Monthly Archives: February 2010

Borderline Personality

Ryder and Jolie in Girl Interrupted (1999)

Hollywood is rich in mainstream movies with characters with Borderline Personality Disorder (BPD)- Winona Ryder in Girl Interrupted, Penelope Cruz in Vicky Cristina Barcelona, and Uma Thurman in My Super Ex-Girlfriend to name a few.  Even celebrities themselves have been associated with the disorder- Angelina Jolie, Megan Fox, Lyndsey Lohan, Amy Winehouse, and Christina Ricci to name several. I wouldn’t be surprised if the list of celebrity borderlines ran longer than that of their fictional counterparts.

So what is Borderline Personality Disorder?

Borderline originally earned its name in psychiatry from being thought to be on the “border” between psychosis and neurosis. In lay terms- almost but not entirely crazy (now refer to the aforementioned celebs to see if you get an aha reaction). The disorder is characterized by pervasive instability in mood, self-image, behavior, and interpersonal relationships. This typically means people suffering from BPD have chronic feelings of emptiness and low self-esteem, suicidal thoughts and gestures (cutting), anger issues, and even bisexual tendencies. Marsha Linehan, an expert on BPD, describes borderlines as “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.”

Relationships tend to be very intense and unstable. I don’t watch much reality TV, but I’d bet network executives cast borderlines primarily to inject drama into their shows to boost ratings. Borderlines are capable of switching from deep affection and adoration to hostile rage and contempt quicker than you can say Britney Spears.  Breakups are especially difficult. Due to fear of abandonment, borderlines may threaten to hurt themselves if their partner wants to move on or date others.

The cause of BPD is unknown, but almost certainly there is a history of childhood trauma. This includes parental abandonment and neglect, poor communication and disruption in the family, and physical and sexual abuse. Clinically, BPD is often misdiagnosed as Bipolar Affective Disorder (BAD) because of the overlap in mood instability symptoms. The main difference is that borderline symptoms are triggered by interpersonal difficulties while bipolar symptoms are autonomous and independent of relationship stressors. Medications are far less effective for treatment of BPD than BAD.

The treatment of choice for BPD is Dialectical Behavioral Therapy (DBT). It’s a form of talk therapy that helps borderlines learn to manage intense emotions to minimize self-destructive, maladaptive behaviors and thus function better in relationships. The goal is to promote acceptance, yet encourage change, which is inherently contradictory and confusing.

For simplicity’s sake, let me use Bruce Banner and his emotional self-destructive alter ego, the Hulk, as a case in point to illustrate the theory behind DBT. In order for Bruce to have a functional relationship with any woman, he cannot transform into the Hulk. But the Hulk is an inseparable part of Bruce, which he can never truly get rid of.  Similarly, borderlines can never get rid of their childhood trauma. DBT will help Bruce learn to accept that he is the Hulk, while concurrently teaching him to harness his emotions so he will not become the Hulk.

BPD can be quite a severe and debilitating disorder. Relationships are particularly intense and unstable. In the entertainment world where steady relationships are already few and far between, an aging celebrity borderline probably stands a better chance of sustaining a career without needing cosmetic touch-up surgery than maintaining a lasting marriage.

Good luck Brangelina.

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Shocking!

One Flew Over The Cuckoo’s Nest (1975)

I recently watched One Flew Over The Cuckoo’s Nest, a classic drama film from the 70s starring Jack Nicholson who plays a patient hospitalized at a locked psychiatric facility. The film is an adaptation of the novel written by Ken Kesey. Interestingly, Kesey gained inspiration for the story from talking to psychiatric patients while high on LSD at the Menlo Park Veterans Hospital in the early 1960s. Coincidentally, I have also worked with patients at the MPVA, sans LSD however. He scored his LSD free of charge from the government, when he volunteered as a Stanford student to be a subject in the covert CIA-financed study of the effects of psychoactive drugs on human behavior.

I don’t usually rent old movies, but I wanted to watch this film because of the infamous “electroshock” therapy scene. Euphemistically referred to as electroconvulsive therapy (ECT) in the medical profession, most people seem to always react with horror and repulse whenever ECT is mentioned. The reason, not surprisingly, is the atrocious image instilled in people’s minds from the movie. After viewing the clip myself of Jack being forcefully “shocked”, I can definitely understand why people are so horrified of ECT  (Check it out for yourself).

I don’t know for sure if ECT was administered in that inhumane fashion back in the spooky days of the asylums, but Jack was definitely wronged¹. Contrary to Jack’s experience, modern day ECT requires informed consent and is done in a controlled environment under general anesthesia and with a muscle relaxant. He shouldn’t have been conscious, convulsing, and writhing in pain. There was no need for the forced insertion of the mouthpiece or the multiple guys pinning him down. More importantly, he shouldn’t have received ECT in the first place- he was not depressed, manic, or psychotic. It was solely given as a form of punishment for his unruly behavior.

ECT is a very effective treatment for severe depression, especially for patients who have not responded to multiple trials of antidepressant medications. It should be legitimately considered by patients for antidepressant treatment, and not reflexively rejected because of the unfavorable depiction from the film.

Hollywood definitely likes to portray ECT as something scary and disturbing, as also featured in Requiem for a Dream.  The entertainment industry will probably never show ECT in its true form, because that would be just too boring and not shocking enough.

Addendum

1. In response to questions about the history of ECT- The procedure was invented in the 1930s. Anesthesia, and later muscular blockade, was not introduced until the 1940s, and took more than a decade to gain widespread use. Thus, many patients suffered from broken bones and ruptured tendons.  Informed consent was also not strictly practiced, if at all, during those days. I guess Jack did receive the standard ECT of the early era.

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Filed under Film, History