Last week local newspapers were filled with the very sad story of the suicide of an Australian actor.
This man had apparently been suffering from depression, and in some of the photographs that appeared in the media of him his eyes revealed a great deal of emotional pain.
Last week there was an item on an overseas newspaper’s website about another young male who took his own life.
After surviving years of self-harm, addiction, anxiety and depression, and, in the last stages of his life, being diagnosed with borderline personality disorder (BPD), Daniel Brocchini ended his life at the age of 26.
Although the author of the item should be commended for discussing Brocchini’s plight, the concerns of the deceased man’s mother, and the inefficiencies of the mental health system, there are issues that arise from Robert Speer’s article (there are criticisms of Brocchini’s GP and a clinic in the piece, even though the latter did indeed have a treatment program in place for him and the former was cautious enough not to just prescribe medications without knowing more about the condition that had so disrupted Brocchini’s life).
In the article, BPD is described in the following manner:
The disease, according to the NAPD (National Association for Personality Disorder), is a “biologically based disorder of the emotional regulation system that may be due to genetics factors, the environment or a combination of the two.” It tends to run in families with a history of mental illness, depression, ADHD or addiction, and often is characterised by abnormal levels of the neurotransmitters serotonin and dopamine in the brain.
When discussing BPD it’s important to note that the vast majority of people diagnosed with it are women and that a large proportion of those women were sexually abused as children.
This reality suggests that describing it as a “biologically based disorder” might be incorrect, even if the relationship between biology and environment should always be acknowledged.
When discussing BPD it’s also important to note that it’s a heavily stigmatised and complicated disorder which doesn’t seem to even be fully understood by health professionals.
On 23 August 2008, the Sydney Morning Herald’s website featured an article about the inquest into a young woman’s suicide. The inquest and the article raised matters to do with the treatment the dead woman had received by a nurse at the Cumberland Hospital:
(The nurse in question) said that during a “handover” of observation duties to another nurse, she mentioned that Ms Chapman may have been attention-seeking, but it was “in the context of it being part of a borderline personality disorder”, not a comment on her suicide bid.
Given that up to 10% of people diagnosed with BPD will commit suicide and that many BPD sufferers use self-harm as a way of coping with overwhelming emotions, it seems odd that the nurse appeared to be trying to separate Ms Chapman’s suicidal behaviour from her disorder, and it seems even odder that Ms Chapman’s devastating actions were regarded as “attention seeking”.
While the popular image of someone with post traumatic stress disorder (more women are actually diagnosed with that disorder as well) is a war veteran whose difficult behaviours are recognised as being caused by an external event or events, the person with BPD is stuck with a pejorative label that seems to imply that a defective character is at fault.
Carolyn Quadrio from the University of New South Wales provided a compelling explanation of the disorder, as well as a persuasive critique of the BPD label, on Radio National’s All in the Mind last year:
Around about the time of Freud when the contemporary psychiatry really began, Freud talked about hysteria. And I think the classic kind of character of the earlier days is the Marilyn Monroe character who would now be called borderline personality disorder. So Freud’s idea of hysteria actually has some similarities with our contemporary view in that he saw that it had to do with sexual trauma in childhood. And even when it was known that people like Marilyn Monroe was sexually abused as children, there was often the view that they’d be seductresses even from an early age, sort of thing. So there was a very strange view then.
It developed from there until finally we come to modern-day psychiatry where the idea of hysteria has been dropped. And part of it now is embodied in the idea of borderline personality disorder. It’s a very unhappy description because it doesn’t really tell you very much. And it derives from a period where it was thought that people with this condition were sort of borderline psychotic, borderline schizophrenic. We now know that that’s probably not true and so we’ve been stuck with this label of borderline. I’ve written about this and researched about it and I think it’s really important that we should drop the name because we actually know what causes borderline personality disorder. It’s very strongly correlated with childhood trauma and what we should call it is post-traumatic personality organisation. So we need to stick with what we know, which is that most of these people have been severely traumatised in childhood, their personalities are very badly affected by their childhood trauma experiences, and in adult life they have very maladaptive ways of behaving, which results in the diagnosis of personality disorder.
A link to a video about BPD:
Looks to me like Speer was being a careless journo, a phenomenon noted frequently at LP. He referred to one of several US organisations for BPD — and if there are several organisations, that usually means divergent views on diagnosis or treatment. (Why didn’t he just use the DSM IV, I wonder?)
