Borderline Personality Disorder: Open Letter to Emergency Department and Hospital Based Staff

By Sonia Neale • 4 min read

emergency240People with a diagnosis of BPD are often accused of manipulation and splitting in psychiatric settings.  A quick Google search reveals that manipulation is the action of manipulating someone in a clever or unscrupulous way, the skilful handling, controlling or using of something or someone, to manage or influence skilfully, especially in an unfair manner, to manipulate people’s feelings. I have never felt skilful, clever, influential or in control in an emergency department or hospital setting yet I have been accused of manipulation and splitting.

What I do feel is shame, shame, shame and more shame, along with confusion and fear.  I feel physically sick and unsafe.  My body is burning internally.  Shame causes the amygdala in our brain to produce a cocktail of poisonous chemicals.  We are burning from the inside out.  Invalidating our feelings is like throwing petrol onto an already fierce raging fire.

Imagine a grizzly bear bounding into emergency and bailing you up against a wall and someone in charge expects, no demands, that you sing “The Star-Spangled Banner.”  How many of you would be able to do that with adrenaline and cortisol screaming around your brain and body?

When my amygdala is in charge of my body, and my pre-frontal cortex is in hiding, I am operating on fright/flight and freeze.  I am falling down a deep, black bottomless pit.  When I am well, I can manipulate, that is, I can plan ahead in a clever and skilful manner and I am in control.  My brain is cold and analytical.  People with antisocial personality disorders have cold amygdala which is why they can con people out of their life savings.  People with BPD have boiling hot amygdala and would find writing their name a challenge.

When we are in the middle of a BPD amygdala meltdown we regress to a very young age and swearing is part of this regressed condition.  We use primitive forbidden language as nouns, verbs and adjectives because we do not know how to cleverly and skilfully manipulate language to get our emotional needs met.  At this point we are almost pre-verbal.  Swearing can help expel the feeling that we are burning up inside.  It dampens and discharges the toxic chemicals.  It feels cathartic.  I feel for the person receiving this torrent of cathartic emotions.  I have been on the receiving end of this a few times.  I feel for the emergency and psychiatric staff.  This is part of the devaluation process consistent with the nine BPD symptoms; please separate the person from the behaviour.  Effective training helps people understand why this happens.  Please do not take this devaluation, regression and lack of language skills personally.

A BPD meltdown with all its colourful language in the moment is a life-threatening experience for us.  Let me repeat that.  We are experiencing an out of body, near death experience.  We are paranoid and dissociated, also criterion for a BPD diagnosis.  Again please do not be surprised when we walk through that door displaying all nine symptoms in the moment.  We are doing what we are supposed to do, according to the DSM V.

The DSM V was written for a reason, it is the psychiatrist’s bible, and one that is always referred to.  The DSM V clearly states the idealisation/devaluation process as part of the nine symptom range, so why do hospital staff show disgust and revulsion when we assign you as good or bad?

An extremely clever group of professors got their pre-frontal cortexes together and created the nine symptoms from people’s observable behaviour which ironically is sometimes used as exclusion criteria for admission to a hospital.  Go figure!

On the other hand, I know of people with BPD who go to emergency or have a hospital stay and are very, no overly, compliant, agree with everything and everyone and still get accused of manipulation and splitting.  This is me; I have never had a violent outburst in a hospital situation.   I have however had many a meltdown at home on many occasions and once at a shopping centre car-park.  Sometimes, hospital staff have preconceived ideas based on other people diagnosed with BPD who have presented at emergency departments.  Please treat each person as separate and unique.

People with BPD are also accused of “splitting” teams in psychiatric settings.  Again idealisation and devaluation are part of the symptom criteria, so again why is anyone amazed at this?  The idea is to have a very strong, very cohesive, transparent team, where everything is laid on the table in front of everyone else at regular staff meetings.  Have plenty of staff supervision and if necessary counselling appointments available.  How well is your team trained?  Have they ever had a person with a recovered lived experience of BPD come and talk to them about what it feels like to have BPD?  Do you have a peer support worker with a recovered lived experience on your hospital based team?  We all need to work together in this.  I have been a BPD patient and now I work in a mental health setting where I can be devalued by a person with BPD.  I know from both sides of the fence what it feels like.

