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The Gift of Therapy by Irvin Yalom

I wanted to talk about this book, as it is helping me process some of the stuff that has come up this week for me. It may be interesting as well, in light of the conversations that I have participated in (here) in the past few days.

This is the first thing that struck me:

"Once we make a diagnosis, we tend to selectively inattend to aspects of the patient that do not fit into that particular diagnosis, and correspondingly overattend to subtle features that appear to confirm an initial diagnosis. What's more, a diagnosis may act as a self-fulfilling prophecy. Relating to a patient as a "borderline" or a "hysteric" may serve to stimulate and perpetuate those very traits"

I knew there was something just niggling at me/bugging me these past few days. And I may still very well be confused about the process and all, since I'm so new, but...

I can't help but think that sometimes therapists put us in a box that we cannot escape from. I feel trapped by it. No other words I can think of to describe it.

For example...oh, hell, let's pick on anger again.. I ran across a few posts today in Facebook that I found interesting. One poster was "pissed off" about certain political issues at the national and local levels. She is intelligent and articulate, and is somewhat of an activist. I could not help but think that what is a "cause" to her, is now just a "trigger" for some of us in therapy. ??

I was told that I have a few "borderline" traits- (anger and black and white thinking) but that I'm primarily "depressed"- due to suppressed anger. Now what?

Before therapy, and even before I came here, I would have thought nothing of having a little bit of righteous indignation about certain issues. Geez, "everybody" does it, it would seem. I certainly have a heightened awareness now about how much anger and irritation I see on the internet. And I generally don't go looking for it, as I'm too busy with school and work. But I'm grateful for the "hide" feature on FB!

Now I feel like I'm "BAD" if I were to express anger like a "normal" person. I almost wish I could go back. Does that make sense? Or does the majority of the population need therapy for BPD? Seriously!

Some of you may know that I'm pissed off at my therapist, about how he confronts me during our talks. But to his credit, he does not believe in treating according to diagnosis. He knows that I'm complex and full of contradictions and both of us are intelligent enough to be comfortable with uncertainty (most of the time)and our own tendencies... (we are both quite stubborn)

And I'm glad that part of me finds the statement that I made above about being "BAD" for getting angry ...kind of ridiculous. I want to own my anger and irritability. They are mine, and part of being human, and I refuse to disown them. If I thought that my anger was "bad".. well, hello black and white! Of course, this doesn't mean one acts on their anger all the time. (You guys are too smart for me to state the obvious, I know) But I have not seen yet anyone mention anything about discernment in regards to anger. Anyone? I'll poke around, or I would love to hear in another post!

So do some of you think that a diagnosis has the potential for creating a problem where perhaps none existed? It's kind of like being labeled the "smart kid" or the "dumb kid" of the family- you take that role on, and become it.

I am going to keep reading this. I used anger as an example, as it seems to be a theme this week. (Can we just blame it on the moon??) The basic idea behind this chapter is to treat the patient like a WHOLE person, not a diagnosis, or (in my case) several.
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number9,

It's good to keep hashing this stuff out, trying to get a handle on it. Recently, I found out that my best friend's daughter is probably borderline or is showing some serious borderline tendencies. Knowing her daughter as I do and learning that she's probably borderline doesn't make me love her any less. I actually feel so much more compassion for her because I know how much pain she is in. And I'm much more forgiving of her now. Because, there was some history there as she and my daughter were best friends for a year, oh, a long time ago. And she just dumped my daughter one day and really just ignored her from then on. I had taken this girl everywhere with us. and then one day, it was as if she just had absolutely no feelings at all for my daughter or our family - she had spent a lot of time with our family. It was as if there was no attachment there at all. It just disappeared one day. Or seemed to. She just seemed to get a high out of the "falling in love" process. She would find person after person to "fall in love" with and get into these intense relationships. I had always held a little grudge because of what happened between our girls and how she treated my daughter afterwards. But understanding borderline a little more, it makes it all so much less about us and more about her and what was going on inside her. And that little grudge has finally turned into compassion.

Everyone gets angry. Everyone misplaces anger. But maybe the difference with the personality disorders (it sounds so awful, doesn't it?) is that a particular trait is causing someone trouble. Like, your anger is causing you a problem in terms of getting closer to people. And that's why it becomes a disorder, when it is interfering TOO much in your life.

