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textsfromtheborderline · 5 years

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I recently received two very important and interrelated questions:

Anon 1:

My psychologist don’t believe my mental illness, I feel like I couldn’t take it anymore, I want to choke myself until I passed out.

Anon 2:

Hello, I’ve been seeing a psychologist for a few months now. I’ve had problems with emotion dysregulation and abandonment issues for almost my entire life, but recently I’ve started reading about BPD and looking at the symptoms, I can say that I’ve never related to anything else more in my life. I’m not 18 yet, but is it still worth bringing it up to my psychologist? Ugh, sometimes I feel like I’m just faking it for attention.

I get questions like this frequently and have addressed them many times on this blog. However, considering the fact that this is clearly a persistent and pressing issue for many people, I’ve decided to do the following:

I’ll give a deep-dive answer to both these questions that is hopefully informative and helpful.

I’m working on a new resource that offers guidance and solutions to the frequent, common problems of BPD.

Before you read on any further, I want to emphasize that dying is absolutely out of the question. Not an option. No dying allowed on my blog. Life is short. You don’t have forever. So please don’t cut your precious time off prematurely.

But this only points to the fact that this incredibly overwhelming impulse is an (over)reaction to the desperate, stressful, and toxic situation that is reinforced by psychologists, psychiatrists, and therapists. There’s a problem where there should be a solution, blame and shame where there should be help and support.

The misbeliefs that Borderlines have about themselves are prevalent and persistent, both out of the sheer ignorance as well as the viciously cruel design of the psychiatric community. It’s time to start changing the way we think about mental health and mental help.

In the plainest possible terms, it’s really hard to find a good mental health worker. The only way to actually do it is through trial and error. Misdiagnosis. Informing yourself and building your own networks when you get referrals from doctors. Going out of town because no one in your area is accepting new patients, then having to pay all the gas and parking bills yourself.

This is all assuming that you can afford a decent mental health worker, of course.

People caught up in the healthcare system, especially in North America, quickly find out how uncaring and ineffective it really is. Why? Because the way it is set up is to run exclusively for profit.

Healthy people are not profitable.

For example, this is reflected in the mentality that pills are given to patients as the very first option for “care.” Psychiatrists in particular receive kickbacks from leading pharmaceutical companies depending on the kinds of pills they prescribe. But pills are not a viable long term solution, in my opinion, because they do not teach life skills and healthy recovery.

So, it is no surprise that a mental health worker who is concerned about profit over long term care will push pills as the first (and often primary) option.

Another example is that there are tiers of help, according to how much you can pay a certain type of mental health worker.

Psychiatrists are trained medical doctors, which means that they can prescribe medications, and often exclusively develop a medication management plan as the only course of treatment. Typically, you can expect to pay up to $500 for an initial consultation, and at least $100 per hour for ongoing services.

Psychologists focus extensively on psychotherapy (i.e. talking through experiences) and treating emotional and mental suffering in patients with behavioral intervention. Psychologists can also be exclusively academic researchers. They are qualified and trained to critically assess a person’s mental state in order to determine the most effective treatment plan, which often includes total lifestyle changes.

Both of these are psychotherapists, in that they use a form of therapy (medication, behavioural intervention) to treat your mental health (the psyche). Hence the term psychotherapy. Given these definitions, personality disordered people should lean toward seeing psychologists.

In North America, some psychologists can charge as much as $200 or more per session, but most will charge around $75-$150 a session. Many also work with a sliding scale fee schedule, which means their fee will depend on your income level (a crucial point for young people and young professionals).

University/college mental health workers (including counselors) are always understaffed and over worked. They are paid from a portion of tuition, so technically their services are free. But their “walk in services” are often the first line of defense, but their sessions are limited to 15-30 mins. There is very little accountability both for the worker and the patient; you’re seen as just another number in a very long, long line. When it’s determined that you’re “well enough”, you will be kicked out to make room for the rest of the people who are waiting. This is the lowest tier of care and it also happens to be the one that is accessed the most often.

Whoever the mental health worker is, then, they are working within a profit driven system. On the one hand, they need problems in order to generate profit. On the other hand, this promotes the idea that mentally ill people (particularly the most “difficult” personality disordered people) should be reduced to nothing more than a problem.