People with BPD have deep seated relationship issues and communication breakdowns.  Do not expect us to operate in LogicLand, expect us to have relationship issues with you as again this is a symptom clearly stated in the DSM V.  It is your job to get training and think outside the square.  Change the way you communicate with us.  We feel toxic shame for being who we are.  Validate us just for doing the best we can with what we have.  Validate us unconditionally just for staying alive.  We don’t get our emotional needs met in emergency departments because you are not trained in BPD language.  We unconsciously recreate our dramas in psychiatric settings.  We replay our dysfunctional relationships in therapy.  When we are exited from emergency departments, sewn or patched up, we are sent home by ourselves without referral or resources or we are referred to BPD therapy services that do not exist.

Thank goodness in New South Wales in Australia we have Project Air Strategy, a university based research centre who are rolling out an education based programme for emergency department staff.  Finally an Australian state government is prepared to put money into people diagnosed with Borderline Personality Disorder.  I feel there are some very clever manipulative people out there with most amazing pre-frontal cortexes who have enough skill, control and influence to convince others in charge of the country’s purse strings that we are worthwhile human beings.

http://www.brisbanetimes.com.au/nsw/personality-disorders-hospital-staff-to-be-trained-in-how-to-care-for-misunderstood-condition-20150119-12td8v.html

Emergency room sign photo available from Shutterstock



BPD: NEA-BPD Family Connections Training in Australia

By Sonia Neale • 3 min read

australiaIn Australia, many families are desperately struggling to connect and support their loved ones with BPD.  In order for things to change something has to be done differently.  This change can come about when non-BPD family members learn new communication skills.  Be the change you want to happen in your family.  You cannot change anyone else, only yourself.

Last year I had the incredibly good fortune to be able to attend the NAMI Conference in Washington DC where I met up with the team from National Education Alliance Borderline Personality Disorder (NEA-BPD) some of whom became friends and we are still in contact.  NEA-BPD is now in Australia.  The fantastic news is that the first NEA-BPD Australia “Family Connections Leadership” training weekend is scheduled for May 2nd and 3rd in Melbourne with Dr Roy Krawitz and, pending interest, in June 29th and 30th in Adelaide, South Australia this year.  Dr Alan Fruzzetti, the co-author of the Family Connections Programme will lead the Adelaide training. This leadership training is only for family members and friends of those with a borderline loved one and for Clinicians. Those interested in becoming a leader of the Australian Family Connections programme can email bpdaust@gmail.com and request registration.

I was unable to fit a Family Connections weekend training into my tight overseas schedule but I was very kindly invited by Valerie Porr to spend a weekend at her TARA Method Family Skills Survival Workshop which teaches family members new ways to effectively communicate using DBT and validation skills and a non-blame policy with solution focussed education.

The skills I learned from Valerie’s workshop and her book I now use on my non-BPD adult sons still living at home.  It works to diffuse tension, arguments and nuclear explosions in our household.  When I say to one recalcitrant son, “It must be awful for you when we expect you to wash the kitchen floor and you want to go out and see your mates, I understand how you can’t find the time.” Paradoxically (there’s “nowt” as queer as folk says my Yorkshire, England born and bred father-in-law) that results in him reluctantly washing the floor, a five minute job and we have a laugh about it.  I have this communication skill down to a fine art now.

Understanding BPD from your loved one’s point of view is crucial to connecting authentically.  When someone is having a meltdown and black rage/mental anaphylactic shock is occurring, they cannot see or hear anything (these senses shut down), let alone take in anyone’s else’s point of view.  What you can hear though is the music of validation, the only thing that seems to cut through the dense swirling fog.  Family Connections teaches, among other things, the genetic, biological and neurobiological reactions so you get an understanding of why and how a meltdown occurs after a seemingly harmless incident or comment.  Validation soothes the savage beast of BPD which enables a small clear space for hearing and eyesight to come back online).  Trust me I know this process intimately.  I wish I could bottle validation and sell it because I would make a fortune. The next best thing is learning it from Family Connections.  Below is some information on how it is run.

Family Connections (FC) is a manualized 12 week (2 hrs/week) group program explicitly for family/friends of people with borderline personality disorder and is based on DBT theory and skills. DBT is the treatment that has the largest number of evidence-based studies of effectiveness for treating people with borderline personality disorder. The target group is family/friends of people with borderline personality disorder and the primary goal is to improve the well-being of family members. It is also hoped that improved family well-being will promote the well-being of the person with borderline personality disorder. FC programs have two leaders who may be either professionals or family members. The FC program provides psychoeducation, skills training and support and participants receive a FC workbook.

