When I was reading this piece I couldn't help but wonder how another Seattle writer would have handled this.....

That said, this is a topic that is hard for me. Back in 02 during a hospitalization, I overheard to residents talking about one patient and calling her a "borderline". They made a dispariging remark and said they aren't even going to go near her for their dislike of borderlines.

I noticed several of the staff felt the same way.

I've been in group therapy and heard the same thing from another therapist- they refused to take someone who was referred to them because she was a borderline.

I have a dear friend who runs a very successful counseling clinic in Ohio. She refuses to take anyone who is a borderline as well.

There are several in my support group, and I notice that they interpret things differently- what is said and what they hear are two totally different things. It's trying.

Then I have someone on the internet who has for the last 2 years taken every opportunity to call me borderline when he can, despite the fact my lawyer has threatened him with libel and I have 26 different shrinks I have seen in 24 years stating in writing that has never been in my diagnosis. This person has also told many people on the internet and in real life I am despite them telling him I am not.

I cannot tell you what it has done for my reputation, and my self esteem. I cannot think of too many other labels to be called that hurt as much as this does, when you don't and never have had more than 2 of the criteria, and one of them applies to every woman in the world if she is menstruating.

Sorry to ramble. Thank you for this piece Philip.

Time gave us the article about "bipolar" children, so this one is not surprising, still, with the controversy surrounding the DSM, it's hard to imagine that any responsible person would believe that separate and distinct personality disorders exist.

A bit from the article:

"Eventually, borderlines became pretty much anything a therapist said they were. Says Dr. Kenneth Duckworth, medical director of the National Alliance on Mental Illness: "If you hated the patient — if the patient was pissing you off — you would bandy this term about: 'Oh, you're just a borderline.' It was a diagnosis that was a wastebasket of hostility."

It was Linehan who changed all that. In the early 1990s, she became the first researcher to conduct a randomized study on the treatment of borderline personality disorder."

So how could this woman possibly come up with a study of this condition as a valid disease, when it's not a valid disease, it's code for the pshrink doesn't like you.

I agree in complete with your analysis. But it was not a good article for the following reasons.

1 it was a big, wet, sloppy, kiss to dbt. which is a lot less effective than its proponents will have you believe, including linehan. it also has some major shortcomings, which of course were not even mentioned.

2 philip adressed the totally duplicitously misrepresented statistics from the journal of clinical psychiatry study.

3 it awkwardly quoted kenneth duckworth who is NAMI's medical bobble-head. what did he add to the article again?

4 the piece explores none of the diagnostic controversy, which is a lot more worthy of a Time piece.

5 he attributed, lazily, the disorders etiology to the standard genetic-enviromental "interaction", which again, is misrepresentation. because of the absolute paucity of "genetic" research on the borderline condition, we can resoundingly conclude at the current time that the evidence factors out a genetic etiology. In mental health research, just having genes implicates them as the cause. It's almost like these people have never been kicked in the teeth before...

There is also no coherent physiological implication in causing the disorder. This controversy is the most newsorthy stuff.

Also, the reductionists and sometimes linhean, throw out the old red herring that not every borderline is sexually abused. of course. well, it is actually somewhere around the grotesque figure of 30-50% -- but thats true not every borderline is. what they dont mention is that around 80-90% of borderlines suffer some kind of abuse, physical, emotional, or sexual. physical and even just simply emotional abuse is enough to cause the condition. thats why she invented the euphemism of "invalidating environment".

There are usually two strains of people who contest the abuse issue on this subject.

1 Families and their allies. ie NAMI, TARA BPD. So thats a big mystery, huh?

2 And The Reductionists -- and there is a subcategory here. Straight Reductionists are people like siever, and that strange family physician leland heller, who purports himself to be an expert at treating the condition exclusively with drugs (good luck!), and others. These people's etiological misguidedness comes from an honest incapacity for self-reflection.

The Reductionists also include a subcategory of people who at one time really weren't interested in biology, or science fiction, or whatever. in fact at one time these people were psychoanalysts, who blamed their patients, neglected the condition's obvious 'traumatic origins' and further abused patients -- in plain terms -- they got it all wrong. These people were obviously for the most part men, and include people like gunderson an kernberg. (i've unfortunately met Gunderson personally, so i don't mince words).

This subgroup is likely secretly ashamed of the former irrational ideas and concepts upon which they operated, outed by herman and linehan and now look to biology to vindicate them morally, and professionaly. In essence they are physicians whithout a sufficient background in the basic sciences, who now promote an untenable, regressive, and unproductive view that the borderline condition is driven by biology, genes especially. These people now also align themselves with the groups that represent the interest of the families of those who have been labeled mentally ill, nami, tara-bpd, etc.

6 if i am correct, several times, Cloud introduced quotes in the piece, from linehan among others, that are from her book and writings, and gave no impression that these were horribly outdated. in fact, they gave the impression these people were interviewed for the piece.

7 this could be the most important and most blatantly false statement in the article which i wish someone would write to him about...

The paragraph that begins, ' linehan changed all that.' in reference to the prevailing gundersonian viewpoint that borderlines were funny-appearing objects that should be doubly-abused by the mental health system. Cloud, attributes this advance to linehan and he is wrong. judith herman published trauma and recovery in 1992 at least a whole year and a half before linehans book and she addresses this over and over, in much better detail, more coherently, than linehan, (who i have nothing against by the way). but it was Herman, not linehan who changed peoples thinking on borderlines.

As an aside, linehan has all these fancy behavioral protocols, yet its more likely her treatment 'works', some of the time, because she forces treaters to take an empathic, rational, historically-informed approach. in other words, the opposite approach of the other leading experts at the time e.g. gunderson.

Altogether this is a sloppy article... I mean, really lazy. Immediately, about halfway through the first page, I got the feeling this article was slopped together -- by the end, I was beside myself. And frankly, there is enough information around to avoid hashing together such a shallow piece, with a remarkably consistent incoherency.

Thankfully, he quoted Joel Paris, who is unfortunately a proponent of the great scientific majesty of behavioral genetics, yet, fortunately, is also a big opponent of polypharmacy with borderlines, and the totally unfounded assumption, that it at least can help with some symptoms, etc, however that line goes. This was the pieces only redeeming quality as a fountain of over-simplification and misinformation.

Someone should write to Cloud at Time.

JC, god bless you. My head is bowed in thanks for that. I too was beside myself by the end of the article, which I read earlier today and have been self-fucking harming ever since, and I outgrew all that. We should blog together, I cut, you fisk what a team. But you hit everything wrong point-by-point, including things I didn't realize, like TARA is now a NAMI type group, yes? I get their email alerts and noticed a sickening turn toward family advocacy about a year ago and lost interest in following them.
Linehan understands the sufferings but she does speak in gutless euphimism wrt to causality, and her techniques are gimmicks meant to clampdown on the point made in the article's introduction; one word describes borderlines: angry. No shit? So rather than explore and privilege the anger like Herman does with her formidable critique of power dynamics Linehan's treatment is to "regulate" the BPD's "dysregulated" emotions. Which in no way resolves anger, it deligitimizes the emotion and makes the borderline self-policing about its arousal and behavioral manifestation.

A complete betrayal, and the only reason it "works" at all is because we are easily manipulated to "be good" due to our shame-based personalities, which were formed around interpersonal violence and sexual abuse by our original "caregivers."

Fucking racket is what it is.
I got kicked out of my DBT group of course, for just this sort of subversive inquiry. Reckon I'm no worse the wear for what it's deprived me.

Philip, I left this comment on the wrong post, could you delete the comment that is a duplicate of the one below? Sorry about that. Thanks.

I first voluntarily sought treatment for my depression and suicidal thoughts when I was 19, in 1992. Right after an MMPI, I was prescribed Prozac and Stelazine. The Stelazine, I was told, was for my "concentration" and "anxiety" to help "order" my thoughts. I have never been diagnosed as being psychotic, and no other tranquilizer was tried before Stelazine.

In 2003, when I started seeing a new doctor, in a long line of doctors (mostly due to moving/relocating), I was diagnosed with Borderline Personality Disorder. I asked him why hadn't I been told before. He said it's something psychologists tend to avoid because it's so hard to treat. And indeed, a few quotes from this article matched up with his statement:

Borderline patients are often overmedicated--partly because therapists see them as difficult--but for Lily, as for most borderlines, the meds did little. "Drug treatment for BPD is much less impressive than most people think," Paris writes in Treatment of Borderline Personality Disorder.

Meds have always done little or next to nothing for me.

BPD treatment has improved dramatically in the past few years. Until recently, a diagnosis of borderline personality disorder was seen as a "death sentence," as Dr. Kenneth Silk of the University of Michigan wrote in the April 2008 issue of the American Journal of Psychiatry. Clinicians often avoided naming the illness and instead told patients they had a less stigmatizing disorder.

Again, I was never told I had BPD until 2003, it was just depression, major depression, dysthymia, anxiety, GAD, or bipolar disorder.

I have a large majority of the "symptoms" mentioned in the TIME article (by the way, yes it's in the print edition), and additionally some classic symptoms that weren't mentioned. I don't think of it as a "disease" in my case, however because of the abuse, neglect, instability, and abandonment I went through as a child and into my adolescence.

Briefly I'll try to give an overview. Before third grade, I was always "different" not really fitting in. I'm not saying that's because of BPD, but because I had an above average IQ, which was never pointed out to me. Then at the beginning of third grade, my father shot himself in our backyard with a shotgun. We were all home at the time; we didn't see it happen, but heard it. After that, my mother couldn't quite take care of me and my brothers and sisters properly, so she had us live with her parents for about 9 months. I lost track of how many time we moved, so as a rough guess I'll say 9 times by the time I was 18. There was very little adult supervision. I encountered various types of abuse, mostly verbal and emotional, some physical, hardly none at all sexual.

It wasn't until my mid-twenties when a therapist suggested I may have an IQ significantly above average. Up until then, because of my poor concentration (which I've often attributed to my LSD use) and the insults from kids at school, teachers, my mother's boyfriend, my brother -- I always thought I was average or below average. But that p-doc wanted to slap a label of ADHD on me. But at least he presented me with new information to consider.

