Health of the non-physical but still very real kind

According to the collective wisdom of the internet and people with little, if any, medical training, I am Evil.

I have Borderline Personality Disorder, one of the dreaded Cluster B personality disorders. People with BPD are stereotyped as manipulative liars, unstable emotional vampires, resistant to treatment, unwilling to change, and all-around nightmare people who should be avoided at all costs. The majority of online spaces focused on BPD are focused on “what to do if you find out a friend or family has it”, and while those sort of spaces are definitely needed, the advice tends to be “get as far away as you can because they are a nightmare person” and there’s very little out there for people with the disorder themselves. What is out there that focuses on people with BPD is… let’s just say it’s not good, for now. More on that later.

I’ve had my diagnosis for nearly 15 years now. I’ve been working to manage it for nearly 15 years. I’ve stopped trying to find support or vent places online, because in those 15 years, I’ve learned the following: even the majority of mental health professionals think BPD makes you a nightmare person who can’t be treated, so of course lay people aren’t going to try to understand the condition either.

Don’t get me wrong; like most other mental illnesses, unmanaged BPD is extremely difficult to deal with, both for the sufferer and the people around them. I was pretty unbearable in my early adulthood, before I learned the tools to properly manage my symptoms. But there are few other mental conditions where the prevailing opinion from doctors is “they aren’t worth trying to treat” and from non-doctors is “if you find out someone has BPD, even if it’s your wife or kid, go scorched earth”.

A part of this is that there’s no pharmaceutical treatment for BPD. The thing that works best is dialectical behavioural therapy, and that’s hard. A lot of the “It’s not worth trying to treat them because they don’t want to get better” mentality stems from before DBT became recognised as the best way to treat it; of course it would look like people didn’t want to “get better”. They’d be given psychiatric drugs that didn’t work and often had bad side effects, so compliance would suffer. It took a psychiatrist who actually had BPD and developed a DBT-based treatment method for standards of treatment to change, and by then, the damage was done. New psychs, being mentored by established psychs, were still being told that BPD was untreatable.

And then – and this can be contentious – you run up against the “people must accommodate me” side of social justice that is bad at nuance.

Accommodations are great. Social justice is great. But when you put a bunch of people whose personality disorder requires a lot of self-management in a mixing bowl with inadequate support from professionals and the mentality of “I shouldn’t have to change; society should accommodate me”, you get a very messy, bad-tasting cake that makes BPD look even worse. To use another Cluster B disorder as an example, I have seen people in these spaces say, with all sincerity, that it’s ableist to deny someone with Narcissistic Personality Disorder their “narc supply”.

This is an extremely unhealthy mindset. It’s anti-recovery, anti-healing. It’s like saying it’s ableist to decline to provide alcohol to an alcoholic. Sure, it’s easier for me to not try to manage myself, but it’s not easier for anyone around me, andnobody is obliged to put up with bad behaviour just because the person doing it is mentally ill. You can be understanding of why they’re doing something while still drawing the reasonable boundary of “you are not allowed to hurt me”.

I’m not going to get into depth about what BPD entails – the wikipedia page is pretty good if you’re interested. I’m also not going to say that we’re all innocent angels who have done nothing to deserve being abandoned, because there are plenty of people out there who won’t or can’t manage their BPD even as it drives people away, just like there are plenty of people out there who won’t or can’t manage their diabetes even when they’re having to get their foot amputated. It’s a lot more complicated than that. BPD doesn’t make you a bad person. Refusing to do any of the yes, very hard, work required to keep your PD from negatively impacting the people around you – that’s what’s bad. That’s unfortunately what a lot of the “support” spaces encourage, and support outside of the internet is still very lacking. It’s like the dichotomy is Evil or Completely Blameless.

Very few people are actually evil. Very few people are completely blameless. I don’t know what the fix is here except for more and better education, and I guess that was part of the point of this blog in the first place.