FC was developed by Perry Hoffman and Alan Fruzzetti and family members and is run under the auspices of NEA-BPD, the largest international BPD advocacy organisation. FC has 3 pre-post studies of effectiveness with significant reductions in family member distress, depression, grief, burden, hopelessness and an increase in mastery and empowerment. FC is provided by the leaders without charge to participants with participants being asked to cover small running costs (photocopying, venue, catering where applicable). FC has been very popular and is run in 16 countries, with over 1,000 people currently on the waiting list.

For more information email BPDAust@gmail.com  

Australian flag photo available from Shutterstock



Reasons Why Recovery from BPD is Frightening – Part Two

By Sonia Neale • 4 min read

I am perfect.  I cannot understand why anyone would want to criticise me!  My worldview is the only correct one, yours is wrong.  You are wrong.  If it doesn’t fit into my world view it doesn’t exist.  Your viewpoint is not valid.  You are not valid and you need to bow to my superior way of thinking.  How dare you disagree with me!  If I feel it, then it must be so.  If I think it, then it is right.  If I want it, then I shall have it.  I AM RIGHT AND YOU ARE WRONG.

In my most active BPD state these were my black and white thoughts.  Compromise was a dirty word.  Empathy, theory of mind and mentalisation were equally grubby and not concepts my concrete brain could grasp.  Not because I didn’t want to but because I couldn’t.  The same way a two year old doesn’t understand how to share something.  I had as much ability to grasp someone else’s opinion as I did bending over backwards and grasping my ankles.  I could have flown to Mars and back on the power of my own scared and frozen ego.  When you are this rigid in your thinking, and you have no idea how you come across to other people, nothing can penetrate your lack of dialectical thinking.  It’s like trying to push a banana through a brick wall.

Receiving criticism is a life-threatening experience. 

Criticism feels like someone has thrown acid in your face.  Years ago I was told by a co-worker I was dogmatic.  Immediately a caustic cauldron of neurotransmitters exploded from my brain, burning down my body and bathing me in a shameful corrosive substance.  The bastard now had to die.  He had destroyed who I thought I was, he had stomped on my ego, ground it into dust and now I was worthless.  Curled up in my bed in the foetal position, I wanted to rip my hair out.  Everything I had achieved was pointless, stupid and embarrassing.  I had to die because of the humiliation.

I am not exaggerating. This is why people with BPD end up in emergency departments.  When you spontaneously combust from chemicals your own betraying body has produced, someone may as well have thrown a lit match at you.  That is what cortisol and adrenaline does to someone with active, unrelenting BPD.  This feeling is not under your control.  It is an emergency situation, a life-threatening disorder.  The physical pain is excruciating.  Other people’s logical explanations cannot put out the flames.  I now had to go out in a blaze of glory.  What part of that intensity is not horrendous?

I’d rather die than apologise.

Death is preferable to apologising, because the fear of being wrong is disintegrating and fragmenting.  Being always right keeps us intact, whole and together.  The way to dissipate that venomous, acidic, corrosive feeling of being wrong is to apologise to the other person, even if you don’t know why you are apologising.  Most people do not have BPD and their brain thinks differently.   Again this is counter-intuitive.  This is “opposite action” that DBT talks about.  The first time is the hardest.  An apology can take the wind out of the sails of the other person and take the hot air out of your own personality at the same time.   An apology gives your brain oxygen to pause, reflect and unpack.  The power of an apology cannot be over-estimated.

When I apologise, my body starts to repair itself.  When I breathe I create brain space, my body stops producing these traumatic and terrifying acidic compounds and starts to produce feel-good chemicals that make me want to cry (in a good way) and nurture myself because it is ok to be wrong, it is ok to not be perfect.  This is where recovery from BPD lies.  The truth hurts.  Recovery hurts.  Recovery hurts so good.  It is ok to want to connect.  Connection with another, even if I don’t like what they said, drains that toxic chemical swampland.  I wish I’d learned this in primary school.

Sometimes we just don’t want to apologise, we want to give oxygen to the burning issues to keep them alive and kicking, justifying our original position.  This feels good and it feels right.  If we don’t have a blistering, searing issue how can we possibly feel alive?  Flaming issues replace the chronic emptiness and boredom we feel inside.  We need to find something else to fill that hollow, barren space.  We need to replace toxic relationships with an internal sense of self.  This is not something you can buy from a shop.  You have to want to want this before you can start to address this.  Tackling that desolate core is terrifying because you don’t know what is missing, so how can you possibly know what to replace it with?

