Transcription
I personally think DBT has been helpful, but it hasn't for me been the, you know, I I felt like it was a very outside fix to a deeply internal problem and began to give me structure, but it wasn't sort of like the lightning bolt that hit my soul or my core.
I think that the problem of a severe personality disorder which BPD is thought to be a marker of the severity of personality dysfunctioning. So I've recently really thought of it as an outcome rather than a starting point. It's the outcome of a lot of processes of psychological development that have not worked for the person. Wow. And instead of the person growing up to gain mastery, they grow up to gain more stress, more dysregulation, more crisis, more futility. They get stuck and it's almost like they become like fossilized and that process disrupts what we call socialization.
So, kids who start out with some early features of borderline personality disorder like emotional dysregulation or neuroticism, which is really a lot of negative emotionality plus impulsivity, they're just at risk to interact with people at school or people at home in a way that creates a lot of stress. And when people are under stress, it's harder to grow. Mhm. So people who have these vulnerabilities then start to kind of interrupt their process of development either because they can't handle the demands that other kids can handle or because they're in and out of treatment and they miss out on a whole set of experiences that socialize them. And that's what helps people get past these normal fears and self-doubts that I think people with BPD just accumulate because they have the absence of other things to counteract that like self-confidence or pride or um belief that they can transform their lives into something they want.
And I think something like DBT, the reason it works is because it's like a giant encyclopedia of learning how to manage yourself and socialize yourself that a therapist or a therapeutic team helps you master over a very long period of time. I think that DBT has a certain um place in the universe of therapeutics and it has a really vital place which is that it's really helped us all to be more practical about helping people instead of really searching their minds which the patient is having trouble doing under that level of stress. It's really about organizing their behavior so that they don't generate more stress which actually counteracts their ability to think about themselves. So it's kind of like a damage control that allows people to stop doing things that keep generating all these problems in order to then start more productive behaviors. And that is really hard work. It's hard work for all of us. We all have bad habits or self-defeating ways of doing things, but people with BPD have them in many areas. So, it's like they may take one step forward, but then two steps back because the concert or the coordination of all the other things they need to do doesn't come together.
That's why I think people with BPD need special specific treatments to help them decrease their BPD symptoms first. and then engage in life in a way so that life helps them develop their personalities in a way that's optimal for their situation. We all have variations in personalities. Some people are more sensitive. Some people are more callous. Some people are more grandiose. Some people are more conservative and riskaverse. And all these things come together for us in very unique individualized ways and then fits with our environment. So if you are a callous, grandiose, non-impulsive person, you can do a lot of jobs really well. So say you're a surgeon or you're an airline pilot. not being affected by people and what they're doing, saying, or feeling, and being able to be focused and systematic and think you can fly an airplane full of 400 people safely across the globe, that takes a lot of grandiosity, that works. But if you're someone who can't get out of bed and doesn't have an opportunity to do something really grand like that, it looks really different to be callous, superfocused on what you want and uh grandiose meaning like having big ideas about what you're going to do. So personality is not in a vacuum. Your personality features have to fit together in a way that works and then it has to fit with what you're doing in a way that works. And that is hard for everyone.
I wish everyone would be more knowledgeable about how to develop their personalities. I think we need to teach kids more about this so that they're less at risk not only for personality disorders but a lot of social problems and also problems of their own kind of self- advancement in life. You know, in the business world, they call them tips about how being highly effective people. In our field, that has to do with managing your personality.