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Re: Borderline/atypical; no AD help; pdoc/T give u Fivefires

Posted by Racer on June 6, 2008, at 11:22:07

In reply to Borderline/atypical; no AD help; pdoc/T give up?, posted by Fivefires on June 5, 2008, at 16:06:06

> > >
> R: Yep. Heard same. And, it almost seems like a cop out to say nothing will work so we're doing nothing.

Is it a cop out for them to say that they're going to do nothing? That question might not be all that helpful right now. What might be more helpful is this question: What can you do to help yourself right now?

> > And yes -- there's a problem, because there's a huge difference between saying, "Oh, well -- this is nothing more than BPD," and "the suffering you're experiencing is caused by BPD, so you'll work on that -- and this medication will help with your pain while you do so." Guess which one I think is more appropriate?
> >
> R: Can't guess; cognition suffering.

What I was trying to say is that I think it's more appropriate for them to try to help reduce your pain WHILE ALSO trying to work on the underlying BPD -- if that's what it is -- rather than just saying, "Oh, that's just BPD -- we can ignore your pain."

There's a medical parallel here, by the way. For many years, accepted wisdom was to treat pain conservatively. Treat the underlying condition, rather than treating the pain, which was only a symptom. Turns out, that's wrong. The pain itself has to be treated as well.

So, your doctors seem to be saying, "we'll address the underlying condition -- but we won't treat the symptom." Problem is, if they don't treat the symptom -- your pain -- they're not going to get far in treating the underlying condition.

> P: Don't know what splitting is? Also, did have some attempts, one just to get into hospital,

Don't worry about "Splitting" -- it's a defense mechanism common in BPD, but if you do it, you probably won't know you do it. Also, it's not diagnostic, so it doesn't help work out if it fits.

> I wonder tho' if it is a subconscious intention at the way I am withering away here? Put food in, comes right out. Walk like 95-yr-old. Feels like body is 'shutting down'.
> After seeing pdocs for 10yrs or so, w/ never a mention of borderline, it was 'a caseworker' who said to me once out of the blue, 'have you ever been diagnosed borderline?'.

If you had been diagnosed as borderline, you probably wouldn't have been told. It's not necessarily helpful to disclose Axis II diagnoses, unless it's directly relevant to treatment. If you're getting into DBT, it might make sense to tell you, otherwise they probably wouldn't.

> T said BPD is same as Atypical Depression.

And I think we both know that the two are very different things.

Are you seeing this T through the same agency that provides the pdoc? And can you discuss changing Ts?

> When she said that, I immediately thought need new T! She had never been sort curt, shallow, uncaring, and then to say would be out of office for a while! This 'you're already sunk so you might as well give up attitute doesn't work for me'. Made me very fearful and sad.

Is that what she said?

Linehan had a description of her view of the etiology of BPD that I really liked. It was very compassionate. I forget the exact description, but she described a child asking for attention, being ignored by the parents until the child went over the top -- and the parents suddenly gave full attention. In other words, she described a child being trained to escalate rapidly. After all, if you need attention, and the only way you have ever gotten it is to escalate, you'll learn fast to skip the lead in and go straight to the top, right? Unfortunately, that leaves you in a very bad position right now -- if you express how bad off you are, your treatment team are likely to see that as the sort of escalation typical of BPD. From your perspective, of course, saying, "I am not 100%" just doesn't convey the extent of your pain. So, not a good situation.

Unfortunately, that being the case, the more you try to get across to them that you're feeling as though they're not taking your seriously, the more they will ascribe your behavior to BPD and refuse to take you seriously. And, unfortunately, although they're the professionals and supposed to be able to take control of this situation in a professional and effective manner -- they just don't have the incentive you do to change the dynamic here. It will be hard to change the dynamic, and you're not in any sort of shape to take something like that on right now -- and you're still the best person to do it.

> Yes, if T is saying this to pdoc, pdoc might be following suit.

From my experience, it's more likely the pdoc telling this to the T...

> Have so couple times; now being re-routed back to pdoc from them.

Your county will have a formal complaint process, and using that process will at least get someone else to listen before routing you back to the pdoc. The usual process is to start by sending you back to the pdoc to work things out; if that doesn't work, they'll send you to the administrator for that pdoc (who'll probably send you back to the pdoc to work things out); and only after that will the county step in. And even if they step in, they may say that there's nothing to do because they don't have any other doctors.

Here's another suggestion: See if there's a PHYSICAL medical doctor you can see. It's not ideal, by any means, but honestly -- sometimes the county GPs are much better than the county pdocs, even for psych meds.

> I know what will say, 'what do you want me to do for you?' Isn't this backwards?

I hope you heard back from him, and that he was more responsive than you feared.

I've already sent you some suggestions, but here are a few other thoughts:

Write a script to use when you speak to the pdoc again. Something like this:

1. Even if you do have BPD, you're still in a great deal of pain.

2. If you do have BPD, that's something you'll address in therapy -- but to do that, you need to address the pain more directly, in order to give you the resilience to do the work.

3. You did experience a certain amount of benefit from Nardil -- but the side effects made it intolerable. That suggests that another medication may be helpful AND more tolerable.

Realistically, it still may not work. I strongly urge you to contact your local NAMI office for help.

Also, a lot of doctors are annoyed by patients showing up and saying, "I've read about this medication, and think it's a good choice." Regardless of what we think of that attitude, it's worth keeping it in mind when you talk to this guy.

Good luck.




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