I don’t have the answer to that, only you do, but I do know it starts off with sitting still even with (especially with) all those burning chemicals flooding while thinking, reflecting and gaining insight.  Insight and awareness alone does not cause recovery.  Practice being humble.  Turn humiliation into humility.  Difficult, isn’t it?  The greatest, most epic battle you will ever face is the one you fight against yourself.  There is no other enemy.  Only then will you recover from BPD.

You don’t actually want to change.

When you have worn a path in your brain with the same reaction to the same situation, climbing out of that deep rut is difficult and you need help getting out.  That hole is your comfort zone.  Everyone else is walking along the cliff of life and you have fallen over the edge into jagged rocks.  You don’t know how badly you hurt because the pain of familiarity feels good.  There is a fine line between pleasure and pain.  Pain produces endorphins which (like morphine and heroin) are addictive.   Pain slides down a dark path and change is a hard climb upwards.  Self-justified moral pain can feel like home.  But it is a lonely place.

Change can also hook you in.  But change involves trust and trusting other people is not only frightening, it feels very dangerous.  Again, you are not the cause of your BPD, but you are the only person who can change your life.

In Part Three, I will talk about the fear of learning to trust.



Reasons Why Recovery from BPD is Frightening – Part One

By Sonia Neale • 3 min read

Over the next few blogs I want to talk about what recovery from BPD feels like.  BPD is a disorder of dialectics, opposites and extremes.  Sometimes a compliment can make us want to die.  Recovery from BPD is not all sweetness, light and happiness and can be a harrowing, nerve-wracking experience.  Revealing your trauma can be like reliving it.  Making patterns and connections from the past to the present is enlightening but insight alone is not enough to change coping skills. Recovery can also feel fake, alien and unnatural.  It’s like trying to make the world turn in a different direction by running backwards.  You can feel like an actor on a stage with a script written by people who have never known what it feels like to want to slash their wrists, explode into a million pieces or throw themselves off a cliff.  How do you retain the essential you, lose the bits that are not working to enhance and highlight the new person behind the personality disorder.  We can be very attached to those parts that do not work well. You have to let go of who you thought you were.  It’s making the unfamiliar feel familiar.  If you could change your past, what parts would you change and would you change them?

Permanent change is scary and difficult to achieve.

Being the pilot in the airplane of your life can feel a lot like flying a real plane in a storm but being unqualified to do so. Being told or gaining awareness that you have a personality disorder can cause sadness, depression and anxiety. There can be much regret for a life unlived. Recognising you are fixed, rigid, unbudgeable and unbending in your response to people and in your outlook on life feels illogical. Understanding how you come across to people can be puzzling.   My mother used to say if you can’t say anything nice about anyone then don’t say anything at all especially works for people with BPD. Think it, don’t say it. Permanent change take a long time, especially when you think everyone else needs to change and you are fine. The hardest part is realising that you need to change yourself. That involves insight and practice. Do not rely on your gut feelings. Learning that feelings are not facts, feels counter-intuitive. It also involves being counter-intuitive about emotional situations, something Marsha Linehan calls “opposite action.” If the definition of insanity is doing the same thing over and over again and expecting a different result, then try “opposite action.” Fake it if you can’t feel it. Happiness can feel very uneasy. People will do anything to change themselves, except do something different.

Separating from toxic relationships causes separation anxiety.

People with BPD can become attached to people who are bad for our soul. Getting well can mean losing relationships. When you become non-reactive, other people may not like this. When you make an active choice not to react, they may question your loyalty to them. These are people who may have a vested interest in keeping you from being reflective and mindful. They may have separation and attachment issues themselves. This can cause a lot of anxiety because having a bad relationship can feel better than having no relationship. When you make a decision to delete people from your address book, the relief can be palpable and you wonder why you didn’t do it sooner. The hardest part about this is actually making the decision. I did this a few years ago and felt most empowered when I did it, rather like cutting out a cancerous growth. But you can still crave for that unworkable relationship years afterwards.

You now have to take full responsibility for your reactions to life.

