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Doctor is not helping or he is being realistic


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Quick history for those who don't know me. I am diagnosed with Severe Major Depressive Disorder, Borderline Personality Disorder "textbook level", Chronic Post Traumatic Stress Disorder, Generalized Anxiety Disorder, suicidal ideation, 20 yr self harm history and it goes on and on

I had an appointment last week and the doctor said what I am feeling and experiencing now is going to be typical for the rest of my life. He said I am going to go through good periods and then I am going to crash which will require another hospital stay then the cycle is going to repeat over and over again. The problem he says is that my "false" self image has so much control it is almost impossible to treat as the therapist will never know which version is going to show up, if it is the positive self image therapy will appear to go very well but chances are will accomplish nothing as in this state I just ignore or brush off the negative. When I am in a negative self image state I only hear what I want to hear and I am waiting for the person to say or even hint at the wrong thing so I have an excuse to verbally attack the person to prove that I am better. The goal he said is to treat the real me but the other two versions are so strong that my true self image is buried and this is the image where therapy would be effective but it is almost impossible to bring out at this stage of the game so I am doomed to repeat the same cycle for the rest of my life.

For the last few months since getting out of the hospital I have been working on the Borderline aspect of my diagnosis and my personality and I believe I have made a lot of progress. I have made great strides in some area and have managed to introduce a buffer between someone else's words or action and my response to make sure I see the picture as a whole and not the scope that comes with BPD which has been unbelievably difficult. My education is in mental health so I understand all of the concepts and I have made sure to apply it to my own life. DBT is not available where I live or even near by for that matter so I have had to use various websites and I have a support group on another forum site that is full of people who have known me for a long time and get where I am coming from so they are able to pick out certain moods or ideas that may indicate that I am falling into a BPD pattern. Now according to my doctor this means nothing that all of the work I have done was for no reason and the only reason I think I am making progress is because it serves my self image in a positive way but like my two "false" self images (positive - negative) it is not real but just a perception.

It seems no matter what I do there is a doctor waiting to shoot it down. The hospital I was in was not prepared to treat someone like me so I was labeled very difficult and almost ignored, I signed myself out thinking that I could receive better help in the community but no therapist in my city is willing to treat me and my own doctor on more then one occasion has deemed me untreatable. I keep thinking my disorders are the main obstacles in front of me but they are not it is the therapeutic and medical community that keep pulling me back down every time I think i have gained ground. Just because I am BPD does that mean they are allowed to strip me of all hope and basically refuse to help?

take care

trg247

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One response to your doc would be to question why he believes the negative will remain the stronger aspect of your fronts. Could the positive person not eventually tug the self-in-the-middle toward the light? Sometimes all we have to hope for is a broadening of the periods of brightness; work in this direction is not wasted. As someone who has studied the matter, you recognize that separating personality and mood is not an easy task and one often must retreat to analogy to do so. I believe this is what your doc seeks to do, but perhaps his way of putting it has been tinged with frustration. I am sorry your care hasn't encouraged you. It sucks to be told that your earnest attempts are phony. That seems mistaken. But turnabout is fair play. I hope you can turn the tables and do what many of us should try: see the "real doctor" behind the extremes of his own encouragement and discouragement, where resides the care he intends to give.

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'The problem he says is that my "false" self image has so much control it is almost impossible to treat as the therapist will never know which version is going to show up, if it is the positive self image therapy will appear to go very well but chances are will accomplish nothing as in this state I just ignore or brush off the negative. When I am in a negative self image state I only hear what I want to hear and I am waiting for the person to say or even hint at the wrong thing so I have an excuse to verbally attack the person to prove that I am better.'

Do you recognize this in yourself at all?

Because I recognize myself in that. I see happy coping me, who never addresses the pain, and then bitter raging me, who won't be vulnerable in therapy. There is the real me, who like you, is doing work. But she gets obscured in the other two at times. I am not sure that the doctor was criticizing the work that you have done, or dooming you forever. I do know how frustrating it is to think you know the cure and not to have access to it.

