Insane in the Membrane

First, an erratum: The hotel that Howard Hughes was staying in when he was so vexed by the glowing silver slipper was Wilbur Clark's Desert Inn (one of the first on the Strip), not the Frontier. Never let it be said that I don't strive for accuracy! Besides, I don't want to be responsible for anyone losing a game of Trivial Pursuit, although I'd be very surprised if that is a question. [wink]

When I was working out today, I was reading the latest issue of Time, and there was a fascinating article about Borderline Personality Disorder. I didn't study Psychology, except for a course in college that I enjoyed very much, but it's always been a sort of hobby of mine. (Most people pick things like scrapbooking...I pick Googie--which I will soon explain further--and Psychology.) Dissociative personality disorder (i.e., multiple personality disorder) was always particularly interesting to me, but a few years ago I had reason to become acquainted with Borderline Personality Disorder, heretofore referred to as BPD. (Not to be confused with Bipolar Disorder, which is completely different.)

I was once close to a person who I came to believe had BPD, and I've encountered another since then who I also have reason to believe suffers from this disorder. As I said, I'm not a psychologist, but my sister Diana got a degree in Social Work and also believes that one of these people (she's never met the other) has BPD. I had an epiphany one day when I was reading a blog in which a woman was writing about her ex and his diagnosis of BPD, and the behavior that he exhibited and things that he said. One phrase in particular jumped out at me: "If you left me, I don't know what I'd do." On the surface, this seems like a fairly innocuous statement of devotion, but considering the other behaviors I was witnessing, it wasn't harmless at all: it was an implied threat, although it was uncertain as to whether to him or me. (I heard later that after I left, he had some sort of emotional breakdown and had to be taken to the ER.)

I found that the emotional upheaval of implied harm was intolerable. Not only did I wonder what he might do to me, he was using emotional blackmail to keep me from leaving. An unspoken, "If you leave me, I might hurt myself." As you may have figured out by now, this gal doesn't play that game. I have no patience and no tolerance for that kind of blackmail, especially in someone who professes affection for me. I got away from that, obviously, but I have since encountered similar behavior, and it's equally as disturbing and manipulative.

When I talked to Diana about this years ago, she said that BPD is one of the hardest disorders to treat, and can take years of behavioral therapy. The Time article confirmed that. Psychologists and psychiatrists dread having to treat a person with BPD, but there is a new therapy that is apparently showing promise. It's called dialectical therapy, and includes individual therapy, small group therapy, and case management in which the therapist works closely with the patient to help them modify their behavior. Drugs have shown very little effect in the treatment of BPD.

In the past, the number one characteristic of BPD patients was considered to be simply "anger." Today, diagnosis is made when at least five of these criteria are met:

1. Frantic efforts to avoid abandonment
2. Unstable relationships
3. Unstable self-image
4. Impulsivity
5. Recurrent suicidal behavior
6. Mood instability
7. Chronic feelings of emptiness
8. Inappropriate anger
9. Stress-related paranoia

Based on these criteria, both of the people I have in mind probably have this disorder, although as far as I know, they haven't displayed suicidal behavior (which is common in those with BPD). Another article I read a while back spoke of the tendency to put others on a pedestal and display an almost fanatical sense of devotion. (The guy I knew set up a veritable shrine to me, with several 8x10 pictures up, and even a few 11x14 pictures. That's a little creepy, believe me.) When the threat of abandonment looms, devotion turns to extreme anger and volatility, and equally fanatical hatred.

I have no answer as to how to deal with those who have this disorder. It's sort of like the old joke: "How many psychologists does it take to change a light bulb? Only one, but the light bulb has to want to change." I remember that when we attempted separate counseling, my tests came back showing that I was psychologically healthy other than a slight tendency towards addictive behavior. His comment was, "I knew it would come back that way. It's never your fault or their fault, it's always MY fault." (See #9 above.) This is only a guess, but I'd be willing to bet that these people are, on the surface, fairly capable of exhibiting normal behavior. I know that this person was certainly different around others...there was often inappropriate behavior and comments, but it was tolerated. His behavior in private was much more volatile (see #1-4, #6, and #8 above). The bottom line was that he mostly believed that there wasn't anything seriously wrong with him. When he realized that there were issues, he still didn't comprehend that it was something he really needed help with, and that it couldn't be solved with medication alone. I suspect that while they may realize deep down that something is screwy with them, and that things never seem to work out right for them, it's probably very hard to admit that some pretty intensive therapy is necessary.

I'll get back to a lighter subject tomorrow, I promise. Reading that article just made me think about my previous life.