BPD A Men’s Health Failure On Every Front

Editorial note: As described on our About page, part of our mission is to encourage discussion and debate on all subject matter related to men’s rights and issues. To this end, we present the following article.

By: Jacob Shaftoe

I’d like to bring up an issue for men.  It’s both personal for me, and I also think it’s important for both men and the wider community.

So, first thing first, lets name and describe the issue in and of itself:  Borderline Personality Disorder, or BPD.  It’s both a mouthful and meaningless in and of itself.  The name was coined through Freudian Psychoanalysis, one of the most widely discredited pseudosciences in human history, so trying to understand it through that name is pointless.  The Europeans call it Emotionally Unstable Personality Disorder, others are trying to get it renamed Hard Life Syndrome.  My favorite alternate label is Complex Post-Traumatic Stress Disorder, because it’s both accurate and somewhat informative.

Now, how to describe the beast to a layperson?  Considering it’s stumped humanity for most of recorded history, I can only hope I’m up to the task.  Here goes:  Are we all familiar with PTSD, or at least the oversimplified Hollywood description thereof?  Okay, from that point I feel I can get somewhere.  So, you and your friends have a great game you play with each other:  You sneak up behind a mate and fire off a starters pistol.  Friend jumps, maybe swears, but then big laughs all round, right?  That is, up till one mate gets back from serving overseas.  He doesn’t have a diagnosis yet, but after what is best described as “The Incident”, you don’t play the starter pistol game with him anymore.  Partly because it’s clearly not fun for him, and partly because of the impressive stitch-count earned by the guy who first tried it, am I right?

As a society, 50-odd years ago, we’d blame the soldier for his illness.  then, 30-odd years ago, we made a movie that linked PTSD with manliness and standing up to bullies.  That movie was Rambo, and everything changed from there.  We learned to see his perspective.  We learned it was as much our fault as his when “The Incident” occurred.  But 50+ years ago, it was all his fault, and off he went to sleep under bus shelters and drink metho, as far from our games as possible.

I’m not spouting hyperbole when I say I know how they felt 50 years ago.  Men are expected to be traumatized by war nowadays.  What we’re not allowed to be traumatized by is life, and human interaction.  Bullying isn’t meant to kill us, but make us stronger.  This we can sort of see is bullshit, but bullshit that stands as the dominant paradigm.  Men don’t cry, men don’t carry emotional scars.  Shit, it takes constant shelling and watching a mate lose his face in the blink of an eye for a man to be traumatized.  Anything less we spit out with the tobacco juice and go back to skinning our lunch.  So, to find oneself traumatized repeatedly, and in subtle, difficult to define ways, and then react “madly”, well…

One of the best analogies for BPD I’ve ever come across described us as “Emotional burns victims”.  We either lost, or never formed the emotional skin that most take for granted.  For us, a simple hug can be agony.  We wish we could articulate this as the kind gesture it was intended to be, but we just got hugged on our burn scars.  An emotional outburst is understandable, if not inevitable.  But the scars are not visible.  So when we yell, what response can we expect?  “Stop being crazy” is the most common, and it’s entirely understandable.  All of a sudden, or over time, little starter pistols take the place of normal interactions.  A firm handshake becomes bullying, a flirty gaze becomes sexual harassment, a kiss that leads no-where becomes an abuse of sexual power.  The everyday world is firing starter pistols left and right, and only we can hear them.  Trust me, we all know this makes us crazy.  It makes us hard to deal with.  Wanna know why?  The best treatment we have includes  group therapy.  I’ve shaken my head in bemusement at the symptoms of others, and had the entire group stare at me as though I was alien, simply because some shared symptoms were expressed differently.  Honestly, I still can’t visualize the process of cutting myself without vomiting a little into my mouth.  But it was really embarrassing to see the same reaction to my wonderfully effective stress-relief method of getting drunk and taking the piss out of angry looking guys till they punched me.

