Borderline Personality. They have found the Silver Lining at last !

At last psychiatry and psychology have seen the silver lining in Borderline Personality Disorder. (BPD)

Less than a month ago Medscape (Psychiatry) reported on an interview they  had with Christopher J Hopwood (PhD), assistant Professor in the Department of Psychology at Michigan State University about his new research that suggested a silver lining for patients with BPD.
Traditionally people with BPD have been seen as extremely difficult to treat successfully and the time consumed doing this was often seen as not worth the effort.
I have treated and am still treating many patients with BPD but I came towards them from a completely different angle. For many years I have been very aware of the silver lining, sometimes even a beautiful, bright , golden lining or perhaps a lining of brilliant, dazzling colours.
I am going to take you back with me to many years ago when I emerged from University as a Social Worker (long before I was a clinical psychologist). I found a job with Child Welfare and was immediately plunged into a sordid, terrifying world.
Let me construct a scene for you, a typical situation for a social worker at Child Welfare:
“The case” would have been referred by a neighbour, a friend or an enemy perhaps. They would report that the children would be living with heavy drinking or alcoholic parents who would fight brutally with one another. They would have dubious friends and inevitably the children would have to leave the house to walk the streets with their mother in the early morning hours until the father would stop his violence to everyone or everything that came near him.
This would be one scenario. There might be a drunken brawl in the home until the main players would fall in a stupor on the floor.
But that would be the night before. I would visit the next morning and meet the children.  There would inevitably be a girl child of eight or nine who would be trying to feed and dress the younger children. Both parents would have passed out and perhaps thrown up on the floor. The young girl would be working consistently trying to find food, trying to take control in an uncontrolled environment, herself the victim of whatever her father and his friends had dealt out to her.
 It was obvious that the children were exposed to unremitting  Traumatic Stress experiencing every evening situations which would need trauma debriefing in anyone who experienced it only a single time..
I might have to visit the home of a nine year old boy who was bruised and bleeding because the night before he had stood between his father and his mother because the father was trying to kill her.
I could go on and on about these situations and their traumatic variations.
My questions in getting to know  these children in these situations were…
Do these children survive.?
 How did these children survive?
And then, later,
What happened to them? Where are the?.
When I went into psychology and psychiatry I met some of them, those who had been in those situations, and had survived. Often they had  done well academically and creatively. Some of them were doing great things for other people or for animals.
True and understandably they were often insecure and had problems with self esteem. True they used all kinds of legal but often repetitive ways to get what they felt they needed. (I found this very accessible to psychotherapy once the person realised that though they needed these methods to survive and to care for their siblings as children .However this tended to ‘drive people crazy’ as adults and they needed to find other ways of doing things.)
At the same time they had often come through with a certain depth of thinking and living. They were often very sensitive to others especially others in pain and they would  do all that they could to help them. Many of them were dynamic and had produced strong leadership qualities. They would be active in the charity organizations and the political and other agencies seeking good for and defending the ‘underdog’.
As I met these people as adults and got to know them I could only hold for them a powerful sense of respect because they had experienced the severe unremitting stress and  they had somehow ‘got through it.’
Many of them were diagnosed with BPD . On the other hand, all BPD people do not have a background like this, but there has often been some kind of unremitting traumatic stress, whether this stems from the cycle of cold rejection and over effusive love of the alcoholic mother or the terrible tension and devastation in a home on the verge of divorce.
The later research on BPD was pointing this out and therapists began to see these ‘impossible patients’ differently.
A person with BPD has been through too much in the adult world to find they can easily trust someone. A therapist has to be true to him or her self and to be sincere in the relationship with the patient . Eventually you can win their cooperation as well as their loyalty and affection.
Not only do they begin to work well in therapy but they start to achieve extremely well academically or in the creative arts.
There is nothing more disappointing  for a child than to come home with excellent results which are only received with apathy. Not to be able to share bitter and anxiety provoking experiences is very difficult. To have no one to care about the BPD’s achievements is far more difficult. They will work hard and achieve well if someone really appreciates it.
To work with BPD is difficult , hard and lengthy work. However it is rewarding and well worth it.
The professor has found that these people do and can change. Psychiatry and psychology are having a glimpse of their silver lining.