Impulsiveness is another borderline trait. I know I can be impulsive when I start to feel bad about myself. I spend money I don't have, go on trips to escape the pain of my everyday life. I need to learn to cope with my emotions so I can get a handle on my impulsiveness or else I'll be filing bankruptcy one of these days. And that's not good.

Think about children and the way the view the world. Mom didn't love me because she gave my brother more pancakes than she gave me. Maybe my brother was a real PITA and she was just doing that to shut him up. But I didn't know that as a kid. And for some reason, maybe it's anger, maybe there wasn't enough positives in our FOO, maybe there was abuse, our reasoning about the world stays fixed right there. And we always view the world in that particular way, not feeling loved or cared about if x does y. And that's what therapy helps us with.

Number9, I used to feel as though I was the only screwed up one in the whole world. And I felt so ashamed that something was wrong with me, with only just me. But look at the field of psychology and all these people who study dysfunction and try to help people who are dysfunctional. There are lots of people out there with issues. It's just that a lot of people hide them well. No one is going around advertising. And it's not always obvious by looking at the outside. You are not alone with this.

xoxo

Liese
number9,
Thanks for sharing about the book - I will have to check it out. My T doesn't diagnose. Sometimes shel'll say it could be depression, or attachment or dissociation or whatever - but she'll always follow that with "I don't care what a diagnoses or label might be - it doesn't matter for the work we're doing." after reading your post, I can feel grateful that she doesn't box me in. Thanks.
I too, have found that I have more compassion for some that have displayed those traits that your daughter's friend had. If anything, I am developing more compassion. But I still dislike the label, because I find myself utterly unlike most borderline people that I have run into.

I have issues, but this just doesn't seem to fit.

When I come across a "trigger" for example-

I really just wish that my T would ask the "why" questions rather that just go right into "you are wrong for doing what you are doing or feeling what you are feeling"

I never really had a problem with anger in and of itself- that is, acting impulsively on it. I tend to be aloof and have a very low tolerance for superficiality and phoniness and bullshit. I don't go around being "angry" about it, but I feel like life is too short to "waste my time" (yes, I know that is a form of anger and blame)

Just from what I have read, I seem like the opposite of borderlne- I don't get into intense relationships with people. I do reject almost everyone before they have a chance to reject me almost at the VERY beginning, though. My rationalization is that I prefer to be alone and do my work.


I can't help but think that if I were male I would have a different diagnosis. Men who are stubborn or argue are probably given more leeway, or are more likely to be considered narcissistic or avoidant or paranoid on top of anxiety or depression. There have been articles on this- why is there a term called "male borderline" in the first place? That sounds suspect. And the fact that I find that irritating, and now have to feel guilty about it, just feels to me like another sneaky way to put people in the little boxes they belong in.

I do acknowledge that I play a role in my depression and withdrawal. I do know that in order to succeed financially, I'm going to have to forge some more real connections with people. I can perform quite well in my job... I call it "showtime" - but later on, I just want to go home and read a book and not have to deal with other people and their "bullshit"- My tolerance for social contact is low. I could blame that on the pressures of school and finances, but that's an excuse and I know it.

So there is a general theme of anger, but not something that requires "anger management". It is more of an undercurrent with me, but it permeates everything. I would call it being jaded/cynical, but it could grow into bitterness if I'm not careful. I had thought that by venting to my T, that would help me keep it under control so that it wouldn't affect me in the outside world. I dont' want to be blunt and obnoxious.

The black and white thinking sometimes does occur, but I think in shades of gray a lot- (and this is when I get accused of overanalysis)

So what I'm saying here is that I'm not trying to pass blame to an external force and avoid working on myself. But these labels are too simple and contradictory to work with.

I am sometimes impulsive, but more often not, and tend to play everything safe lately, I have more fear than I used to.

I don't idealize and demonize people, I had an earlier awareness of that in other people so I avoid doing that to others.

I don't engage in self-harm practices. I was an adrenaline junkie not long ago, if that counts. I like pushing my body and fear to the edge.

I do have MAJOR trust issues. And I'll dig my heels in when I need to. And I get pissed about the same things that "normal" people do- politics, bad drives, etc.

so honestly, yeah, there may be "borderline" tendencies, but if I have them, then I think that most people on the planet do, too. Meh. Remember, I was just told that I had a few "tendencies" in the wake of an argument with my T.