Based on my "symptoms" I'd say I match up more closely with BPD than anything else. I cenrtainly often never really felt I had a "chemical imbalance." More recently it's becoming clearer and clearer that my mood changes are due to events or triggers, especially minor ones, that I don't react to very well. (Many things, insights, my brain, have become clearer to me since I quit taking the Stelazine in 2003).

Without having a journalist's eye for detail and not noticing about that article other people have mentioned, I take issue with this paragraph from the article:

Those with borderline disorder usually appear as criminals in the media. In the past decade, hundreds of stories in major newspapers have recounted violent crimes committed by those said to have the disorder. A typical example from last year was the lurid tale of an Ontario man labeled borderline who used a screwdriver to gouge out his wife's right eye. (She lived; he got 14 years."

I expected the author to elaborate that it's another Hollywood/media stereotype, and that there's lots of people with BPD who have no desire to harm other people. I verbally can "fly off the handle" pretty quickly and get very loud, but I'm far too sensitive and empathic an individual (must be the writer in me) to want to harm other people. I may lose control and start throwing around the F word, but the last time I actually struck someone out of anger I was a teenager. And even that was very rare. I have, however, been very rough with my telephones and tv remote controls, and my freezer door

Finally, I'd like to say that I find it odd that no one in this discussion thread has mentioned this admission about the lack of efficacy of medication from the article:

Borderline patients are often overmedicated--partly because therapists see them as difficult--but for Lily, as for most borderlines, the meds did little. "Drug treatment for BPD is much less impressive than most people think," Paris writes in Treatment of Borderline Personality Disorder.

Linehan and DBT are always the go-to for borderline treatment. Most Borderline in-patient treatment centers focus on this form of therapy. What most American's do not know is that Europe and Australia are finding much better results in Schema Therapy. The studies conducted on this form of treatment showed less medication-dependent and happier patients. And there is no need for eternal support groups and self-talk to manage emotions.

My biggest gripe with DBT is for all the hype on it's effectiveness, many people I have met with this form of therapy relapse often. Yet they defend its success.

I like Schema Therapy too based mostly on how it's helping a friend who is in it and based on what I've read, the theory makes sense. Not to mention a schema, no matter how wretched implies an underlying intelligence that is knowable, sophisticated and germane to the situations borderlines get themselfs into, while all these other approaches push the "capricious" "evil" "perverse" utterly alien personality organization that "psychologists don't want to deal with."

Another thing I've never understood, maybe I'm not smart enough to get it, but what's with the "dialectic" in dialectic behavioral therapy? The article gives the standard explanation, the goal of "synthesis" between contradictions -- both client and therapist are supposed to "accept" the craxy lady while working to "change" her. Really? Which the fuck is it -- accept or change? You can't do both, they are in fact opposites. It's this sort of bullshit makes the cult of Linehan turn my stomach inside out. That's profound.

JC:

First, you are correct that DBT has shortcomings and is not as effective as its advocates would like, but it has definitely been shown to be effective in the treatment of BPD in several controlled studies, especially in self-harm and suicide attempt reduction. For a good review of DBT in general and the evidence for it, you can see the Annual Review of Clinical Psychology (2007; 3:181-205).

Second, there IS some literature on the hereditary and genetic contributions to BPD. It was estimated to be 35% in one large Norwegian twin study (Psychological Medicine. 2008; 38:1617-25), and another Norwegian twin study that involved 92 monozygotic and 129 dizygotic twin pairs found a heritability of about 69% for BPD (Comprehensive Psychiatry. 2000; 41:416-25). Furthermore, when individual traits were looked at an even higher hereditary rate was found, particularly for the traits of affective instability and impulsivity. So, although the actual numbers may be in dispute, there is decent evidence for a genetic component to BPD, mainly in the form of an unstable and impulsive temperament.

Third, great points about the “reductionists”. I mean, ultimately, it is all neurobiological, but still, how anyone can ignore the significant environmental component of BPD is beyond me. But I guess anything is possible! :)

Fourth, an interesting approach is Peter Fonagy and Anthony Bateman’s Mentalization-Based Treatment (MBT), which has shown some preliminary results that are promising. The idea is summarized as follows:

“… a pervasive history of invalidating (non-mentalizing) responses from attachment figures generates skills deficits primarily in emotionally charged interpersonal situations where social-cognitive capacities are essential. The failure of interpersonal understanding further compounds the social stress, leading to major difficulties of emotion regulation and interpersonal problem solving – at worst, actively evoking chaos in relationships” (Mentalizing in Clinical Practice, 2008, p. 275).

Anyway, just wanted to throw this concept your way since you’re already pretty familiar with the other usual suspects: Linehan, Kernberg and Gunderson. Mentalizing failure is an intriguing synthesis that does not require any psychodynamic formulation and integrates the phenomenology of BPD with attachment research in a very plausible way. Have a look at it, and let me know what you think! :)

Take care.

flawedplan:

I can see how the “dialectical” part of DBT can be confusing. Maybe this will help.

One of the core features of BPD is dichotomous thinking, a.k.a. all-or-nothing thinking, a.k.a. black-or-white thinking, a.k.a. splitting. In other words, they have difficulties seeing people, situations, etc. as consisting of a complicated mix of opposing elements, some good and some bad, some positive and some negative. The "dialectical" part of DBT attempts to help them bring the opposing elements into a higher synthesis. In other words, rather than someone being “EITHER good OR bad”, they are seen as “BOTH good AND bad” in different respects, but still as a single personality. By gaining this insight, patients with BPD are better equipped to respond to stressful interpersonal situations in more adaptive ways.

With regards to the BPD patients themselves, the dialectic is between themselves as necessary products of their past experience (which they cannot change and must accept) and as open to a new way of being in the present and future (which they can change rather than accept the status quo). That is the Zen part of DBT where a contradiction in duality – i.e. acceptance versus change – is dissolved into a deeper unity – acceptance AND change – which also occurs in Zen koans.

I hope this helps!

DBT is bullshit behavior mod, and that sop to the incest survivor's personality development as a "necessary product of their past experience" is an insult because this "experience" is avoided (invalidated) by the very same DBT pimps whose theory presumes backwash from "invalidating environments." What's an invalidating environment? Ahem, well now, mumble mumble ah, really now, dredging up all that (cough, cough) unpleasantness but hey these temper tantrums are really something. Let's stop them.

In DBT the client is kept in conflict with the self. What they call "distress tolerance" in practice amounts to emotional suppression. DBT trains people to devalue their screaming and deny its logic and legitimacy. The hypocrisy is, as ever with psychiatry in denying the traumatic origins of the "disordered" personality, while muttering bullshitery bromides about radical acceptance of mysterious "invalidating environments" that surely factor in somewhere, somehow, but are nothing to be dealt with head-on. There's only one reason to ignore etiology in a personality that's been shattered by experience--the experience makes the powerful uncomfortable. Of course DBT is popular because it collaborates with our culture's abusive status quo, doesn't recognize imbalanced power structures, and puts the focus (blame) on the behavior of the victim.

BTW I'm not knocking Zen techniques per se (though when it comes "mindfulness" in mental health ACT is more true and honest than DBT), but any chickenshit, evasive list of practices held out as a remedy for issues the experts won't themselves look at is contemptible. Humiliation, shame, rage, terror, chaos, abandonment, repetition, loyalty, indoctrination, re-traumitization, self-destruction, these are perpetuated and motivated needs that can't be dismissed as peculiarities, and can't be assuaged by avoiding their cause and effect nor their present-day intent and purpose. All of which is dark, inchoate and deeply troubling to the actor (duh) but the therapist really ought to have a clue. Nothing in this article tells me they do, which amounts to being "othered," by stupid people with delusions of adequacy who use the fact that our lives are egodystonic as leverage to submit to their lameass DBT dictates. Til the next fad rolls around. Maybe next one won't treat women like insentinent cows, that would be a real step forward, I'm just sayin'.

"...Again, I was never told I had BPD until 2003, it was just depression, major depression, dysthymia, anxiety, GAD, or bipolar disorder..."

Andy,
I will never understand this dance of diagnosis and many people has a collection of diagnosis.
I wonder how can statistics, which is crucial to biomedical studies and predictions, be so accurate.

JC,
Great posting. Thank you.

DBT, as practiced by my local mental health clinic, is a punitive and unproductive affair. The last time I looked they had a dry drunk perpetrator of domestic violence (she took after her partner with an axe!) running the groups. Given the abuse histories prevalent in this population, well... what a choice.

Jim Chu refers to "borderline with a big B and borderline with a small b" to make the point of how often psychiatrists slap the label on customers who are merely annoying.

Sherry

FP,

This bit you wrote about DBT reminds me why I respect you:

"A complete betrayal, and the only reason it "works" at all is because we are easily manipulated to "be good" due to our shame-based personalities, which were formed around interpersonal violence and sexual abuse by our original "caregivers.""

Uh, yeah, exactly, but don't you see that when an abused person is forced to pay money for care, even if s/he's dropping the gold coins s/he doesn't really need anyway into the unconditionally positive regarding hands of Carl Rogers himself, the act of payment for care is abuse. Abused becomes masochist, abuser sadist.

And "helpful" dgueller has posted some helpful stuff about DBT and zen for you. I hope he bills out high to the insurance companies of the "BPD" for Zen koans. What is the sound of one hand writing a b*llshit, death sentence dsm code in a medical chart? Kaching.

Meanwhile, as Andy Alt correctly points out, the article has this bit:

"Borderline patients are often overmedicated--partly because therapists see them as difficult--but for Lily, as for most borderlines, the meds did little. "Drug treatment for BPD is much less impressive than most people think," Paris writes in Treatment of Borderline Personality Disorder."

Now lets see, you take a person who has a history of being abused, as all humans do to some degree, who feels angry because the border of his body was violated, and blur all borders by forcibly intoxicating her or him. You are robbing that person of the physical and mental control of their body, making distinction between real and unreal much more difficult, and then labeling this theft as "treatment" when the only possibility from such treatment is deterioration.

