Transcription
Myths, obstacles, and roadblocks that patients might have approaching treatment. There's one in particular that I want to try to dispel. I hope I can. I mean, I don't know. I don't know if people will go along with it, but I want to say it with a lot of conviction.
I think the biggest myth and roadblock is the idea that someone suffering from BPD has zero self-control. I've had so many patients come into treatment and when I discuss how we would work together, it always includes the idea that if you, for example, whoever the person is, you feel that urge to cut yourself, do everything you can in the moment to resist the urge. That there is not a necessity or an inevitability to doing so. And often people say, "I thought you knew something about this disorder. I thought you were an expert. The first thing about this disorder is I have no control." Now, that's the myth I'd like to dispel.
I think it's a gradient. It's like a spectrum. People with BPD clearly have difficulty mustering up as much self-control as somebody without the condition, but I think it was totally inaccurate to say they have zero self-control. But if a person believes they have zero self-control, they don't try to call up what measure of it they have. They just give in to whatever the urge or the impulse is. So, I think that's the worst misunderstanding that there's zero self-control.
I understand it might be just a tiny little fraction of the patient's mind and you know, their psychological apparatus. But if you don't think it's there, you don't begin to exercise it. And to use perhaps a bad analogy, it's like a muscle. If you never exercise it, it just atrophies. So, I think it's important for the treatment and it's respectful for the patient to see that they have some abilities that maybe nobody expected of them. Nobody. Often clinicians fall into that erroneous thinking that you can't expect the person to have any measure of self-control. And I don't. I I think that's looking down on the patient in a way that that isn't fair.
A related misconception is that people with this disorder can't improve a lot. In a way that's beyond my understanding and I don't think we've studied enough. There's a variability in the degree to which people improve. As we know, some people have a hard time making improvement and some people make a lot of improvement. But from our point of view, it helps when you have the initial encounter with the patient, those first evaluation sessions, and you get to know them and you internalize an image in yourself of them to be very sensitive to the positive qualities they have and to imagine them the best you think they could be. To imagine them in their potential and to sort of keep that in mind. Otherwise, you give in to a negative image that's all about problems and I find that it's too. Many clinicians are too quick to just say, "Oh, this is a disabled person and always will be." I don't think that's fair.