Here is the frightening part.  No-one can make you angry or upset.  No-one causes you to cut yourself or guzzle a bottle of booze or throw a bunch of pills down your throat.  When you react to something, it is always your choice.  Learn different choices.  If there is no DBT programme available at least read a book.  Then you have the power to respond or react.  Responding is empowering yet horrendous because you are changing your reaction, yet your body is on DefCon 1.  Process that feeling.  Learning not to self-destruct, cut your arms, or swallow your stash can be terrifying because the urge to do this is overwhelming, especially in that black swirling headspace.  I have self-destructed and I have learned to not self-destruct.  I learned this in therapy but I also had to practice it outside therapy.  Fifty minutes, once a week gives you a tool.  Use that tool.  The first time you use the tool not to cut, drink or overdose gives you a body memory that stays with you the next time.

Remember you did not cause your BPD, but you are responsible for it.



Why is Australia Afraid of Borderline Personality Disorder

By Sonia Neale • 2 min read

A rising crisis and process of discrimination is largely being ignored in mental health within Australia. If people with mental illness are stigmatised within the general community, then people with Borderline Personality Disorder (BPD) are sometimes stigmatised and discriminated against within the mental health system itself.

BPD is a disorder of emotional dysregulation, inappropriate anger responses, lack of impulse control, interpersonal relationship difficulties with rejection and abandonment issues, paranoia, dissociation, self-harm and suicide ideation. It is widely estimated internationally that 2-6% of the population have BPD and of this 10% go on to complete suicide. Surely this qualifies as a matter of national urgency that we need to do something about?

According to the Diagnostic and Statistical Manual V, fulfilling five out of the nine symptoms qualifies for a BPD diagnosis giving a combination of at least 256 presentations. Often there is a misconception that all people who suffer from BPD are low functioning. In fact, there are some high functioning people in the professional services whom you would not suspect have a BPD diagnosis. Outward appearances can be very deceiving because with enough stress and pressure their internal thought processes and sense of self and the world can fragment and disintegrate without any external actions or behaviour. There are also people who find it difficult to function outside a hospital setting; as well as everyone else in-between. No two BPD presentations look alike yet we mostly hear described the ‘acting out’ type of BPD presentations.

BPD can be perceived as an untreatable, incurable and unrecoverable disorder. Anecdotal evidence suggests psychiatrists baulk at diagnosing patients because it is thought to be too stigmatising and unhelpful. This is not a supportive, respectful or dignified response as it can be most enlightening and a great relief to find there is a name for this condition. There is also a world-wide movement to change the name of BPD to Complex Trauma or Emotional Regulation Disorder which is felt to be a better descriptive formulisation.

Even if people receive a diagnosis there are very limited services. Aside from Dialectical Behaviour Therapy delivered by clinical psychologists, there is nothing I can find in Western Australia, no support groups, no self-help groups and no NGO service programmes.   On the other side of Australia, there is Spectrum and there is the Australian BPD Foundation, an organisation that is mainly based in Victoria, but is starting to establish branches in all other states.  These are all innovative and creative services that have helped many people. For the greater majority though, especially in Western Australia, a clinical psychologist seen through Medicare Better Access is the only option. Unfortunately only ten sessions a year is allowed, and this is nowhere near enough for long term stabilisation and recovery.

Some NGO organisations and health services refuse to accept people with BPD onto their mental health treatment programmes. While there is some online information, what is sorely needed as well as service provided programmes is peer and consumer led offline real-life support and self help groups. Specific programmes need to be developed by people with a recovered lived experience. BPD paid peer advocates need to be situated in all emergency departments to mediate between presenting patients and emergency department staff. This can go a long way towards reducing stigma and discrimination. Education programmes in schools, hospitals, universities, NGOs and other health organisations is vital for public understanding that this is a treatable, recoverable disorder. As well, early intervention programmes for mothers with BPD and their babies and adolescent BPD services should be Australia’s Department of Health’s top priority.

There is a wide prevalent mistaken attitude that people with BPD always present a chronic risk management, however those who suffer from BPD can and do enjoy long periods of stability in between episodes of debilitating symptoms. There needs to be a huge cultural shift towards embracement and inclusion because with the right support, the right programmes and the right treatment, it is not only possible to recover from BPD; it is also possible to live a highly productive, creative and enjoyable life with BPD.



