Borderline burnout | Ad Libitum
Dealing with assholes in your life is probably one of your biggest problems, it’s just that you probably don’t know the technical term for their assholery: cluster B personality disorders. You may even be one of them, causing even more problems for you.Here’s a modest serving of truth you should care about if you think someone you know “needs help” or even if you’re just a concerned taxpayer wondering where all the money is going. Axis II and its related problems like substance abuse, criminality, domestic abuse, fecklessness, giving birth to multiple children other people have to pay for etc. etc. account for the majority of problems encountered by the mental health services. Most of the problems psychiatry deals with nowadays are social not psychiatric problems, it’s just that these problems have been medicalised so that psychiatrists are now entrusted with them instead of sadistic clergy or correctional facilities. The bad news is that the pills do nothing for these problems so you have a whole lotta shit for which you have jack shit in the way of treatment.
What is borderline personality disorder? Academic description here. Real-world illustration of the borderline patient and her invariably violent POS boyfriend below:
Even if you don’t give a shit about dregs of society like them, this sort of thing is very prevalent. Who do you think lives in council estates for the most part?
It’s not a class problem. Little Miss straight A student cutter bulimic suicide attempter from the middle/upper classes goes on to marry the POS narcissistic abusive politician or doctor or dentist and retains her class status but she still needs a benzo just to get out of bed. I’m looking at you, Iris Robinson, although I don’t expect anyone reading this blog to understand the reference to your obscure ass unless they happen to follow Northern Irish politics closely.
When they’re in their teens, 20s, 30s even, you get the glamorous portrayals like Girl, Interrupted or Fatal Attraction. The media love covering this type of thing because there is nothing sexier than a crazy hot chick. Right? The tabloids were for example wetting themselves in a heightened state of arousal when Fist Brown kicked Rihanna’s ass and there was uncertainty about what she’d do. Will she stay, be a doormat, go back for more? Now of course the vampiric obsessive public interest is back because they’re probably back together. OMG.
But it won’t last forever. When Rihanna hits the wall at 30 or 35 (sooner in her case due to her substance abuse problems), when her skin starts to look like leather and the metabolic syndrome sets in (cf. Britney Spears, Christina Aguilera, Jessica Simpson and all the other dilapidated fat ageing ex-hotties engaging in desperate behaviour to get a moment’s attention), nobody will care about her problems anymore. Nobody.
So where do all the borderlines go when they grow up??? I can’t help but notice that all these young bitches in their prime kind of fizzle out and you don’t hear about their problems as much. Do they stop having these problems? Do they still have them just no one’s around any more to notice them because everyone’s abandoned them and it’s a sort of a tree falling in the woods situation? This is what I wanna know. Where are all the older borderlines? For that matter, where are all the ugly young borderlines?
The answer is that NO ONE CARES. Not just borderlines but women in general if they are unattractive to begin with or after they have hit the wall, so to speak. Sorry, I’m only describing reality as I see it, not as I wish it to be.
I have known many young borderlines, not just professionally but also in private life, who are fat/ugly/unattractive. It’s not all sex, drugs and trash music like for the Rihannas of this world, ok? This is how the other side lives: Many of these women end up celibate in their 30s, 40s, some have never been in a relationship at all. This is fine for people who don’t desire a relationship but for them it’s horrible because it’s what they live for. It’s a sad life because they never got the attention in the first place and the attention/emotional intensity is something they desperately seek. Families hate them and abandon them at the first opportunity because they turned out defective, not just mentally but also in reproductive terms. Friends eventually abandon them one by one because they can’t handle the drama and the abuse anymore. They end up engaging with da services and torturing their shrinks instead. Because they don’t have any turbulent emotional relationships IRL they will create a lot of fake drama/hysterics with their doctors to get the hit. Usually the GP also gets more than he bargained for due to the usual plethora of concomitant somatic complaints.
The story of ugly girls is a sad, awful story and I don’t have it in me to delve into this in any more detail.
What about the former hotties, now fat and/or aged? Well, there is stuff like this:
Did you even make it past the first few seconds? Revolting, isn’t it? Do you think this is flopping because it’s a bad song? Newp, it’s one of the best songs she’s put out but no one cares about a fat chick with an alcohol problem prancing around and singing about wanting to fuck your body. Who wants to fuck her body except a niche audience? If she had her Dirrty era body this would be smashing on the charts/radio.