It's a cruel form of torture, sadism. And why is it the abused is sick the abuser not so much?

This comment is going to focus heavily on the reverse of which I intended to focus upon most, but here goes:

FlawedPlan: I actually have a secret wish to blog with you, but we can talk about that later. haha. I just need to adress dguller, and I have limited time for this post.

Sherrie: I think Schema Therapy is more coherent, less rigid and will overtake DBT, which doesn't have a whole lot to stand on at this point. Young doesn't ignore any aspect of reality in fashiong this model of treatment, which can't be said of linehan, unfortunately.

dguller: Yes, DBT is extremely touted beyond its own merit. Yes, there is evidence for its efficacy in contolled trial for treating those specific aspects of "Borderline" behavior.

With us, the majority of self-harm behaviors are tolerable in therapy, are not necessarily dangerous, and should not be the focus of treatment, whith people whose psyches are sharded into pieces. Linehan's treatment does not have a robust effect on suicide. Her original trials certainly didn't, and again it probbaly has to do with the superficiality and rigidness with which it is applied in communities. The findings form DBT trials are often not ery generalizable, because it requires resources and training that are almost unifromly absent in the mental health system, at least in the united states. It ends up a truncated application. That said, you can not control for things you can't quantify in a trial when determining what caused someone to not kill themselves. And that fact will plague her over-reaching insistence on DBT's behavioral protocols.

Second, dguller, I don't mean this in a terribly offenisve way, but I need to say it. I think you come off terribly shallow at timesin your commenting. For the record, I don't pretend to be normal in any way. I don't think you told flawed plan anything new about the "philosophy" behind DBT, and your posts often smack of a certain smugness, many here have commented upon as being unique to psychiatrists who are overly confident in their treatments or "ideology".

On the genetic research behind BPD... I'm glad we agree. There is a total paucity of basic research into it's genetics. There are a few recent norwegian twin studies which you point to done by the same group whihc to the best of my knowledge have not been replicated. Either way, there are only afew of such studies.

Unfortunately, poverty, and sbuse also run in families. So twin studies will highlight a lot of spurious associations. In 2006, with the first study, Gunderson, was making grandiose claims about the biologcal basis of the disorder.

More to that, heritablity, does not even need to imply a genetic cause. And of course there are no BPD gene polymorphisms. And with traits, the minute you look at a single trait, your not looking at BPD. How do you people not think about these things. It's s just so wrong and illogical on the face of it.

Do you think Gunderson cared all that much about molecular biology when he was training as a psychoanalyst.

Like I said, but which you ignored. Having genes inplicates them as the cause in psychiatric research. Psychiatric genetics is in the gutter right now, which of course you know, or should.

We havehundreds of twin studis in schizophrenia, yet there is still no significant gene polymorphism or group of them to implicate. Schisophrenia! Now BPD, maybe you don't work with people like us, but my early life trajectory was extraordinarily successful despite the chaos and abuse in my family. And i had the least impulsive temperament imaginable. I personalize this, and give you permisiion not to mince words, or necessiatte extra respect, bc the notion that the traits in BPD are heritable is so fundamentally illogical, you'd have to be a veritable sociopath like Gunderson to not look at whats put forth as "evidence", and say, "This isn't science."

Sally, you keep trying to make ideas trump experience and that will never work. In this discussion my own personal lived experience prevails. For instance in your attempt to persuade me that therapeutic relationships are inherently awful because money changes hands you say:

"Uh, yeah, exactly, but don't you see that"

Don't you see that? is argument, you could argue eleventyzillion reasons why I should see wreckers and still to no avail, since I spent over 20 years in psychotherapy, and have nothing but good experience to chronicle and hold up as a standard.

Including good experience in payment by the way, haven't you ever heard of "Doctors Without Borders"? These programs exist everywhere. Most of my 20 years in therapy was free, given by university grad students, or community programs paid for by the YWCA and United Way clinics. I found free therapy in four different American states, that is a fact.

I've had therapists see me without payment by anyone, who volunteer their time to indigents just like "normal" people volunteer for programs in their community. Why wouldn't they?

Most of my friends around the country are poor and get free therapy, Austin has these programs, including completely volunteer psych services for musicians called the SIMS Foundation, where shrinks see rockers in crises! Check out the website and tell me how abusive and exploitative these folks are to the artists in their community.

http://www.simsfoundation.org/

Strawman, Sally, time to set him on fire.

Sally:

First, I do not bill insurance companies, and so that particular personal attack will not stick, but I’m sure you’ll come up with others in the future. :)

Second, you state that the “act of payment is itself abuse”. Does that specifically refer to payment for therapy, or are you generalizing to all forms of payment as a form of personal violation? If it is only for therapy, then what is it about therapy that contributes to the abuse? Is it all therapies or just some?

Third, you object to medications and therapy as sadistic and abusive in abused patients. What do you recommend to help them?

Take care.

FP,
Thank you very much for the sims tip. I have a musician friend who can't get therapy because he hasn't got the money for co-payments.

I do have to say, though, that your experience is so atypical as to be almost unknown in my area of the US. I worked with people in need of therapy for decades and only ONCE met a therapist who didn't require payment. Once. And yes, it was a powerful experience. Mainly because it was so unheard of.

Quite the opposite. Therapists in my experience routinely throw people out of treatment for inability to cough up co-payments. This includes people in group therapy whose co-pay was a paltry ten or fifteen bucks, very little to a doctor pulling in over 100K a year, but quite a lot to someone living on $600 or so a month.

Psychotherapy in the US is a paying business. That's a fact. And the payments are quite high, over $100 an hour. No one's time is worth that much, IMO.

I'm genuinely glad you've had an atypical experience, but it is, alas, atypical. I don't expect someone to pay their light bill with good intentions, but neither do I expect someone who professes to be in a highly paid "helping" profession to deny help to someone in genuine need for lack of a group co-payment. There's a balance.

Dguller,

Yep, charging for therapy is abusive, drugs are not therapy, they're pain relief which I've told you I'm not opposed to if doled out honestly. Telling people that addictive drugs that cause suicide will cheer them up, that these drugs are not addictive, and that the drugs correct a chemical imbalance, yeah, that bothers me. Telling someone, well paxil gave me a pretty good buzz and seems to relieve anxiety in lots of my patients, is another story altogether.

You write:

"First, I do not bill insurance companies, and so that particular personal attack will not stick, but I’m sure you’ll come up with others in the future. :)"

What's with the smiley emoticon, dude, seems disingenuous, incongruous, threatening, passive aggressive.

You ask:

"Second, you state that the “act of payment is itself abuse”. Does that specifically refer to payment for therapy, or are you generalizing to all forms of payment as a form of personal violation? If it is only for therapy, then what is it about therapy that contributes to the abuse? Is it all therapies or just some?"

I mean what is called "psychotherapy," as opposed to therapy, and while I'm sure there are other things it's wrong to charge for I don't readily have a catalog of them at hand, charging abuse victims for human kindness (or more likely sadistic retraumatization) is certainly abusive, kind of like the anecdotes about the dictator billing the family of the unjustly executed for the bullet.
You keep characterizing me as one of the folks who somehow favors psychotherapy over drugs when that's not what I am.

You write:

"Third, you object to medications and therapy as sadistic and abusive in abused patients. What do you recommend to help them?"

I don't think medication is wrong, but I think dishonest drugging with drugs that don't help is. As for therapy, peer counseling, anonymous and free.

Do you work for free or are the tax dollars of Canadians paying your bills?

FP,

I'm glad you weren't charged for "therapy." If psychotherapy is free and done by volunteers, wonderful. I'm quite familiar with Doctors without Borders, a great organization.

You write:

"...I spent over 20 years in psychotherapy, and have nothing but good experience to chronicle and hold up as a standard."

and

"Humiliation, shame, rage, terror, chaos, abandonment, repetition, loyalty, indoctrination, re-traumitization, self-destruction, these are perpetuated and motivated needs that can't be dismissed as peculiarities, and can't be assuaged by avoiding their cause and effect nor their present-day intent and purpose. All of which is dark, inchoate and deeply troubling to the actor (duh) but the therapist really ought to have a clue. Nothing in this article tells me they do, which amounts to being "othered," by stupid people with delusions of adequacy who use the fact that our lives are egodystonic as leverage to submit to their lameass DBT dictates. Til the next fad rolls around. Maybe next one won't treat women like insentinent cows, that would be a real step forward, I'm just sayin'."

Seems like you contradict yourself or am I misunderstanding, have you had no bad experiences with psychotherapy? The idea that psychotherapy is available for free in the US to anyone that want's it is big news to me. What's the DSM for if all psychotherapy is free and no one needs an insurance company billing code?

Of course I think not getting therapy saves lives so I think not being about to afford "mental health care" saves lives.

Nope, no contradiction

"I spent over 20 years in psychotherapy, and have nothing but good experience to chronicle and hold up as a standard."

It's that standard I'm concerned with wrt to treating survivors of childhood abuse (aka Borderlines), which is cognitive-based behavioral therapy. That's what they do now, and it stinks. None of my therapists were behaviorist. They laughed at behaviorism, the very idea of it for treating the transference-laden world the abuse victim flails in.

Support groups are great, but peers aren't capable of taking on the material, and they shouldn't have that responsibility. You assume people will be lucid, which marks you a very bad peer counselor from the git.

Sally:

First, the smiley emoticon was supposed to be an ironic and friendly form of mockery of your repeated attempts to insult me in various ways. Here it is again -- :).

Second, my salary is paid for by the universal healthcare system in Canada, which is why I do not have to charge individual patients or insurance companies. Socialized healthcare, baby!

Take care.

JC:

First, what aspect of reality does Linehan ignore?

Second, you state that most forms of self-harm and self-mutilation are “tolerable” to you, because they are not “dangerous”. I can assure you that I have never met any patient with BPD who found such behaviour tolerable or safe in any way. They always harmed themselves when in extreme emotional distress in order to avoid their intense psychic pain. The fact that DBT is able to reduce this behaviour is no small feat, and should not be minimized.

