and save them from difficult and unfair experiences in life. The one positive of a personality disorder is you can prevent it from happening, we cannot do that with all mental illness but when we can, we have no excuse but to try our hardest.

Advertisements

Mental Health Month “All queered out”

The relationship between the LGBTQ community and Mental Health has long existed. Someone who believed same-sex relationships to be a sin, may point to the mental health ‘sickness’ of those who are attracted to partners of the same gender. This goes back to the seventies where mental health and being queer or transgender, was considered a mental defect/illness. It was not until the early seventies that the bible for Psychiatrists changed this diagnosis and it no longer was considered a mental illness.

During this time of stigma, those who admitted to being queer or transgender were often subjected to camps and programs that attempted to ‘cure’ them of their ‘proclivity’ of course they were unsuccessful but they did a great job of messing up generations of queers, so much so that many stayed in the closet, marrying and having children and never ever admitting who they really were.

Someone who is anti-gay may argue, that means they have a choice because they choose to stay in the closet and marry, they can be normal after all!

There is however, nothing normal about pretending to be someone you are not, and this definitely can be one reason LGBTQ people suffer from a higher than average degree of mental illness.

If it’s an argument of which came first, the chicken and the egg, then you can cross-compare to other studies looking at marginalized and condemned groups such as racial minorities, and see that levels of mental illness rise when bigotry and condemnation in the larger society are directed toward that group. No surprise, hate begets mental illness. It’s not all in your head!

How can hate cause someone to be mentally ill if mental illness is not a mailable and ‘chosen’ ailment? Hate cannot cause someone to get cancer, so how can we argue mental illness is as serious as cancer?

Hate can lead someone to drink too much, smoke too much, and that can cause cancer. It is called an indirect relationship. Cause and effect. The same is true of hate and the LGBTQ community, if you are condemned, judged, shamed, picked on, hated and treated badly day after day, that can literally drive you out of your mind. More commonly, a pre-existing tendency toward certain mental illnesses is exacerbated and tipped over the edge.

This does not mean, anyone ‘chooses’ to be mentally ill, but like anything in life, extreme stress CAN bring on symptoms. They have long known this with Schizophrenia, Bipolar and Borderline Personality Disorder and of course, PTSD has its roots in society as does anxiety. You cannot remove societal influence from the development of a mental illness yet it is as ‘real’ as any other disease in terms of true manifestation and side-effects.

Historically gay and minority populations experienced a high degree of stress and fear. They were having to hide who they were, meet in secret, they could be arrested because their emotions were illegal if expressed physically, and they often had other concerns such as low-income, poor access to care in the community, nobody to talk to honestly and unanswered questions about their own identity.

Our society is typically Heterosexist and Heterodominant because the vast majority of people in our society are heterosexual. It is one thing to show two women kissing, and have a bit of bisexual fun, quite another to be a committed full-time lesbian. Most people don’t relate to that, they may try to understand but that’s like a white person understanding the experiences of a black person, you can only go so far with that.

Thus, LGBTQ are misunderstood at best, and not understood at all at worst, with pastiche and parody being the status-quo. Historically this was even more so, as it was an illegal ‘act’ to be with someone of the same gender sexually (and everyone considered the deviancy of gay sex to be the key to being homosexual rather than thinking for a moment it could be about something other than sex).

Unfortunately a large portion of gay men were so promiscuous it did not help the ’cause’ because they really did live the life style that heterosexuals feared. I do condemn this in the sense that I see no good coming out of sleeping with twenty strangers a night, and whilst that may seem homophobic of me to say, having read the history of HIV and AIDS I see a causal history there as to why homosexual men became one of the earliest groups to be significantly infected by HIV/AIDS. This set the gay cause way back because straight people condemned all gays outright for the actions of the few, and believed HIV/AIDS to be a gay-plague, which of course it was not.

Reading the history of this time, I tried to better understand what would lead gay men to be that promiscuous, my first thought was, a lot of straight men would do the same thing given half the chance! My second thought was, it’s about reaction. Gays were subjected to such strict secrecy and condemnation they could not really be ‘out’ and when finally some cities were tolerant enough to be relatively out, certain populations ran with it. I understand the reaction/action/reaction cycle it exists in every subjugated population to some extent, and every new generation reacts to their parents, it’s a cycle of over-throwing the old for the new. But the level of promiscuity in cities like NYC and San Fransisco was a contributing factor as to why HIV/AIDS initially hit the homosexual male population so hard.

