Question:
Dr. Heller,
First, I can only imagine how many
emails such as this one you must
receive. I would not be contacting you
if I felt I had not exhausted all other
avenues available to me as the husband
of a wife who has been diagnosed by two
mental health professionals as having
BPD. If you could take a minute to read
this and respond, I would greatly
appreciate it.
The question is rather straightforward:
SHOULD A PERSON WHO SUFFERS FROM BPD BE
TOLD THAT THEY HAVE THIS DISORDER?
This question literally torments me,
because even though I've been told
about my wife's diagnosis, she has
never been told. I've been advised by
therapists that I, as her husband should
not be the one to tell her (i.e., the
message to me has been that it is not
dishonest because "the most loving
thing for you to do is to not tell
someone suffering from BPD that they
have BPD". For almost a year now, I
have held true to this advice.
About six months ago, however, I had
real hope for change because my wife
enrolled in the DBT Training Class
within Vanderbilt's Psychiatric Clinic
in Nashville. Unfortunately, after my
wife completed the program and after 22
years of marriage, my wife in one of
her rage states physically
abused/injured my 18 yr. old daughter
and then as I tried to break it up, I
got a fist from her to the face. This
is something I will not stand for. I am
insisting that my wife acknowledge that
she has a "rage issue" (but did not
mention BPD or say anything to suggest
a "disorder") and that she get help.
She seems open to this and
characterizes her problem as "anger
management".
So, back to my question, it just seems
logical to me that a person suffering
from BPD needs to know of their
disorder so they can understand how the
disorder may be influencing their
behaviors, their tendencies, and how
then to best get help or skills in
addressing these behaviors. How else
does someone get treatment and develop
the right skills to help with a
disorder without knowing or
understanding what the disorder is?
This would make no sense to me. Now I
see my wife wanting to get help, but
most likely going to the wrong place
(anger management). Worse yet, in one
joint therapy session where the
therapist was pointing to some issues
on my wife's side, my wife said "if
you are suggesting that I have some
deeper, underlying issues, I wish
someone would put a label on it, it
would bring me a lot of peace." This
particular systems therapist was 65
years old and is not really bought into
BPD or labeling people with anything
for that matter. She spent many months
working with my wife one-on-one with a
systems therapy approach and then was
"shocked" when my wife lost it on her
about how broken she was and what a
waste of time the therapy was. The
therapist told me it took her two or
three days to recover from this which
just reinforced with me how clueless
this person is with BPD patients. Other
therapists have told me individually
that being able to put a label on it is
huge.
As I type this note, I just want to
scream. I really feel my wife needs to
know about her diagnosis, that it could
greatly facilitate her healing, yet I'm
told by "professionals" that this could
really backfire. She has great
motivation to get better, yet I feel
that she is not getting the help she
needs. Without her getting the help she
needs, our marriage will not survive
this latest physical episode.
Would you please let me know if you
believe a person with BPD should know
that they suffer from BPD? Is it
fundamentally important to their
healing? Any suggestions on how to best
communicate this to a patient?
Any words of advice would be
appreciated more than I can express!
Dr. Heller's Answer:
As the motivational speaker Zig Ziglar
says: "The truth can be denied but it
can never be avoided." The BPD is a
neurological illness (likely glial cell
dysfunction) with an instability and
epilepsy in the brain's "trapped,
cornered, wounded animal" instinct
area. It responds remarkably well to
the right medications. The unprovoked
mood swings, chronic anger and
irritability, emptiness, boredom,
rejection sensitivity and the frequency
of rages can be controlled by the right
dose of Prozac (fluoxetine). Tegretol
can markedly lengthen their "fuse," and
as needed medication is available for
rages.
Letting them know is not easy, and
they're likely to get angry when you
tell them. My recommendation is at
http://www.BiologicalUnhappiness.com/AskDoc/q1.htm.
The "Life at the Border"
book itself is more effective when left
on the coffee table so the individual
can discover the diagnosis by herself.
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