Third, you make valid points about the need for a DBT practitioner to be competent in all its aspects in order to utilize it effectively and to its full potential. However, even those who have been trained briefly in DBT can have a positive impact on patients.

In Linehan’s recent 2006 study (Archives of General Psychiatry. 2006; 63:757-66), most of the 16 clinicians administering DBT had no DBT training, except for the 45 hours prior to the onset of the study. Even without the extensive training, there was a significant difference between the DBT group of 60 subjects and the community treatment by experts (CTBE) group of 51 subjects in the study in terms of suicide attempts (23.1% versus 46%), ER visits (15.6% versus 33.3%), and hospitalizations (9.8% versus 35.6%). Both groups improved on their depression, hopelessness and suicidal ideation scores without significant differences between them. Both treatments were administered over the course of one year, and then followed up for another year.

So, even with a 45 hour training course and some subsequent supervision, there are significant reductions in affective, cognitive and suicidal tendencies. I’m not too sure where you claim that DBT’s reduction of suicidal ideation and behaviour is not “robust”. Linehan’s calculated effect size of DBT versus CTBE was 0.49 in the 2006 study, which is actually pretty robust.

Fourth, flawedplan appeared to need some clarification about what the “dialectical” part of DBT was all about. I tried to provide that information for her as best as I could. Perhaps if you could give me some specifics about how my comments here are “terribly shallow” and “smug”, then that would be helpful.

Fifth, I am also happy that we agree that BPD is certainly not primarily a genetic condition, but I wish that you would be less dismissive of the Norwegian studies that I cited. Yes, they are few in number, but that does not necessarily mean that they are false. I suppose that we can say that, so far, there is some evidence pointing to a genetic influence in BPD, but that more studies are needed for further confirmation. However, I do not think that you can “resoundingly conclude at the current time that the evidence factors out a genetic etiology”. BPD’s etiology is multifactorial, and genetics likely plays an important role.

Sixth, heredity does imply a genetic cause. What else is inherited by twins with identical DNA that are separated at birth into different environments? Yes, it is possible that they both happened to be adopted into families that shared all the key features that influence children to acquire BPD, but then how do you account for the fact that monozygotic twins have a higher heritability of traits than dizygotic twins in those studies? Was it just chance that the monozygotic twins were adopted into BPD-conducive families compared to dizygotic twins? Or can we just reasonably conclude that there are genetic factors at play here?

Seventh, if a psychiatric condition consists of certain key traits and those traits have a genetic and heritable component, then how is it illogical to say that the condition may have a genetic component that underlies its core traits? It is not illogical, i.e. implies a logical contradiction, and if you feel that it is, then perhaps you should provide the two propositions that contradict one another in the idea. However, the idea – although coherent – may not be true, but that is for empirical studies to determine, not a priori reasoning.

Eighth, psychiatric genetics is still in its infancy right now, and there is a great deal more work to be done. Perhaps this field will go nowhere, or maybe it will go somewhere. Only time will tell. Oh, and there are some preliminary studies that point to genetic polymorphisms involved in BPD. You can find them on Pubmed.

Ninth, I am happy to hear that your temperament was not impulsive and that your early life was successful despite having a difficult upbringing. I am unclear about what this has to do with this discussion. Were you diagnosed with BPD?

Thanks, and take care.

Dguller,

You write:

"First, the smiley emoticon was supposed to be an ironic and friendly form of mockery of your repeated attempts to insult me in various ways. Here it is again -- :)."

Friendly, in what sense? Apparently your understanding of friendly is as weak as your grasp of the concept of agreeing.

Since even the Time article writes that the borderline diagnosis is ambiguous, under what circumstances are you morally comfortable giving someone that label? Are you basing your label on self harm? If so what constitutes self harm? Does it have to be physical damage or do you go with the vaguer things like the DSM's "frantic efforts...?" What is the medical definition of "frantic?" What's your policy on whether or not "the patient" should be told of her/his label (diagnosis)?

Do you automatically give a child you encounter or anyone else who has experienced sexual abuse this predictive label? Do you not understand that the people of Canada do in fact pay your salary and that the money could be put to use treating real medical problems?

Also, didn't you introduce yourself here saying you had experience as a patient? If not, have fun with my tangent...If so, and you feel comfortable disclosing it, I think knowing what psych label(s) you identify yourself as having, which have been given to you by others, and how the two catagories mesh, though I can understand if you don't wish to provide such information, though if you don't provide it, I think we're entitled to an explanation of why you don't.

FP,

Psychotherapy is all about negative attention. Research indicates it doesn't work as does anecdotal evidence. You want someone to make frantic efforts and harm themselves, tell them they have an incurable illness that programs them to do so and thus, must center their life on talking to you about it to be of the least harm to others. Sheer nonsense, and cruel too.

As for peer support, I've been pretty successful with other women in violent relationships and have a 100% placement rate with my vocational rehab clients. However, if you like psychotherapy, good for you.

Recently, I worked with a woman who had been labeled alcoholic and had grown up with lots of physical abuse. Her therapist, paid for by the state, had explained to her that because of the alcoholic gene (which there's no evidence of but it's a pop culture fav), she was probably a difficult child who caused physical abuse and that she owed an amends to her abusive parents, so no, peer counseling isn't perfect, but lucid or not, the idea behind it is to reward positive behavior, not muck around in abusive garbage.

Sally, I think that therapy can be abusive but I don't think it always is. If I had had only my first couple of experiences with therapy I would agree with you 100%. My first therapist permanently lost his license. He had serious mental problems. He invited me to bring a stuffed animal to therapy even though I was in my twenties & had not had a stuffed animal since I was a child. He infantalized & crippled his patients & they got worse & worse. He was most definitely an abusor. Unfortunately, there appear to be few standards for what passes as mental health care & that's a serious problem. Therapy can be just as abusive as overmedicating someone.

But, I finally did find a therapist with a clue. This therapist turned my psychiatrist in to the state medical board. She testified against him & was not paid to do so. She stood up for me when I would not stand up for myself. She did not cripple me, but instead told me how courageous I was. She did not label me with a personality disorder but instead validated the shit I had been through. I really am grateful to her & do not feel she took advantage of me in any way. I wish there were more therapists out there like her.

I really don't know where to begin. So I'm not going to. Actually, I think I'm just going to stop commenting here. I love reading Philip's posts, and maybe I should stop there.

dguller: You know, whatever I'm not going to adress your response but Im just going to ask aloud why you engage in such exchanges with people, the majority of whom are patients. Whatever. No big deal.

... whatever. And you're smug to Sally too. Whatever.

Honestly, if my psychiatrist spent this much time commenting among this milieu in such a fashion, I'd be frightened. I'm gonna hold off on commenting for a long while.

btw, selfharm behaviors are adaptive. Suicidal ideation and what drives it is most important. obv it is a way to deal with our pain.\
dguller that wasnt adressed to you specifically. no need to respond

You misrepresent my position again, so I'll correct you again. "I like psychotherapy" is a globalization. I like skill, Sally.

And your peer counseling is the usual manipulative behaviorism, you know how to do it because anyone can, easy to learn, easy to teach and easy as hell to see through. You'd last a nanosecond with a puzzle.

Sally:

First, I am friendly towards you, because I have no ill will about you at all. I enjoy our conversations and wish nothing but the best for you. I understand that you are hostile towards me and strongly disapprove of many of my comments here, but that has no bearing on my perception of you as a human being with inherent worth and value. That is why I can be friendly towards you.

I can appreciate the cognitive dissonance that you experience when I am polite to you, because it is hard to reconcile your conception of psychiatrists as people to be despised and ridiculed for being insensitive and inhuman to their patients and my presentation of myself as a decent -- I hope! -- human being who has been generally quite courteous to people who have had mainly hostile and negative comments towards me. So, you find cognitive consonance by mocking my friendliness and behavior here as pathological, by interpreting my politeness as condescension and contempt, and by exaggerating my errors, which makes it easier for you to justify to yourself your behavior to yourself.

It is all very typical, and if you want to read a great book on the subject, see Carol Tavris and Elliot Aronson’s “Mistakes Were Made (but not by me)”, which was published in paperback in 2008. It has certainly made me more aware of my own biases and prejudices, which are plenty, and to try to look for disconfirming evidence for my cherished beliefs and to be able to admit when I am wrong rather than rationalizing my errors away, as most people are inclined to do. I do not always succeed, but it is worth the effort. :)

Second, I am comfortable diagnosing someone with BPD when they meet the diagnostic criteria for it. Self-harm is one of the criteria, and I would certainly consider BPD in anyone who engages in self-harm behavior, but they would have to have the other features of BPD for me to make a diagnosis of it.

I try to avoid making personality disorder diagnoses in acute settings, because how someone presents while acutely distressed by a depressive episode or in an extremely stressful situation, for example, is not necessarily how they think, feel or act when they are not. However, if someone has a longstanding pattern of meeting BPD criteria, then I would consider it more likely, but certainly no psychiatric diagnosis is immutable and definitive. They are always open to revision, particularly because there are no objective diagnostic tests that could seal the deal.

Third, “self-harm” refers to recurrent, impulsive, and reckless behavior that results in harm to the patient, and includes cutting, cigarette burning, sexual improprieties, substance abuse, gambling, binge eating, and so on, if done as a means of diffusing internal painful affects, to gain attention, or to control another individual.

Fourth, the “frantic efforts” to avoid real or imagined abandonment that you mention does not have anything to do with the self-harm factor, and the DSM-IV criteria explicitly excludes suicidal and self-harm behavior in the “frantic efforts” feature.

Fifth, I always inform my patients about what I think is going on, because it is important for them to understand their condition and start to do their own reading about it for better self-understanding, as well as being able to direct them to appropriate resources in the community.

Sixth, I do not diagnose sexually abused children with BPD, because most sexually abused children will not develop BPD.

Seventh, as far as I can recall, I never introduced myself here as being a psychiatric patient. I have been a patient in other medical circumstances, but they are hardly relevant here, because they were for small surgical procedures that left no residual deficits whatsoever.