When we consider what a heterosexual who knows little about homosexuality must have thought upon hearing that some homosexual men with HIV/AIDS were sleeping with twenty plus partners a night, as well as doing drugs, it’s not hard to see why there was another wave of backlash against the gay community en mass.

That said, times have somewhat changed and whilst you can still find ‘bath houses’ and gay men (and some lesbians!) who wish to be as promiscuous as those early days, there is also a greater appreciation for actual relationships among the homosexual population. This should be emphasized more in our culture, as heterosexuals still believe homosexuality is about sex, and it is often a very small part of what goes into being a homosexual. The stereotypes are hurtful to the community as a whole, those include the idea that all lesbians are ugly, all queer men are paedophiles, all lesbians are men haters, all bisexuals are sex-addicts, all gay men are perverts.

Going back to mental health … when HIV/AIDS first hit, there were not enough resources to help the gay community, and there was therefore, even less help mentally. After the crisis began to die down and some treatments that worked began to help people live longer and HIV/AIDS was no longer a literal death-sentence a strange thing occurred…. there was a mass influx of extreme depression among the survivors of the ‘gay plague’ as it was known.

Survivor guilt and the depression that comes from severe illness and PTSD (seeing all your friends die) are HUGE factors in the development of mental illness. Some survivors actually deliberately stopped taking their HIV/AIDS medication and let themselves sicken and die because of not being able to stand surviving. They felt they didn’t deserve it. Why me and not my friends?

This was exacerbated by virtually NO resources for gay individuals who needed to talk about what they experienced, witnessed and felt. This still stands, in most cities throughout the US there are no specific mental health services for the homosexual and bisexual and transgender populations.

During my studies as a psychotherapist I sat in a large room with over a 1000 counselors on a briefing about ‘homosexuality and mental health’ during which everyone was told that to be homophobic or intolerant of homosexuality, was incompatible with being a mental health professional. Sounds good huh? Not so good. Of the 1000 there I would easily hazard a guess and say that a third, possibly half, were somewhat prejudiced, very ignorant and possibly homophobic. I say this after hearing them speak, the questions they asked, the people they were.

This is not condemning someone who is homophobic, any more than I would someone who is racist. It is your right. But it’s not legal and it’s not moral. So given this, those people have the difficulty of being legally required NOT to be what they actually privately are. Do you think many of them would admit this? Do you think they would stand up and say ‘I am against homosexual relationships’ and possibly lose their license? For those who are homophobic or anti-gay, you may be shaking your heads and saying ‘this is why it should not be legalized, you are forcing people to feel what they do not’ and I agree with the latter statement.

If you are homophobic you probably shouldn’t be a therapist with the exception of working in a religious community for like-minded people.

If that sounds extreme, well it is. Just as I would say if you are racist you should not work in a public setting but you would be fine in say, a community that supported your views and this cuts both ways (white and black).

LIkewise, if you are sexist, don’t work with the opposite gender.

I’ve been told that when you are a ‘ist’ you should work through your feelings and you should take clients who push your buttons. I don’t agree. Therapy is a fragile experience, and people pick up on intolerance. When I was training I saw and heard enough people to see, they KNOW when you are not comfortable with them. The same goes for ignorance, there is no place for ignorance and therapy when it comes to treatment. If you don’t understand it, refer, refer, refer. To someone who does.

The problem is funding, there are no funds for the queer community because it’s seen like Planned Parenthood as a problem more than anything else.

So if gays don’t have access to good mental health services (and other services) is it any wonder they have higher percentages of certain diseases and mental health issues?

The bottom line is; LGBTQ populations exhibit higher levels of anxiety, depression and alcohol/drug abuse than the standard population. This is not because they are all sex-addicted club fiends who pour drugs down their throats whilst sleeping with twenty partners a night. But the reality of this does lead ignorant people to label mental health as a weakness and point to this as an example. Some even go back to the idea that mental health is a perversion of nature, just as the pilgrims did when they put mentally ill people to death or locked them up.

It doesn’t take long to learn about a group of people you have nothing in common with and it can go a long way. Typically Native Americans ask that therapists working on reservations be of Native American heritage. Some say it should not matter who the helper is, it is more about their willingness to help.

