Introduction (cont.)

Life at the Border

My explanation of borderline is:

	A) through a combination of medical/genetic predisposition and emotional trauma (most commonly adoption, incest, early parental loss and child abuse), the brain is damaged, and uncontrollable mood swings result.
	B) Dysphoria (a profoundly painful emotional state) is triggered by mood swings, stress, and emotional pain. The pain is so severe that borderlines will do almost anything to make the pain go away - the dominant cause of self-destructive behaviors, manipulation, drug and alcohol abuse, suicide and self-mutilation. The borderline is desperate for relief, and often finds it in drugs and endorphan releasing behaviors such as reckless driving, binge eating and binge spending.
	C) Psychosis develops from even mild stress, dysphoria, fear of abandonment, and emotional pain. It can be severe, and is frequently destructive. It is often associated with symptoms of temporal lobe epilepsy.

My treatment approach has 4 steps:

	1) Stop the mood swings. Prozac (fluoxetine) stops most mood swings, chronic anger, emptiness and boredom in 3 days, although it can take a month when severe depression is present.
	2) Stop the dysphoria and psychosis. Neuroleptics like Haldol (haloperidol) work well even in very low doses.
	3) Improve stress tolerance. This involves psychological counseling and other techniques to develop a healthy self-esteem and better psychological defense mechanisms.
	4) Retrain the brain. Borderlines think like borderlines - they've spent their entire live with instability and pain. Aggressively retraining with motivational books and tapes works - if the patient will do it. Borderlines live in the black and white. When they are in the "white," they can be charming, kind, and very loving. Unfortunately the "white" lasts only a short time, as they tend to feel vulnerable and become dysphoric relatively quickly. That "white" is who they really are, when all the symptoms of the illness are taken away.

I feel very strongly that this disorder can be beaten. Untreated, it has a dismal prognosis. It's important to acknowledge the diagnosis, and fight for a better future. Denial won't make it go away. I've seen miraculous improvement in many borderline patients. They deserve the opportunity to recover. We may not like the behavior and attitudes this illness can cause, but we must remember that borderlines are fellow human beings who have no choice in the matter.

This book is written for borderlines, their loved ones, those who are interested in mental health issues, and health care professionals who want to help. It is designed to give the borderline all the information needed to get help, to understand medical/psychiatric facts and concepts, and how to recover. I have tried to write in layman's language, and have included a glossary at the end.

This book explains what I do and why for my patients. It is. not my intent to be the reader's physician. Do not take any medications based just on this book - you must have your own physician evaluate you, prescribe appropriate medications, and do the proper follow-up.

I say to to my borderline patients "you've been stuck in a pit all your life with no way out. I've given you a ladder, but only you can climb the ladder." It is my hope that borderlines who read this book will overcome whatever needs to be overcome and climb the ladder to a life of love, happiness and mental health.

Leland M. Heller, M.D. 9/13/91

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