Eighth, you say to flawedplan that “psychotherapy” has “research” that shows that it “does not work”. What type of psychotherapy are you referring to, and what research are you talking about? And what would a therapy have to do to “work”, according to you?

Take care.

JC:

You made specific factual claims in your comment, which I disputed. I provided my reasons and evidence for my position, and instead of answering them, or even acknowledging that maybe you may have been wrong about anything, you prefer to engage in ad hominem attacks against me as a participant on this board. Apparently, if you say that Barack Obama is really a Muslim and someone points out that this is false, then they are somehow defective as a human being.

You call me "smug". Upon what basis? I do not make fun of you or mock you for being allegedly wrong. I do not prance around in an arrogant fashion declaring that I know the Truth and everyone here is ignorant and stupid. I do not question your motives or integrity for saying what you do. I do not do so, because I believe that it is neither true nor appropriate in this dialogue.

I just make my points in as objective and dispassionate a way as possible, avoiding bringing my personality or yours into the discussion, because they are irrelevant to the factual accuracy of the matter at hand. I take it as an assumption that you are a decent human being who is trying to understand the truth and is making your points in good faith. Why you cannot extend that courtesy to me is beyond me.

I am humble enough to know that I am probably wrong about a variety of issues, and when a belief that I hold is demonstrated to be false, at least I have the integrity to admit it and usually thank whoever proved me wrong, because they saved me from repeating a mistake in the future.

You don’t have to agree with me, but at least engage with my points in a reasonable way. Do not insult me and pretend like that is a legitimate response in a discussion, because it is not.

“Whatever”? Whatever.

dguller, what good do you think comes from giving someone a borderline diagnosis? How exactly is this going to help the patient? By giving them this diagnosis you will keep them from ever entering certain occupations, negatively impact future treatment by other practioners, and so on. I would avoid therapists & psychiatrists who gives these kind of diagnoses like the plague. I'm sure had I continued to be disagreeable in the psych ward that diagnosis was right around the corner.

dguller,

You write:

"I can appreciate the cognitive dissonance that you experience when I am polite to you, because it is hard to reconcile your conception of psychiatrists as people to be despised and ridiculed for being insensitive and inhuman to their patients and my presentation of myself as a decent -- I hope! -- human being who has been generally quite courteous to people who have had mainly hostile and negative comments towards me."

My problem with psychiatry is that psychiatrists are just as human as everyone else, not that you're not human. You're not subhuman, you're just wrong.

You're not me and you don't know what I experience or what my conception of psychiatrists is. Mocking is not friendly behavior, neither is it polite behavior. I'd prefer it if you stop.

you write:

"Third, “self-harm” refers to recurrent, impulsive, and reckless behavior that results in harm to the patient, and includes cutting, cigarette burning, sexual improprieties, substance abuse, gambling, binge eating, and so on, if done as a means of diffusing internal painful affects, to gain attention, or to control another individual."

Okay, I get how you tell that some one has cuts and/or cigarette burns though I don't necessarily agree with the diagnosis, but gambling, substance abuse, binge eating, sexual impropriety, them's pretty vague, subjective stuff to be labeling by.

Fourth, the “frantic efforts” to avoid real or imagined abandonment that you mention does not have anything to do with the self-harm factor, and the DSM-IV criteria explicitly excludes suicidal and self-harm behavior in the “frantic efforts” feature."

So, my dear pal dguller, how does the DSM define frantic, what's the medical meaning of that word?

You write:

"Eighth, you say to flawedplan that psychotherapy” has “research” that shows that it “does not work”. What type of psychotherapy are you referring to, and what research are you talking about? And what would a therapy have to do to “work”, according to you?"

Here's one link: http://www.nytimes.com/2008/12/21/books/review/Stossel-t.html?_r=1&em

and a classic:

http://www.sallysatelmd.com/html/on_wsj01.html

And of course I'm with Satel at least on the therapism thing. The reason I never got my lpc and don't practice counseling anymore, it's immoral. This is why I first loved the biomedical model. As I've written here before, many well intentioned people in the mental health field at first glommed onto biopsych after witnessing the failure, disastrous, of psychotherapy.

Humanistic psychotherapy has been such an absurd failure, but then biopsych turns out to be a sham too. Oh well.

Lisa:

I think that being provided with a diagnosis is a two-edged sword that can be either helpful or harmful, depending upon how the diagnosis is given and what follows from it in terms of treatment and support.

With regards to BPD, I actually do not like the term, which is an anachronism from psychoanalysis, i.e. these patients are on the border between psychosis and neurosis.

When I diagnose someone with BPD, I first explain to them as best as I can how the problems that brought them to psychiatric attention to begin with are due to the emotions, thoughts and behaviours typically associated with a condition known as BPD. If my formulation rings true to them, and it usually does, then I tell them there is good evidence to support helpful treatment to improve their tolerance of psychic distress, their mindfulness of their mental states and those of others, their ability to regulate their emotions and their capacity to have healthy interpersonal relationships. I then refer them to the appropriate services.

I actually object to the notion that all difficult patients are to be diagnosed with BPD, because there are many different reasons for anyone to be frustrated and oppose psychiatric treatment, and having a personality disorder is only one of them.

Also, your point is well taken that a diagnosis of BPD can result in some patients refusing to participate in certain jobs, as well as possibly lead to a belittlement of their suffering by future clinicians. However, this does not necessarily have to be the case, and in all likelihood, the interpersonal problems that result in an inability to work in certain occupations predates the diagnosis in many cases.

Take care.

JC,
"Honestly, if my psychiatrist spent this much time commenting among this milieu in such a fashion, I'd be frightened. I'm gonna hold off on commenting for a long while."
First, I totally agree with you about the two shrinks I've seen engage in this behaviour on this site. They are truly creepy.

But, please, please don't stop commenting. Your comments are thoughtful and well written. I always look forward to hearing from you. Don't let some sick shrink deprive the rest of us from hearing from you. I've decided the best approach to these pinheads is to ignore them. I hope you will be able to do this, although they can be quite provocative. You don't have to include them in the conversation, but I do hope you will continue to converse with the rest of us.

Best wishes,
Sherry
PS: Can you think of anything more crazy making than a "friendly form of mockery"? How fecking bizarre. I wonder what unfriendly mockery looks like? Oh, I forgot...mockery is, by definition, hostile. It's bullying. Just what any psych patient needs in their life, eh?

I don't understand what's going on with JC but I appreciate your comments and hope a little distance will bring you back. dguller has a way about him that some people find objectionable, he tries to improve by tightening up the logic but logic is useless in the case of aesthetic offense. Trying a different approach is a thorny proposition -- why should he change for the sake of someone else's comfort, plus he's modeling "congruence", which is functional and healthy, and for me a "litmus test" in dealing with mental health professionals. Just think about the message he's sending, and what it means to be without apology.

As for you dguller, kindly get hip to the concept of a victim class, and the way your profession perpetuates it. Are you aware that abuse victims are routinely misdiagnosed with BPD? That your bullshit armchair "heredity" speculations dominate the framework for "making sense" of BPD and encompasses the the cohort with abuse histories? That this diagnosis is ridiculously gendered toward women? Do you think it's a coincidence that girls who grow up beaten and molested in a patriarchal society are routinely slapped with the witchy, stigmatizing and misogynist BPD label? Which dismisses etiology, ignores her actual issues while diverting her from relevant treatment? Literally -- people labeled BPD are denied mental health services b/c it's AXIS II and considered lifelong and untreatable. Her years as captive in her own home are denied, the aftermath, which is her fuckedupness seen as a constitutional defect, every antic meaningless in the eyes of her clueless spectators. This goes on, while PTSD is a politically correct professional joke and you know why, or should, you really should.

Where the fuck is DR. X? I could use a little help here.

I haven't read the thread yet (my comment above refers to a comment left by JC way up there) but I do see Sally has outed herself for the glibertarian she is by quoting John Stossel and Sally Satel as laughable sources, since both of them are notorious rightwing neocon freepers who live off of the wingnut welfare wagon -- Heritage Foundation, New Republic, World Net Daily, etc. Sally, what do your mad research skilz tell you about these publications or do you not have the slightest clue as to who you are invoking as credible sources?

FP,

That's Scott Stossel, princes patient, not John Stossel. Scott Stossel, the deputy editor of The Atlantic, http://www.theatlantic.com/doc/by/scott_stossel
Ain't it hip how you use words like skilz, no. You're not stupid but you can be a bit functionally illiterate, and missed this one by a pretty wide mark. If only you'd put down your labels and pick up your brain, you're talented and smart, still, Skilz...and the New Republic is not the Heritage Foundation. As I've said often, I disagree with Satel about a lot, but agree with her about therapy. You're proof we're both right...skilz...maybe dguller's taking of care will warm you up.

I caught up. So let's review: Sally quotes columnists and not just any columnists, but Sally Satel and John Stossel as a source of evidence that psychotherapy blows. We further learn that she is an apostate (another right wing trope, a quick google of "I didn't leave the Democratic party, the party left me" gives 297,000 hits), who's real issue with troubled souls who bravely seek professional guidance is her very important career-snit with the mental health profession, that forced her to change career paths. Because that's what it's all about. Fuck me!

As for mockery, someone call the WAAAAAMBULANCE no one does that in the blogosphere, and if they did it would be hostile, creepy, frightening, disingenuous, bad faith, unsupportable, anything but entertaining. Which is always the real sin among puritans, innit.

dguller, talk to me, I won't bite hard. I'm curious about how you go about discerning trauma in a patient that so many of your colleagues would label borderline. Especially since people with severe abuse histories generally don't volunteer that information.

I'm interested in this discussion, but will disclose outright that I don't agree that "BPD" exists as anything other than the repackaging of social ills under a medical rubric. Which is not the same as saying there's nothing there.