I disagree. It does matter. Just as if you are black and you have been subject to racism you may wish to see another person of color, there’s nothing wrong with that, just as there is nothing wrong with being female and wanting a female gynecologist or therapist.

More gay people need to educate the majority about the specific issues relating to their population so those heterosexual therapists can actually be of some help to queer populations. Even more than that, those therapists who are anti-gay or prejudiced should recuse themselves. Yes – step away – don’t see homosexual patients – do them a favor!

Currently the accepted protocol is to be objective and even if ‘you are personally anti-gay’ you can be objectively helpful to a gay client. That’s ridiculous, no you cannot. I have a friend who is fairly anti-gay and works as a therapist and he is not ever going to be helpful to a gay client and can do more damage than good. Period. I have told him this but until the system changes, his boss and other leaders will insist that anyone, irrespective of their personal beliefs, treat gay clients.

Let’s change this…. and some other things and maybe the rates of mental illness will begin to decline in the LGBTQ population and with it, the high rates of suicide.

 

Mental Health Month “Shame”

SHAME

“Shame on anyone who provokes unnecessary shame.”

For those who have never experienced mental health issues, it may be possible to consider a mentally ill person as wallowing lazily in their feelings of elected sadness. This may provoke a feeling of ‘isn’t it a shame?’ a sense that they are wasting their life choosing to act and behave this way.

Many times the mentally ill person will be quizzed;

Do you work out?

Do you eat right?

Do you sleep enough?

Sometimes those quizzes are not kind queries but have the double-headed effect of sounding like criticisms. The implication being; If you worked out (better or more often) if you ate better (your fault) if you slept well (rather than badly, by choice) you’d not be sick.

I go back to my earlier point, barring cigarette smokers, would we say this to someone who told us they suffered from cancer? (And is it even morally right to condemn a cigarette smoker for his/her part in their disease?).

Who the hell do we think we are?

Well … we think we are the well ones, the ones who have the answers to the malady of elected depression and/or mental-illness. We think this because we have no ability to empathize with a different way of feeling, because we have no experience of it ourselves or we do and we ‘got over it’ so we assume everyone else can.

It’s worth noting, there are differing types of mental illness (no shit Sherlock!) and of those, differing degrees and/or cause/effects. By this I mean the following;

If you are raped, you may suffer depression, anxiety, flash-backs and PTSD afterward. If you don’t that doesn’t make you stronger. If you do that doesn’t make you weaker. Those symptoms may go in a short time, they may persist, they may last ages. It will depend upon a myriad of factors, mainly, whether you had a pre-existing mental illness or not.

If you are already anxious and depressed and you are raped, then it stands to reason, it will exacerbate pre-existing symptoms. If you are not anxious and depressed and you are raped, you may have fewer symptoms because you are not adding to an existing list of symptoms. Again, taht doesn’t reflect how strong you are.

See it this way … if you have an auto immune disease like thyroid, you are at higher risk of getting another auto immune disease. That’s because whatever propensity predisposes you to the development of the auto immune disease, makes you vulnerable to others because they work similarly as they have ‘auto immune’ in common.

With mental illness, people with bipolar often experience Borderline Personality Disorder at the same time, and ADHD. People with Depression often experience Anxiety at the same time.

Sounds bad?

The propensity is by no means a death sentence, it’s just like saying if you have red hair you are more likely to get skin cancer than if you have dark skin, but dark skinned people CAN get skin cancer and not every red head does. Propensity is not a certainty as there are other (epigenetic) factors at play as well as our friend CHANCE.

And chance, almost rhymes with choice – bringing us back to the point. Shame is a choice. It’s a choice we as people who experience mental illness can make, to avoid as much as possible, and it’s a choice people who know mentally ill people can make when they deal with them.

You can choose to treat others as you would wish to be treated. The law of karma let’s call it.

Or you can choose to satisify some blood lust within you and make someone else feel very, very bad. Yeah you have that power, you are almost a super hero – not.

Shame is inextricorbly linked with sexual abuse in childhood, rape, molestation, illness, rejection, certain religions, gender, sexuality and other societal conventions that often it appears, seek to remind us we are not good.

As women we are told, we are dirty if we sleep around.

As children we are told, we are perverted if we masturbate.

As loners we are told, we’re weird because we prefer a book to company.