As if it isn’t incredibly dehumanizing and disgusting to reduce us to nothing more than a problem to be solved, at a significant cost.

Then on top of that, we have limited means to complain if we are abused by the system and all the people in it; we cannot hold mental health workers accountable for misdiagnosis, unproven treatments and pills, sudden appointment cancellations, and lack of follow up because we are dismissed as just being “too difficult” and “too crazy” to be listened to.

I was doing some consulting work for the largest mental health organization in my region. They were under pressure to have their services evaluated. They were by no means underfunded or understaffed; they had hundreds of psychologists and psychiatrists. The facility was modern, clean, environmentally friendly. They treated even the most “severe” patients, including Borderlines and Narcissists.

Yet they had no complaint process or means for mentally ill people to provide feedback. Why? I was told it was because the feedback that these people could potentially provide could never be trusted, due to the fact that it’s coming from an unstable mind.

I suggested that resources need to be created with mentally ill people in mind, and that they should be written in language that each person, given their mental illness, can easily understand and implement. I was told the pros had never even considered this idea before.

I was told that people with BPD and NPD in particular were just “too difficult.” They were drug addicts. They were irresponsible. They were violent. They were prone to suicide. One client had killed themselves recently, and when the outraged family demanded accountability, they had no course of action because there was no framework put in place by the organization. The mental health worker responsible for care was not held accountable because they had washed their hands of that client. They were already “too difficult” and suicidal, so their death came as no surprise.

Mentally ill people are not taking responsibility, I was told, because they are lazy and unwilling to work for recovery. Why? They supposedly like their mental illness. And these mental health workers apparently work oh so hard, but it is useless because their clients cannot be cured. The topic of E-health was touched on as a means to counter the fact that a lot of mentally ill people are too intimidated or too ill to actually come in for a session. But this organization did not want to implement even monitored Skype calls because “bringing the care to the people who need it most” was too complicated and they didn’t have any accountability measures in place. E-health is an emerging field, and as such, I was told that it is too risky to try this suggested approach.

Sitting there and listening to all this made me sick to my stomach.

I recall a tumblr post along these lines:

“if you want us to see a doctor so bad does that mean you’ll pay for our doctors appointment, pay for all our sessions, get rid of our fear of doctors, shorten the absurd amount of time we have to wait to get appointments, take away the intense stigma professionals have against people with certain mental disorders, transport us to our sessions, remove us from abusive environments that prevent us from booking appointments, make sure that professional diagnosis is always 100% right every time, and remove all the abusive psychiatrists in the system??? (x)

Essentially, the underlying message that is given to mentally ill people on behalf of the health care system and its workers is that no one gives a fuck about us.

Yet somehow, we are still expected to invest tremendous amounts of money, time, and energy to get better- because despite reaching out for help from professionals who we expect will competently do their job with our well being in mind, the entire burden of being mentally well still falls entirely on us.

And we’re supposed to be the crazy ones?

The Validity of Self-Diagnosis:

Taking all this into consideration, I think that self-diagnosis is valid.

As personality disordered people, when we are faced with incompetent mental health workers whose professionalism is questionable at best and life threatening at worst; when there is such prevalent stigma against personality disordered people out there; when we cannot afford care; when the quality of that care is poor; and when we’re so scared and confused that we turn to finding information on our own and then find it accurately applies to our life-

Why wouldn’t we frame our own thoughts, feelings, and lived experiences (for free!) within a diagnostic framework that matches our internal processes?

It’s true that not everyone has a psychology degree. It’s true that the DSM is a flawed diagnostic manual (something I extensively critique in my own work Between The Lines: Comparing BPD + NPD and suggest five keys ways it can be improved). It’s true that there’s a chance for misdiagnosis.

But that chance is still 50/50, because despite the “professionalism” of mental health workers, they are also just as likely to misdiagnose personality disordered people (most notably, with anxiety/depression/bipolar) than they are to accurately “prove” that we are accurately mentally ill.

It’s really no wonder that people like Anon 2 feel that they are “just faking” their mental illness for “for attention.”

Dear Anon 2, you’re not “just faking it for attention.” Your thoughts and feelings about your own mental health are real and valid. If you relate so strongly with the symptoms of BPD, then that demonstrates your admirable level of self-awareness and willingness to recover! I talk about situations just like yours here and here.

