What BPD feels like...

Sorry I've not been around as much as usual.  I had a bit of a hiccup and couldn't to manage to write.  However, someone gave me this link which, if tending towards being cheesy is nevertheless a helpful insight.  I related to most of it anyway! Please watch it.

What BPD feels like

S.C.I.D. Danger

Well my DBT pre-commitment sessions are drawing to a close.  One more to go and then I start the programme properly.

In this penultimate session Joy explained that we’d pretty much covered all the pre-commitment work and there was one more baseline assessment to do.  This time not a multi choice questionnaire but a s.c.i.d.  This immediately made me think of dirty pants but Joy went on to explain it was a diagnostic tool for Borderline Personality Disorder.  

S.c.i.d. is an acronym for Structured Clinical Interview  for DSM disorders (DSM being an acronym for a diagnostic manual of some sort).  Confused by acute ‘acronymitus’, I preferred to revert to my own understanding of ‘skid’ – “a dirty stain on clothes or fabric caused by a pooey bottom.”  It turned out this wasn’t such a bad interpretation.

The interview took the form of a series of questions covering a range of the BPD diagnostic criteria.  These were asked by Joy who was able to ask me to explain further or clarify any of my answers.  It also meant when I said, “No, I don’t do or experience that!” she was able to ask about it in a different way to make sure.  

I’m not quite sure why we did it.  I had to have a BPD diagnosis to be referred to do the DBT in the first place – though she did say that if I put the work in I could expect not to meet the criteria anymore at the end, which is a very appealing thought.  The actuality of the interview however was as unpleasant as any huge skid you can imagine.  It forced me to think about all the things about me and that I do that really are horrible smears in my life.  By the end I felt pretty crap (excuse the pun).

Role on the end of DBT!

Oh Joy!

1.    A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.

I guess from a medical perspective todays blog might relate to the above diagnostic criteria for BPD (called splitting).  I’m not sure though.  I accept that I do have a tendency when an important or professionally influential relationship has a more intense moment, to polarise my opinions about the person to either good or bad.

For example, in my work I (my company) took on a fairly large project.  It was working in partnership with another organisation and a project steering group was established to keep the project in line with the aims and objectives agreed with the funder.  One person on this steering group was a “Maverick” or a “loose canon” or in terms of meeting funding requirements, “a total nightmare!”  As the person who was responsible to the funder, and for the running of the whole project it was my job to deal with her.  She did not respond well to any form of training / support / being told politely to come in line.  In the end I saw her as completely cancerous to work with (i.e. malignant and needing to be removed), I became ill and had to recruit a new director for the project.  She is still causing problems for the project now, and I still see her as 100% impossible to trust or work with.  The person who took over for me is nothing less than a saint.

Now you could say that fits with the diagnostic criteria shown above, and if it does, so be it.  The bottom line is, my opinion of her as a colleague and team member is totally right.  End of!

So, back to DBT.  I thought things were developing OK with Joy.  I didn’t 100% trust her, but then it’s early days.  I’ve only seen her seven times.

The last session didn’t start off particularly well.  I had completed a worksheet as homework and we set about discussing it.  There was one bit where she wanted me to see something differently.  I didn’t agree.  The question on the sheet asked for one thing and I answered it.  She thought I should have a different answer and set about trying to make me agree with her.  There wasn’t much radical acceptance going on here and I wasn’t feeling like a doormat either.  In the end I realised she wasn’t as good at disagreeing with me as other CPNs I have known.  For example, John can put forward an alternative point of view without it feeling like a confrontation – and he can even tell me I’ve got something completely wrong without making me feel useless.  He can also acknowledge when things have got a bit tricky and communicate he is still ok with me.

Having realised I was winning the argument I went and quoted the sheet to her and the logical nature of my response.  She gave up at that point and now I’m not sure she is able to help me. 

 At the end of the session she told me she had received the occupational health report request relating to my recent job offer.  She said she had dictated it the day before, it would be typed up that day and sent out the day after.  I let five days pass from the day it should have arrived and then phoned occupational health to see where things were up to.  The report had not arrived.   

I phoned Joy to see what had happened.  She said it was in her tray for checking, and then she would send it later on in the day.  I protested that she had said it would be sent the Thursday before.  She denied saying that it would be dealt with the week before.  It would’ve been ok if she’d said, “sorry, I didn’t manage to get it done then, but it will go today!”  That would’ve been disappointing but no harm done.  However, in denying what she did say to me she has broken trust.  She is unreliable and not honest.  This is not an example of “good / bad” relationships or splitting.  It is just a fact.

It gives me a dilemma regarding DBT.  

