| Psychotropic Medications
by Patty E. Fleener M.S.W.
Most of my adult life has been spent in chaos - emotionally, in
relationships, in jobs and as a parent. Basically this thing called
"borderline personality disorder (BPD) and bipolar disorder (BP)" has
impaired EVERY area of my life.
I was also a relationship or "love addict." If I didn't have
a man in my life I felt invisible. The man was a mirror of myself. If
the man treated me well, I was a good person. If I was treated poorly
I felt I was a "bad" person.
I have a history of being involved in many relationships, usually with
men who were unable to make a commitment. The relationships were
always "on again, off again." I was forever "breaking
up" with these men, only begging to come back within hours.
Many times I would rage at these men, feeling that if they were not
making me happy, they were "bad" and needed to be punished.
That's right. I read somewhere on the net that some borderlines feel
that "bad" people deserve to be punished and that was
correct during a many years of my life. The bad people were usually
the men in my life and it was their fault that I wasn't happy and that
the relationship wasn't working.
I could never leave a relationship on my own volition, even if I no
longer liked or respected the person. My whole self lay with that
person. If they were no longer a part of my life, then my whole self
went with them. I was invisible. I didnít have a "self" to
go back to.
Each chaotic relationship that ended (which took me forever), I vowed
that next time would be different. It never was. Each time I got
emotionally involved with emotionally distant, emotionally abusive,
alcoholic men. I was told that we attract people that are on the same
level of mental health we are on. Each time I would verbally abuse
these men, not realizing what I was doing.
I lost friends, relatives and even burned out some counselors. No
matter how much advice I got, or how much direction I received, it was
like I was living in a different world than everyone else. Nothing
seemed to penetrate this "tunnel" that I lived in.
When I was in my 20ís and early 30ís, I should have been arrested
many times. I have kicked in several doors, smashed a car windshield,
sliding glass door, apartment window, and have thrown a few objects.
Never would I physically hurt a human being, but their objects better
be nailed down.
This aggressive, impulsive behavior normally took place under the
influence of alcohol and was always directed towards the male in my
life that I felt rejected by.
At this time, I was completely alone besides my husband. My entire
family had ex-communicated me. Just when relatives thought I might be
showing some improvement, I would once again fail. The only thing
consistent about me was my inconsistency.
I began several years ago, a long process of trying different medications to
treat my depression, mood swings and rages. I couldn't figure out why
nothing worked and I lived for a "long time" feeling too
depressed to shower, to change clothes or do chores. I even became
I was angry at my parents for many, many years, feeling that they
"caused" my borderline disorder. At least that was what I
was hearing from the books I was reading at the time. Somewhere a long
time ago, I was traumatized and it was "their fault." Again,
they were "bad" and needed to be punished.
Though many borderlines have a history of childhood abuse, research
lately suggests more of a genetic link than trauma. Many people who
have been traumatized do not have the borderline personality disorder.
Research says that children of mothers who have the borderline
personality disorder are five more times likely to develop the BPD
than those that don't. You can't blame your parents for their genes
and chances are when they had you, they were unaware.
I strongly urge you to forgive whoever it is you are feeling angry
with, no matter what they did to you. You don't have to have a
relationship with this person, but inner forgiveness will free you
tremendously from that bond and open your life for healing.
Finally I reached a point in my life where I was able to forgive my
parents for whatever "wrongs" they have done to me. I began
to realize that I did want them in my life. I wanted to be loved and
have peace in my life. I realized the anger I held hurt me
tremendously and that I was using a lot of energy holding on to these
feelings. I also decided there was no point in hurting my parents,
that I could give them the gift of letting my anger go.
As I look back, I see all of my anger was in vain. I used to see them
as emotionally causing my BPD when really I feel in my case it was
genetic. All those years wasted when I could have had a nice
relationship with them and spared them the tremendous hurt I put them
However, part of many families' problems with their borderline loved
ones, is how their illness effects them. I strongly urge families to
become educated about this disorder. This education can improve
relationships and provide understanding to the borderline's behavior.
When you see the behavioral problems as a medical disorder in the
brain, one's response to that person changes. It isn't that the
borderlines is "messing up again," it is that the borderline
is probably doing the best she/he can with this medical disorder.
During the time I forgave my parents, I quit "splitting" -
seeing people as either black or white. I realized that people are
many different shades of gray.
Through meeting Dr. Leland Heller online, I learned that BPD is a
MEDICAL ILLNESS. I learned that BPD indicated damage to the limbic
system in my brain. The limbic system is what controls emotions and
those of us with the BPD have difficulty controlling our emotions. We
can go from feeling good to feeling suicidal in seconds.
I learned that there were in fact medications out there to help me. I
realized that the answer to getting better was FIRST to get on the
right medications, THEN do the therapy.
At this point I realized that only understanding WHY psychologically I
became BPD would not make me better. I realized that becoming involved
with therapy would NOT make a difference as my brain was STILL
damaged. I needed to heal my brain. This was the start. The latest
studies about BPD not only indicate this, but that BPD is a form of
epilepsy and that certain antidepressants, mood stabilizers and
sometimes the use of neuroleptics could help to heal my brain and in
turn help heal me and my BPD behaviors and thought patterns.
