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.

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Mental Health Month “Friends without benefits”

Friendship.

Watching TV shows, reading books, the influence of an ideal, ‘friends forever’ the friends who are there when you need them, friends for life, friends through thick and thin.

Probably should preface this with “unless you are mentally ill”

Why?

Mentally ill people struggle to maintain life-long friendships and connections. An unkind soul may say “can you blame anyone for not being able to put up with THAT?”

Yes.

One reason mentally ill people struggle is the sense of isolation, loss, abandonment, and judgement, all discussed before. Friendship and ties to the community is the basis for survival for most people. Isolation and rejection can lead to suicide and worsening illness. It is not the duty of anyone to befriend a mentally ill person but equally as a society if we put our rapid judgement aside and turned from only seeking ‘fun happy people’ to socialize with, and gave a little thought to those suffering, our empathy would go a long way.

We are selfish on the whole when it comes to friendships. We don’t want to ‘bother’ too much, we don’t want to make an effort. We want something easy and fun. If it’s not we’re likely to drop it.

But the effort we put into our children, our families, our marriages, should equally be considered when looking at friends in need. If we cannot be a good friend are we even a friend? Or are we just a fair-weather friend?

Many people I have spoken with have talked about how much it hurt to be ‘friend dumped’ and how often this occurs when they are going through a hard time. The worst being, it can compound the already existing feelings of worthlessness and self-blame.

It is not the responsibility of others to take care of mentally ill people but it begs the question … if you are only friends with someone when the going is good, are you really friends? If you only want to be friends with someone without any strings attached and no difficult times, how invested are you? In short, are you even a friend?

Friendship is perhaps an art that is lost on us these days, with our increasingly ‘busy’ lives and selfish preoccupations. But remember, society functions well when all of us care about those in our society. If we simply live for ourselves and give no regard to others and their well-being, are we really the good and giving people we envision ourselves to be?

If we are Christian is this the Christian way? If we are Buddhist is this the way of the Buddha? If we are aiming for empathy and treating others as we would hope we would be treated, are we acting accordingly? What would happen if we suffered from a mental illness? What would we expect?

It is worthwhile considering this. A close friend of mine became incredibly ill with a brain tumor and she observed that she lost many friends, including those who went to her church. It showed her the time observed adage that you know who your friends are in your moments of crisis and need. This is where physical and mental health share something in common, in both instances, people flee the individual like rats from a sinking ship.

Finally we can say this is something both mentally ill and physically ill people experience. But why?

People are afraid of illness. They see someone with a brain tumor and act like it’s contagious. They know it’s not logically but this is an instinctive fear. They want to avoid sadness at any cost, they want to avoid reality at any cost, nobody wants to dwell on the possibility of death. It takes a very strong soul to want to go there.

Consequently at your time of need, the very hour you really need people there, you are deserted. Before I began visiting the hospital regularly I was completely unaware of this, I had no idea how many hospital rooms were emptied of visitors and support systems, how many go without any friends to comfort them in their hour of need.

I recall as a kid going to see a friend who was diagnosed with schizophrenia in the state hospital and how he talked about losing all of his friends. It seems like not much has changed.

And ask yourself this … how much would it take to care?

Recently another acquaintance developed Terminal Stage 4 Ovarian Cancer, when asked, her colleagues, who had worked with her for TWENTY YEARS put off going to visit, until someone posted on Facebook ‘she’s going to die! Go see her before she does!’ and then, the herd mentality took over and everyone went to visit. It was ingenuous and false, and I came to see, these people who had worked with this woman for two decades, really didn’t care, they wanted it over with.

I understand the knee jerk response to death and all things unpleasant, but we’re all going to die, is this how we would wish others to react to us? Empathy means, consideration of how we treat others, as much as how others treat us, and the two are connected by an understanding that it cannot be a one way street. As painful as it may be, supporting those in their hour of need is what makes the world a better place. If we are too busy to attend to that, what does it say about our priorities?