Please don’t let people invalidate you out of their own sheer ignorance, arrogance, cruelty, and lack of compassion.

The “expertise” of Professional Diagnosis:

People like Anon 1 have been so deeply invalidated and dismissed by their mental health worker that they feel suicidal.

Please take a moment to let that sink in.

All mental health care workers follow the “medical model.” That is to say, you are either “sane” or “insane.” As a result, diagnostic criteria are developed with the assumption that there is only one “normal,” “right” and “healthy” way to live. Everything else is just pathologized and labelled as a disorder (especially in North American society, which has a disturbing propensity for black and white thinking as well as pathologizing emotions)

In contrast, Neurodiversity itself “ is the infinite variation of neurocognitive functioning within our specifies and it is a biological fact.”

Building off of this, the neurodiversity paradigm suggests that the diversity in our ways of thinking and feeling makes us stronger as a species, as communities, and as people. The neurodiversity paradigm is a specific perspective on neurodiversity – a perspective or approach that boils down to these fundamental principles:

1) Neurodiversity is a natural and valuable form of human diversity.

2) The idea that there is one “normal” or “healthy” type of brain or mind, or one “right” style of neurocognitive functioning, is a culturally constructed fiction, no more valid (and no more conducive to a healthy society or to the overall well-being of humanity) than the idea that there is one “normal” or “right” ethnicity, gender, or culture.

3) The social dynamics that manifest in regard to neurodiversity are similar to the social dynamics that manifest in regard to other forms of human diversity (e.g., diversity of ethnicity, gender, or culture). These dynamics include the dynamics of social power inequalities, and also the dynamics by which diversity, when embraced, acts as a source of creative potential.

This is where the terms neurodivergent and neurotypical come from:

Neurodivergent, sometimes abbreviated as ND, means having a brain that functions in ways that diverge significantly from the dominant societal standards of “normal.”

Neurodivergent is quite a broad term. Neurodivergence (the state of being neurodivergent) can be largely or entirely genetic and innate, or it can be largely or entirely produced by brain-altering experience, or some combination of the two (autism and dyslexia are examples of innate forms of neurodivergence, while alterations in brain functioning caused by such things as trauma, long-term meditation practice, or heavy usage of psychedelic drugs are examples of forms of neurodivergence produced through experience).

A person whose neurocognitive functioning diverges from dominant societal norms in multiple ways – for instance, a person who is Autistic, dyslexic, and epileptic – can be described as multiply neurodivergent.

Some forms of innate or largely innate neurodivergence, like autism, are intrinsic and pervasive factors in an individual’s psyche, personality, and fundamental way of relating to the world. The neurodiversity paradigm rejects the pathologizing of such forms of neurodivergence, and the Neurodiversity Movement opposes attempts to get rid of them.

Other forms of neurodivergence, like epilepsy or the effects of traumatic brain injuries, could be removed from an individual without erasing fundamental aspects of the individual’s selfhood, and in many cases the individual would be happy to be rid of such forms of neurodivergence. The neurodiversity paradigm does not reject the pathologizing of these forms of neurodivergence, and the Neurodiversity Movement does not object to consensual attempts to cure them (but still most definitely objects to discrimination against people who have them).

Thus, neurodivergence is not intrinsically positive or negative, desirable or undesirable – it all depends on what sort of neurodivergence one is talking about.

Neurotypical, often abbreviated as NT, means having a style of neurocognitive functioning that falls within the dominant societal standards of “normal.”Neurotypical can be used as either an adjective (“He’s neurotypical”) or a noun (“He’s a neurotypical”).

Neurotypical is the opposite of neurodivergent. Neurotypicality is the condition from which neurodivergent people diverge. Neurotypical bears the same sort of relationship to neurodivergent that straight bears to queer.

Hence, neurodivergence is a very real and very valid approach to mental health, especially when it comes to personality disordered people. It is supported and used by some credited therapists as well, such as the website Eggshell Therapy.

Despite this reality, mental health workers generally remain unwilling to acknowledge it. This is highly unprofessional. A competent, knowledgeable mental health care worker should be willing to consider all possible perspectives when it comes to the way a human mind works. But as we’ve established, most mental health care workers are far from professional.

