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Welcome, Miss Megan here!! Daycare teacher by day, Greys Anatomy binger by night. | 18 | Borderline Personality Disorder| emotional abuse surviver | Sephora addict | artist | lover of all things cat related | back to Tumblr after 6 years!!

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6 years ago
tequilamockingbird2015

tequilamockingbird2015:

BPD Stigma

Since I’ve been working as a residential counselor and a therapist trainee for a bit now I’ve gotten an inside look into the mental health care system that I did not have before. The ableist comments my co-workers, colleagues, professors, even fellow neurodivergent people have made about BPD are taking quite a toll on me. I was hoping by now I would be used to it–I hear these comments all the time. But it still hurts me deeply and makes me question myself and whether I really should be a therapist if I truly am some kind of monster. I have tried all my CBT and DBT skills but nothing alleviates the pain or prepares me. I dread going to work on days when I know I will run into my ableist colleagues. I gently defend us but often I am met with resistance. It’s frustrating, really, knowing how differently I would be treated if they knew I had BPD.

I do have some valuable ~intel~ on why and how the stigma perpetuates. Thought I would share a little with you all:

1. New clinicians are literally taught to hate and fear people with BPD. I learned in my AP Psychology class in high school that I was to avoid borderlines at all costs because they are out to destroy the lives of the people around them. One of the first things I learned about BPD was that borderlines cannot be treated and don’t want to be treated. I had one professor who said that people with personality disorders aren’t suffering; borderlines in particular just *think* we’re in distress but we actually cause distress for everyone around us. This is taught in classes and even in my job orientation for a residential program.

2. Clinicians use the term “Axis II” or “borderline” to describe ANY client they don’t like. Any client who is manipulative or picks fights with other client is called “borderline” even if they don’t meet criteria. I can’t tell you how many times I pointed out to my colleagues that the client they labeled as “borderline” or “Axis II” did not actually have a personality disorder.

3. Confirmation bias. Doesn’t matter if you have a PhD in psychology from an Ivy League: you are still susceptible to bias. And with new clinicians being taught to fear and hate clients with BPD, they go in expecting that such clients will indeed be difficult or manipulative. They are attuned to the smallest things that may reinforce this bias that they are primed to–even things that other clients or neurotypicals do that clinicians don’t mind much. We are hypervigilant for signs that people hate us; they are hypervigilant for signs that we should be hated because they have been taught to be on their guard, and, well, afraid. It’s priming at its finest. Priming clouds your perception. It’s simple psychology, really.

4. We are extremely attuned to the emotions of other people. Clinicians who already are biased against us give off signals we pick up on, whether they realize it or not. So if someone dislikes us–even if they think they are hiding it–how do you think we will respond? We can be rude right back, and this can balloon into anger. If you have someone with anger issues who can tell you don’t like them or that you are judging them… well, it’s not hard to see where that goes. And really, whether you have BPD or not, how do you react when someone is rude to you? You’ll probably be angry too. Maybe you will be up front about it–maybe you will call the other person out. Or maybe you will become passive aggressive and give off the same social cues they do. Either way, the clinicians are eliciting the very interaction they expect to have from us… and they have no idea.

5. Do you see the vicious cycle here? Your BPD client is now angry with you and treating you poorly. You’re already hypervigilant for signs that these clients are awful, and here it is. Odds are you weren’t aware your client picked up on your dislike for them. So their anger might seem to have come from out of the blue. You succumb to confirmation bias.

6. What if you are presented with something that goes against your confirmation bias? What if you meet people with BPD who really aren’t nearly as bad as you believe they are? What if some of them are actually compassionate, empathic people who are a joy to work with? These clients are dismissed as “not really borderline” or “too nice to be borderline.” Maybe it strikes a personal nerve with them: maybe they feel that their experience with a “difficult” borderline is invalidated. What it means is simply that BPD manifests differently with each person, and that having BPD doesn’t inherently make you “bad.”

7. Generalization. One bad experience with a BPD client and suddenly *every* BPD client is bad. Because that’s what the stigma says. And your professors, and colleagues, and supervisors. Generalization is a common cognitive distortion for pretty much anything else: you may hold onto that *one* time you had an unfortunate encounter with someone of a specific population–maybe a specific gender, SES, profession, sexual orientation, race, religion, region, and so on–and suddenly they represent everyone from that population. And so you place more scrutiny on anyone from said population. You don’t give them a fair chance.

So when a clinician or aspiring clinician meets someone with BPD who does indeed match the stereotype–lashing out in anger, abusive, manipulative, etc–that one person represents all people with this disorder. I hear a lot of people say “my mom/ex-girlfriend/sister had BPD and she was abusive and horrible” (notice how it’s usually females?) and I do recognize such people exist. If these people actually did have BPD, they were likely treatment-resistant and in denial that they suffered from mental health issues. Untreated BPD clients who refuse treatment can (but not always) be manipulative or abusive or difficult. But here’s the thing: you don’t have to have BPD to act like that. Many neurotypicals simply choose to be that way. It’s not uncommon. But the people with BPD who are like this and refuse treatment or lack insight do not represent everyone with BPD. There are people with BPD who don’t lash out or hurt others. And there are some that do but are willing to pursue treatment so they can manage their anger without hurting anyone else because they genuinely do not want to cause harm. They may lash out because they never learned how to express their needs–often times these clients had neglectful parents and had to act out to get their attention. Or they may have an extremely hard time containing (or feeling like they have to contain) their extreme emotions, and they may act out as a result. In other words, it’s something they genuinely struggle with; it is not 100% in their control. They often feel horrid when they realize what they have done and want to improve their emotion regulation. While there is never an excuse for harmful behavior (even if it is due to BPD), I have seen many people with BPD who took ownership of their actions. On that note, I’ve seen people without BPD (mostly neurotypicals and one person with depression) refuse to do so…

