Category Archives: Borderline Personality Disorder

BORDERLINE PERSONALITY DISORDER: INTRODUCING A TRILOGY

connor-kinsella-jck-training Sian5 

I’ve known Siân Lacey Taylder for many years. A shared masochistic love of a) writing and b) a non-league football team sort of brought us together a long time ago, but it was much later on I discovered her history of Borderline Personality Disorder (BPD). It never was and still isn’t a big deal to me, and I can’t actually remember how I came to know, probably because it doesn’t matter. I love her writing, she’s thoroughly individual and supports Weymouth Football Club, so that’s quite enough for me.

But there is one area where perhaps we’re not quite on the same team. I spent many years as a mental health nurse, particularly in forensic secure units. Siân has spent many years living with BPD. I’ve helped physically restrain people like Siân, usually in an attempt to stop patients gouging their eyes out or rip their arm to shreds with pieces of glass. If some parts of the blogosphere and Twitter are to be believed, I’ve more than played my part in a rather nasty, controlling, self-serving, stigmatising and hugely anti-therapeutic mental health ‘system’. And Siân has been one of our victims. We shouldn’t get on. But we do.

We first posted these articles in the summer of 2012 following a conversation where I moaned about my fellow mental health professionals being at least under-appreciated and at worst, branded as some sort of fascist movement dedicated to making the lives of the mentally ill as impossible as possible. So taking her own experiences of BPD and often less than positive contact with ‘the system’ as a starting point, we thought we’d put this series together.

A recent Twitter discussion on the @mhchat community featured BPD and while I didn’t catch it ‘live’ it certainly caught my attention later, not least because of a number of comments from service users highlighting some of the issues which had precipitated the original series, and the fact that as a trainer I’m currently rewriting and updating a shortish book on personality disorder aimed at mental health professionals and community mental health workers. I could have just posted a link but soon discovered that WordPress had somehow mangled the formatting of the original work so here I am rewriting and reformatting my contributions while leaving my collaborator’s  contributions in their original and, in my opinion, highly readable state.

Part 1 is a very personal account of BPD from Siân herself. She describes the ‘good Siân’, the ‘gregarious, outgoing, quirky, generous’ person who is very good company and makes people like me like her very much. And she describes the ‘bad Sian’. The one whom ‘mental health professionals would like to eradicate from the face of the earth.’

In Part 2 she looks at some of the pitfalls of the mental health system and how labels such as ‘Borderline’ have proved so spectacularly unsuccessful at describing or helping someone as atypical as she is. But (and it’s a big ‘but’) do professionals and service users really have to be so many poles apart, and might we work together more effectively?

Finally in Part 3, I put a mental health professionals viewpoint on Siân’s observations. And while certainly not agreeing 100% with all she has to say, I ask if it’s possible for both the online and real-world camps of professionals and survivors to ‘put down the weapons’ and work more collaboratively, more imaginatively with a disorder which is so often castigated and misunderstood by so many.

BORDERLINE PERSONALITY DISORDER: PART 1 OF A GUEST SERIES FROM SIAN LACEY TAYLDER

 Sian5

When Connor very kindly asked me to contribute to his excellent blog from the perspective of someone living with BPD (Borderline Personality Disorder) I think he was preparing himself for a metaphorical kicking. ‘I’m getting a bit hot under the collar over the survivor movement’s constant haranguing of the mental health professions’ he told me, as if he could almost feel me winding myself to vent my spleen.

I want to say ‘it ain’t so’ but that would be telling an untruth. The two sides of the equation – let’s call them ‘the professional’ and ‘the patient’ – ought to be travelling in the same direction, should, really, be striving for the same goal but I would suggest that isn’t always the case.

Why? Surely ‘the professional’ works with ‘the patient’ and in her/his interest? To answer that question I would like to describe, in sometimes quite graphic detail, the ‘realities’ of living with BPD and its various relatives (amongst others Narcissistic Personality Disorder, Paranoid Personality Disorder). Forget, for a few minutes, any textbook or clinical definitions, put any preconceptions to on side and try to see how from my perspective.

Let me begin by stating the bleeding obvious. There is no typical BPD ‘sufferer’ and maybe the condition lends itself to a greater variety of manifestations than other, similar, maladies. There is no one-size-fits-all and therein, I think, lies the first of the problems I would argue that the mental health profession – not necessarily the practitioners but the managers and commissioners, still believe in a universal panacea.

That stipulation – not necessarily the practitioners but the managers and commissioners – will become a recurring theme.

Some of the clichés are true enough. The underlying theme is one of instability and insecurity, in every aspect of life: emotional, professional, financial. But ‘instability’ is a pejorative term; in the mindset of the mental health professional it’s symptom of BPD that really must be cured and I think that’s something we need to address.

