Monday, 2 December 2013

BPD Blessing or Curse?

I love detective shows. One of my favourites is Wallander. He struggled with an illness for most of the first series before reaching crisis point and finally being diagnosed. Now, the exact name escapes me, but his diagnosis both troubled him and made him laugh as it was called something like 'blob'. Each time he told someone his news and the name of his 'diagnosis' he both laughed and took the opportunity to explain what he understood of his condition and how this would affect his life in the future.

If only Mental Health diagnoses were as simple as Wallander's 'blob'. I have a friend who thinks that I shouldn't be as comfortable with my diagnosis of Borderline Personality Disorder with co-morbidity of Clinical Depression as I am. He feels that the word 'disorder' is an insult to me and the stigma of the diagnosis will hinder me rather than help me.

I understand his reservations and I have, as a professional, encountered the assumptions prevalent in some areas that this is not a treatable condition,that those of us who exhibit 'emotional sensitivity' to the extent that we require intervention, are among the most difficult of service users and that we absorb more resources than is warranted. In short, I have heard BPD sufferers described as 'manipulative', 'difficult', 'emotionally blackmailing' and 'highly volatile', by fellow professionals when working in the Criminal Justice System. Unfortunately, the most prejudiced views came from colleagues within Mental Health teams who sought to distance themselves from managing 'these people' and kept telling us that the anti-social behaviour displayed by some BPD offenders was a 'criminal justice' problem and one that had no answer within the psychiatric or psychological community. Then slowly, just before my own diagnosis in 2009, whispers began of a 'treatment'(Dialectical Behaviour Therapy) available for BPD which began in America. Suddenly, this has become a diagnosis with hope for management if not cure. However, I wonder if the optimism of those working within DBT has communicated itself to other medical professionals who have limited contact with BPD or DBT?

Some observations of me and my 'diagnosis'.

1. Although the title 'Borderline Personality Disorder' indicates that I have a fundamental flaw in my very being I don't see it as such, but as a failure of language and semantics to adequately explain complex emotional distress and its impact on my ability to live a fulfilled life.

2. The reality of resource allocation determines that resources follow need and risk. If a nomenclature encapsulates a cluster of symptoms which are shared among a significant group using local resources, then it follows that it is easier to identify the need for those resources to be directed towards treatment of 'blob' or 'BPD', whichever is most convenient to refer to at the time - this one is for the bean counters! For good or ill, for the sake of the accountants we all need to be fitted into neat little boxes that can be counted!!

3. What is important about BPD is the relatively recent acceptance in certain areas that there are treatments available to help 'sufferers' (for want of a better word) manage the worst symptoms of emotional dysfunction.

4. I am lucky to live in a postcode which quickly established an intensive DBT programme lasting nearly two years, with adequate aftercare and staff willing to see beyond labels and perceived 'difficult behaviour'.

5. Despite the name of my 'disorder' I am not BPD - I am an individual with a large number of characteristics - some of which make me more susceptible to certain emotional struggles - some of which provide an inner core of strength which allows me to make the most of the treatment offered to me.

6. There is a reality about a significant proportion of mental illness, which clearly links to significant trauma in childhood. Too often the question asked by practitioners has been 'what's wrong with this person?' rather than 'what has happened to this person to make them react to life in this way?'

The willingness of DBT therapists to ask this question, to listen to the answer and to acknowledge that my previous ways of coping with life were understandable in the light of the answer, is one of the keys to the success of this programme in helping me manage patterns of emotional dysfunction which had lasted over 30 years.

For me BPD is not a diagnosis of stigma - that is other people's problem. It has given me clarity about what had been an undefined pattern of self destructive behaviour. Like the label or not it has opened the door to hope of moving forward with my life.