I see a SMH sub-editor has moved in to the LP circuitry — you mean imply rather than infer that a defective character is at fault!
He could have just looked on Wikipedia for a start:
http://en.wikipedia.org/wiki/Borderline_personality_disorder#DSM-IV-TR_criteria
Excuse my mistake there. I should’ve read this website first:
http://grammartips.homestead.com/imply.html
Amendment has been made.
Suggesting a biological reason for BPD is concerning because it might just mean more drugs as opposed to more of the kind of therapy that’s been proven to work for BPD (e.g. CBT and DBT). Of course, there are times when these therapies are undertaken in conjunction with medication. Listen to Dr Bob Johnson on the video linked talk about the causes of personality disorders and the way they’re being perceived as genetic by his profession. He disputes that idea and talks about how these disorders are the result of early trauma. He also says they’re absolutely curable with the right expertise.
Thanks Darlene, very informative post.
Indeed, a goody, Darlene.
Thanks Laura and Joe2, that’s appreciated. It’s such an interesting area to look at and it’s sad (and irritating) to read a lot of the stuff that’s out there about the disorder. There’s some good stuff out there as well though and attitudes are changing.
People diagnosed with the disorder who live in Melbourne might be interested to know about Spectrum:
http://www.spectrumbpd.com.au/
To me, the notions of “determism” and “powerlessness” come to mind. To be condemned to a cyclic existence triggered by factors seemingly utterly unrelated to reality and the factors of one’s own personal formation and life; or at least not being able to make a meaningful connection between one and the other, as wth self harm patterns for childhood profound trauma victims, has genuinely frightening connotations. “Fucked up” would be the common prejorative rationalisation and “Rosemary’s Baby” seems to be a realistic representation of the trip; wild, uncontrollable and suffocating.
Whatever the mix of inherited and trauma induced biological factors, it does seem significant that the condition can be alleviated through dialectical behaviour therapy, unlike the purely biological psycho or sociopathologies with which it has been linked.
I’m not sure what some of you read. Possibly a paraphrased version. Dan’s GP was held in high esteem by both the writer and myself. Mental health themselves admitted the “system” was broken. The point trying to be made was that Dan and I spent ten years seeking help. Because of his addiction behaviors, he was always written off as an addict rather than determining the underlying causes which both Dan and I knew existed. The diagnosis only came two weeks before his death, too late for him. Please be respectful with your posts, both the writer and myself did our research, and this was the information available to us. Thank you
Many thanks for this piece, Darlene. I have a direct interest in this topic. My adult daughter and I are both convinced that my wife (her mother) has this condition, albeit she herself is in denial on it.
Unfortunately she has a very simplistic view of mental illness. In her view, you are either crazy or sane. Her position becomes even more complicated for others to understand because she is highly functional and competent, talented and a tireless and creative worker, and compassionate, caring person in all other respects.
But in relations to others she can be dysfunctional and gradually alienates people. She long ago(23 years) fell out with my family, who could have been supportive of her and would still love to welcome her back into the fold. She hates them with a passion still, and sometimes merely the mention of one of them will be enough to set her in a rage. Our daughters, now living in Melbourne as we continue in Warrnambool, barely speak to her and one still suffers depression, resulting, I suspect, from childhood trauma from her mother’s rages.
I, too, think that childhood trauma is the more likely explanation for my wife’s condition, rather than biological factors. Her mother died when she was about 9 years, possibly 10. Her father was unable to cope and shoved her two brothers and her in an orphanage and the care of the church. These alone would have been a lot for a young girl to cope with but I know that over those years in orphanages and convents she was subjected to some unspeakable cruelty and humiliation. I am not aware of any physical or sexual abuse, but suffer she certainly did. To this day she is reluctant to let people get close to her.
I have done a little research and will follow up your links. On what I have read my wife would fit about 6 or 7 of 10 likely symptoms. An interesting exception is that she’s never shown either suicidal or self-harm indications (unless you count the destruction of human relations as a form of self-harm). In fact, she has a good sense of survival and has coped with the heartbreak of rejection or fighting with our daughters by throwing herself into new work or new learning.
I will try to remember that term “post-traumatic personality organisation”. I agree that it is a much more reliable description.