Still, now I have a diagnosis.  Now, at least I understand my problems.  Now, there is a working therapy for my issues.  So, why am I sharing this, in here of all spaces?  Simple:  BPD diagnoses are mostly female.  BPD diagnoses by gender are 75% women, 25% male, yet practitioners who deal with BPD believe that it affects men equally.  So, why the under-representation?  Gender biases.  Gender biases that lead to most men being diagnosed in prison.  Hang in there, it’s gonna get really complicated from here…

Our culture tells us who to be, who we are, and what is valid.  Some of the more prevalent views on gender can look a lot like this:  Men don’t have feelings, and when we do have to have feelings, they are usually expressed in manly terms:  Drinking, fighting, sex, and crashing cars.  Women can have feelings, but not too many, or they’re whiny, narcissistic attention whores.  So, when one of the main diagnostic criteria is parasuicidal behavior (read: intentional, willful self harm), how do we, as a society process that term?  Cutting yourself, swallowing pills then calling your partner, screaming at your partner “I hate you, don’t leave me or I’ll kill myself!”.  How many males can empathize with, or even identify with that?  Moreso, even if you can, and some surely do, how comfortable would you be with reporting this publicly, especially if you’re aware that these are “girly symptoms” of a “girly disease”?  So, men clearly don’t engage in parasuicidal behavior due to distress.  We don’t get drunk after a breakup, and keep hitting on some giant’s girlfriend rudely, in the hope he’ll take a swing.  We don’t drive too fast, we don’t have unprotected sex with multiple partners.  We don’t punch walls and break our hands, and we always put the gun down when the cops tell us to.  Nothing to see here, we’re all perfectly sane.  No crazy girly behavior here.  Also, no-one ever gets hurt as a result of our behaviors, unlike those crazy broads.

Me, I had no problem with my diagnosis, and none with my treatment.  Then again, I’ve always been a statistical outlier. I don’t even like football.  So, not being judged “manly” was already par for the course in my little world.  So, I read between the lines of the diagnostic criteria, and saw everything I hated about myself.  I saw any means to change these things as the only viable means of feeling at ease with myself.  The easiest way from “I hate myself and want to die” to “life might be worth living” was obvious to me:  Don’t be that which I hate.  The recommended therapy claimed to offer a means to that end.  That claim is powerfully valid, and scientifically verified.  First time for everything, I suppose…

So, on to the waiting list I went, to go to Dialectical Behavior Therapy (DBT).  DBT describes BPD in ways that allow for it to be treated, which is the same as saying it described BPD correctly.  The treatment is complex and difficult, requiring a whole team of psychologists, including some I never met overseeing the therapists I did see, in order to keep a close eye on their judgments.  Why?  Because it’s really easy to loathe people with BPD.  We hurt ourselves and everyone around us, and spend weeks at a time in fight-or-flight mode.  We threaten self harm when we’re scared or feel threatened, and we’re scared regularly and easy to threaten.  Like all humans in fight or flight response, we often threaten those behaving in ways we fear.  So, keeping the therapists themselves from getting over us requires another, specially trained therapist.  That’s how hard it is to help people with our problem.

The other reason DBT is so effective in treating difficult issues, particularly ones formerly believed to be intractable:  The Dialectical model of acceptance and change.  It utilizes Cognitive Behavior Therapy techniques, as well as mindfulness, a kind of meditational self-awareness.  Cognitive Behavior Therapy (CBT) was, in it’s heyday, a great advancement for psychology.  It has great tools for helping people reorder their lives.  It worked so often, some saw it’s ineffectiveness in dealing with BPD as all the proof they needed to believe what was always assumed:  BPD is incurable, untreatable.  You’d have better luck nailing jelly to a ceiling.  CBT’s strength is it helps you to focus laserlike attention on the very things you need to change, but does nothing to make this process comfortable.  Applying this approach to people who often try to kill themselves as a direct result of focusing too much on that which they hate about themselves is fine when you’re unaware of the second half of that concept.  DBT acknowledged that second part, and developed means to deal with this issue at the same time.  Rather than separating symptoms from “annoying” behaviors, it treats everything at once.  It’s as grueling as a ladder out of hell, but at least the rungs aren’t coated in jagged glass anymore.  Interestingly, a large component of DBT was designed purely to minimize harm to the treating therapists.  I don’t think anyone who has been around BPD patients would ever suggest that we’re easy or fun to work with, and I’ve been one.

So, imagine you’re a therapist who has never practiced this model, and comes from a time before it was even thought of.  Imagine you’ve tried to help people with BPD, and by people, statistically we mean women.  So, all you see from any patient is someone who: A) Doesn’t get any better;  B) Has trouble even accepting, and responds very poorly to your treatment;  C)  Constantly “overreacts” to everything you say, and takes your words out of context to generate some “fantasy” of you actively persecuting them and D)  Are almost all women.  What conclusions would you think you might come to from this set of circumstances?