Apologies again for my insensitivity. Just sayin’.
I had a borderline patient recently who exemplifies this problem. She’s had teh sexy once but now it is no more. Well, maybe not so recently, but the encounter is still vividly emblazoned in my mind several months later because her life was just so fucked up and sad. This woman showed up one day for assessment. Not therapy. Slim, extremely well put together. Skinny jeans, a top that, erm, accentuated her shape, full make-up, flamboyantly-styled red hair. You’d swear she was in her 40s but nope, look at her chart, 59 years old. I balk. I’ll fess up straight away to my immediate strong countertransference reaction: I’m knocked over by her appearance. I want to look like that when I’m 59. But the red flags are everywhere. I instinctively know what kind of patient I’m dealing with.
Anyway, off we go and literally, her second sentence was, “I have been sexually abused as a child, you know.” So off she goes telling me her life story in that deliciously impressionistic / histrionic way. I learn all about her bulimia, cutting, multiple relationships, her sense of always being alone in the world. I am unable to pinpoint an episode of major depression or indeed anything else belonging on the Axis I anywhere in this extensive history. As the hour draws to an end, an utterly unproductive hour might I add, she grows impatient with my lack of emotional reaction so she goes for the heavier weaponry. Her gynecologist says she should use a vibrator to prevent herself from wilting down there. She provides additional gory detail. I nod noncommittally. She gets upset.
And then it comes, the classic shit-test: “Oh, I’m sorry to be telling you all this. You must think I’m crazy.” {laugh}
This poses a difficult situation for me (and her) because yeah of course she is crazy but of course I can’t say either yes or no because saying yes is unacceptable and saying no is a lie which she can see right through so I lose all trust/respect I may have built up because now she knows I’m a liar. This is the story of her life. Every relationship she attempts to form goes like this. She lets the crazy hang out within five seconds of meeting people. Accept me as I am, warts and all!
An aside: patients/laypeople always complain that doctors only spoke to them for two minutes – or two seconds – before making up their mind, sometimes before they were barely allowed to open their mouth. This is very frustrating. I’ve been on the receiving end of this as a medical patient many times and there is nothing more off-pissing and demeaning than that when it happens.
But – again, I’m sorry but I’m just saying it like it is – when a patient walks in, if you have training/knowledge/experience/talent you sort of know what’s going on straight away. When she came in I knew right off the bat what was up with her. How did an hour of my time spent listening to her further my understanding of her diagnosis? It didn’t in the slightest.
This is just one of those un-PC intangibles but of course I must be lying, psychiatry is a science, SCIENCE I TELLZ YOU, and you need 10+ years of training to become a psychiatrist. Whatever, keep telling yourself stupid shit. I remember speaking to a professor of psychiatry once about this absurd charade of having shrinks going through much the same length, though not rigor, of specialty training as actual doctors like surgeons or something. Five or six years of medical school + seven years of postgraduate training MINIMUM to become a consultant (over here anyway). Fucking ridiculous, right? And he was like, “YEAH BULLSHIT!!! We could be churning out these guys after two years because there are all of like three things that can be wrong with the patient in psychiatry – schizophrenia, bipolar, depression. Doesn’t take long to learn how to spot these! Oh, ok, there is the fourth thing: all that other crap.”
So when an actual Axis I problem comes through the door, you know. A medical student should be able to spot it. Schizophrenia is kinda hard to miss, as is actual mania or depression. When the other stuff comes in, they talk a lot and think they are saying some deep shit because they think they are special unique flowers and no one else has ever faced these problems in this constellation before. Pfft. Yes, doctors are shits, bigger shits than the patients, they take on too many patients due to greed and have no time to even pretend to listen to them, but unfortunately I must say that a lot of the time it doesn’t backfire on them to do it because the chances of your first impression being wrong is low.
Back to my borderline. Life was different for her when she was 16 or even 26. This anecdote would have WORKED on a male mental health professional when she was at those ages. Her family, friends, boyfriends tolerated the dramatics. She had a lot of male attention back then but never of course formed any lasting relationships that would carry into the old age. Now she’s a hairdresser in some horrible place where all the young women shit all over her and her heightened sense of interpersonal dynamics makes her even more attuned to the problems so she feels even more rejected. Her most recent husband died. She has no one, literally no one. She is fucking some old guy she doesn’t even like and knows she’s only doing it to satisfy her relationship fix. And she’s telling all this to me, a female stranger without any emotional investment in her. SAD.