My questions to my pdoc, and to yours is; what does he suggest you do? Imagine for a moment that this pdoc has a point (suspend the sneaking suspicion he needs more help than you) and try to imagine what you might need to do in this case. Is it at all possible to spend some time mindfully observing yourself to see if he has a point about the positive/negative cycle?

I can see how his words got you on the defensive. But if you drop that for a moment (you can always pick it back up later if you need it) what could you do in response that might work for you? You can't control what this pdoc thinks. But you can try to engage with him and work with it.

What would that look like and involve?

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Hi:

Thanks for the responses.

The high positive self image level I am very confident, believe everything I do and say is right, completely focused at the task at hand and emotionally feel very stable. I also know that none of it is real

The negative self image lives in the major depressive disorder world and it is a battle just to keep going. My doctor has said he is unsure if the MDD is a condition on its own or its a byproduct of BPD. My MDD has been very difficult to treat and no medication is effective for long which is why he started to think this way.

The area between the two extremes is when I don't know or recognize whether or not it is my false self image or the real one that is at work and responsible for my moods and behaviors. A week or so ago I would have said it was the real me but my doctor appointment blindsided that thought.

Every situation I enter I do with caution and I quickly try to get a read on the person, a behavior I have been doing for as long as I can remember. If my read says to be careful with the person I basically put up all my walls but if it sees the person in a positive way then I approach with caution. I have a habit of practicing potential conversations to ensure they go the right way with certain people. I have started a new program and in a couple of weeks I have my initial assessment meeting and I am wondering which version of me is going to show up and I know I need to be as open as possible but part of my brain is saying if they know everything then I will not be accepted and they are my last option as no therapist in my city will come near me. I can almost plan when to be really borderline or the extreme but on a normal day to day basis I have no control over it or at least it does not seem that I have control over it. I can see why my doctor does not believe therapy will help but at the same time I need to believe my life is going to get better.

Sorry for being all over the map, my World is a mess at the moment.

take care

trg247

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'Every situation I enter I do with caution and I quickly try to get a read on the person, a behavior I have been doing for as long as I can remember.'

This is typical BPD. If you have had an unstable childhood, then it pays to get a feel on what is going on before everything blows up in your face. You go in, try to sense what the person is about, and what they want from you, what you need to do to avoid getting hurt. Then you do it. The problem is, you don't respond to situations authentically in real time, from the real you, you respond to the person, it's sort of like being a mirror, or a chameleon.

'If my read says to be careful with the person I basically put up all my walls but if it sees the person in a positive way then I approach with caution. I have a habit of practicing potential conversations to ensure they go the right way with certain people.'

I'd be interested to know what the right way is. Is that where people are pleased with you? Where there is no conflict? Where you are not vulnerable?

'I have started a new program and in a couple of weeks I have my initial assessment meeting and I am wondering which version of me is going to show up and I know I need to be as open as possible but part of my brain is saying if they know everything then I will not be accepted and they are my last option as no therapist in my city will come near me.'

I can imagine how stressful this is for you. You go to all these appointments, make yourself vulnerable, reach out, and get shot down. It's very, very painful and reminiscient of what you might have suffered in life before. How would it be if you went to the assessment, and the first thing you said was something like 'I am sat here trying to figure out how you want me to be, because I am afraid that you will reject me unless I get this assessment right?' That is the truth, it takes into account the way you operate, and it helps them understand you better. I have done that in my appointments, once I realized I had this exact problem. I still do this. Therapists find it helpful, but more importantly, I am being honest with myself. Is there any way to sit and be quiet before the appt that day, notice which you is in charge, and then tell them in the appt?

'I can almost plan when to be really borderline or the extreme but on a normal day to day basis I have no control over it or at least it does not seem that I have control over it. I can see why my doctor does not believe therapy will help but at the same time I need to believe my life is going to get better.'

Your life will get better. I think what your pdoc is doing is trying to shock you into action, trying to ring this big bell of mindfulness to say 'hey, can you see what I see? What can we do?' Therapy won't help much if you continue to operate how you did. However I am not sure that you will be able to now, because you KNOW that you do that.