You don’t need to think to long on that, I can show you

That’s right, a mental health professional categorizing an entire diagnostic group as “Crazy Assholes”.  Also, as all women.  I submit to you that both these assertions, while understandable, are also provably false.

We know a lot about how BPD occurs.  We know more about the common conditions that spawn it than we do about serial killers.  They’re frighteningly simple for such a long-misunderstood illness:  Take a somewhat-to-highly sensitive person, add emotional invalidation from peers/authority figures/loved ones, and if you really want to guarantee that someone ends up with BPD, then add significant trauma, usually but not always prior to adulthood.  That’s it.  It’s really that disgustingly simple.  The sensitive bit is probably what threw people for so long.  Sometimes you get one kid in a family with BPD, even though five kids were raised the same way.  So clearly, something was seen to be “wrong” with these kids.  Never mind that you can have the same thing occur with peanut allergies without any blame.  Biology can be weird like that.

So, sensitive people, invalidation and trauma.  Now, I’m a father with a young child.  Every time I read a story about a father losing their children to what’s described as an unbalanced legal system and an angry, judgmental spouse, I wonder something to myself…  Is this guy maybe sensitive?  I know I’d be traumatized by even the possibility of losing my kid, let alone losing them while the state invalidates my parental abilities, my very identity as a father.  To only be seen as worthy of regular payments to justify my existence.  To have an angry ex -wife cut down every good thing I ever did, publicly, only to have the final arbiters of justice within our society scowl in agreement and pronounce me a bad father.  That would mix trauma and invalidation, no?

Now, hold that thought, because here comes a big kick in the balls.  This shouldn’t be a fun read for anyone.  Here’s the whole criteria according to the DSM IV, seen by many who treat BPD with DBT as possibly the least-worst description the DSM ever managed:

1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
9. Transient, stress-related paranoid ideation or severe dissociative symptoms

Here have link if you want to see for your self 

It gets better:  5 out of nine.  If you have 5 of these nine criteria being regular features of your life, you have BPD, according to (arguably) the best consensus ever published on the issue.

Ring any bells?  To me, in this context, the criteria don’t just match crazy broads, they match everything I’ve heard from or about the experiences that lead to the rebirth of MHRAs.  Invalidated in their maleness, traumatized by relationship breakdown, driven to anger, self loathing and suicide.  This, if I’m correct, the epidemic that leads most to the doorstep of this movement…  Ring any bells?

So, never mind those of us who grew up with this illness, who’re denied diagnosis and treatment by gender biased interpretations of behavior.  Ignore us by all means, we’re only somewhere between 1.5-5% of humanity.  That’s half the estimates for this illness in the general population.  Yet, within the heart of a community dedicated to men’s health, and rectifying the pain men feel in certain biased and traumatic circumstances, someone publicly states this illness is unquestionably incurable and evil…  and feminine.  Someone who clearly hasn’t kept up with literature and therapeutic models, someone who ignores the wealth of research on the illness, and the efficacy of relevant treatment models.  Someone who sees it through a gendered, blaming lens.

I could give a fuck for myself here.  I had wonderful luck with getting diagnosed at a very good time in my life, and got the very best treatment available.  I’m now approaching the point where I’m not sure if I even meet 5 criteria anymore, and I used to hit all nine with a sledgehammer, and really put my back into it.  What worries me is all the men undiagnosed.  DBT was developed my Marsha Linehan, in order to try to treat suicide (mostly in women).  Here we are, decades later, wondering why so many men kill themselves, and the most prominent psychologist in this community has nothing to say on BPD that wasn’t known, and wrong in 1938.

I’m writing this article for two reasons.  One is to call into question many apparent misconceptions about BPD in the wider community.  The second is to pose a question for those still practicing psychology who would argue that BPD is incurable:  If your interpretation of what BPD is all about is valid, and the DBT model of BPD isn’t valid, then please provide some, or any evidence, that disproves or calls into question decades of peer-reviewed studies that confirm its efficacy.  Third, is viewing an illness that could be effecting anything between 3 and 10% of the male population, and is the leading cause of non-psychosis related suicides, as feminine and incurable, not to mention evil, really a great step forwards for men’s mental health advocacy?

Seriously, I really fucking hope not, because for the men whose entire development of BPD hinged on traumatic experiences involving women will have only one hope for anything approaching recovery:  Group therapy in a room full of “crazy assholes”, all of whom are women.   Still, I made it.  So, if nothing else, on this one front I can prove every biased therapist wrong:  My name is Jacob, and I’m a man, and I’m also not a crazy arsehole…  And I’m healing.