This is borderline personality disorder, 40 years later. If we’re being technical about it, she no longer meets criteria for it. It’s kind of fizzled out. No drama, no cutting, no puking, no suicide attempts, just a weird old bat who tells strangers about using vibrators. Not a crime! But can we really say it’s gone? This isn’t to say ALL old women stop taking overdoses or engaging in dramatics/emotional blackmail. I know plenty of patients older than her who still do this and end up in the emergency rooms quite regularly still. But it is also true to say that many of these women sort of normalise as they age which is curious. No doubt there is hormonal/neurotransmitter involvement, but I think a big part of it is social/sexual dynamics and how femaleness and female acceptable behaviour is perceived.
What’s really sad is that even the shrinks abandon them when they are over the hill. Shrinks are no better than other human beings; on average, they are probably somewhat worse. Her male mental health professionals (some, ok, not all, I always have to put in these disclaimers for stupid idiots who can’t read and/or jump at the opportunity to take everything personally) would have been practically salivating at the prospect of having her in long-term “therapy” 40 years ago, allegedly for her own good but actually for their own narcissistic perverse sexual titillation and power trip. I can see it, an old man, perhaps smoking, in the 1970s sitting there in a dimly-lit room with an erection while the hot young chick describes the stuff she does for her violent abusive boyfriend while looking at her shrink for approval and signs of reciprocation with big teary eyes. Thing is, the situation is difficult for the shrink too and we shouldn’t be unsympathetic toward him and his attempts to cope with his countertransference reaction. Even leaving aside ethics and all that stuff, if he fucks her, he will reinforce her self-destructive attention-seeking behaviour. If he doesn’t fuck her, she will experience abandonment / rejection all over again.
I haven’t really paid much attention to this problem until recently but truth is, psych wards are full of old women, ex-borderlines, who were up to all sorts of dramatics in their youth. Now that I’m paying attention I see them everywhere. You only see a cross-section of their life, they’re there now frail, dilapidated, the fiery personality disorder long fizzled out, only remnants of it remaining. Husband is usually dead or long divorced. No friends or family left to manipulate/abuse anymore. Everyone’s had their fill and now you’re 70 all alone and no one cares or visits and you’re rotting in a psych ward. They kinda linger in this weird subspace with a different diagnosis, almost always bipolar II or recurrent major depression, anxiety, stuff like that. They come in on their 17th admission and are always discharged in the same condition they came in. The discharge letter usually fraudulently lists a long list of meds that allegedly brought on a remission of symptoms and other biobabble to satisfy the insurance companies, but none of this is informative or true in any way. Axis II diagnosis is almost NEVER given to the patient, officially or otherwise, young or old. What should have been explained to them when they were 20 was never explained so their life is conceptualised as someone who suffers with depression or bipolar or whatever.
The system and the doctors are GUILTY. These patients need to be told the truth. I’m not saying that the truth will cure them or set them free but they do need to fucking know what’s wrong with them so they can cope in whatever way they can instead of waiting for the next pill to work and blaming us/being angry at us when it doesn’t. Many people develop a deep resentment of psychiatry because they never respond to any medication. Sometimes this reinforces a feeling of worthlessness/defectiveness, “Look at those other people on the ward getting better!”. Yeah it’s horrible watching others come in with the same official diagnosis as you, recurrent major depression, getting better because they have an actual depressive disorder which can respond to antidepressants whereas you, well, you’re doomed to your dysphoria forever. Psychiatry should tell people the truth, IMO. This is as bad as the elderly patronising sexist male doctor deciding not to tell a woman patient she is dying of cancer because she’s better off not knowing. It’s better if the whole family knows but not her, totally, I can totally see how that makes total sense.
Who are you anyway to make that decision for another human being, you stupid narcissistic fuck?
The bottom line of this post is that women have it hard, older women especially so. Everyone has it hard, for sure, men in the coalmines and all, but women have it that bit extra harder because evolution dictates that their perceived worth expires very early on in life so unless they maniacally searched and found themselves a man and kids or some other purpose in life early on, there’s trouble in the form of SSRIs and benzodiazepines and psych admissions on the horizon.