More of that anon. I haven’t yet mentioned the almost fanatical devotion to extremes. Everything is black or white; there can be nothing inbetween. Grey represents tedium and orthodoxy, the mediocre and the banal; characteristics that should not just be avoided but sought out and destroyed at all costs. I once had a psychotherapist who tried to persuade me that the grey was, in fact, in silver. I was lost in a haze of antidepressants at the time and she very nearly fooled me.

Very nearly, but not quite because deep down inside, you see, I don’t want to be ‘cured’. I’ve become so viscerally hostile to anything that might be construed as conformity or compromise that it might appear, to the neutral and/or relatively rational observer, that I seek out adversity even in places where it doesn’t really exist. For example, writing this essay – some would call it a rant – I soon realised that I wanted the reader to either love me or hate me; the last thing I desire is pity because pity is the preserve of the weak and the wretched. I don’t so self-pity, I don’t do misery; I only do self-destruct.

And that’s the Narcissistic aspect of BPD. I’m so often overcome with loathing for my fellow human beings that I could easily be mistaken for a misanthrope. Yet when I love someone I love them with a passion that soon veers into self-destruct. I rarely vent my anger on others; hatred – and violence – always turns in on itself.

BPD has led in more directions than there are points on the compass. On the negative side it fuelled a latent gender dysphoria which ended up in gender reassignment surgery (in tabloid talk that’s a sex-change). It’s brought me to the verge of alcoholism and anorexia and encourage – yes, encouraged – me not only to self-harm but to revel in it; for several years gin and a sharp blade were my constant and sometimes exclusive bedfellows and I would literally spend hours gazing lovingly at the rows of knives on display in my local supermarkets. I tread a thin line between wealth and destitution; I’m perennially in debt because I don’t understand money in the same way as many of you do. If it’s there, I spend it; if it’s not, I borrow or blag and something always comes up in the end.

You can see how it can lead to a precarious existence. One more than one occasion BPD compelled me to quit my job, my home and my family to seek refuge on the other side of the world but guess what? Those bastard little demons saw it coming; they packed their bags and followed me; they turned up in El Salvador 48 hours later on my hotel doorstep.

You don’t believe me? Ask the duty manager; he’s the one who talked me down. And he didn’t laugh when I told him that although I hated those bastard little demons I couldn’t live without them. If there’s one phrase that defines the nature of my BPD it’s my relationship with those bastard little demons; I’m drawn to that which ought to repel me. Like a moth to a flame.

Finally it drove me to two overdoses, the latter of which was, I concede, pretty damned stupid and could well have proved fatal. But I survived. And you know what I’m going to say next, don’t you?
I don’t regret any of it.

Because, ridiculous as it might seem, there are positives and even if they appear to you to be vastly outweighed by the negatives, and if you were to offer me a pill or a course of therapy that put everything on an even keel I’d tell you where to stick it. What you call normality I call subservience; what you call instability I call a voyage of self-exploration. You’ll note how everything revolves around the self; the ego is the sun around which the rest of humanity must revolve. There are those who know me who would speak of my gregarious, outgoing personality – and that’s the key word, isn’t it? Personality. They would describe me as generous of spirit, intelligent, quirky and good company but they would be describing the ‘good’ Siân; some of them have known me long enough to come across the ‘bad’ Siân but she keeps herself to herself; locked away in her own little world.

The ‘bad’ Siân, of course, is the Siân the mental health professionals want to treat. They’d like to eradicate her from the face of the earth. Trouble is, more often than not I prefer the ‘bad’ to the ‘good’ and I don’t want to be rid of either.

Still with me? Well done! Now, with Connor’s permission I shall, in the second and concluding part of this polemic I shall endeavour to find some common ground on which mental health professional and service users might meet and smoke the pipe of peace.
It’s not going to be easy!

Siân is author of The Society of Sin, a Victorian Goth-erotic fiction inspired by her Dorset connections, and is currently in the process of publishing her autobiographical novel Death by Eyeliner. You can find out more about her here.

BORDERLINE PERSONALITY DISORDER: PART 2 OF A GUEST SERIES FROM SIÂN LACEY TAYLDER

Sian5 

You should know that some of my best friends are mental health professionals. Indeed, my best friend is a clinical psychologist and I’ve nothing against the profession per se. True, there have been occasions when the system has let me down – sometimes quite badly. Like the time when, in the immediate aftermath of a serious trauma, a trainee RMN pitched up with the suggestion that I be referred to an alcohol dependency unit without being aware of my specific circumstances (I had, as it happens, just been raped).

Or the time my GP sent me to the local A&E because I’d carved ‘Siân is a bitch’ into my forearms (yes, I even did the circumflex); the duty psychiatric nurse asked me a few cursory questions then told me to ask my doctor for a course of Prozac.