Further reading, courtesy of Marsha Linehan, who developed Dialectical Behavior Therapy

About the author:

 Jacob Shaftoe is an odd little duck.  Sometimes he writes poetry, sometimes he packs trucks, and he definitely prefers the company of free thinkers to that of ideologues.  However, he will engage with either, because we’re still all humans just trying to make sense of a ridiculous world.  He is a sensitive man, and lives in Sydney, which is proof he’s not yet entirely sane.

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8 thoughts on “BPD A Men’s Health Failure On Every Front

  1. I don’t agree that PSTD is the right place to look for understanding of BPD. It’s not about trauma, it’s not triggered by an even. BPD is different. It’s a lifelong habit, a way of seeing the world, a way of dealing with people. The characteristics of a BPD person are:

    1 – Everything is either 100% wonderful or 100% bad
    2 – This is always someone else’s fault. Usually the fault of whoever they are emotionally close to, who they feel dependent on.

    When your partner is BPD, you always are either the most wonderful, perfect man in the world and everything in the whole world is happy; or the most horrible human being in existence and the whole world is horrible and dark. Most importantly, this status changes in a flash, with no logic or reason, depending on how he or she happens to be feeling *right now*.

    Who else is like this?

    Babies. Babies are like this.

    The BPD person is someone who has never emotionally advanced beyond infancy. Unfortunately, although they are emotionally infants, they can throw a kitchen knife like a grown adult.

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    • Paul, I agree with you as much as I disagree with you. In the end, I can completely understand why you have the point of view you have. It’s totally valid, it just also happens to miss some salient, well studied facts.

      What you say about people with BPD having the coping skills of children is entirely accurate. I know this because I’ve spent years learning these skills through therapy. However, I presume you don’t blame illiterate adults for not having learned to read as children…

      In any case, you seem to be into invalidating any empathy for people with the diagnosis, and that’s equally understandable. Hell, I’ve got it and I had to make a profound effort during group therapy at times, just to cope with others behaviors. Oh, and I’ve been in more than a few relationships with BPD women, so trust me when I say that I get it.

      The problem is, so long as this is viewed in the wider community as: A) Female; B) Incurable; and C) Entirely unrelated to the extraordinarily high rate of male suicide, then what exactly are we going to be able to do about male suicide?

      You see, there is a treatment, and it works. It takes junkies who can’t count the number of suicide attempts they’ve made and helps them to be sober people in stable relationships. Paul, I have BPD, and was told frequently around the time of my diagnosis that mine was a serious case, very serious. Flash forward about 7 years now, and I’m in a very stable relationship (I think I’ve raised my voice about 5 times in 7 1/2 years), I don’t even take the suicidal thoughts seriously any more. There’s no self harm, no drug abuse, no mood swings. Shit, I got a three year old kid and I’m coping with that and loving it.

      But for every man in my position who gets a diagnosis and looks up what it might mean for them, there’s Paul Elam’s article, telling them they’re basically psycho women who’re incurable and kinda evil, empathy-less harpies. Could you concede that that, in and of itself, doesn’t actively help men seek treatment for an issue that isn’t gendered, is massively under-diagnosed in men, and is the leading cause of non-psychosis related suicide?

      Finally, there’s a really important point to be made here: We’re not all alike. Having BPD isn’t any more defining than owning a hat. Some people with BPD are (like myself I hope) reasonable people who had a problem they didn’t understand, or know how to control. But, like with all humanity, some people are shitheads. I’ve been in enough rooms full of people with BPD (Not only in therapy, mind you. Goth clubs and drug dealers houses get a fairly good turnout too :p) to be able to see the difference. Sometimes I wonder if those who have such raging hate-boners for BPD may not have been traumatised by a particularly shit-headed BPD case at some point.

