Poster boy
My younger brother is like the poster boy for borderline personality disorder, but since mental health professionals seem to be looking only for BPD poster girls, none of them had ever considered this diagnosis for him. No, I’m not sure whether I think BPD is a useful construct, but he does fit the criteria to a T (except, as far as I know, the last one, “transient, stress-related paranoid ideation or severe dissociative symptoms”).
Last week, I kept mentally writing a blog post in which I would describe all the ways he fit the criteria for BPD, but refer to him as “she” until the end of the post, where I would say that there was one major lie in the post and to switch all the pronouns, I’m actually talking about a guy, not a girl. My brother can be awfully exasperating, but what really bugs me, and what that post would have really been about, is sexism in the mental health profession. About how I, a girl, have been called personality-disordered simply because I used to cut myself or because sometimes I’ve disagreed with doctors’ opinions about something, but someone who very obviously fits eight of the nine criteria for BPD isn’t diagnosed with it because he’s a guy. I’m not really interested in amateur diagnosis of anybody other than myself, but it seemed appalling that behaviour that would get a female slapped with the BPD label was ignored in a male. I never did write that post, because 1) it would have wound up being awfully long and I’m lazy, and 2) it seemed malicious to write a post delineating all of my brother’s very worst qualities when he is one of my favourite people in the world and one of my best friends.
Now there is another reason to never write that post, which is that a doctor has finally considered that he might have BPD. Until the other day, my brother’s official diagnosis was generalized anxiety disorder, but he’s been in the hospital for a couple of days because of suicidality. One doctor is saying bipolar spectrum disorder and another is saying borderline personality disorder.
As for how he is doing in there, it varies. He went voluntarily, but then when he said he wanted to leave and it was stupid and he should have just killed himself instead of going to the hospital, of course they changed his status to involuntary. For a while he was really mad that he’s stuck there because he wants to go online and see if his girlfriend is terribly worried about him, as he wants her to be. He was doing a countdown online to the day he planned to kill himself and dramatically telling his friends that it would be his “last day on Earth.” His girlfriend has a good summer job on the other side of the country and he is upset about that because he would prefer that she come home to her apartment and work at the part time waitress job that she had before she found the better job. He thinks that her wanting to make money to pay the rent for her apartment, where he sometimes lives with her for free as he has no job, means that she doesn’t really love him. My mother said today, though, that he is feeling less angry about being in the hospital now because he thinks he should stay until he feels safe.
Feelings can shift so rapidly in the hospital sometimes, can’t they? Most of the time, it’s very boring, so when anything at all happens, sometime it seems monumental and you can overreact.
This is not an anti-BPD post. My brother behaves like a stereotypical, worst-case-scenario borderline, and of course I’m going to vent about that. I realize that most people diagnosed with BPD aren’t actually like him, and I’m hopeful that whatever the hell is wrong with him, whether it’s BPD or something else or BPD and something else, he will soon get some appropriate help and will feel better and not be such a pain in the ass. Even if he is bipolar without BPD, I’m glad that somebody has finally noticed that something other than GAD is going on.
June 20th, 2007 at 5:39 pm
i’m reasonably sure that rob will be dx’d bpd as well… or maybe they’ll just stick with personality disorder (nos). i don’t know if you’ve read enough or remember enough about rob’s symptoms from my blog, but i’d be interested in hearing your thoughts about that.
June 21st, 2007 at 9:04 am
I hope he is able to get out of the hosp soon. Thats the deal here as well; anyone who is a a high risk patient has to be involuntary.
June 21st, 2007 at 11:58 am
The hospital is the most boring place on earth, and that’s a good thing, at least in my experience. You’re right that it makes any event stick out and makes your own thoughts the most entertaining thing going on. I hope he gets the help he needs and medication that serves the diagnosis.
June 21st, 2007 at 12:20 pm
I don’t know when he’ll be getting out. My mother says that originally he thought he’d be out by Friday, but now he’s not even sure that they’ll give him a weekend pass. He doesn’t want to do things like go to sleep at a reasonable hour or eat three meals a day (would you want to eat three hospital-food meals a day?) and people are also worried about how he’ll react after he contacts his girlfriend.
I feel guilty posting about this stuff here, since it’s not my stuff to talk about, it’s his.
anonymous mom, you’ve got to remember that although Rob does seem to have a lot of BPD symptoms, he’s also quite young and recently diagnosed with bipolar disorder, which complicates things. My brother is older than Rob, so he does have a long-standing behaviour pattern of BPD symptoms past, um, teenagerhood. I try not to play armchair psychologist for anybody except myself, though, so it’s not even like I believe firmly that my brother should definitely have one diagnosis or the other, or both, or neither, but I was pretty disgusted that he had so many BPD symptoms and no one was looking carefully at them, most likely because he’s a guy. This kind of sexism doesn’t help girls who get labelled with BPD for no reason, but it also doesn’t help guys whose BPD symptoms are ignored.