It's still an opinion piece. There is a place for that, but you present these two columns like they're some big research gotcha motherfucker, when they're simply opinion, and the world is filled with similar opinion. Have you read Hillman's We've Had a Hundred Years of Psychotherapy and the World's Getting Worse? The difference between that book and Sally Satel is what's known as "internal critique"; Hillman is a wonderful Jungian clinician, who critiques mental health practice from the standpoint of a playah. So what, mental health is a contentious field. But you're not a good-faith critic who gives a shit about improving mental health matters; you're an ex-smoker. You say astonishing things like "psychotherapy doesn't work", though even more revealing is your refusal to clarify what you mean by that, though I think it has something to do with ponies?

Sally:

First, you are correct that I was wrong to use the word “mockery”. What I meant to imply was a playful and friendly making fun of your tendency to insult and mock me. I should have chosen my words more carefully, but the point still stands that you are offended by my smiling whereas I am not offended – but rather am amused – by your repeated insults towards me. Oh, and I’ll stop making fun of you if you stop insulting my integrity and assume some degree of good faith towards me.

Second, you are correct that the self-harm criteria of BPD, like many DSM-IV criteria, consist of subjective states and objective behaviour that are arbitrarily delimited in a somewhat subjective way. Regarding the substance abuse, sexual improprieties, etc. the issue is whether these behaviours that result in harm to the patient are done repeatedly and impulsively for the sake of distracting from internal psychic turmoil, manipulation or attention seeking in order to avoid abandonment by those close to him or her. So, it is not just a matter of someone gambling repeatedly, but doing so in a reckless manner that results in substantial financial losses, and is done not out of an addiction necessarily, but mainly in order to get attention and manipulate their spouse, for example, in a maladaptive way. That is the syndrome here, not just gambling or sleeping around.

Third, there is no “medical meaning” of “frantic”. The idea is being emotionally out of control and acting in extreme ways in order to keep someone from leaving in the short-term, but ultimately pushes them away long-term.

Fourth, those two articles that you cited were book reviews by columnists. The first one begins with a quote from the author being reviewed: “Psychotherapy works. Multiple studies conducted over the past half-century have demonstrated that two-thirds of people who engage in psychotherapy improve.” The columnist then complains about the one third that don’t get better, implying that psychotherapy therefore does not work, which is an odd argument.

He then spends the rest of the article decrying psychoanalysis, which I agree has a limited evidence base, and concludes regarding medications and CBT: “repeated controlled studies clearly showed both drug and cognitive therapies to be effective in ways that psychoanalysis, with its hours on the couch, has not been shown to be”. So, the article is not very impressive with your claim that “psychotherapy” in general does not work, but rather seems only to demonstrate that psychoanalysis is not effective. The second article is similar to the first one in terms of not being persuasive.

Perhaps if you could cite the research studies that show all forms of psychotherapy to be ineffective, then that would be helpful here. Otherwise, I will have to conclude that your assertion is your personal opinion based on your individual experience, which is certainly valid, but not necessarily generalizable.

Take care.

FP,

It's disingenious of you to not admit I didn't refer to John Stossel, but to Scott Stossel, who's a bit more highbrow and venerable.

You write:

"But you're not a good-faith critic who gives a shit about improving mental health matters; you're an ex-smoker. You say astonishing things like "psychotherapy doesn't work", though even more revealing is your refusal to clarify what you mean by that, though I think it has something to do with ponies?"

What I mean by psychotherapy doesn't work is that psychotherapy encourages people to hold on to their problems, to become their problems, to spend their lives as mental patients, like you. Therapy for 20 years. Seems like if it worked you wouldn't have needed it for 20 years. You're paying for a compassionate friend. Oh, wait, you're not paying and don't admit anyone does, but most people do.

I don't object to compassionate friendship. I object into compassion being commodified. I object to records being kept, etc. I think you're pretty cognizant of my arguments. My problem is not with the people seeking help as a group or even with many of the people providing it but with the entire "help" delivery system, the entire way of imagining what "needing help" is.

Perhaps mental health counseling would be okay in a prison, after one has been convicted by a jury of his peers of unacceptable behavior, problematic but not as bad as what we get now.

As I think I've written before, my first twinges of disgust with psychotherapy came as child experiencing harm from the way my mother and entire family was treated by my mother's "psychologist." But I've been in the system as an abused child, a rape survivor, "battered" woman, homeless person, and alleged alcohol and drug addict, as well as a paid expert in social security disability hearings. I've got credentials as an inpatient severely mentally ill patient, a convicted criminal court ordered to get help and as a collaborationist.

So I've got some experience as a playah (ow, and way more time on the streets than you, princess).

Again, as I think I've written before, outside of me though, when working with a population then called "battered women," I became disgusted with the therapists I was in staffing with, social workers who would make comments like "I don't understand how a woman could let herself be treated like this," and really believe that statement, and of course a notorious psychiatrist who apparently believed that for a woman, being physically assaulted by a man was enough for a diagnosis of bipolar disorder.

And then there were the industrially injured workers, a last straw for me. Ordered to undergo "psychological" evaluations by the insurance company, yep, the same one paying me as a workers comp rehab counselor, these guys were like lambs at slaughter. The psychologists got paid to find pre existing psychological conditions that would render the worker incapable of working so the insurance company could cut their benefits for a lost limb, and the workers rarely got that the evaluations being confidential meant shared with the insurance companies lawyer.

So a label of borderline or, for the men, antisocial or schizo affective was a trendy one, meant your physical injury wouldn't be attended to. This phenomenon is part of what drove me to law school, as was my poignant desire for my own pony.

It's fair to compare me to an ex-smoker, as I've seen the bad results from therapy in my personal life, though I've not entirely quit smoking. And I think psychologists like Eric Fromm and Alice Miller are wonderful but not just for some, for everyone.

I actually really don't like Satel. Some of her other work is truly horrible, but her points about therapy are on the mark I think. I suspect that you assume that starting with her assumptions about therapy automatically leads one on the intellectual path to her other thoughts. It doesn't necessarily.

I've not read the Hillman book but from browsing reviews, I think I'd like it. Currently I'm reading "The Implicit Relation of Psychology and Law: Women and Syndrome Evidence"
by Raitt, Fiona E.; Zeedyk, M. Suzanne.

Paula J. Caplan is another good critic and her views are probably more in line with yours. I think you'd like her book, "You're Smarter Than They Make You Feel: How the Experts Intimidate Us and What We Can Do About It."

I think you enjoy insulting me because I've got a wee bit (and I do mean wee) of professional training and yet you're not intimidated by me. I suspect this because I'm a woman and the respectful kowtowing you toss dguller's way as well as the way you sidled up to TF has something to do with your respect for men. I know your critiques get to me worse than others here probably because I think of you as a peer. You might want to look at that in therapy. I don't. Or give up the therapy, again, you're bright and rowdy, one of the many mental patients who should be running the asylum, though I fear how I might fare under your rule.

Flawedplan:

I usually ask about traumatic and abusive histories when I inquire about their developmental history. That is usually about 30 minutes into the assessment, and so if I was able to develop rapport and a good alliance with the patient, then they typically feel safe enough to tell me about any trauma, abuse and/or neglect in their lives. I think that disclosure of abuse histories is dependent upon how trusting and comfortable a patient is with the assessing clinician, and in how the clinician asks about the issue. Naturally, sensitivity is paramount here.

Regarding BPD as a diagnostic entity, I already said that I dislike the term itself, but I think that it does reasonably capture a clinical syndrome. Why do you reject the idea that it labels a genuine entity?

Take care.

Dguller,

Perhaps if you could list all studies showing anything at all about everything, I could sift through them. But instead I'll just ask you to provide one study proving any kind of psychotherapy works.

As you know, the Stossel book review lists several problematic studies indicating psychotherapy doesn't work. The only evidence that it does work is anecdotal, partly, dare I say it, as we agree, because there's no way to objectively measure whether psychotherapy of any kind works. If somebody likes it. let'em keep doing it, but continuing something because you think you like it isn't proof it works.

Meanwhile, a great piece you might want to look at is this:

"Battered Women and Bad Science: The Limited Validity and Utility of Battered Woman Syndrome" by M McMahon.

And Philip, I promise to try not to hijack anymore threads with this stuff.

Sally I hope I am not the only one who will engage with you b/c you're truly the gift that keeps giving. I expect you're considered a "loose cannon" in the antipsych community, and that your cringe-inducing screeds are the cause of untold garment-wrenching among fellow travelers, but you say what they won't dare and I think it's important that you do. You're on the front lines of antipsychiatry, doing yeoman's work.

I pick on you because I think you're a complete asshole; a thief and a liar who colonizes human beings. That's really all there is to it.

Case in point:

You might want to look at that in therapy...or give up the therapy

Misrepresenting facts in evidence: I'm 51 years old, asshole, haven't been in therapy for eons, fired one psychologist and been fired by so many psychiatrists I've lost count, but that's the game. So, you lied. Or is it that you don't assimilate? Whatever, you're still an asshole, a self-righteous know-nothing who proves it with unrelentingly incoherent assertions such as the claim upthread that humanistic psychology is a "disastrous failure." You know what that is? Yep. It's like calling Picasso's Guernica a failure, and chances are that's been done too.

What does Maslow's Hierarchy of Needs fail to do? Better question, what is Maslow's Hierarchy? Let me help you out here. Humanistic psychology has no qualitative research base, it's a theory, an aesthetic, pure knowledge production, of course it "fails", it's based on European Existentialism! "The purpose of life is to be defeated by greater and greater things." Huh? Indeed.

And finally, you lay out what's meant to be a defense of your vituperative hatred of users of psych services because in the field you found (wait for it) institutional hypocrisy! counterproductive policy! oh noes! This makes you an idealist!! No Sally, it makes you a self-aggrandizing child. Institutions suck? They're all a bunch of phonies? Oh thank you, Holden, such titanic insight, what a formidable and encyclopedic brain you have! And your hands stay clean, how appropriate for a daughter of privilege! Your career, in ruins, it wasn't supposed to work out this way, was it? If only you could have known, if only you could face the music, if only you couldreceive, Sally, watch one season of The Wire and grow the fuck up.

