Personality Disorders Community

Life at the Border - Foreword

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Dr. Leland Heller's comprehensive new perspective on understanding and treating the Borderline Personality Disorder (BPD) presented in 'Life at the Border' offers victims and their families an opportunity for improvement and possible recovery from this serious, destructive illness.

Dr. Heller classifies BPD as primarily a medical (i.e., physical) illness with inherited and early developmental origins which have caused a malfunction in the brain's biochemistry. The major symptoms - depression, negative thinking, chronic excessive anger, identity instability, excesses in behavior, impulsiveness, boredom, maladaptive defenses, and a variety of relationship problems - result in the severe and persistent emotional, marital, family, job, and other social problems. Thus the core of his analysis is the conclusion that physical problems cause most of the emotional and social problems rather than the reverse.

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Looking at the illness from this viewpoint and with his background in the Family Medicine, Dr. Heller originated a multidisciplinary approach designed to address the diverse symptoms simultaneously by integrating successful treatment methods from medicine, pharmacology, psychiatry, psychology, (especially behavioral and cognitive), social work, group therapy, marriage and family therapy, individual psychotherapy, motivational theory, and even success and organizational strategies used in business and personal growth programs.

I was quite skeptical of Dr. Heller's optimistic reports when I first began observing his BPD support groups. The mental health community has found this illness to be a chronic, difficult, life long problem with poor chances for major improvement, even with enormous effort. Dedicated therapists have worked intensely with motivated patients to help them improve - yet their progress has been limited. Attending many sessions of both the BPD and family support groups convinced me that Dr. Heller's approach, combining medication with other therapies, was indeed having a significant impact.

Dr. Heller's comprehensive approach appealed to me because of my interest in Systems Theory, which was emphasized in my graduate training at St. Louis University School of Social Service. Systems Theory says that changes effect everyone involved: the patient, friends, relatives, etc. Family therapy grew out of systems theory and with group therapy, has grown rapidly in the past three decades.

I have observed the success of combining appropriate medication with individual and group counseling in treating depressed patients. Medication helps control depression's physical part, enabling psychotherapy to help patients resolve emotional, family, and social problems. Unfortunately, many patients, physicians, families and therapists cling to the false belief that the patient should not depend on the "crutch" of medication; that somehow this dependence makes them "weak."

Many educated people still believe a depressed person is "lazy" and can feel better if only he or she "wants" to feel better or tries harder. There is evidence that the underlying causes of many depressions are physical as well as psychosocial. How sad it is to see a person painfully depressed for months or years who also feels guilty, believing he or she is causing it! Would anyone condemn a diabetic for depending on insulin, a cardiac patient for depending on nitroglycerin, an arthritis victim for depending on aspirin, or an epileptic for depending on anti-seizure drugs?

Combining medications with other therapeutic strategies makes good sense for the treatment of depression and for the more complex illness, Borderline Personality Disorder.

Currently, Dr. Heller and I have developed and are implementing an intensive, highly structured BPD outpatient group treatment program. It is based on the investigation, recommendations, and finding reported in Life at the Border. In the program, the term Borderline Personality disorder is replaced with 'dyslimbia' meaning a malfunction in the brain's limbic lobes. This is Dr. Heller's term which emphasizes the physical origins of the illness. The patients and their families find the term 'dyslimbia' acceptable and descriptive of the underlying medical problems, whereas the name Borderline Personality Disorder is offensive and insulting.

The therapy groups are unique. They are highly structured and include components of formal education (lectures and reading assignments), skill development in daily organization and planning, positive thinking and speaking, and behavioral activities. The closed group setting offers a safe place to share concerns, are strongly encouraged to select a family member (or other important person in their life) to participate with them in treatment.

Initial indications are very encouraging. Patients express enormous relief at having a diagnosis and symptoms understood by others with the same problem. Patients and families say they feel hopeful for the first time. Medication controls the majority of severe mood problems, anger and psychosis, enabling patients and families to begin the hard work of rebuilding identities, relationships, and lives.

Dr. Heller's analysis effectively combines and acknowledges the valuable previous work and research of dedicated colleagues in pharmacology, medicine, psychology, and related mental health fields. While current studies and ideas are allowing progress, more investigation and long term research are needed in all areas of BPD and it's treatment.

Dr. Heller's energetic and optimistic message in Life at the Border is an important beginning.

Mary Elizabeth Hausman Sales, MSW, ACSW, LCSW
Therapist Director
Outpatient Borderline Personality Disorder Program at Glenbeigh Hospital of the Palm Beaches

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