They rigidly cling to the medical model because it justifies the existence of their particular field of study and somehow automatically qualifies them to (mis)diagnose people, all while being paid very well for it. Dismissing self-diagnosis and neurodiversity invalidates mentally ill people; increases the risk of misdiagnosis; blocks the development of a meaningful and practical treatment plan; and obviously makes for a very strained working relationship.

Talking To Mental Health Workers About Your BPD:

Before you start you first assessment or initial session with a mental health worker (and even if you make it past the very first one), it’s a good idea to ask them what they think their job really is. Literally. Ask them for a job description, in their own words, about their work and how they view their client relationship.

Chances are, they’ll spew something along the lines of:

“My job is to help you. But you have to put in the work yourself.”

We’re already off to a bad start here: being condescendingly reminded that you have to actually make the right choices for yourself and learn how to live in a healthy way is a moot point. If you are coming in to see a psychotherapist, it is very probable that you have already put in most of the work (including self-diagnosis or at the very least, prepared points and questions) but that you are expecting a professional to competently and compassionately help you have the capacity to implement positive changes for your mental health.

My naïve understanding of the work that mental health workers do is that, precisely because of their “expertise”, they would be able to make up for the skills and knowledge that I could not do on my own. Instead, the concept of “self-help” keeps getting shoved down the throats of people who are tremendously vulnerable due to their mental illness. If you wanted to rely solely on self-help, it is fair to presume that you would not be seeking professional help.

Of course, “help” in their eyes is usually supplying pills (especially if the mental health worker is a psychiatrist). Even if your body reacts badly to it. The rest is, of course, up to you. Just help yourself!

On top of all this, mental health workers are operating under the assumption that they will “cure” you of your mental illness, even though they should know that this is impossible. In other words, they aren’t there to help you learn to live with your mental illness in a healthy way (because that’s not profitable). They’re here to tell you what you should do about how “wrong” you are according to the medical model, while you pay them to help yourself.

And if you really want to reaffirm that point, ask them next what they think of the concept of neurodivergence and how it applies to you (you can even use Eggshell Therapy as a reference point). Their answer will likely be dismissive and re-emphasize that if you do not follow their specific treatment plan, then your condition will just worsen-maybe to the point that they cannot even “help” you anymore.

Having said all this, I don’t want to paint all mental health workers with the same bush. There are brilliant young professionals and aspiring mental health workers out there now who are working their asses off to make mental health better and more accessible for all. But I’m still talking about how the health care system is right here and right now. Good mental health can’t wait.

It’s also important to keep in mind that personality disordered people can cross the line as well: resenting authority and stubbornly refusing to implement a mutually agreed upon treatment plan; acting out and raging; manipulating mental health workers; failing to show up for appointments all together; lying and smearing; threatening; being “offended” by deep, probing discussions about their own mental health; and dropping out of care without a valid reason after only one or two sessions.

There are evidently massive issues coming from both sides. The key takeaway is that bringing up mental health to your psychotherapist cannot possibly thrive in a climate of intimidation, confusion, and invalidation.

When you discuss your mental illness, it is important to draw from facts, your own lived experiences, seek clarification about the DSM criteria, and have plenty of examples how your daily behaviour fits into this framework. What prompted you to relate to this criteria so strongly, and why is it worth considering?

It’s always important to be as polite and respectful as possible. That goes both ways. And although it feels like you’re going through the wringer, if one mental health worker doesn’t work out, you are not chained to that situation. You are free to leave and seek out the services of someone else who is, in your opinion, more qualified to help you. This does take a lot of time and effort, with plenty of mistakes thrown in during the meantime.

But you are not alone.

Start building support networks: family, friends, teachers, social workers, colleagues…anyone who is willing and able to help you. Good mental health is not something that you should feel like you have to achieve on your own. You should be supported and cared for.

Hopefully, mental health care will improve drastically within our lifetime. I want us to keep in mind that we are striving for our own recovery in a kind way. That we can set good examples of how important it is to make sure no one gets left behind.

Above all, despite these systemic obstacles, we do need to talk about our mental health because that’s the only way anyone will ever listen to us.

#q + a #anon #cluster b #bpd #borderline personality disorder #actuallybpd #actuallyborderline #mental health #mental illness #psychology #recovery #resource #textsfromtheborderline

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