How lonlieness, existential despair, cynicism, lack of trust, and growing bitterness turned into BPD seems a little odd to me. I own my shortcomings, but this diagnosis, (sorry) in my opinion, is a bit overdone.

Had to say that.

So what you said about feeling like I'm the only one- feelings of intense shame- I didn't feel that until I someone told me I have BPD tendencies. I feel MUCH worse for it. I don't want to share a diagnosis with some that I met that I find repulsive.. needy, whiny, temper-tantrum throwing, immature brats that project all their shit on everyone else. I have felt that way at times. I want to have my T tell me that he supports me and is there, but I'm not calling him right now. I want to swear at someone that cuts me off in traffic, and depending on the day, wish them serious ill will, but I let it go. I get pissed off about the same issues everyone else does. Some days I take things personally. Now when did this become a serious pathology?

If it wasn't such a label, a stigma, and was presented in a way that it wasn't a pathology, I would find the traits useful tools for self-awareness. I wish they were stand-alone traits, and not a lumping together of almost every defensive reaction to the external world under the sun.

As always, reading your posts Liese, they help a lot. I may be one of those who hide my issues- there is a big ball of bitterness in me that I want to dissolve before I make myself ill. So that's why I believe in working through triggers, locating the "whys" (for me it's often related to FEAR) than just get chastised for having triggers in the first place.

Again, thanks, you all this is helping me so much. After I sign off, I think about what I could do different, and am developing more awareness. The sad thing is that it is helping more than talking to my T is at the present moment.

I have to ask- your daughters friend- is she addicted to love, or is she just trying to reject first, before the other person has an opportunity to reject her? I think that that is a borderline trait. OK, I definitely do that. So we do have for sure, one positive BPD trait for number9!

My desire to not contact T, to "detach" may be part of that.

What a confusing "diagnosis"!!!! arrghh, thanks!
In no way am I implying that those with BPD are "whiny temper-tantrum throwing, needy drama queens"- but some are. I am trying to let go of these judgemental thoughts, but I have to be honest and say that I don't particularly enjoy being compared to these types that I have met. Nobody here, for sure. Keep educating me. I'll listen. Smiler
quote:
And for some reason, maybe it's anger, maybe there wasn't enough positives in our FOO, maybe there was abuse, our reasoning about the world stays fixed right there. And we always view the world in that particular way, not feeling loved or cared about if x does y. And that's what therapy helps us with.


Sorry about all these posts, but I found a real live trigger that I have.

I don't like being ignored, and tend to take that personally. If I feel like I'm being ignored or diminished or blown off or not heard or not seen, I get triggered. For sure.

Geez, Liese, I'm using you as a therapist, I'll back off for a bit.
Hi Number9.

I have BPD and I am high functioning. I am not whiney either! But I know what you mean by that. I am not demanding on anyone or society and I internalise most or AlL of my distress. My BPD has largely been hidden all my life and only comes out when I am in a major depression - this current episode has lasted a year. I haven't been attached to anyone in my life and in this last year have had my first attachment. When that person terminated me (my T) - I went crazy. I was irrational and psycho and cranked up about 9 out of 9 of the criteria.

I never knew why i never wanted to live, why I hated living, couldn't connect with people, couldnt feel anything, why I hurt myself. When I was terminated I realised that my behaviours and thinking were not normal - I couldn't understand the self harm and couldn't understand the SU stuff. I knew I wasn't normal. I knew that the depression label didn't fit all my stuff.

I looked again at BPD. when i was not crazy depressed and traumatised by my attached person - I was fairly *normal*'. But clearly I wasnt normal and clearly everything written about BPD fitted me.

Since then I have felt really comfortable being part of the BPD "community". Finally I know where I fit in. i told my T that I dont want an official diagnosis but we both know I well and truly fit. BPD is a continuum and depending on the circumstances in my life - i move up and down that continuum. I don't mind being on it. Apart from talking to people on this forum, no one - other than my attached people (2 x T's and an ex T) know that I am BPD.

SD
quote:
I am not whiney either! But I know what you mean by that. I am not demanding on anyone or society and I internalise most or AlL of my distress. My BPD has largely been hidden all my life and only comes out when I am in a major depression.


