Borderline Personality Disorder

I knew that it was only a matter of time before somebody suggested that Julie might suffer from Borderline Personality Disorder.  The self harm is a strong indicator, and as she grew older, and other diagnoses could be ruled out, BPD was bound to surface.  In fact, for the last year, many of the people who have worked with Julie have dropped increasingly heavy hints that there was something that might be of interest to us here.  Eventually one of the doctors took it on himself to talk to Julie about it.

You could argue that doctors often have to give difficult diagnoses – a terminal disease, dementia etc – but there can be few diagnoses more difficult to introduce than borderline personality disorder.   The very name of the condition is tremendously unhelpful:  most people might assume it meant that there was something intrinsically defective about the patient – perhaps even “morally” defective.  In fact, even knowing that "borderline" is just a tag that became attached historically to a group viewed as "borderline" between two other diagnoses (both now obsolete), scarcely improves the overwhelming feeling that this group of people has never been viewed with much affection or concern by psychiatrists.

Because Julie has been in hospital so much, I am never very sure how much she knows about different psychiatric labels.  I only got my answer when I sat in on that very difficult conversation: it was obvious that BPD meant nothing to her, and that she had not picked up on any of the hints dropped earlier.  She listened politely, asked a few questions, and took away the printed information they had give her.  Read about it, have a think, and let me know if you agree with me, said the doctor cheerfully.  It was me that had to seek confirmation that they were not planning to change anything in the meantime: her support, her medication, could continue unchanged for the moment.

It was only 24 hours later that the problems started.  The doctor had not helped himself with the language he used to describe BPD.  It was not an illness, he said, but “just the way you are”.  It took time for Julie to digest this, and what she finally took away with her was that the doctors had abandoned her.  They thought she was making up her symptoms, they didn’t believe her, she wasn’t “the right sort of person to be treated”, and they were going to withdraw their support for her, abandoning her to a kind of personal hell.  All the positive messages the doctor had tried to convey – that the outlook for BPD is good, that treatment makes a difference, that she was likely to go on to live a happy and productive life, that she was unlikely to have a degenerative condition like schizophrenia – were all washed out in the shock of hearing those few words: “just the way you are”. 

She was terribly hurt and confused, and it was very painful to witness. She stopped taking her medication suddenly and became unwell as a consequence.  Nothing I could say to her was the least use.  There was no point trying to say that all psychiatric diagnoses carry an element of personal opinion, that it is not clear whether describing one thing as "illness" and another as "personality" makes much difference in practice, and that in 20 years all the labels will probably have changed anyway.

Only time will tell if Julie is reconciled to this diagnosis, or whether she rejects it.  It probably doesn’t matter a lot in the short term – she will continue to receive support – and in the longer term it isn’t really clear whether or not this diagnosis will follow her, and be a help or a hindrance.  It is a diagnosis which still attracts a great deal of stigma, particularly inside the medical profession, but opinions and practices are changing.  I know that there are people who think that BPD sufferers are time wasters and attention seekers, but I also know (personally) people who recognize the real difficulties of managing the condition and who are supportive and caring.  If she does live with the label, let’s hope she meets lots of the latter sort of people.