The Therapeutic Underbelly of Borderline Personality Disorder

By Sonia Neale • 1 min read

The Rose

The most difficult aspect of Being Borderline is intimate relationships and that includes the special relationship we have with our therapists.  After nearly twenty years of (on and off and when needed) therapy, a certain familiarity happens and feelings, not always positive, can occur.  I will be honest here and I find that envy of my therapist and her happiness can threaten my internal security.  Because I know less about her than she does about me, I tend to fill in the blanks with “stories” of how perfect her life is.

This is one of the many reasons there are no shortage of therapists unwilling to engage with people diagnosed with borderline personality disorder.  There is no doubt we can unwittingly (and wittingly) press therapeutic buttons.  It is their job to gently needle us out of our ego centred comfort zones so we gain insight into our less than desirable personal qualities which I might add are universal, it just depends on the extent.  In a conversation with my therapist where we are working on why I see her as a threat to my happiness, she referred to this as the “therapeutic underbelly” of our work together.  What lies beneath our valuable work together and what is known in the trade as “transference.”

For everything there is its opposite.  It was Sigmund Freud who coined the term “transference” as well as “counter-transference” which is therapist feelings towards their clients.  Even Freud was not immune to his own feelings for his clients as he used to regularly transgress boundaries and even take his favourite clients on holidays with him.

So why would I pay someone good money if I see them as a threat to my security and happiness?  Because due to my BPD thought processes, I am aware enough to know never to compare my insides with anyone else’s outsides.  My perception of her as a “threat” to me is not based in reality.  She is at peace with herself and is happy with her life.  I sometimes forget that peace and happiness is not a finite resource, that when you give peace and happiness away, it expands exponentially and creates ongoing karma.  This is something I have to practice every day.

For a few days there instead of stewing in my own juices and emotionally dysregulating up to DefCon One, I sent her a morning email hoping she had a wonderful day and a photo of a flower I had taken.  I kept a record of how I felt and found that the mornings I send her positive vibes I felt she was less of a threat to me.  I had to stay very mindful and after a while I was feeling quite good about myself and less threatened by my perceived perfection of her.

Mindfulness and meditation without judgement on thoughts both good and bad have a way of helping me through the drama of my life and connect me with others in a real way.



Being Borderline Abroad

By Sonia Neale • 4 min read

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I recently was awarded the Inaugural Barbara Hocking SANE Australia Fellowship to study mental illness overseas. The sole focus of my application was Borderline Personality Disorder and what services and programmes I could bring back to Australia.  I was so excited because I could now set out to change the world.

For the past nine weeks I have been travelling the world with three weeks to go. Ordinarily this is a recipe for disaster for someone with boundary issues, self-harm tendencies, routine and daily structure issues, food, alcohol and drug dependencies, entitlement and anger problems, inter-personal skills deficiencies, mindlessness, mood swings, black and white thinking and everything else BPD.  Even though I have eighteen years of therapy behind me, sometimes the unexpected can happen and I need to be able to deal with it on my own because my family are back in Australia, and I am the only person I can rely on to sort things out.  As well, I am representing an Australian mental health organisation who have placed their trust in me to do a good job.

So when I lost the connection to my mouse going through Los Angeles customs, got financially ripped off by a British hire car company, had no wifi access in the Ireland because my sim card did not work as promised and somehow connected to international roaming (very expensive and expecting huge bill) or found myself at night at Waco airport with taxi issues, I had to get myself free from not only the situation but the toxic headspace that these happenings engendered.

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Being Borderline overseas can be frightening. I have circumvented several panic attacks over many different scenarios. I have woken up in different countries, with different seasons and different time zones and for several minutes I have to work out am I safe, do I have enough money, am I physically well and who am I and what am I doing here?  I have to breathe, pause, feel the anxiety, breathe and pause again, remember that I am OK, I am functioning.  My pre-frontal cortex has learned to kick in quickly.  If I get overwhelmed I can also email and skype with my husband.  I got sad and irritable one day and I emailed him and he said he gets sad and irritable as well with me being away and I resonated with that and felt validated as well.

Living out of a suitcase for three months, collecting experiences, business cards, conversations, books, papers and souvenirs along the way is tiring, exciting, fascinating, mind-blowing, scary, frightening and terrifying but never lonely and boring. I am comfortable with my headspace because I have very few demons inside my head anymore.  However on this trip I have had many “aha” moments and shifts in cognition about historical events.