The same applies to the mentally ill. This can literally be a life saver, a life line, a much-needed support network. Suicide often occurs because of isolation and a feeling that the world would be a better place if I were not in it. Surely losing friends and being ignored, adds to that feeling and thus, the reverse is true if loyalty and constancy exist.

Obviously some friendships have an expiry date and that’s okay, that’s the nature of the beast, but if you’ve stopped calling someone because you are fed-up with their mental illness and it’s not ‘fun anymore’ consider this, what would you want if you were going through the same thing? Should friendship simply be about benefits?

Mental Health Month “the invisible mentally ill”

Most people when faced with the knowledge someone is mentally ill says

why don’t you just get some help?

therein lies the rub

this writer can attest, ‘getting help’ isn’t as easy as clicking your red shoes together

In the US today there are large portions of what I term ‘shut-in depressives’ those people who are under-or-un diagnosed as suffering from Major Depressive Disorder. They are typically under-employed/unemployed/self-employed or on a pension. They do not factor into many of our statistics in this country. If we added them, imagine how much the landscape of mental health in this country would change? IE; More sick people than we realized.

Why aren’t they counted?

Many times if you aren’t insured by your full-time job you don’t have access to mental health resources. Even with insurance you are severely restricted to how much you can obtain. Individuals with this coverage often fear being discovered and do not use it, or fear the stigma from doctors who if they see ‘anxiety’ on your medical chart, will literally see any illness you have as being psychosomatic (in your head) so … chest pain? Anxiety. Headaches? Anxiety.

My friend who had headaches and was mentally ill was told, it’s anxiety.

It was a brain tumor.

Secondly; Those who are not full-time employees of a company who still insures their workers (and this is growing daily) has to purchase their own insurance. If you consider the cost of say, one of the lowest plans, at $450 a month, a car payment, plus a $8k deductible that has to be paid out of your pocket before you can begin being covered, how many people working say, part-time or a low to medium wage job can afford that? May as well not have insurance!

Of course if you want to pay out $900 a month like a friend of mine, you get great insurance. $900 will also pay for a rented apartment per month.

Thirdly; Those who choose not to go with the self-pay medical insurance are not irresponsible they are normal working folk who cannot afford to pay that much per month. They rely upon pay-as-you-go services like walk-in-clinics. Such clinics cannot refer you up the chain, so they’re great for a sprain or ant bites, not so good if there’s something seriously wrong.

Forth; The ER. The USA has seen huge numbers of people coming into local ER’s with mental health problems, they are second to major car accidents seen at ER’s and typically include the homeless, the low-income, the undocumented, and students. This is a short-term solution. If you are having a manic episode they will pump you full of pills, give you a script, a few lists of people you can follow-up with and send you on your way after a 3 day hold. Given that most state-run hospitals for mental illness were closed in favor of ‘care in the community’ more mentally ill people can be found in jail and prison than anywhere else. Second to that, the streets.

But what we do not consider, are the numbers of invisible mentally ill who fall through the cracks and defy the stereotypes. I will call those people high-functioning mentally ill, by this I do not mean they are ‘better’ than the mentally ill man on the street, but they are able to cover their mental illness a little more, and ‘act’ more functioning. This is the same as a high-functioning alcoholic, and it does in no way suggest those who are not, are weaker.

The high-functioning depressive is typically older. We hear a lot about teen depression because of the higher rates of suicide upon early diagnosis among teens. There are more resources for teens and young people than middle-aged brackets because the two age groups highest for suicide are the very young and the very old.

Where does that leave the 30-year-old mother suffering from postpartum depression or the 35-year-old man who is living in the back of his parents garden in a trailer or the 45-year-old wife who drinks during the day to cope?

The invisible and the high-functioning (because both are not mutually exclusive) walk among us. Typically if you ask them how they are doing they will say ‘fine’ and you will know they do not mean it but you will not ask them more and they will know they do not mean it and will not offer more. Why? Because unlike at 16 when you trust the world to want to listen, a few years down the road you get it, nobody wants to know.

