A Challenge to `Bashing the Borderline’

The issue of stigma surrounding the diagnosis of borderline personality disorder is not just an issue of misunderstanding the diagnosis.

I do not believe that addressing and redirecting the stigma around and misperceptions of the diagnosis will change the pervasiveness of dismissive and cold behaviors, sarcastic comments and emotional reactions of staff that are then blamed on the client’s symptomology.

After all, how often has this particular topic been addressed in the clinical community? Rather, I think the unaddressed problem comes from staff’s desire not to alter the stigma of borderline personality disorder (BPD), which would then challenge them to change their behaviors and reactions and take personal responsibility for their own counter transference.

With my clients, I look at any problematic behavior as purposeful; in other words, even destructive behaviors serve a purpose on some level.

Counter Transference

So, for us in the clinical profession, what purpose is served by perpetuating the stigma of BPD, by not changing our reactions to those to whom we have counter transference?

For me, very honestly, I think that our need for emotional catharsis, for camaraderie, for a chance to vent, for a chance to release our own frustrations and counter-transference in some way is met through our option to “bash the borderlines.”

If we change how we choose to react to those diagnosed with BPD, then we lose that opportunity to release our own frustration and we must find another way to meet that need.

But isn’t that exactly what we ask our clients to do? Treatment team meetings, from my observation, do tend to encompass a lovely variety of staff vents about the patients, which ultimately is not the purpose of treatment team meetings, is not effective in supporting the client towards their treatment goals, but does serve a purpose for the staff.

Change the Stigma

So what would cause us to be motivated to change the stigma with which we perceive and respond to those who are diagnosed with borderline personality disorder? Here’s an idea starting with the background story:

I am privy to information about the private lives of my colleagues by their own choosing. The information I am given about their past and current struggles, I do not take lightly; I take with great privilege and with great responsibility.

As such, being aware of the challenges and diagnoses my colleagues have faced, have overcome and still battle, makes me much more aware of what comes out of my mouth.

For example, this past week, as the treatment team made sarcastic comments about the “denial” shown by one of our substance use disorder clients that was, per my perception, attributed to that client based on his diagnosis, rather than clinical presentation, I wondered how the staff sitting to my immediate right, who has been sober for two years after multiple treatments and relapses, must feel about what is being said. In some ways,it’s  in reference to her.

When staff make dismissive comments about patients being “a junkie,” or “a borderline,” how would it change your perception of what you said, the feel of what you said, if you knew the staff member standing next to you, in the conversation, that you’re speaking to, had lived and overcome the very thing you sarcastically bash?

I often hear statements made about those who are diagnosed with borderline personality disorder that they will not get better, that they will be stuck in this symptomology their entire lives and will be in and out of hospitals recurrently.

Tell that to the many of us working around you, working with you, who have carried that diagnosis, and because of  our recovery efforts, now no longer meet diagnostic criteria for the disorder or who carry the diagnosis still, but are skilled enough at managing their symptoms that you are unaware; who do exactly as we teach our clients to do; effective symptom management.

For those of us diagnosed with borderline personality disorder who sit in treatment teams with you, do we not disprove everything you say about the diagnosis?

Not Just a Borderline

So the client who so challenges our own emotional regulation skills is not “just a borderline,” but rather someone whose symptoms of borderline personality disorder are not yet under their own control, because there are many other “borderlines” right around you who do not behave, well, “borderline.”

Similarly as the writer of this commentary, I am choosing to ask to remain anonymous. Why would I want to self-disclose at risk of being, myself, then disregarded and looked at with the same stigma-colored glasses?

“Normal people,” healthy people, non-diagnosed people disagree, have bad days, stand up for what they believe in, assert themselves, get tired, have a range of emotions and so on.

But for those whose diagnoses and pasts are known, the perception of that normal range changes: if I come in tired with “a bad hair day,” the question will be, “did she relapse?”

If I have a difference of opinion with the treatment team and assert my advocacy for the patient appropriately, will I be seen as being “too emotional?”

If I get irritated at work, will peers be afraid I will, “go off” and “walk on eggshells,” around me and disregard my knowledge base in favor of seeing me only as acting on emotion? How dismissed will my efforts and capacities be if I self-disclose?

Food for thought. Thanks for listening.

Choosing to publish under the pseudonym Stella Gray, the author is a LCSW and LCAS-A who has 8+ years professional experience serving the high acuity dual-diagnosis population particularly in the inpatient setting.

Team meeting photo available from Shutterstock

A Challenge to `Bashing the Borderline’