I spend a lot of time at airports, eating airport food, paying airport prices and sitting in planes watching “The Big Bang Theory.” So far I have watched the same eight episodes of Season 7 twice, whilst sandwiched between two fat people (Hark at the kettle because I’m not terribly slim myself at the moment).  I also have to negotiate international menus and try and find local but healthy choices.  Early into my trip I decided to choose what looks like fun food I want to eat, I can always lose the weight when I get back home.

So being Borderline overseas means being flexible, seeing shades of grey (not the movie) staying in the same mood, being consistent and reliable, eating regularly with real food (not just cookies and chocolate), not giving in when people drink alcohol or smoke (I’m an ex drinker/smoker) being patient, very patient, courteous, polite, deferential, socially amenable to all situations, being empathic and taking on others perspectives, tipping wait staff realistic tips and most of all, exercising extreme mindfulness.

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I have met some amazing people, if you are reading this, you know who you are. People who have opened up my mind and expanded it with different perspectives on the same theme, from the register clerk at a Texas gas station to a psychiatrist at a NAMI conference.  I have met people who have taken me into their homes for the night, driven me far and wide so I can get to my next destination, bought me a meal, shared their most precious stories, given me books, files and invaluable information and generally all people have made this “gone walkabout” Aussie feel welcome and at home, no matter what US state or country I am in.  I am humbled by the kindness of strangers who are no longer people unknown to me but are now friends.

One of the major advantages of being Borderline is the ability to merge and take on characteristics of others. This expands to countries and cultures as well.  When in England I drank tea and my accent took on a British quality.  When in America I drink coffee and was staying at a B&B where the host, who had lived through two world wars, said Grace before breakfast and expounded his views on this new-fangled idea called Science.  He called me Miss Sonia.  I will miss him when I leave Texas.  I even went to church in Waco because I felt so attuned to this place.  Everyone said to me, Waco?  And I said there was a pot of gold in every place I visited, I just had to look hard enough.  One does not always recognise a pot of gold even when one stumbles into one.

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I found gold nuggets all over Ireland. From the beach called Greystones (aptly named) to the Spanish man who was part of the Mindfulness course I did.  Ninety two people from 27 countries shared five days together in a function hall in Wicklow County, each of us on our lonely little yoga mat islands.  I got thoroughly pissed off when one morning I came in to discover his yoga mat had the audacity to touch mine and I felt personally violated.  When we had a group sharing session I mentioned this and then he turned around and gave his version of this angry woman who tapped him on his shoulder while he was meditating and asked him to please move his yoga mat.  That gave others permission to share their territorial rights stories as well.  Part of the learning process of being Borderline is finding out your impact on how you come across to other people.  I said to him that was the gold nugget I was told we would find in this course.

Next week I get to go to Canada. I am truly blessed having received this Fellowship.  I set out hoping to change the world, and the person who has changed the most is me.

 

All photos by:  Sonia Neale



Borderlines Working with Borderlines

By Sonia Neale • 1 min read
Stormy Oceans

Stormy Oceans

If non-Borderline mental health workers are triggered by working with people with BPD then how do peer support workers with a diagnosis of BPD cope with working with Borderlines?

Triggers, both conscious and unconscious can catapult people in to the past where old issues surface and can affect how workers interact with their clients.

One of the symptoms of BPD is becoming emotionally overwrought with an inability to decrease that arousal and staying at that high level for several days. Obsessions, ruminations, delusions and even micro-psychosis around the event, always relationship driven, don’t diminish easily. When working as a peer, trigger upon trigger can occur where personal stuff gets activated, and it is not unusual for peer workers to have to leave the job they love because it can affect their own mental health.

Having worked with a therapist myself for many years, I am getting a sense of what it feels like to work with someone with low insight and sense of responsibility. It sucks, I feel devalued and the work we did together dismissed as irrelevant. Everything I have ever read about BPD countertransference and how workers feel came true.

The other part of me, understands the illness better than most, the lack of social skills, inability to find words to convey feelings, feelings of perpetual victimhood and had the utmost empathy for their inability to navigate through the dark, murky waters of BPD.

I have to differentiate my professional and my personal feelings and days after the event I am still slightly stinging from this. I went above and beyond the scope of my job description for this person. This is not unusual when working with people with BPD. They can easily evoke the “rescue gene” in me as I elicited the “rescue gene” in my therapist.

I know I did my best for this person. I know my heart was concerned only with recovery. All I can do is let go and move on and wish them all the best. Hopefully one day she will see that, like my therapist, I am not perfect, I just did my best.