AFTER we have found the right combinations of medicine, THEN we can
receive great benefits from counseling, if we receive the proper kind.
(See below on types of therapy recommended for BPDs).
One of the most important things I learned was that having BPD was not
my fault. I didn't ask for it, cause it and don't deserve it. It was
not only ok to forgive myself for my past BPD behavior, but essential.
Dr. Leland Heller taught me that.
Iím 47 years old now and it was only a few years ago that the
diagnosis of bipolar disorder was diagnosed in addition to the BPD.
This is why it is important for ALL of your disorders to be diagnosed
and treated. The symptoms of these two illnesses are very similar and
it seems to me that many with the BPD also have bipolar disorder. It
is common with the BPD for other disorders to be present as well. This
is called the "affective spectrum." EACH of these disorders
must be treated medically.
I believe the first issue that needs to be addressed in recovery as I
said above is getting the correct diagnoses. This can happen while in
the hospital or in a mental health professionalís office. If you are
still unsure of your diagnosis of BPD, I recommend you receive a
second opinion from a qualified professional.
It is quite common for a person that has the BPD to also have other
disorders as well. This is called the "affective spectrum."
So, make sure you have a reputable Dr., preferably a psychiatrist to
do a fully history on you. Many BPDs also have the bipolar disorder.
Some also have ADD, etc.
You will experience a variety of feelings after being diagnosed. It is
likely you will experience shock, denial, anger, confusion and much
sadness. If you are like me, you will stay in denial of your illness
for many years. I was first diagnosed in the hospital by a
psychiatrist and was not only in shock but was very angry. I was 33 at
the time. At the age of 40 I finally began to come out of denial.
Denial will keep you from getting the help you need but always
remember it is normal initially to experience some denial. The key is
working through this denial.
Many people I talk to are relieved to get their diagnosis. Finally
they can put a name to what has plagued them. Finally they can move on
After receiving a proper diagnosis of BPD, the next step in recovery
is medication. The things that didnít work before, on the right
medications can work now." I FIRMLY believe that therapy will do
no good unless one is treated properly with the right medications and
research is confirming this.
If you are going to a therapist or psychologist who says they can help
you without medications and encourage you to discuss your past hurts,
RUN! Borderlines do not regulate emotions properly and this form of
therapy is NOT recommended. Therapy that is centered in the present
time, working on behavioral symptoms is recommended however.
There are some DBT (dialectical behavior therapy) therapists who
believe that DBT therapy is all you need and that medication is not
only not needed but insist that you go off all of your psychotropic
medications before you begin your DBT therapy. I cannot disagree more.
If you are current with the research and aware that the BPD is a
biological, primarily genetic disorder you will very quickly take the
nearest exit if you meet such a DBT therapist.
Be careful what you read on the Internet and in books and be careful
in what I am telling you now. My advice is to read the research
yourself. Take the time. You are worth it. I have a page that has some
tools that will assist you in your own research here. When you read
the research, be skeptical as well. Who is doing the research? Does
the researcher has anything to gain? Etc...
However, there have been many reports that DBT therapy in addition to
medication can be quite helpful. Cognitive therapy can be excellent
therapy for the BPD as well. The DBT is not the ONLY therapy mode
recommended for the borderline personality disorder.
Personally, I have not had the pleasure of learning DBT.
Research regarding BPD HAS been done with interesting results that
most mental health professionals are not aware of. These professionals
have not received any new training about the BPD and still hold onto
outdated opinions that were once thought to be true but are simply
INCORRECT from what we know now.
If we have been told to by our therapists and Drs. to read the book
"I Hate You, Donít Leave Me" we will put the book down and
feel that there is no hope for us. Remember this was the first lay
book written and during that time, not much was known about treatment. This
author has just written a new book entitled "Sometimes
I Act Crazy: Living with Borderline Personality Disorder."
The very people that are out there to help us (doctors, psychiatrists,
psychologists, social workers, therapists, etc.) are the very people
that are extinguishing any hope for recovery. This is how I have lived
most of my life, feeling I am doomed to be sick and feel sick for the
remainder of my life. I have researched BPD for the last several years
and am beginning to recover myself and I am here to tell you there IS
hope. We CAN get better. In fact, I no longer meet the criteria for
BPD! Let me say that again, I no longer meet the criteria for BPD. If
that can happen to me, I KNOW it can happen to you.
For me, one obstacle I had to face after receiving my diagnosis was
the misinformation I had about BPD. I searched the Net thoroughly,
read the latest research information, spoke with other BPDs on the Net
and began reading NEW books about BPD. I became educated about BPD. I
discovered that BPD patients were actually GETTING BETTER. No longer
was my information only a theory.
O.K., so here is Patty with this enormous medical problem with
information on medication that can make me better. How do I get this
medication with most mental health professionals still buying into the
theory that BPD is not only untreatable but also that we are
"bad" and "hard to treat and be around?" There is
enormous stigma attached to having BPD in the mental health community.