8. Many clinicians without a DBT background lack genuine understanding of this disorder and how to treat its symptoms effectively. Which isn’t surprising given that there isn’t much research on BPD compared to, say, depression. And this is a very complicated disorder, as we all know. If you truly understand something, it’s far less intimidating. A huge part of my recovery is the introspection that helped me understand why I am the way I am. Why do I split? Why am I so emotionally reactive? Why am I so desperately afraid of abandonment? My illness seemed far less scary and far less overwhelming once I understood its origins and etiology. Since there are few resources on BPD for people with the disorder, our community here on Tumblr had to create them. We shared our collective knowledge and provided a safe place for people like us to continue the process of self-discovery. Since I was diagnosed and got patched into this community, the blogs, articles, journals, etc written by BPD sufferers have absolutely skyrocketed in number. And if other people without BPD (including clinicians) looked at these resources and increased their understanding of BPD, perhaps they would in turn be more open-minded about this disorder. After all, we tend to fear what we don’t know.

9. BPD is hard to treat. I don’t deny it. If you don’t have specialized training in DBT, you are probably not prepared to help BPD clients. We might split on you or lash out at you with no warning. We are far more likely to make progress when treated with DBT. A major reason even well-meaning clinicians keep us at bay is because they are afraid to work with clients who are chronically in crisis. What do you do when nothing you do can help your client? And your client continues to be suicidal or self-harm? The idea of not being able to help a client (and losing a client to suicide) is something most clinicians fear. And clients with BPD have a chronic illness with ingrained cognitive and emotional patterns that have been present most of their lives. Even when they seem to be doing well, they can very suddenly relapse with little to no warning. Clinicians may feel guilty or unsure of themselves or ashamed or helpless or even angry with the client for not getting better. I’ve been passed around from therapist to therapist like a mentally ill hot potato because they just didn’t know what to do with me. One of my first therapists in college got frustrated with me and told me I “liked to wallow in my misery.” After my second year with her when I wasn’t making any progress (in fact, I was getting worse), I told her “I’m not actively suicidal but honestly if someone tried to kill me I would probably let them” she said “I don’t think I can help you”… which is fair, but she didn’t exactly say it nicely. She referred me to outpatient services outside of the counseling and psychological services center for more severely ill students. And even there I was passed around after getting officially diagnosed.

And I think it’s this last point that is really the source of the stigma. We have a complex, chronic, poorly understood disorder with symptoms that have endured for a long time. I had the opportunity to tell Marsha Linehan my story and I asked for her guidance. I desperately wanted to know how a therapist with BPD could withstand the stigma day after day from virtually everyone in their professional and academic circles. I asked how I could find a way to cope with my fear that I am indeed a bad person, that the horrific things people say are true. At least I can remind myself that she had BPD herself, and she has quite obviously saved the lives of so many people. But how did she do it back when the stigma was even worse? When no one else had publicly come forward?

She said it’s simple. Whatever clinicians say about BPD comes from their discomfort about the fact that it is hard to treat us. She said “They find it hard to treat BPD clients, so they decide they don’t like them.” From there it evolved and warped into generalizations about us sucking people into our drama, using manipulative “tactics” to get what we want, and even lacking empathy. And it’s comforting, I imagine, when you realize that other therapists are struggling with BPD clients too. Then that doesn’t mean you’re a bad therapist… it means it’s the client who is the problem. And yet, Marsha said that even though they may say rather egregious things, it all stems from being frustrated that we are difficult to treat. Not that we’re bad people. This is truly the core of the stigma.

Yeah. I know. None of this is good. It certainly paints a negative picture of mental health professionals.

But I assure you that not all clinicians are like this. There are therapists and psychiatrists who do enjoy working with us and do challenge the stigma against BPD. My DBT therapist says that on her listserv (for other DBT therapists) there is nothing but love for their BPD clients. My new psychiatrist was completely 100% open to working with me even though she knew I had BPD, even though the outpatient clinic she works for nearly turned me away, saying “we try to send borderlines elsewhere.” DBT therapists are passionate, happy people who truly love their BPD clients. DBT is spreading rapidly and more and more young therapists are specializing in BPD, even though they are surrounded by the stigma.

If you have access to mental health care and would like a therapist (but would rather not run into ableist ones), look specifically for therapists who do DBT. When you have found one, ask them to refer you to a psychiatrist. They will know who will and won’t work with BPD clients, and I *think* psychiatrists are less likely to turn BPD clients away since they don’t need specialized DBT training to effectively prescribe medication.

I hope that things will improve from here. I hope we can invite the psychiatric field into our world for a little and work with them to further their understanding of this disorder. My anger with and hurt by the professionals who made these statements will not get me anywhere. I became cynical, bitter, even symptomatic, spiraling into depression over the things they said. But if I want things to change I must be willing to open the conversation and let go–this was Marsha’s message to me, and I have taken her words to heart. Some people will be resistant of course… I’ve seen this plenty. But others will be willing to let their guard down a little and be more receptive. This I have seen too.

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