Listen and Learn

What’s the condition that doctors fear most? Cancer? AIDS?  According to a report by Time magazine, it’s actually this –  Borderline Personality Disorder (BPD), perhaps better termed, ‘Emotional Intensity Disorder’.

Marsha Linehan, one of the world’s leading experts on BPD, describes it as follows: ‘Borderline individuals are the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering’.

The condition affects between 1 and 6  per cent of the general population and accounts for some 20 per cent of psychiatric hospitalisations.  Sufferers experience extreme mood swings and find it difficult to relate to others. They feel chronically empty and are often drawn to impulsive or addictive behaviour – binge-eating, risky sex, overspending or drugs. Those with the disorder are at high risk for suicide (10%)  and self-harm (75%), and it is three times more common in women than in men.  Whilst many mental health conditions such as depression, respond well to drugs, BPD appears to be an exception. As a result, it has gained a reputation for being ‘untreatable’ and even permanent. Dr. Allen Frances, a former chair of the Duke psychiatry department, has written, “Everyone talks about [BPD], but it usually seems that no one knows quite what to do about it.”
Yet recent research may suggest a way forward.

Clinical trials at the University of Washington suggest that specialised psychotherapy can make a huge difference to patients – reducing suicide attempts and the use of psychiatric services.  Both Cognitive Behavioural Therapy (CBT) and psychoanalysis have been shown to work better than other standard talking therapies.  The question is,  why?

The bottom line seems to be this: both therapies start by taking the patient’s concerns seriously.  In other words, they listen. They don’t dismiss, side-line or even fix. That’s not a fluffy Christian sentiment.  It’s the explanation of specialists in this field, including Anthony Bateman of St Ann’s Hospital, London.  (Source: ‘Fix You’, Peter Aldhous, New Scientist, 27 August 2011).

What if anything, can we learn? That there are no simple answers? Yes.  But there are ways forward. We may not know how to handle our own problems, let alone those of other people. We may feel overwhelmed and inadequate in the face of suffering. We may feel that, without training and expertise, our efforts are useless.  But in the midst of our ignorance, we do know a few truths.  Everyone wants to be heard.  No-one wants to be labelled, dismissed or written  off. And all of us can listen.

4 thoughts on “Listen and Learn

  1. My wife is diagnosed BPD (which is a poor name – Emotional Intensity Disorder is a potential replacement). She’s definitely improved since the STEPPS programme, which is largely CBT-based.

  2. Thanks Paul – I’ve updated the post with your suggestion and any other comments or observations would be hugely welcome. Glad to hear that the STEPPS programme has been helping too.

  3. Well, I’ll share a bit since someone may well find their way to this page who’s struggling with it.

    I think the key skill Adele learnt was to notice the way her emotions are heading. Once you notice that, you can do something about it simply to get it roughly under control – just avoiding things getting worse.

    This is clearly not the perfect solution – it doesn’t deal with motivations, the heart and other things that make the condition worse. But unless you do this, you’re not going to sleep at night, you’ll wear yourself out with shouting/crying etc. Which is going to keep the cycle going.

    Over time, you can then start addressing the assumptions that drive some of the feelings and start challenging them.

    One particularly common ‘filter’ as they’re called in STEPPS, is fear of abandonment. This really is a viscious cycle as it leads to mega-clinginess in a relationship. Then the partner is stuck – either run with it and see no one else for weeks on end, or risk enforcing the belief that’s creating the behaviour. And if someone chooses the former, unless they’re really committed, they’ll get fed up and leave.

    I looked at some website forums for partners of BPDers and the advice was atrocious. ‘Get out now’ they said (or screamed). I understand why, but it’s selfish and cowardly (not to mention not being an option if you’re married).

    Really committed, stable, loving relationships will probably do more than anything else for someone suffering from BPD/EID. But they’re really hard to find.

    Finally – there is one positive thing about the emotional intensity. Because occasionally the emotions are positive ones, appropriate and joyful. It can lead to crazy fun moments like dancing in torrential rain watching fireworks explode from the top of a hill. But they’re not really crazy – it’s those who stay inside just because of a bit of water who are crazy.

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