The latest in our series exploring less-discussed mental health issues details the writer’s experience with being treated for BPD
Borderline personality disorder, or BPD, is amongst the most stigmatized mental illnesses - not merely by society, but by health professionals as well. Treatment resistant, manipulative, attention-seeking, unstable and incapable of maintaining a stable relationship are some of the many things that might cross one’s mind when BPD is mentioned. What fails to cross most people's minds, however, is that 75% of people with BPD will attempt suicide, and 1 in 10 of them will die by suicide. The numbers are huge, yet the help remains minimal.
I was diagnosed with major depressive disorder (MDD) and BPD four years ago, and my life has changed massively ever since. I have felt relief because I finally know why I feel the way that I do. I have felt scared. I have felt judged. I experienced support and stigma. I experienced becoming less human and more diagnosis. I experienced the good, the bad and the ugly of living with a BPD diagnosis, and I'm going to do my best to share what it’s like to live with such a diagnosis in today’s stigma-infused society.
On the one hand, the University Counselling Service (CAPS) were extremely understanding of my struggles, and they always put me before my diagnosis. My experience with CAPS showed that they acknowledge the high levels of stigma associated with a BPD diagnosis and the harm that this diagnosis can do when it implies that your personality - the very centre of your being - is disordered and flawed. The treatment I received from CAPS has made me feel like my diagnosis is merely a different lens through which I can view the world, which in turn, made me feel more human, less "diagnosis". Unfortunately, the way that CAPS dealt with my diagnosis is not the way that most professionals would. I know this, because I have experienced the opposite treatment you can receive when you are diagnosed with BPD.
Earlier this year, I was discharged from the hospital following an overdose and I was due to see my psychiatrist in nine days. I went into the consultation with not many expectations. I was just hoping I would get my antidepressants reviewed, and perhaps a dose of hope for the future. I went in feeling hopeless, like I would never be mentally well. I went out still feeling hopeless, with a confirmation that I will probably never be mentally well.
One of the first questions the psychiatrist asked me was if I was aware of my diagnosis, to which I said I was; I have major depressive disorder (MDD) and BPD. Despite the fact that a depressive episode is what prompted my overdose, not BPD, the MDD part of the diagnosis was disregarded. Instead, the psychiatrist went on to make it clear that I have a personality disorder. That is, a “pattern of behaviour” that is not likely to change. Accordingly, I was told that medication is not likely to improve my situation, and I was advised that if it is not doing me any good, then I should stop it altogether. The idea that medication won’t help makes sense, as there are no medications for personality disorders. However, there are a variety of different antidepressants, other than the one that I was on that could have been looked at. Unfortunately, a possible change of antidepressants was not considered because the fact that my depression is what prompted my overdose was entirely overlooked. Simply because a personality disorder diagnosis is stigmatized enough to undermine all other diagnoses and the help that they require.
I was also told that therapy is not likely to help me either, and that this is the reason why I have been fruitlessly chasing a therapy referral from the NHS for two years. The reason being that I have done a fair amount of therapy in the past and it is not likely that more therapy will help. What was never acknowledged, however, was that the therapy I received years ago was a type of therapy that did not work for me. Instead, it was suggested that something seems to be stopping me from getting better. When I questioned that a bit further, I was advised to investigate what that something could be in my own time – but figuring out what is blocking your recovery is not something you can do on your own. Despite that, I was told that I might be trying too hard to get better, and that sometimes people need a break from therapy and medication. Perhaps some people do benefit from such a break, but I did not agree that this was what I needed at that point in time. However, I knew I wasn’t being heard, and I knew there was no way I was going to make this psychiatrist look past my diagnosis and into my current situation.
I was not prepared to hear that my options seemed to have run out, so I stopped asking questions and became passive instead; agreeing with all that is being said just because I wanted to leave. I was upset and it was noticeable for the psychiatrist who later on that day, contacted me and offered me some possible referrals. Referrals that were only offered after an arduous consultation that was quite hard to digest and get through.
This experience left me feeling like I have been stranded on an island and told to swim my way back to shore. Except I am not adept at swimming, and I cannot make it to shore without risking drowning along the way.
The most unfortunate thing about this experience is that this is not only my reality, but the reality of many others who like myself, struggle to access needed help because of that one, stagnant diagnosis. I am aware however, that not all professionals are the same; in fact, I have spoken to some really loving Community Psychiatric Nurses through the NHS. It all depends on luck and who you get to see, and this is where the problem lies. A mental health community team should be based on consistency and a good level of support no matter who you are seen by. Your health should not be determined by luck; luck should not even be part of this.
If the stigma attached to certain mental illnesses does not alleviate, then we will continue to lose lives that, with the appropriate help, could have prospered, and the 1 in 10 statistic of people with BPD dying by suicide is only going to get worse. Following this experience, I decided to do whatever it takes to get better, because I realized that waiting on an NHS referral would mean waiting forever and if it is not waiting forever, it is possibly waiting for another negative consultation. Therefore, I decided to try private therapy, and I am fortunate enough to be able to afford some private therapy for the time being, but most others are not, and they deserve better.
Borderline Personality Disorder is “a pattern of behaviour”. It is also a troubling and dangerous pattern of behaviour, but patterns of behaviour can change with the appropriate support. BPD is not a death sentence and it is surely not something that anybody should run away from - especially not mental health professionals.