Or the time when, sensing an imminent descent into the emotional abyss, I contacted my local community mental health team to ask for help. The reply I received was courteous but patronising, more or less implying that unless I staggered into the surgery with my wrists already slashed there was nothing they could do.

The upshot of all this? The worst in short-term planning. Instead of trying to avert the crisis why not wait until it comes crashing through your front door in all its bloody glory? Those few pennies you might save by limiting preventative care will be peanuts when you’re presented with the bill for my incapacity to engage with society – and pay my taxes.

Please don’t misunderstand me. I’m not suggesting the entire NHS should rearrange its priorities to account for my every change in mood swing, and I’m sure some of you – from the Julie Burchill School of Empathy, perhaps – will be shouting at your computer telling me to get a grip. I don’t want your pity, I really, really don’t; all I’m asking for is a little more consistency and some ‘joined up thinking’.

For example: I have been, more than once, referred to a therapist of some kind but the referral always comes with some sort of proviso. Normally it’s a limited number of sessions; last time it was six which was just about time for us to get to know each other. I had the option to continue on a private basis but a recent outbreak of BPD had left me with a paltry, part-time income.

Then there was the time I struck up a productive relationship with a Freudian psychotherapist. What should have been – and did, indeed, start out as – a fractious, adversarial relationship ended up like a marriage made in heaven.

Does it sound like a physical relationship? In some ways it was – only without the intimate contact, of course – because it has to be intense. Sadly, after a summer of psychotherapy, she suddenly disappeared. I never did find out what happened to her; I managed, eventually, to get an appointment with someone else but when I told him I was feeling better he declared me fully restored to health and no longer in need of therapeutic support.

Three months later I was up to my old tricks again and never really let up for the best part of eight years. I should add that in all that time various GPs, medical professionals and even the police were nothing less than understanding; what constrained them, what we were all fighting against, was – still is – an inflexible, unimaginative system. A system that insists that mental illness is no longer taboo but hasn’t yet worked out how to deal with it. Whether through ignorance, lack of funding or wilful desire, it just doesn’t take us seriously.

But I’ll say it again. I don’t want your pity and I certainly don’t want to stretch the resources of an increasingly-underfunded public service which, in any case, can’t offer much more than a metaphorical plaster and a patronising pat-on-the-head. On the basis that prevention is usually better than cure what I would really like to see is a radical rethink on the nature of BPD; of what it means to be sane or insane. It’s an argument that is more sociological than medical because BPD is as much a political condition as a psychological malady.

In Madness Explained, an excellent exposé of the myths surrounding mental health, Richard P Bentall argues that mental illness is not a product of brain dysfunction than can be cured – usually with medication – but a series of symptoms only a minority of which cause significant problems for the ‘sufferer’. In the words of one Amazon reviewer ‘I go to the doctors and they want to drug me to get rid of everything ‘wrong’ with me and flatten my personality … when only 10% of these symptoms are actually causing me any distress!’

Perhaps we should dissect the nomenclature. According to Bentall, the term Borderline Personality Disorder was coined to ‘describe a type of personality characterised by extreme emotional instability, severe problems of self-esteem, self-destructive behaviours and intense and unstable relationships with others’. All well and good; that’s an accurate-enough description of my own condition but phrased in a manner which would seem to render me pretty much incapable of living anything resembling a ‘normal’ life.

Not that I’ve any desire to live a ‘normal’ life; sounds like complete and utter madness to me. The fortunate truth is that I’m perfectly capable of being a fully-functioning, productive member of society – for most of the time. There are certain environments in which I couldn’t survive: the office, the nine-to-five; the corporate world or the micro-managing boss. But within the relative freedom of self-employment I thrive.

But society loves labels; whether it’s class, race, gender or sexuality it insists on packaging the relevant behaviour and prescribing it as the norm. Then capitalism comes in and sells it back to us; we no longer live lifestyles, we consume them.

Society will tolerate a certain amount of variation from the norm – the English love an eccentric, after all – but it also has its boundaries and when we transgress them we are considered deviant.

Deviant, disordered and, sometimes, dangerous.

Because that’s what it all boils down to, isn’t it? My personality is on the borderline; the borderline of what? Of what society perceives as functional and dysfunctional? Normal and abnormal? If, during a period of intense emotional distress, I feel compelled to cut myself I am doing so for a reason. I don’t expect to be condemned for my behaviour and even on the warmest summer day I’ll cover up the scars to spare your distress.

The problem is that the cutting comes with the territory; it’s a coping strategy to deal with a society I consider to be alien and hostile (there’s the paranoia talking) and any attempt to treat it, to remove it from my emotional repertoire, would be tantamount to a full-frontal lobotomy. It would kill my creativity, imagination and character stone dead.