The list goes on. It’s safe to say, it appears a fond past-time of humanity to judge and to shame. And we don’t have to be in 1600’s Salem!

Just because it’s 2017 don’t think this practice has stopped. We can find it in bullying, which incidentally, is the number one cause of teen suicide. We can find it in work-place bullying which owes a distinction because it affects older people and is growing in prevelency world-wide. We can find it in older populations who are ignored, neglected, considered less important and ‘past it’ to be contributors. We can find it in minority groups and ethnic groups, same-sex relationships, gender roles and identity or lack of, and all the shades inbetween.

My grandmother used to say; People don’t like what they can’t understand and they don’t like difference.

So I guess, if you’re left-handed, queer, red-haired, freckled, hazel-eyed and autistic you might feel left out.

Okay so that’s an extreme but how many of us don’t entirely fit in some way?

You only need to be into one thing others aren’t, or not like wearing dresses, or burn instead of tan, or have darker pigment than your other family members, to experience the feeling of shame imposed upon you by a bizzare set of ideals and rules.

In other words it’s modern society or as I like to call it, torture.

Except this didn’t start just recently, it started when we began to communicate with each other (read Vanity Fair the novel if in doubt) we use shame and shaming as a coping mechanism (attack other before we are attacked) a weapon (divide and conquer) and a tool (defeat the others first, win). Society is a battle-field. For the mentally ill they are easy targets, who among us who struggles to get out of bed in the morning can handle much more?

Even when someone doesn’t know it, they can shame others. It is very common place to say things without meaning them in a bad way. Perfectly ‘good’ and kind people can inadvertantly say something that can be taken the wrong way ‘I wish you felt better!’ and pain ensues.

Obviously you don’t want to walk around on tiptoe when talking to someone who is suffering, but at the same time, just as we should be aware of the sensitivity of other subjects we should consider the sensitivity of how we address depression and other mental diseases.

Not everyone who is bipolar is a mass murderer or school shooter

Not everyone who is schizophrenic will kill their parents

Not everyone who is depressed will jump off Golden Gate Bridge

But some may and those tiny minorities are but the extremes. Beneath those few extremes lie shades of grey. The depressed person who cuts themselves, the anorexic who develops heart problems, the BPD who alienates people and ends up alone, the bipolar or cannot read a book, and so it goes on.

Everyone has something. If we remember that, then we can treat mental disease the way it should be treated, as a disease, an illness, but not the sum of a person, only an element of their whole. Something to be conscious of, aware of, sensitive to, without stereotyping the whole.

The best technique in the world? Listen to what a person has to say. You can learn a lot. And by doing this, you afford an opportunity for your friend to speak about things without a feeling of shame or judgement. In the long run this acts much like talk therapy and can be incredibly cathartic as well as a really good way of realizing, mental illness doesn’t define you.

Mental Health Month

Fortunately quite a few people are making time for this important subject. Raising awareness.

Before you click off thinking; “I’ve heard this before / I know this already” consider the following;

  1. If you have not suffered from a mental health issue you’re in the minority

2. More people die from mental health influenced factors than anything else

3. There is today more depression in the western hemisphere than ever before and our answer is to medicate using medication that is poorly proven to resolve depression and was only ever meant as a temporary solution, with therapy a rare and restricted ‘luxury’

4. We are cutting back so many mental health resources we now have less than we did in 1970, yes that means we’re going backwards not forward

5. Whilst some mental health issues are better known and understood today than 40 years ago, the terrible truth is … they are judged just as much as they were before people knew more about them and those who suffer from mental illness are often pushed to breaking-point by others who see mental-illnesses as a “choice” even by carelessly chosen words.

Words like – Depression is looking back / anxiety is looking forward / wellness is in the present.

People may say things like ‘snap out of it’ and be well meaning even but imagine saying that to someone who has cancer?

The implied condemnation / judgement / criticism or just put-down in many ‘helpful’ comments furthers the progression of the disease.

Ultimately mental health is seen as a sign of character. If you are mentally ill you have a weak character. If you are not mentally ill you have a strong character. Follow the progression of that.

Strength does not come into whether someone is mentally ill or not, any more than if someone has breast cancer. But like blaming a smoker for their lung cancer, most people see mental illness as something that someone can change ‘if they just tried’ and more of a character flaw, a negativity, a bad attitude, than a crippling, life-reducing disease.

Still think we don’t need to talk about mental illness?