I myself as a mental health professional remember my co-workers
laughing about how horrible BPDs are and God forbid you would have one
on your caseload.
The psychiatric nurse practitioner (NP) who was trying different
medications for me for many, many months without success, was the
first person I needed to approach about new treatment. Her reaction
was simply "There is no treatment for the BPD and if you are not
happy with my treatment, you can go and find someone else" and so
I did. Many health professionals have large egos that interfere in our
treatment as is so in this case. I could not penetrate her ego long
enough for me to even give her information.
The second NP also had a large ego so I approached her with the new
BPD information very subtly. She did listen a little but refused to
believe the information I had about BPD and firmly felt there was no
hope of actually recovering from BPD. I was able to start on one of my
medications but she refused to try Tegretol with me. So, there I was
sort of "half treated."
Many months later, I returned to a previous Dr. I had and before
switching my insurance, I asked him if he would try me on new
medications. He was open and willing, realizing that though he was a
good doctor, he was not up on the latest treatment for BPDs.
Thus began a new Patty who no longer rages, anxiety level and
depression way down, feeling much more together and stable. Not only
have I noticed a marked difference in myself, but all those around me
feel I am a different person. People are enjoying being around me. No
longer am I living a chaotic lifestyle, but a quiet, peaceful
I know this can happen to you if you are committed to receiving good
treatment and will no longer tolerate misinformation. It is up to us
to educate most mental health professionals and to leave professionals
who refuse to listen. This is the hardest obstacle we face in getting
better - getting the proper treatment from someone who is up to date
Remember, it is important also to realize that EACH diagnosis you have
needs to be treated. Not only did I have to medically treat my BPD,
but my generalized anxiety disorder, panic disorder and my bipolar
disorder needed to be treated as well.
Abandonment issues still plague me although I have improved greatly in
this area. If I don't hear from someone for awhile or they say
something that I could construe as abandonment, I feel abandoned all
over again. Ninety-five percent of the time I find that what I have
perceived as abandonment has really not been that at all. The person
got busy and hasn't had the time to call or they are having a bad day
and just got chewed out by their boss and I took on their attitude as
a disapproval of myself.
In the past, these abandonment issues were so strong that I knew
eventually at some point everyone would abandon me. The way I coped
was to abandon them before they did me. Or, I would pretend that their
relationship with me was not all that important. I have lost many good
friends through my own fears. As soon as I would abandon them and say
"goodbye," within about an hour my fear of being alone would
kick in and my anxiety level would climb. I would contact that person
and try to "get them back." As you can imagine, my
relationships were quite chaotic. I was a yo-yo. No one could ever
count on me to be the same person throughout the relationship.
Though I am living my life out of chaos and have stability and peace
in my life, I still notice that I cannot handle stress as well as
perhaps someone without this disorder. In the past many times when
experiencing a stressful episode, I would emotionally over-react and
thoughts of suicide would run through my mind. (On a scale between 1
and 10 - being the worst, I would immediately react in the range of 10
emotionally). There was no in between regarding how I reacted. Today,
thought I still over-react, my emotions do not race to a 10, but stay
somewhere in the middle.
Recovering from BPD is a process that takes time. As I said earlier,
work on getting on the right medications first. This is your start.
When your brain is "firing out of control" it's unreasonable
that your behavior, such as rages, will change until you can take the
medication to help control that.
Another addition to my life that has helped is adding exercise to my
life and eating better. I am amazed at how much better I feel now that
I exercise regularly. My entire body feels lighter and
"upbeat." Exercise decreases depression, anxiety, lowers
blood pressure, increases self esteem, increases overall health,
assists with sleep, increases brain function, etc.
Personally I have read statements like that so many times and it has
never motivated me to exercise. However I can personally guarantee
that you will feel better and on the very first day your self esteem
Other things I have noticed being medically treated (taking
medications) is that it seems my ability to love has improved
tremendously. I seem to be able to connect with my "higher
self" more than I was able to and even my faith in God has been
strengthened. I think being free of having so many distressing
symptoms has improved not only my relationship with others but with
myself. I notice I have more energy that is not being used up into
negative energy - feeling so much emotional pain. There are parts of
me now that I am able to share and express that are no longer covered
with my illnesses.
If you are like me and have other disorders along with your BPD, now
that the tremendous weight of the BPD is off of your shoulders, you
will begin to feel the symptoms of the other disorders.
In my case I was able to finally be diagnosed for the bipolar disorder
and the post traumatic stress disorder. I cannot remember Dr. Heller's
exact words but he said something to the extent of "If an
elephant is standing on one foot (the bpd) and the an anvil is on the
other, you won't notice the anvil until the elephant is off your
foot." The anvils for me was the other disorders I had.
Now you can begin to deal with those other disorders and your life can
begin to heal.
Hang in there. I'm rooting for you!
Other Today Websites
Mental Health Matters for information
and articles. Get
help to find
a therapist or list
your practice; and Psych
Forums for message boards on a variety of MH topics.
Copyright © Patty Fleener, M.S.W. All