I'm a firm believer that psychotherapy does not work. In fact it is designed to keep you sick. I don't think this was the intent, but that is the outcome. Take therapy and medications out of someones life and they will be forced to make the changes necessary to deal with their daily lives. The way the system is people can be jerks, umm bpd or any other lable someone chooses and it is ok because they are taking medications and in therapy. It takes all responsibility from people to change the behaviors that is causing distress. Many times it is the therapy that keeps the distress on the surface and doesn't allow the person to actually deal with their problems. But of course, they don't have too because that is what they are in therapy for. Don't believe me, next time you go to therapy set a date for the end of therapy and watch how fast your therapist starts to bring up all your problems he/she has made you believe you have. Sally is right, people are paying for a friend. A friend that enables you to stay stuck in all your life problems.

Gah, sorry, must use preview button or start opposite day. "Humanistic research has no qualitative research base" should be "has a qualitative research base" aka that leftwing bleeding heart hippy shit, as explained here:

http://en.wikipedia.org/wiki/Qualitative_research

dguller, it is important to dislike the term BPD because it's essentially a pejorative in both clinical practice and popular culture. I would like to go beyond disliking the term. It needs to go. I also think that "it does reasonably capture a clinical syndrome." The poignancy in what that statement leaves out is beyond my capacity to properly rage.

BPD "Borderline Personality Disorder" I guess some don't like that label very much. I personally am not fond of any psych labels myself.
Quote "beyond my capacity to properly rage"
So let's call it what it is then; someone with so much rage and anger that they continuously take it out on themselves and the rest of the world (because they only see the world as their own personal victimization cycle). This is usually do to their diminished ability to maintain meaningful relationships ( I love you, but I hate you syndrome), stunted emotional maturity , and an inability to come to grips with who they are.
Those that bravely get past the label or stigma are usually those willing to make dramatic change and grapple with their demons/neglect/trauma/abuse. I personally don’t believe or put much stock in medications or therapies being able to cure, relieve, or change BPD with much measure of success; since its cause lies in behavioral acts and being a victim of trauma/abuse which in turn manifest itself in a disruption of a healthy functioning persona or personality.
Those that overcome BPD want to desperately face their demons and regain a healthy life of meaning and purpose. They force themselves to look deep within; and then reach outside themselves to find their true inner self. Of course those are the few; most others will just perpetually hold on to the rage; and by fifty something years old will never let it go no matter what ( it really does become their own little comfort horror).
I can’t help but feel empathy for those with BPD because they are truly victims. Though I can also understand why I would never allow someone like that to have any meaning or effect in my life; your kind are like an emotional terminal cancer that never stops growing or spreading on who ever or whatever it touches. That’s just the reality of the disorder whatever you wish to call it.

The moderation is slow today, but maybe people are just in shock, I know I am. Jane, your prejudice is duly noted, anyone else want to compare and contrast the anger reserved for dguller with the tolerance given to the bigots in this thread? On the one hand we have a droll and unyielding psychiatrist, on the other are ex-patients who's personal baggage with the mental health system compels them to punish folks living with psychiatric disabilities. These are the people who would turn back every ongoing pissant gain made for inclusion, accommodations, crises and stabilization units, publicly funded programs that benefit the mentally ill, including the arts, but especially income supports and federal disability insurance. Awesome. But dguller, yes, he really should be put in his place.

All that, MATW from my use of the word "rage" in a failed attempt at eloquence? Are people with BPD forbidden to use the word "rage"? I'm supposed to be nice, like you are nice? Eat shit.

Dguller, that's why it has to go. Read the comment again, but every time MATW references BPD replace it with the word nigger. If you think I'm overreacting, you should read up on what's known as BPD fleas. Yes, as in fleas.

FP,

I hope your rantings against me dispel some of your anger. They certainly don't prove you're mentally ill. Sorry. I'm certainly not a spokesperson for some group or movement and would not want my words held against anyone else.

You write to dguller:

"These are the people who would turn back every ongoing pissant gain made for inclusion, accommodations, crises and stabilization units, publicly funded programs that benefit the mentally ill, including the arts, but especially income supports and federal disability insurance."

I guess the thing about you that frightens me the most is your idea that to be an artist one must be mentally ill. You miss the point that your way of thinking leads to the idea which you probably like that if you are an artist you are mentally ill and hence should have your rights and means of expression restricted to protect "normal" people. It's precisely your sort of thinking that Picasso's art, particularly Guernica, is in protest of, and is the most beautiful argument against.

Jane you write:

"Sally is right, people are paying for a friend. A friend that enables you to stay stuck in all your life problems."

Thanks Jane.

FP,

When you wrote the bit below, it really helped me to understand what we disagree about. You wrote:

"Whatever, you're still an asshole, a self-righteous know-nothing who proves it with unrelentingly incoherent assertions such as the claim upthread that humanistic psychology is a "disastrous failure." You know what that is? Yep. It's like calling Picasso's Guernica a failure, and chances are that's been done too."

Just because I'm an asshole doesn't mean I'm wrong. No, it's psychiatry that calls Guernica failure. Picasso, after a few years of Carl Rogers would have become Thomas Kincaide. What your train of thought leads to is the Kincaidization of humanity which is why I feel its so important to speak out against it. Though I think there's a place for Kincaide, I don't think that sort of art should replace Picasso.

Here's a statement I strongly disagree with that represents the romanacing of being labeled mentally ill as a work of art in itself. Guess who wrote it?

"I regard neither Picasso nor Joyce as psychotics, but count them among a large number of people whose habitus it is to react to a profound psychic disturbance not with an ordinary psychoneurosis but with a schizoid syndrome."

Now think, where would we be if these guys had "gotten help?"

Quote: "Read the comment again, but every time MATW references BPD replace it with the word nigger"

Thank you for validating every word I wrote by your malaise and tortured response.

Now exactly who is the Bigot here? Your choice of words and attachment to a race based reference shows the incredible lengths you’ll go to capitulate in your ill conceived scheme to validate your never ending ordeal of quite obvious painful emotional problems.

With all that wonderful rage coming out, this antisocial malfeasance through behavioral grand standing, and your precious counterproductive social entitlement views; I can almost predict you living a full and happy life.

Ok, I don’t really see you being fulfilled or having much meaning at all in this life; but doesn’t it have such a nice ring attached to it anywise. Just maybe it deserves some serious contemplation and deliberation; though I am conceding the fact that this could be way beyond your emotional grasp and abilities.

Maybe you can just test run a few more of those drugs stock piled in your medicine cabinet just to see how you'll do. I mean why you would need a doctor or a therapist anywise?

Are you getting enough negative attention to fill your bitter plate yet?

Sherry, thanks for the encouragement above, you just made my day. I like your prespective better.

JC

"I guess the thing about you that frightens me the most is your idea that to be an artist one must be mentally ill. You miss the point that your way of thinking leads to the idea which you probably like that if you are an artist you are mentally ill and hence should have your rights and means of expression restricted to protect "normal" people. It's precisely your sort of thinking that Picasso's art, particularly Guernica, is in protest of, and is the most beautiful argument against. "

Colonization: ur doin it rite.

Sherry, thanks for the encouragement above, you just made my day. I like your perspective better.

JC

PS: flawedplan: we should really blog together, if you're inclined to.

PPS: Thanks again Sherry. ;)

Sally:

Well, I don’t think it’s plausible for me to list every study that shows that every type of psychotherapy works.

However, if you want just one study that shows that any kind of psychotherapy works, you can look at the 2006 Linehan study of DBT in BPD patients that I described above to JC, which showed substantial reduction in suicidal behaviour, emergency room visits and hospitalizations with DBT treatment over one year with an additional year of follow-up, as well as reductions in scores of depression, hopelessness and suicidal ideation.

A good review of the current evidence for DBT in general can be found at the Annual Review of Clinical Psychology (2007; 3:181-205). A good meta-analysis of 16 rigorous controlled CBT trials is at the Clinical Psychology Review (2006; 26:17-31). If you want other articles about the other forms of psychotherapy, then I would be happy to oblige you, but I think that these two are enough to show that some forms of psychotherapy certainly “work”, although there is always room for improvement, because they are not panaceas at this time, and probably never will be.

Regarding the Stossel piece, you mention that it cited studies that showed the psychotherapy doesn’t work. Again, the main thrust of the article was psychoanalysis, and not any of the recent forms of evidence-based psychotherapy. Also, the Strupp article dealt only with brief psychodynamic therapy exclusively when it compared therapists to empathic professors. It has no bearing upon the validity of other psychotherapies, and even Strupp eventually developed a manual for an effective form of brief psychodynamic therapy in the early 1980’s based upon his studies in the Valderbilt research studies.

Take care.

flawedplan:

Just for clarification: Do you think the constellation of symptoms that coalesces around the DSM-IV criteria for BPD

NEVER or RARELY or SOMETIMES

accurately represents some people's psychological states, behavioral responses to those states, and strained interpersonal relationships?

Thanks!

Dguller,

You write:

"Well, I don’t think it’s plausible for me to list every study that shows that every type of psychotherapy works."

Now you're getting the point. I'll take a look at the studies you mentioned.

FP,

Wow, I guess this rage level is normal for you. Colonization?

Sally:

Yes, I get your point. If I say that some form of treatment does not work, then that means that I have to list every single study that shows that it works. It does not mean that I have to cite just one well-designed study that shows that the treatment is equal to placebo. Got it.

Take care.

Oh, and just a quick question to visitors to this website: Who likes the work of David Healy, and is he a reliable author?

Thanks!

Wow, I guess this rage level is normal for you. Colonization?

Just when I think you can't top yourself you put another cherry on the cake.

You're an abuser Sally, maybe not the welts and bruises sort, but the emotional, deeper, more insidious and damaging form seems to be your preferred method of pathological abuse. Why don't you see a doctor? Oh, right.

To colonize is to invade and occupy territory, it's the transfer of one population (the abuser) to another (her target). Welts and bruises are preschool, what abusers want is psychic territory; ownership of their target's voice, her subjectivity, and sense of self, who she is and what she's all about. That's what successful abusers steal. It is the most difficult violation to overcome, but those who have come with radar, and see it a mile away.

