Sunday, 1 June 2014

Crossing the borderline - it’s all about the stories

These are not the kind of stories that begin with, once upon a time, and end with happily ever after. They do not always unfold in a logical manner with a clear plot line and character background. They are often the drip-feed between a description of symptoms and sometimes unfathomable behaviours. I am talking about – that which must not be named. I am talking about the backdrop for people who are given the label of borderline personality disorder.

I am often torn between the value of diagnosis in targeting the kind of help a person needs and the stories that accompany labels. In any kind of diagnosis – mental or physical health – there is a set of criteria that must be met in order to place someone within a specific category. For some people, they might wear it like a badge, look, I’ve got this. For some it is a relief that what they are experiencing is actually written down in a diagnostic manual. For others, it increases the shame which has already permeated every chapter of their own life story.

Personality disorder basically means the way a person has developed according to their childhood and life experiences and most probably trauma. Think about this for a moment. Their personality has had to adapt in such a way as to be able to survive as a person. What must these circumstances be to facilitate someone to have disordered emotional development? It is certainly not a story of being valued, accepted, nurtured, understood, cared for, protected, enabled. It is not a story of mutually nourishing relationships. People with this label struggle with relationships more than anything else. They struggle with relationships with their family, partners, friendships and with health professionals. We expect them to behave just like us and are surprised when they don’t.

I am not surprised. What does often surprise me is the creativity and ingenuity for survival. That someone can find a way to navigate life without most of the tools and psychological clothing or even skin that most of us have. That’s right, they feel naked and raw most of the time. They might self-harm as a way to find some caring either from themselves or someone else. They might attempt suicide because the pain of being in a raw state is unbearable. They might become over-attached and have inappropriate boundaries with anyone who shows them interest and caring. Ironically in their craving for connection, their behavior disconnects them from others.

Unmet needs are at the heart of their experience. So how do we even begin to meet those needs? If damaged relationships are at the root, then we know that healthy relationships are part of the healing. So how can we be in relationship with those who don’t know how? How can we help someone to work with their vulnerability when they feel so raw most of the time? I would venture to say, and I’m sure there will be some disagreement, that it might be vital for us to show some vulnerability too. To truly be my authentic self in that or any other relationship, I must be prepared to give careful, thoughtful, respectful and specific feedback about how it feels to be me in that relationship.

"You know nothing about Hope, that immortal, delicious maiden forever courted forever propitious, whom fools have called deceitful, as if it were Hope that carried the cup of disappointment, whereas it is her deadly enemy, Certainty, whom she only escapes by transformation."  George Eliot

These I have found are the powerful moments of transformation. The very fact that I have let down my own armour of theories and models to simply be human, to be real, is what creates space for a shift. Like any practitioner, I have invested vast amounts of time and energy in my learning – so to suspend that in mid-air, while I just be me, with the other – makes me feel vulnerable, exposed, maybe a little naked. I have no doubt, for I have felt it in those intense moments of connection, that these authentic relational moments of courage make change possible.

Of course, this goes hand-in-hand with the solid base on which our psychological theories and models of therapy are based. We are not swimming about in the deep ocean here without some buoyancy aids. I have my life-jacket and believe me, it’s tied on tight – anyone I am working with would expect nothing less. But we both have to remember to kick our own legs – helping and being helped can never be a passive encounter.

So let’s not let this story be about a dialogue which continues to contain phrases like “borderlines”, revolving door patients, problem clients, attention-seekers, para-suicidal, self-harmers, lost causes, here we go again, draining. My hope is not just for more understanding and compassion, but actually for excitement, drive and enthusiasm to being part of making a difference in someone’s life, to being a witness to true transformation.

I would like to be a witness to the transformation of how mainstream services view and treat borderline personality disorder.

Dr Murphy – signing off

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