And it’s not just that nobody wants to know about depression it’s that nobody wants to know a depressive, or be friends with a depressive, or be married to a depressive, or date a depressive, or hang out with a depressive.

Does that sound harsh? Do you feel the need to defend?

It’s a harsh truth because if you asked anyone, yourself included, would you rather be friends with someone who is depressive or not, most people statistically check the ‘not’ box. Does that mean if you are dating someone who reveals they are depressed you will automatically dump them? No because you are invested and loyal. But if you went on a dating site, would you choose the profile of someone who says they are depressed most of the time? A few will say yes, and mean it, but the majority, will not.

And that’s the crux of it. It’s a circular self-fulfilling prophecy.

The depressed person – puts off the non-depressed – by their sense of isolation and loneliness – and becomes more lonely and isolated because their depression causes others to avoid them.

So feeling isolated breeds more isolation in effect.

And they still say … snap out of it (like anyone who feels this way, is choosing that for a fun buzz)

Now, to be fair, isn’t it understandable and isn’t it unfair to expect people who are not depressed to ‘friend a depressive’ and be responsible for cheering them up? Sure. But that’s not what a depressed person needs. They know their partner, sister, mom, aunt cannot ‘cheer them up’ because it doesn’t work like that, and neither do magic wands.

What a depressed person wants is the same as what everyone else wants. They want to be accepted for who they are, they want to be respected, they want to be liked, they want to be loved.

But on the other hand they are battling feelings of isolation, alienation, despair, panic, anxiety, fear, nightmares, terror, self-hate, phobias, sensitivity and paranoia.

You may say, well if someone is paranoid then how am I supposed to help them?

Again, it’s not your job to ‘help’ it’s your role if you choose, to be in their life, just like you would anyone else.

For most this is a difficult chore. They find it hard when the depressed person bails on them because they cannot get out of bed, when they have a melt down for no apparent reason, when they are quiet and not talkative, when nothing they do seems to make them happy.

Oh happiness, the illusive demon for the depressed, always out of reach.

Or in the case of the bipolar, there, gone, there, gone, there, gone.

No depressed person or mentally ill person chooses their burden, and yet, the world is intolerant of their disease in a way that is unique to mental illness.

The next question has to be … why? We’ll deal with that in a future post.

So the bottom line is – among us today are many who are invisible to mental health services (of which there are precious few). They are not poor enough for the very lowest income options, they are not well off enough to realistically afford their own insurance, coverage or get a job that will provide that, and as America was founded on the work ethic and our health care was tied to our ability to work this was a problem that bore the need for alternatives, which we now have, but they are so expensive it defeats the point.

Where does the stay at home mom or stay at home wife, or part-time-worker with depression go to get help and treatment that is reliable, cost-effect, consistent and long enough in duration to have any effect?

Having lived in several countries I am in a position to attest, it’s not that much better in other countries. There are more services literally speaking in countries with socialized healthcare but they are so full as to be practically redundant for the complex needs of their societies. I have yet to find a model I would use to base future health care ideals upon.

Then of course you have countries like India, China, Russia, that have a mixed-bag in terms of their approaches to the issue of mental health. For some, it’s almost akin to a crime, for others, admitting it will effectively condemn you to forced inadequate treatments and large-scale stigmatization (more on stigma and shame in future posts) and others socially encourage the condemnation of the mentally ill so that it’s not even discussed and acknowledged.

So as a whole, when we look at all the countries that make up our planet, we are failing to help those who have mental illness, really, really failing. And worst still, there are those among us, who we don’t even know are suffering, who have nowhere to turn, and effectively subsist rather than exist.

You can see them if you look close enough. But most of us don’t want to, or are too ‘busy’ to care. With everything in our ever-busy lives, when do we have time? The only ones who may really try to do something, are going to be our nearest and dearest and for many depressed people there are no nearest and dearest.

What if you are alone more or less and you are mentally ill and you don’t have money, where do you go?

Posing this question to a mentally ill person in the midst of a crisis they are likely as not to say, I’d just give up and take my own life.

Next time you judge someone for being suicidal, consider, have we left many other options for them?