The Many Faces of Being Borderline

By Sonia Neale • 1 min read
Interpret this!

Interpret this!

 

Misreading neutral facial expressions as hostile is reported to be what distinguishes BPD from other mental illness disorders according to this article from US News Health

Rolling the eyes, the extended blink, the nose wrinkle, the eyebrow rise, the lip twitch; all these can be erroneously interpreted as provocative, insulting and combative and cause huge ruptures in relationships. However, sometimes these interpretations are spot on. We can display our deepest prejudices in our facial expressions and not even know it.

The eyebrow rise can display surprise, the nose wrinkle can portray disgust and the extended blink, an indication that the person is either bored to death or that you have tapped into some shameful secret or synchronous event or both. I’ve been eerily accurate on several occasions with my therapist through the extended blink and the nose wrinkle; all confirmed by subsequent personal interrogation, just short of thumb screws, to extract a confession. But the hotter my mood, the less accurate I am. Depending on my internal state, misinterpretation is also possible.

People with BPD are highly tuned into their environment. Hypervigilance is another hallmark of BPD. This is a learned survival skill, where accurately interpreting the finer nuances of another’s intentions can save one’s life. Getting it right albeit half the time means you can go on to live another day. It means you will survive long enough to pass your genes onto the next generation. This makes perfectly logical evolutionary sense.

Checking faces and reacting to expressions is highly advantageous when your main care-giver or your so-called friends at school convey mixed messages, verbally annihilating on one hand and smiling sweetly while doing it. Or punching you in the face all the while grinning and telling you this is for your own good. It is hardly surprising when you become unconsciously and bodily tuned into your environment as a self-protection measure and have a meltdown when someone looks sideways at you.

Context is important. Press the pause button and check out what else is happening in the room.
What is the general mood of the conversation?
Are these people “safe?”
What else do I sense is happening between us?
Did they just look up, but because I was feeling enraged did I interpret it with hostile intent?

Relationship history is also very important.
What is your past relationship with this person?
Is their expression about you or them?
Have you triggered a personal memory for them?
I had an aggressive boss who gave me the lip curl once. Later on she told me she had been trying to get rid of me for six months.

Upskilling old behaviour patterns and mindfulness can settle nerves and give comfort that not everyone who blinks or grimaces is the enemy to be beaten and annihilated at all costs.

Photo:  Benson by Sonia Neale



Damning Diagnosis or Blueprint for Healing

By Sonia Neale • 1 min read

Fox Glacier, New Zealand

In 2005 I was given two diagnoses. One was for cancer and one was for Borderline Personality Disorder. Both diagnoses were delivered with a complete lack of caring and empathy, but the cancer diagnosis was not imparted with disgust and revulsion, either real or perceived. After the cancer diagnosis, I cried, came to terms with, made friends with and learned to live with it until surgery removed the tumour.

I was given support, love, kindness, empathy, flowers, fridge magnets that said “Don’t worry, be happy” and family and friends wanted to take me out on picnics. I found the BPD diagnosis far more difficult to take in; in fact it gave me chronic indigestion for many years. I was ashamed and embarrassed, told no-one and called it “depression and anxiety.” Going through the grief process, I cried, denied, got angry, bargained, got depressed and then accepted it and with that acceptance I grieved no more and started a new life. I then embraced it with loving/kindness.

Within that acceptance came peace and gratitude. Then came knowledge, education, advocacy and activism. I started to tell people, came out on my previous blog Therapy Unplugged and was surprised when people didn’t take out a restraining order on me. Then, turning it upside down, I made it my life’s mission to educate and inform the world that with the right treatment, the right support, people with BPD can recover and live a well life. I now work in mental health supporting people and educating organisations on what BPD is and what it isn’t.

BPD is no longer seen by some as a life sentence, an incurable, untreatable condition, just like cancer was a few decades ago. I still get upset, I still get angry, I still react with emotion to life, I still act on impulse occasionally and I still feel abandonment and rejection when people don’t reply immediately to my emails, but I no longer act on these feelings. I process them, decide how important they are and let them flow in and out of my mind, let go and move on.

The DSM is not perfect and I used it as a descriptive guideline, it does not define who I am, it describes my behaviours only. I am much more than the sum total of my diagnosis.

However, not everyone feels the way I do.

South Island, New Zealand

 

Photos by Sonia Neale:  South Island, New Zealand 2013



 
 

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