• ·         If I sack her as my therapist I lose the opportunity to do DBT and I really need and want to do it. 
• ·         If I challenge her formally it will be her word against mine and hers will be the winning voice because her team will back her up and I’m just a “Bolshy Borderliner” anyway. 
• ·         If I do nothing I will not get the benefit of the therapy because I don’t trust her.
• ·         If I talk to her about how I feel at our next appointment it might help but it will probably make things worse.

As the saying goes, “I am between a rock and a hard place!”

Stigma Stinks

One would expect, even assume that those in the healthcare professions would hold back on their prejudice towards those of us with a BPD diagnosis.  There are clear guidelines for staff on care of people with a BPD diagnosis and for those who self-harm.  

To keep balance, I will say now, that the majority of people I have encountered in healthcare settings have been perfectly fine with me (even when a little flummoxed at my response to certain situations).  However, when responses are negative it’s so hurtful and undermining of any self- respect we have mustered up in the first place.

I have recently come home from a short stay in hospital.  I had an operation for a non-mental health related condition.  Most of the Dr’s and nursing staff gave me the same treatment they gave everyone else.  Even my consultant, who was actually one of those who I have completely flummoxed by disassociating while in an appointment with him, causing him to doubt my mental capacity to understand and make choices re. my treatment plan without additional support.  This was probably my fault because (for fear of stigma) I had told him about my depression diagnosis but not BPD when he took my medical history.

Anyway, back to the point.  All the staff who cared for me during my hospital stay must’ve noticed the scars and bruising to my forearm, which looked quite bad as I’d had a tricky couple of weeks.  I had thought the bruises would’ve gone by the time I went into hospital – but they weren’t!

Of all those staff, only 5 showed any indication that they had noticed.   

One, with a gentle and caring touch as he checked my pulse, another two with a lingering of stare and then continuing as normal – no change in attitude.  Then a theatre nurse who commented 

“Those are nasty bruises. How did you get them?” To which I gave my standard response of,

“Just a bit of stress relief!”  She seemed a little embarrassed at that and I never saw her again because shortly afterwards I was unconscious till back on the ward.

The final one was the bad one.  A Bank nurse came on duty as the team were short staffed that day.  When she took my blood pressure she asked,

“What happened there?”  I gave the same response as before to which she said “Ah!”  From then on she treated me as if I was scum.  She glared at me if we had eye contact, she snapped at me when I asked if my observations were OK as I was hoping to go home later that day.  Her attitude towards me had completely changed while she was still friendly and cheerful with everyone else.

This triggered off in me a host of other unhelpful emotions and thoughts.  For example,  I was soon convinced that all the staff hated me and were trying to send me home to get rid of me, not because I was ready (even though I wanted to come home!)  My anxiety levels were going through the roof and this was reflected in my blood pressure and heart rate.  I became irrationally tearful and over compensated by getting louder and less appropriate with my humour around the other patients.  I had to battle with the urge to self-harm even more than normal.   I had a resurgence of suicidal thoughts.  My reaction culminated with me packing my bag and trying to sneak off the ward behind another patient who was leaving.  This got me shouted at by another nurse and bundled back to sit by my bed, (I’d had abdominal surgery and carrying and lifting are big no-nos for a few weeks).  This left me in such a state that when Joe finally arrived to pick me up I was a weeping wreck as soon as I was out of sight of the ward staff.

The point of today’s somewhat rambling blog is this.  Attaching stigma to anyone (for any reason) is a crap thing to do.  It brings no benefit to anyone.  It is based on ignorance of a bigger picture and not balanced facts (i.e. even if you have seen your negative beliefs about Borderliners in action, and experienced it first hand, it does not mean all Borderliners are the same or that those who suffer with it the most, can’t be treated and recover).  Stigma exists only to perpetuate a sense of powerlessness to change in the stigmatised individual or group, and to make those who do the stigmatising, falsely feel better about themselves.   Stigma stinks!

Some would say I should put in a formal complaint about the bank nurse but I know there is no point.  First, my diagnosis would work against me.  Those of us with BPD are assumed to be over sensitive, awkward and manipulative and the nurse would say that I was being typically Borderline and paranoid.  Second.  It would just be my word against hers.  No-one else will’ve noticed because no-one else was present in our conversations and the glares and snide looks were subtle.  Third, though what she said and her change of attitude were real, my fears, intrusive thoughts and feelings related to that grew as the day went on, and with reflection, the situation may have been a little exaggerated in my mind by the end of the day.  So – not a case for a formal complaint, but a case study on how those in caring professions need to be professional and not allow their personal prejudices and feelings to affect the way they do their job.  End of sermon!