      Which leads me to my last, cute little thought: BPD is where people suffered some sort of trauma that deeply affected them and their emotional equilibrium, which almost always leads to that Black/White, Good/Evil thinking you mentioned. Now, after having trained in letting go of judging others and myself in those black/white ways (part of how I’m getting better), I can see it just as clearly in others. So it’s kinda interesting to me to see it almost universally applied by those who suffered at the hands of a spouse with BPD… In the end, it’s clear that there must be some kind of evo-psych explaination for this reflex in the mind: Hurt too much too often by X = X is evil. The same mechanism makes for racism (and I don’t use the ridiculous term reverse-racism, so Suey Park is at the front of my mind here), for sexism, be it misandry or misogyny (interesting note: My computer’s dictionary doesn’t even contain misandry), and also leads to BPD in extreme cases. It actually makes me wonder if what we call BPD isn’t just the bad end of a perfectly normal response to trauma. Get bitten by enough spiders, you tend to squish on sight, or scream and freak out.

      It’s a shame that some of us got bitten too much by life, before we had a chance to cope rationally with it.

      Like

      • “and is the leading cause of non-psychosis related suicide?”

        Can you post a source for that stat? I agree that BPD is generally considered a “female” problem & that it is likely under-diagnosed in men, but I do find it difficult to believe that it is the cause of most male suicides.

        I am willing to be convinced though.

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      • Actually, getting stats on that would be difficult… I’ll break down how I got there though:

        Heh, so I can’t find the video itself of Marsha Linehan talking about her decision… When developing DBT, she had to have a target diagnosis to get funding, because bureaucracy. She was developing a treatment specifically for suicide. When she was forced to pick between Major Depression and BPD as a diagnosis to be treating, she concluded that BPD was more profoundly suicidal, and chose to target BPD accordingly.

        In any case, that’s anecdotal (twice removed, it’s my recollections of a video :p), so, I googled BPD suicide rate, and got these:

        http://bpd.about.com/od/understandingbpd/a/suicide_ar.htm

        http://en.wikipedia.org/wiki/Borderline_personality_disorder#Self-harm_and_suicide

        This one claims it’s actually higher than even schizophrenia: http://www.tara4bpd.org/dyn/index.php?option=content&task=view&id=23

        and the most conservative and stringent I’ve found is: http://www.ncbi.nlm.nih.gov/pubmed/16757458 , which has it at somewhere slightly under 10%.

        Also, keep in mind the numbers of those undiagnosed and misdiagnosed. It’s a prick to diagnose BPD, and it’s quite often someone gets the (lifelong) diagnosis of Bipolar Disorder (hilariously often contracted to BPD, just to avoid further confusion :p), only to end up being diagnosed, treated and “cured” of Borderline Personality Disorder.

        Apparently with Borderline in particular, those few men that get diagnosed can have up to twice the suicide rate of women with same. I’m sure you can provide your own jokes on that one front, and I can stick to the serious side here…

        So, massive underdiagnosis of men (along with more common misdiagnosis), coupled with general stigma relating the illness to crazy broads (remember, there are all sorts of legal things that happen if you have a psychotic illness. Forced medication and hospitalisation are common. BPD, however, isn’t medicable, so it also isn’t something one can’t ignore. Often, one can just ignore it and hope it goes away.), and you’d certainly have some of the difference in suicide rates explained. Borderline personalities tend to kill themselves, or try sincerely, and us men, we’re good at finishing what we start. I remember a great conversation with a couple of other guys in psych ward about suicide attempts, and none of us were so banal as to just cut our wrists or try to OD…

        So, I’m very happy I got treatment, and I’m more than a little disappointed that someone who claims male suicide rates as a reason to be an MRA, but pokes scorn and gendered insults at an entire group that seem, from the stats I’ve been seeing today, to be somewhere between a group that is significantly at risk of suicide and the group with the single highest rate of suicide, especially when male.

        So, in order to appeal to the rage of those who had horrible relationships with untreated or improperly treated BPD diagnosed partners, we’re willing to sacrifice any moral high ground on a stated concern, one that ends the lives of innocent men?

        At the risk of being as misunderstood as Paul Elam is, so regularly, when he makes public jokes about being violent: I’d love a chance to punch him in the face. Not for myself, or my pride, or to make myself feel like a hero to those he’s harmed with his ill-concieved words, but just to prove that some Borderlines anger-management issues don’t play out in divorce court, but lead directly to assault charges being laid.

        🙂

        Like

    • ?

      Not sure I follow, but I’ll happily explain the logic behind it, if you missed it:

      Men underdiagnosed, leads to suicide. Failure on healthcare front.

      Men’s rights leading voice publicly states that a curable illness is incurable, and talks about it in purely female terms. Failure on Men’s Rights and health front.

      You only need to be fighting a war on two fronts to be almost guaranteed of failure. Hence the title.

      Like

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