I happened to catch a WNYC program this week (Leonard Lopate) on Borderline Personality Disorders (BPD) featuring two individuals affected by same who are lobbying for greater understanding of this condition, which affects perhaps 10 million Americans, and a Weill Cornell Medical Center psychiatrist commenting on same.
First off the title for this condition is apparently an historical accident. Personality Disorders are lesser forms of disruption of individuals only sometimes connected with the more recognizable categories of mood disorders, schizophrenia, etc. When first identified the “borderline” part of the label was intended to suggest that this disorder was on the borderline between neurotic and psychotic conditions:
Frankly the full picture of what is being characterized did not come through to my understanding as a philosopher wanting clear cut descriptions, but some odds and ends emerged. Women are vastly more likely to be diagnosed with BPD, but men may suffer from it as well — but being more outwardly aggressive when expressing what seems to be deep inner emotional anxiety and pain, may lash out rather than turn their aggression inwards as do women into conditions such as anorexia, bulimia, and self mutilation. There was, thus, a suggestion that a good number of our male prison inmates may actually be suffering from this mental disorder which is treatable, if not healable.
Apparently medications can assist with symptoms, but the discussants stressed that therapeutic counseling and group therapy (to deal with alcohol and drug abuse) are really necessary for effective treatment. Sadly our medical insurance moguls do not consider this a covered illness such as the standard labeled ones (bi-polar, schizophrenia, depression) so that most of the 10 million have no affordable access to treatment and tend to self-medicate with drugs and alcohol — and commit suicide in large numbers — about one in ten ends her (his) own life.
Another question mark is whether abuse of children is a causative factor with BPD? The discussants were not certain on this. Many abused children do achieve successful lives. However, one wonders whether we are not creating wounded persons with our abuses of children. I have been particularly horrified to learn that our institutions — state and private — devised to incarcerate children — as well as paid foster care — are likely to produce serious abuses of children. Such is publicized periodically. The juvenile detention system of a relatively progressive state, New Jersey, was condemned for such this a few years ago.
Kids with emotional problems are per this report dumped into inadequate and often destructive institutional settings. I will never forget myself delivering a young African American boy (13) with whom I had been working to the men’s violent ward of the Orangeburg State Mental Hospital (NY) following his mother’s near death through an attempt at self abortion prior to legalization. There was no other institutional provision for temporally orphaned African American kids. This experience marked him for life.
One would have hoped that we might have made more progress since the 1950s. However, apparently we have not. Kids are still being dumped wherever.
The following is a recent report from one of my students working directly in an institution funded in part with public monies where kids can also be dumped by paying parents who have had it with them. They may be terribly young and frail, ill with serious conditions that may have been caused by abuse by the very parents who have dumped them into this hell hole.
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“My complete ethical dilemma is that I feel very deeply that I cannot leave these kids here, it is my duty to help them; but in order to keep my job I’m expected to look the other way when staff use excessive force and otherwise create distrust rather than trust in the children whom they are entrusted to care for. Of course when I speak up within the school I get veiled threats in response. Just as an example, one child sustained a spiral fracture during a “therapeutic hold” and had to be hospitalized. Several other girls jumped out of the window of their dorm and ran to a pay phone a mile down the road to call the police. Upon xray fractures were found in these girls arms. Where is the state here? Where are the CPS agencies? Are the police a complicit participant, purposely turning the other way when these kids go AWOL and are picked up?
“Here is a typical example: an aide in the Health Center teases a boy who has severe rectal bleeding and rectal prolapse – now first of all what the heck caused that? I’m not even going to go there. In this case, after yelling at him all night, “you’re disgusting! Throw your garbage away! your hygiene is disgusting! you’re the reason for birth control!” – the aide in the Health Center takes his gameboy away and tells him she’s going to sell it on ebay. He cries out, “please don’t sell it! Please!” The aide snickers and calls the campus supervisor and says “____ is acting out – he needs to be restrained.” The supervisor arrives and they ask me to give this poor kid, who has simply been harassed into a state of outrage, a huge dose of Benadryl to knock him out. They tell him if he doesn’t take the medicine, they will be forced to give it with a needle or to restrain him (pin him to the ground and sit on him until he “gives in.”) (They call this a “therapeutic hold” – it looks more like domestic violence to me – is there any difference between a childcare staff person using force to force submission and an abusive boyfriend doing so??) I feel it’s traumatic and causes mental illness.”
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My former student is doing what she/he can to alleviate the conditions of the kids — many of them very young — who have been abandoned to this hell hole. Needless to say this is but one of a number of America’s abusive institutions where vulnerable people of all ages are consigned to living hells. One hears of them periodically. The drive to reduce costs by our pols, ranging from Bush to our newly elected NY governor, Spitzer, will presumably decrease even more the quality of care given to our vulnerable ones.
Beware that you yourself do not end up in a nursing home designed to speed your arrival in heaven/hell? Some of my other students working in such terminal institutions have had equally grim stories to tell . . .
“A war is just if there is no alternative, and the resort to arms is legitimate if they represent your last hope.” (Livy cited by Machiavelli)
Ed Kent 718-951-5324 (voice mail only) [blind copies]