June 22nd, 2007 at 12:08 am
Great post, Polly.
Anonymous mom, without knowing too much about your son’s situation, I’d have to agree with Polly. It’s always risky diagnosing personality disorders in teenagers, as teenagers in general exhibit the kinds of behaviours associated with BPD and other Cluster B disorders at a higher rate than do adults. To a certain extent it’s just part of growing up, especially when you have to grow up under challenging conditions, such as being dx’d with bipolar disorder.
I wish psychiatrists were more interested in identifying specific problematic areas of functioning (which may well include some of the various DSM criteria for BPD) and addressing these directly, rather than just reaching for the big grey book (or the big green book if your doc is psychoanalytically inclined) and slapping people with totalising and potentially very stigmatising diagnoses.
June 28th, 2007 at 5:58 pm
Wow. Interesting… gender views on bi-polarity. I would really like you to share these thoughts with something that I’m putting together.
So here is the deal:
Join a small group of bloggers and interview the medical director for the National Alliance on Mental Illness (NAMI) and Harvard Medical School Professor Dr. Ken Duckworth. Triple board certified by the American Board of Psychiatry and Neurology in Adult, Child and Adolescent, and Forensic Psychiatry, Dr. Duckworth has extensive experience in public health – in offices ranging from Acting Commissioner of Mental Health and the Medical Director for Department of Mental Health of Massachusetts to Medical Director of the Massachusetts Mental Health Center for eight years.
This news conference is one of a series of calls sponsored by Revolution Health designed to give bloggers access to world-class experts in their areas of interest. The call is informational; you are under no obligation to write about the conversation unless you find it useful. I’ve included more information about Dr. Duckworth and Revolution Health at the bottom of this message.
This week’s call is taking place in conjunction with the Revolution Online Health Fair , launched in partnership with 10 national nonprofit organizations, including the National Alliance on Mental Health. At the fair, each nonprofit is hosting an online “booth.” For every visitor to a partner organization’s booth, Revolution Health will make a donation to that partner — for a total of up to $10,000.
Again:
WHAT: Conference call/news conference with Dr. Ken Duckworth
WHEN Friday June 29th, 2007 3 -4 PM EDT; 6 -7 PM PDT
WHERE: Conference Call – number to be provided
WHY: To answer questions on bipolar disorder.
We will also provide audio after the conference if you would like to post a link to that as well.
Please RSVP, either by email or telephone (see below) when you know if this is an opportunity that interests you.
Thanks. We’re looking forward to hearing from you. With best wishes,
Cynthia Samuels for Revolution Health
Email: cindy.samuels@revolution.com
Phone: 202.236-1844
About Revolution Health
Revolution Health (http://www.revolutionhealth.com) is the new health resource website founded by Steve Case, partly because of the difficulties he and his family faced during his brother’s battle with brain cancer. He wants to make it a bit easier for those who follow by providing tools to support both patient and family. I’m working with Revolution to support the work of bloggers who follow health issues. One way we’re doing that is by conducting these topical briefings, just for the blogger universe. Revolution wants to highlight its ability to aggregate and share critical information on health issues by providing new information and contact with health leaders in relevant disease communities.
More about Dr. Duckworth
Dr. Ken Duckworth serves as the medical director for the National Alliance on Mental Illness (NAMI). Triple board certified by the American Board of Psychiatry and Neurology in Adult, Child and Adolescent, and Forensic Psychiatry, Dr. Duckworth has extensive experience in the public health arena.
First serving as Acting Commissioner of Mental Health and the Medical Director for Department of Mental Health of Massachusetts, then as a psychiatrist on a Program Assertive Community Treatment team, Dr. Duckworth was also Medical Director of the Massachusetts Mental Health Center for eight years.
Dr. Duckworth won the award for Clinical Excellence from the Massachusetts Psychiatric Society as well as teaching awards from Boston University, for his work at Harvard Medical School, and from the American Psychiatric Association. He was also a recipient of the Ken and Rona Purdy Award for his work to combat stigma.
Dr. Duckworth attended the University of Michigan where he graduated with honors in 1981 and Temple University School of Medicine where he was named to the medical honor society, AOA. While at Temple, he won awards for his work in psychiatry and neurology.
Dr. Duckworth is currently an Assistant Professor at Harvard University Medical School. He is also a board member of the American Association of Community Psychiatrists.
Dr. Duckworth has served as a school consultant for a decade, has had an active private practice, and currently does community mental health work with Vinfen Corporation in Boston as their Medical Director.