QUESTION:

Dear Dr. Heller,

I am new to the idea that I have BPD.  But thanks to writings from you and many others on sites like Mental Health Sanctuary and other places I now have hope that I’m not just a crazy loser.  Other people share my struggle.  Other people have felt the same wild impulses and loopy ideas that have destroyed my life over and over.  The fact that others have recovered gave me hope I had forgotten I had lost.

Recently, after a year of functioning, holding a job and paying bills, I crashed.  I lost it on a customer at work and got fired.  I then saw an HBO special on depression with Mike Wallace, which made me realize I was putting out symptoms all over the place.  I only have the local county (Brevard–only about 90 minutes from Okeechobee!) facility called Circles of Care.  As far as free goes, it is excellent.  I made an outpatient appointment (they still remembered me) and by the time it came I had visited several sites online and found I fit the criteria for BPD.  People on Mixed Nuts (www.mixednuts.net) and The Healing Path (www.geocities.com/ubester) gave me encouragement and information that led me to believe I didn’t have to keep repeating the same cycle of striving and disappointment over and over again.  It was like I had a new way of looking at life.

The therapist I met was very disappointing.  She was competent and friendly, but reacted badly when I brought up BPD.  Prepared for this, I had a floppy disk with links and text on it but she shied away from it.  I probably came on too strong.  We discussed it for a few minutes, she was like “Why do you want to be THAT?” and I explained that it wasn’t that I wanted to be like this, but that it was reality and if I had this it would explain why I had failed at treatment so many times.  She seemed interested in having me bring printouts of the info, but chose to retain the old diagnosis of bipolar with schizoaffective tendencies that the last therapist had tagged me with (funny, I have never had a mania or a hallucination, and I know when my feelings and perceptions are out of whack–but I have several characteristic BPD traits).  She did prescribe the Neurontin and Prozac I had read work well for BPD.  I feel much better now.

Question.  How can I persuade her to spend the time and effort to learn what you research pioneers have found out about BPD and effective ways to treat it?  I realize it will be hard to break through the stigma and misconceptions surrounding BPD and harder still for others (bureaucrats) to become educated and devote scarce resources to it.

I almost feel like if the medication works and I can keep getting it there, I’ll be fortunate.  I gather the dialectical behavior therapy is long, involved, and time consuming.  I can’t see it happening on a fifteen minute appointment every two weeks basis, even though I’ll try.  I have missing years, and have long suspected some traumatic events in early childhood, like other BPD’s report, and don’t think dialectical behavior therapy the proper forum for deep digging.

Suggestions?

ANSWER:

I wish I knew!  I’ve been fighting this battle for 12 years.

The problem is old beliefs, and the incredible slowness of the medical profession – including therapists – to respond to the information.  Most medical information on the BPD is 7-14 years old.

You’re on target questioning the bipolar diagnosis if you’ve never been manic or hypomanic.

You might want to print up a few key studies to show her, or you might need to ask for another therapist.

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