SD, do you take medication? Does it help? After reading your post I think I want to talk to my T about BPD. I've often wondered if I was bi-polar (yet it doesn't really fit), and from what I read, some of it is similar to BPD. I long for a diagnosis, but have not gotten any other than MDD (major depressive disorder)....which really doesn't fit by itself. I've asked my T, "What is wrong with me?" She says, "Why, cuz you're depressed?" I never asked my P, the year I saw him, what my diagnosis was. Well, I think I might bring it up with her again on Monday.
SomeDays:

In reading your description of your internal pain, I think I'm beginning to understand. I too, am alone, not attached to anyone but my T. Added stress and depression can make things unbearable sometimes!

Is it more of a general feeling than anything?

These posts are so helpful, because this stuff is complicated.

Ninn: I have thought about meds again. The only formal diagnosis I have had is also MDD. It seems like the BPD stuff isn't as much an issue without the major depression. Should that be treated first? I do know that the depression sometimes has a mind of its own and can become a monster and affects everything else significantly.
I went through months of trying different meds and never really got better, that is kind of why I was wondering....

I always had a "mood stabilizer" prescribed along with the anti-depressant, but many of them actually made me worse, and the rest didn't really help much. He was trying, Symbyax, for treatment-resistant depression. That helped me sleep, and gain weight. I think I also have an anxiety problem....that is why the first med chosen was Lexapro (that med messed me up and he cancelled my appt and went out of town the day before Thanksgiving last year, so I ended up in the hospital). Seriously, I'm feeling very stressed about my moods, trying to describe them to people, trying to live with them, trying not to judge myself because of them, trying to be a mom to four while feeling like I'm suffering inside Frowner The only self-harm I do is hitting my head (when I get emotionally overloaded, it actually calms me right down) and starving myself. Now I'm feeling like I need to feed myself, in a way of addiction. I don't drink, but want a drink badly! Or I want to take Ativan. And, I only have 2 Ativan left and doc wouldn't give me more than 15 pills because they are addictive he said (he told me to find a different doctor if that is all I was willing to take, so I don't see him anymore). Meds scare me, but I feel like I need more help Frowner
Hi number 9

If you met my friends daughter, you would love her. She's pretty, smart, talented. It's just her close interpersonal relationships that are a mess. Before she discovered boys, I think she was addicted to love. But when she got into boys, she started to get dumped, things started to get hairy and then the self-harm and suicidal stuff started

Maybe it's all a matter of degree. And maybe if it will help if you think of all people have needs and some people use more attractive Behavior to get their needs met and other people learned less attractive behavior. Maybe the behavior itself is unattractive but what is really going on underneath is that they are not feeling heard or they are not feeling important. We all need to feel important so maybe if they learn what they are actually asking by whining and learn a better way to go about it, life would be better for everyone.

Does that help? Because no ones needs are more legitimate than everyone else's Does that make sense? Maybe borderline refers to the level in the brain at which emotions and needs are being processed, down in the dungeon, never seeing the light of day I don't know if this is true but that's how I see myself You can bring these things out and start looking at things in a new way.

I Am wondering about the existential despair, if it's really nothing more than at attachment injury and the person has never learned and is unable to form meaningful emotional connections with other people that might ward off those feelings of despair and hopelessness. They can only do this with the help of another mammal (therapist) Again these are just my thoughts.

Wrote this from my phone without my reading glasses so I have no idea if it makes sense Good copout huh ?
xoxo
Liese
Yep. Read your marriage therapy post.

Wow- yeah, anxiety. I hear you. I almost forget about it sometimes. I do drink wine, but too much makes me gain weight- and vanity keeps me on track!

Ativan- there have been some nights where it has been pretty bad. Nights can be really hard, no? I think that the "inner borderline number9" comes out at night. I ruminate then, get pissed, go over arguments, what I shoulda said.. what was their motive, where do I stand, as well as general anxieties about money, performance, starting a new business, and a general feeling of doom...etc. Overwhelm.

I had a handful of pills once, got from my mom. I hoarded them in a little jar by my bed. As in "in case of emergency, take one"- and it had to be REALLY bad in order for me to take one, because I only had about 8.

Meds scare me, but I came into it all wanting to work through the pain, not just numb it.

There is an excellent book called Dark Nights of the Soul by Thomas Moore. This book really helps me with the big D- he treats it with such respect and care. To him, it is not a pathology, but a rite of passage. You have to experience that dark place, not push it away.

The pain that SomeDays describes- not sure this book would address that. But I'm starting to understand the attachment part of all of this. That creates its own anxiety, for certain.

That and the fear of weakness. In reading your posts, it sounds like you are quite strong.

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