What comes to mind when you hear the diagnostic term “borderline personality disorder”?
As a mental health trauma therapist working with children, adolescents, and some adults, I have seen my fair share of individuals of all ages diagnosed with Borderline Personality Disorder (BPD) and suffering from a very traumatic journey. And many of my clients, whether diagnosed by me or another mental health professional, have demonstrated very different reactions to the diagnosis. My adolescent clients, primarily the boys, tend to accept the diagnosis and treatment recommendations without much problem.
However, some of my clients struggle a great deal to accept the diagnosis and treatment recommendations. Why? My experience has shown me that rejection of the diagnosis and treatment recommendations is based on years of unintelligible, incorrect, and stigmatized ideologies of BPD. For years, the media has categorized individuals with BPD as “crazy,” “broken,” “shattered,” “dangerous,” “scary,” or even “possessed.” Although the manifestation of symptoms can be complicated and every individual is different, the majority of people diagnosed with a mild-to-moderate form of BPD can recover enough to lead normal and stable lives, with or without medication and therapy.
That’s why Dr. John Gunderson, MD, from MacLean Hospital’s Borderline Center’s Clinic, and Dr. Perry Hoffman, PhD, from the National Education Alliance for Borderline Personality Disorder, edited a book of twenty-four personal stories from individuals diagnosed with BPD called, Beyond Borderline: True Stories of Recovery from Borderline Personality Disorder. Each story offers a different perspective and a different journey with the goal of ending on a positive note. They are written with a personal tone to connect with the reader and simultaneously highlight the intensity of the writer’s suffering. At the end of each story, the writers conclude by offering insight into how they are living their lives today. The goal of the book is to emphasize recovery and hope.
As a therapist who has worked closely with people suffering from BPD, I question some of the stories in this book, as I am sure many other professionals and even laymen will. For example, it is difficult not to question how much the stories were shortened to keep each story structured and short enough to provide room for the other personal accounts. I also questioned whether the writers were all clients at MacLean Hospital, and if so, why were these individuals chosen to share their stories and not other individuals suffering from BPD? In addition, I couldn’t help but wonder what ultimate good the focus on “recovery” and “success” could be doing to the millions of other people suffering from severe or treatment-resistant forms of BPD and who may never be able to obtain the level of “success” spoken of by the writers. For example, individuals suffering from severe or treatment resistant BPD may find it very difficult, if not impossible, to have a marriage and children, return to school for a degree, or obtain employment. What message is the “recovery” model sending to these people? On the one hand, the message would be that they too can recover and that there is hope. But on the other hand, some sufferers may believe that recovery is only for some individuals and not others, and that perhaps pursuing a degree, a job, a family and children, or something similar is the only way to achieve “success” with BPD. One of my clients, having read multiple books of a similar nature, reported feeling that such personal stories seemed “fake” and “overly positive” to her and that they were trying to “prove something.”
Likewise, some readers may question what actually defines recovery and who determines if someone has recovered. For example, because BPD can be a crippling diagnosis, it is likely that what someone calls “recovery” today could change tomorrow. One writer from this book, in the chapter titled Letting the Light In, explained what she thought was “recovery” only to find out three years later that she was not fully recovered. She reported that perhaps she was still grieving the loss of her mother or that life itself finally brought her to a state of burnout which resulted in multiple hospital admissions, the firing of her long-term therapist, and the loss of her position as a social worker. Perhaps readers should consider each story as an example of good behavior and emotion management rather than recovery. The term itself can lead to overly high expectations and a false sense of hope. One writer put it very nicely by stating:
“Today, I woke up energetic. Today, I did not plot how I could become invisible. I can once again look people in the eye. Don’t get me wrong — I still have my moments of despair. Sometimes I still put my headphones in on the Metro ride without actually playing music so that no one will talk to me” (pp.28-29).
She makes it clear that although the struggle continues, “recovery,” for her, is that she can cope another day and that many of her symptoms feel as if they are under control.
Despite some of the questions and concerns readers may have with this book, it is still a good book to share with family, friends, and even clients. For mental health professionals looking for a personal book to help clients learn more about their diagnosis, Beyond Borderline is a good start. For individuals who may be struggling with their new diagnosis of BPD, this book can lend personal insight into how others have struggled and offer a sense of community. For any sufferer of mental health challenges, it is always consoling to know that someone else understands you and feels your pain.
Beyond Borderline: True Stories of Recovery from Borderline Personality Disorder
New Harbinger Publications, August 2016
Paperback, 192 pages