Your sanity is my insanity; your chaos my order. Madness is as much environmental as it is neurological, if not more so. I’m a bit like a snake in the grass: leave me to my own desires and I’ll cause you no harm; trap me and try to change me and I’ll do my best to bite back.

If you missed Part 1 of our BPD trilogy, it’s here.

Siân is author of The Society of Sin, a Victorian Goth-erotic fiction inspired by her Dorset connections, and is currently in the process of publishing her autobiographical novel Death by Eyeliner. You can find out more about her here.

BORDERLINE PERSONALITY DISORDER: PART 3 OF A TRILOGY FROM SIAN LACEY TAYLDER AND CONNOR KINSELLA

connor-kinsella-jck-training 

As an author and trainer I’ve written enough about mental health to wallpaper a small room. I’ve travelled the length and breadth of the country running courses on personality disorder, and can list the DSM-IV diagnostic criteria while hopping on one leg and loading the dishwasher. I’ve also spent many years working with personality disordered people in secure units, in acute admission wards, in the community. I’ve spent literally hours at a time trying to prevent patients gouging out their eyes, setting fire to themselves or trying to hang themselves with a bath towel, all the while trying to avoid the saliva aimed at my face and blotting out the screaming and shouting with ‘nice thoughts’ about home, family and the post-shift kebab. 

So I know a lot about BPD, then? Er, actually no.
Before reading Siân’s posts I assumed, with the eyes of one who has for many years seen BPD from the ‘professional’ side of the ward or treatment room, that BPD rendered a more or less constant diet of chaos, misery, institutionalisation and sometimes death. Through training and writing I try hard to dispel the idea that all individuals with BPD are manipulative, wildly emotional and self-destructive, but if you’re paid to treat or support people with this diagnosis, it’s always seen as bloody hard work and universally unpopular.
I was keen to hear Siân’s account of her encounters with ‘the system’. I’m certainly no apologist for the many, many faults of a mental health structure which has not so much failed over the years but never really got it’s act together in the first place.
As Siân puts it, we have: “A system that insists that mental illness is no longer taboo but hasn’t yet worked out how to deal with it. Whether through ignorance, lack of funding or wilful desire, it just doesn’t take us seriously.”
And it’s just this sort of voice I wanted readers to hear as opposed to some of the increasingly ‘shouty’ anti-psychiatry stuff spouted on just about any online forum having the words ‘mental’ and ‘health’ in the title. I asked Siân for a service user perspective that might inform and stimulate without stereotyping all mental health workers as a battalion of burnt-out, syringe brandishing stormtroopers whipping out section papers at the mere suggestion of deviation from the cultural norm.
To quote Siân again: “The two sides of the equation – let’s call them ‘the professional’ and ‘the patient’ – ought to be travelling in the same direction, should, really, be striving for the same goal but I would suggest that isn’t always the case.”
No it most certainly isn’t, for reasons that are far more widespread and complex than can be tested on the attention span of our readership. But I’d like to think that my guest blogger has eschewed anti-psychiatry polemic for a considered argument as to where at least some of the problems emerge. Siân highlights a rigid mental health care bureaucracy focussed on crisis management and firefighting, often where an inferno might have been averted with the pre-emptive application of a damp tea towel. And please let’s not have any ‘lack of resources’ argument here. Early intervention can save lives AND money.
At the more individual end of the scale, Siân offers us a glimpse of the ‘piss poor professional’. This is a phenomenon I know only too well as being far too common in the caring professions and about which I’ve guest posted in the Not So Big Society blog.

I probably don’t agree wholeheartedly with everything Siân argues. As a self-confessed science nerd I’m actually quite excited by much of the recent research evidence pouring out of the world’s ever growing collection of CAT and MRI scanners. I would argue argue that neither BPD nor any other mental disorder cannot be explained purely by environmental circumstances or social construction. But like Siân I do believe very strongly that ‘patient’ and ‘professional’ should be travelling in the same direction. So how can we do this?

Only by both sides dropping their weapons and beginning to realise that there is nature AND nurture, that there is medication AND talking treatments, that not anyone wearing an NHS badge is the spawn of Satan and that not everyone labelled as BPD is a spitting, screaming attention-seeking nightmare. A little understanding could go a long way on both sides of the void.
I could go on but let’s save that for another time. To paraphrase Star Trek’s Mr Spock, sometimes the needs of the reader outweigh those of the blogger, so let’s just leave it there and say a very big Thank You to Sian Lacey Taylder.

If you missed Part 1 of our BPD trilogy, it’s here, and Part 2 is here.

Siân is author of The Society of Sin, a Victorian Goth-erotic fiction inspired by her Dorset connections, and is currently in the process of publishing her autobiographical novel Death by Eyeliner. You can find out more about her here.