What is there to say? You do what they do. A abuser never relies on facts that can be disputed, such as actual, verifiable deeds or statements "you said this" "you wrote this" "you did this". An abuser says "you think this" "you feel this" "you care about this" "you don't care about this." See how that works?

Abusers are opportunists, they target certain people. The equation requires the victim be vulnerable to blitzing and totalizing attacks on their character, which are hard to defend yourself from, because they don't reference things that can be verified, as in words and deeds, and because everyone has *some* shame and self-doubt susceptible to activation by awful, twisted people.

Children take this shit from abusers, as do malleable adults who have low self-esteem. People who know and like who they are don't stand for it, and recognize it as intolerable.

Abusers are an open book, they're all alike and they do the same things -- that's the pathology-- they can't do other things -- so if you're ever wondering if you're dealing with a perpetrating asshole look for patterns to make a valid judgment, especially projection.

You tend to frame your questioners as "scary" and "creepy" and "frightening", though among them only you Sally, have been found by your society to be a danger to self and/or others. That's projection: expelling onto others something all about you that you can't let yourself look at.

Who is resident obsessive on this blog about psychiatry? Who alleges it is I who is stuck in a rigid, inflexible and maladaptive identity ("mental patient"), although I ran a mental health message board for five years expressly for people who reject identity politics, called "Our Common Condition: Human Being." You labels me a mental patient as if that would shame me, because being a mental patient would shame you (projection), and even though it's open knowledge that I haven't seen the inside of a doctor's office in nine years.

But abusers are impervious to facts, it's all about destroying the sense of self, orientation, the *who* in there, the personhood. As if.

You're right, we've all been victims of abuse to some degree. Not everyone grows into a perpetrating asshole like poor mixed up Sally. I think we both know the psychology in play: People who grow into abusers identified with the person who wrongly took advantage of their own vulnerability during crucial developmental junctures. Becoming like them made you feel less threatened, though it didn't make you less vulnerable, nothing in your environment changed, but you did didn'tcha? Siding with the bully feels safer, though the price for that is self-hatred. Now there are two people against you, mummy and me are one. And all because you didn't have another model or sympathetic witness in your corner at the time to offset the damage being done. Sad, isn't it.

And thus the main reason I think it a social duty of anyone who has intense authoritarian histories to work through it therapeutically, or you will unwittingly make the world a shitty place by being in it, invading, occupying, extinguishing, paying it forward, paying it back with zero self-awareness, just doing what comes naturally. Open book, you should read it sometime.

$$$$$

I think I just wrote that whole mess for JC. Do you still wanna blog with me? You know I'm out there. robinplan@sbcglobal.net

Some of you were discussing genetic basis for BPD. Personally I agree with the posters citing child abuse as a major cause of BPD. But it does appear that there is now research showing that there are likely genes on chromosomes 1, 4, 9, and 18 that have something to do with developing BPD. I read about it in a blog posting BPD Linked to Human Chromosome 9 that includes links to a few articles on genetic and biological research involving BPD.

The statistics showing 5.9% of the US population has BPD come from a study done using interviews collected in 2004 to 2005 as the Wave 2 National Epidemiologic Survey.

That data set has been used for other studies. For instance, NPD (Narcissistic Personality Disorder) is believed to afflict about 8% of men and 5% of women in the US. The rate of NPD among those with BPD is 7 times higher. You've got to realize that some people with personality disorders have more than one of them.

Take a look at these two web postings for more information:

Study Finds High Correlation of BPD, NPD, and Schizotypal Personality Disorder

BPD prevalence may be 6%, 3 times higher than previously thought

A salad interlude that speaks to my mind on this thread:
This life is uncertain, it's scary, it’s crazy. Especially this shit that seems one's very soul. Labels you can organize identity around until they are you. And if we push against what seems to be, and find our varied ways back to shaky integrity, we all know different roads.
What’s to be done when to be labeled is the key to help and the key to harm? (And there has already been so much harm). One can be locked up or locked out by the same institution and both are devastating. When it comes hard to trust and every shadow shifts and we are all, after all, just people, what then?

What’s to be done when to be labeled is the key to help and the key to harm? (And there has already been so much harm). One can be locked up or locked out by the same institution and both are devastating. When it comes hard to trust and every shadow shifts and we are all, after all, just people, what then?

Perfectly put, j, and thank you.

I think the borderline diagnosis needs to go. I worked in the health care field for many years & when people see borderline on someone's medical record a lot of assumptions and comments are made. None of them are good. Obviously no one is going to say to the patient what they're saying behind closed doors. What Sherry said is correct. Health care providers do not want to work with patients with that diagnosis. I heard the words manipulative, troublemaker, drama queen, etc. used to describe someone with the borderline diagnosis. I do not see how it helps a patient to saddle them with that diagnosis, even if they meet the criteria.

During my psych rotation, I observed a nurse giving report to another nurse. When the oncoming nurse heard the patient had a diagnosis of borderline there was much groaning & the nurse said, "Oh, I can hardly wait." She had not even met the patient & this was the attitude. I guarantee you they're not saying "poor dear" when they see that diagnosis.

I could also see the harm that's caused when a patient is given that diagnosis and then does some internet browsing. Will this patient wonder if her psychiatrist believes she is a manipulative troublemaker? How much time will then be wasted in therapy with the psychiatrist attempting to convince the patient that he/she doesn't really hate that patient?

I've noticed a similar thing happening with the fibromyalgia diagnosis. I wouldn't want that one on my medical record either because of the comments I've heard from other health care professionals. That diagnosis is now being linked with the image of an overweight, needy, histrionic woman. I've seen many a health care professional roll his/her eyes when fibromyalgia is mentioned. Is it right? Nope, but it's what is happening & physicians need to be cognizant of the impact of these diagnoses.

FP,

Again, your rage is impressive.

I haven't been found by society to be a danger to myself and others. I was never present at any hearing to have such a determination made. I appealed the order which was found to have been entered illegally and it was determined I was neither a danger to myself or others or in need of mental health treatment.

J,

"This life is uncertain, it's scary, it’s crazy. Especially this shit that seems one's very soul. Labels you can organize identity around until they are you. And if we push against what seems to be, and find our varied ways back to shaky integrity, we all know different roads.
What’s to be done when to be labeled is the key to help and the key to harm? (And there has already been so much harm). One can be locked up or locked out by the same institution and both are devastating. When it comes hard to trust and every shadow shifts and we are all, after all, just people, what then?"

Exactly. Compassion and tolerance are the keys here, courage. Thanks.

Dguller,

You wrote:

"Yes, I get your point. If I say that some form of treatment does not work, then that means that I have to list every single study that shows that it works."

Nope, I just requested one study showing that one form works. The first sentence below was sarcastic. The second sincere. You did list some studies which I'll look at though this is all getting a bit exhausting, kind of like going to the Pope's website to argue in favor of abortion.

I wrote:

"Perhaps if you could list all studies showing anything at all about everything, I could sift through them. But instead I'll just ask you to provide one study proving any kind of psychotherapy works."

FP,

It hurts me when you call me an abuser, and, though I had lunch and dinner with friends don't know about my blogging activity, and since I won my lawsuit, don't discuss mental health issues with me, I spent a significant amount of other time crying about your post from yesterday.

As I previously quoted, you wrote:

"You tend to frame your questioners as "scary" and "creepy" and "frightening", though among them only you Sally, have been found by your society to be a danger to self and/or others. That's projection: expelling onto others something all about you that you can't let yourself look at."

Technically the fraudulent order said I was likely to "rapidly deteriorate to the point where it was likely I would become a danger to myself or others without mental health treatment." And I corrected that I have never been found by my society to be a danger to myself and others, and for that matter wasn't "rapidly deteriorating" at the time.

Your inaccurate description of what happened to me makes me glad that my friends and I took the four years and piles of lawyers to get it on the record that I had never been found a danger to myself or others so that no one could use such a determination against me as you attempt to do in your post.

What haunts me is the fact that at this point in time few other people reputedly "found by their society to be a danger to themselves or others" have the recourse I did. The other side, all lawyered up and wealthy after a thorough review of my entire life including my psych and gynecological records, work history, pharmacy records and email, could find no expert to say I suffered from a mental illness.

Anyone reading this who has a record of being found to be a danger to self or others, know that the determination was not fair, had no "science" behind it, is not you and does not mean you are evil or toxic.

If people know about such a legal finding, they may treat you like FP is treating me, but hang in there. Whether you agree with me about psychiatry or therapy or not, don't internalize that order. Someday I hope to be a position to help others over turn their "involuntary commitment orders." I owe my life to the other "dangerous patients" I was incarcerated with.

"Someday I hope to be a position to help others over turn their "involuntary commitment orders." I owe my life to the other "dangerous patients" I was incarcerated with. Anyone reading this...don't internalize that order. "

On June 20, 2006, William Bruce approached his mother as she worked at her desk at home and struck killing blows to her head with a hatchet. Two months earlier, William, a 24-year-old schizophrenic, had been released from Riverview Psychiatric Center in Augusta, Maine, against the recommendations of his doctors.

But the doctor's notes also show that William's release was backed by government-funded patient advocates. According to medical records, the advocates -- none of them physicians -- appear to have fought for his right to refuse treatment, to have coached him on how to answer doctors' questions and to have resisted the medical staff's efforts to contact his parents. As one doctor wrote, William told him his advocates believed he is "not a danger, and should be released."

William's father, Joe Bruce, obtained his son's medical records from Riverview eight months after the killing. "I read through the records and I just remember crying all the way through," Joe Bruce says. "My God, these people knew exactly what they were sending home to us."

http://online.wsj.com/article/SB121883750650245525.html

"Anyone reading this who has a record of being found to be a danger to self or others, know that the determination was not fair, had no "science" behind it, is not you and does not mean you are evil or toxic."

Translation:

We are engaged in war with organized psychiatry about which group is to hold authority over you, all else, including you is collateral damage.

with regret, i am closing this thread.