QUESTION:

My current psychiatrist has me on Paxil and Klonopin. I am taking Atenolol 100 mg. which was started by a Cardiologist three years after going to his office for what I though was heart problems and turned out to be anxiety. I am not better. I am frequently out of control and spending much time doing damage control. My psychiatrist does not really listen to me. Just writes the same old prescriptions and says see you in a month. He also has made two dosage mistakes on my prescriptions in as many months. I don't like him, but my psychologist wants me to continue to see him.

I tried to find a new psychiatrist but one said I'm not taking on new patients and hung up on me. The second was very nice but insists on doing both med. mgt. and therapy, which I think is great, but his schedule is too full to see me. He did have a consultation with my psychologist and said I was the most severe BPD he has seen. He spoke to my psychologist regarding suggestions on how to treat me. This psychiatrist also said I would be hard pressed to find another psychologist who could see me twice a week like mine does currently and suggested I stay with him.

My psychologist, after I freaked out at a Carpal Tunnel Surgery two weeks ago, told the surgeon that I was a manipulator. I honest to God have no recollection of what was said or what I did. But I apparently asked for them to give me enough drugs to kill me. My psychologist wanted me in a long-term facility. Mentioned that I should probably go off my meds because they're not working. I immediately sent him your articles about the counter-productive affect long-term hospitalization would would have on BPD pt. I also sent him your articles about Prozac. I also sent him an article about mental health care providers calling BPD's manipulative.

My psychologist saw me three times a week in the beginning, made phone sessions on the weekend and called me when he was on vacation. As time went on, he began to realize my dependence on him and cut out vacation calls, then cut out phone sessions, then said I could not call his office at all unless it was to cancel or reschedule an appointment and he would not speak to me except in his office. I wonder why he thinks I'm (a BPD suffer) is feeling abandoned. I do have to say he has put up with a lot of junk from me over the years. But after this last out of control spell he is making a contract that I will have to sign with all kinds of strict guidelines and necessary structure. If I commit a sin against one of those commandments, I'm out.

I now feel as though I can't say what I feel, I'll do the wrong thing, make an unnecessary phone call unknowingly (severe dissociation). I feel as though his office is not a safe haven anymore. I feel like I'm being asked to walk a tight rope while blind folded. I feel like a toddler who is being potty-trained and has his first pair of underwear on and was told that one accident and I'll be given away. I've written these feelings to him. I'm waiting for the "stop writing me clause".

I cry all the time, I think about suicide all the time, I feel cornered, abandoned by the one person who gave me unlimited support for three years. He now treats me, I feel harsh. He said it's providing structure. It hurts my feelings. When I called and insisted on talking to him, he got on the phone and said I was harassing his staff and he had nothing to say to me and he'd see me at the next appointment and hung up on me. I didn't say one word. He didn't even know why I called. I feel like I don't have his support anymore. I don't have family support, I'm just lazy, like to sleep, make my life what it is all by myself, made my bed now lie in it, etc., etc., etc.

The only thing that has kept me alive this week was finding your articles on the Internet this week. I'm sending them to my doctors hoping they'll begin to treat my disorder correctly, both with medicine and therapy. But what do I know, I'm just a half wit with a mental illness who can't make decisions for myself, let alone for them. I'm scared to death to see this contract.

I cry as I write this to you, I'm suicidal as I write this to you and I have no hope as I write this to you. I just printed the page that has your tape available for sale on BPD. I'm going to send away for it ASAP. I have all the BPD disorders, OCD, Self-Injury, addiction to pain killers (which started after given them after my last surgery). I'm a 42 year old mess who fears my tomb stone will read Born 1961 - Departed 2003.

PLEASE HELP ME! WHAT SHOULD I DO? I NEED YOUR OPINION! THE SECOND OPINION I LOOK FOR WILL BE FROM DR. KAVORKIAN!

DR. HELLER'S ANSWER:

In my opinion, the BPD is a medical disorder of the "trapped, cornered, wounded animal" part of the brain's limbic system. The right medications will have an enormous impact on you. The combination of Prozac (fluoxetine) followed a week later by Tegretol (carbamazepine) should make a huge difference, especially since you were described as "severe."

Treating spells of dysphoria (anxiety, rage, depression and despair) with as needed medication instead self-destructive behaviors will make a huge difference in your life.

It's likely the Klonopin is worsening the severity of your episodes of losing control of your behavior. You need to find out if you have the cognitive generalized anxiety disorder that will also need treatment with BuSpar (buspirone).

There are medical literature articles backing up this medication approach.

It appears you have been through a great deal of misery and it's immensely important that you realize it's not your fault and you do have a chance at a good life once the medications are right.

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