Once you have awareness of something, you can fix it. If the bath taps are on but you don't know, fixing the flooding will be tough. Now you know to do something about the bath taps. Please don't be despondent. This is something that you can get help for.

But it will take that scary moment of going into that assessment and being real. That is a risk. You have these two approaches as a defense, they got you through a certain time in your life, and now if you want a better life, they have to be let go of. That is never easy.

But it is possible. I have managed to go far along that path, and I'm nothing special. I know that you can do it to, and I'm with you on the way.

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The practiced conversations are to make sure I get the changes to the meds I am looking for if required and to makes sure I don't come off as a high risk factor which would send me back to the hospital again. It is a balancing act. I have also found when I don't practice before I end to get in the wrong head space to quickly and what I really need does not come through clearly.

The relationship I have with my doctor is odd to say the least. I spent last October in the hospital and saw him five days a week. My communication skills depends on the mood I am in so I would just write everything down from what I was experiencing to what I thought was causing it to how I was trying to fix it. I also brought up areas from my past that I believed led to the position I was in today, this process was odd as there were three versions to each - the first version would be my babysitter was difficult to deal with and would react quickly, the second version would be when she reacts it meant that I would get hit and the third version went into detail on how she broke wooden spoons across my body. I guess I was testing the water with him and at the same time protecting myself from the past. He suggested that any therapist or doctor that I deal with has a chance to read my lifebook as it shows my whole picture quickly and clearly something I am not able to do verbally easily ...... this might be a good idea but is very unlikely that I would do it, I have had this doctor for a couple of years before he had an idea what my past was like. I ended up checking myself out of the hospital because it was not set up to deal with someone like me, I need people who are consistent and on the same page who will call me on my behaviors and needless to say that was not available in the hospital so I came up with a plan to get treatment in the community which my doctor fully supported at the time of my discharge. I really tried to get a therapist through every avenue I could think of them but none of them were willing to take me on, my first appointment after my discharge my doctor said this is not a surprise as your basically untreatable for your BPD is too strong and will not allow it ... the asshole did a complete 180 on me. So I went to work on myself or continued to work on myself, I have read everything ever written on the web about BPD and the types of therapies used that have shown success and I believe there have been changes but I am not sure if they are real and it would be nice if I had a therapist who could at least steer me in the right direction and question which mindframe I am in to make sure I stay focused and not allow the BPD to take over.

I have put in a buffer between someone elses words or behaviors and my actions to make sure I see the whole picture before I respond and for the most part I am pretty good and most people in my life know why i pause before answering and are supportive. I have been trying to get into a better mind frame but when the main "professional" involved is saying there is no point it is hard to keep working. I mean if I make changes that are from my false self image is that not better then standing still doing nothing. I keep hearing I need to rediscover who I really am and work from that stand point but honestly I don't have a clue anymore or have an inclination on how to draw my real self out. I am getting my butt kicked by depression right now because I am lost and don't know which direction to take so I spend too much time in my head which is the last place I should spend time in at this level. I think my next appointment I am going to ask him to just lie to me from now on as I need to believe I can get better and him knocking me down everytime is not helping.

thanks for responding

take care

trg247

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I was approved for long term disability yesterday through the federal government yesterday once they received the letter from my doctor which shoots my theory full of holes that my last appointment was the doctor trying to snap me awake and make me work harder. This assistance is not easy to qualify for and the majority of people are turned down initially but I guess they saw the words borderline personality disorder and agreed with my doctor that I am basically untreatable with no real shot of ever returning to the work force. Weird thoughts going through my head during the phone as half of my brain was saying "Woo hoo I got accepted" and the other half was saying "Ah crap the bastard (doctor) was right. I am screwed". Very odd life I lead.

take care

trg247

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guess they saw the words borderline personality disorder

uh, no. those are not some kind of magic automatically get disability words. what got you on disability was the severity of your case, as documented by your doctor.

borderline does not equal unemployable. there's lots and lots of employed borderline people hanging out on the boards.

more productively, perhaps you should use this time to really work on yourself. you say you've been doing your own research and trying different strategies. well, now's the time to focus on that stuff without having to stop and focus on working.

you seem really determined to work on this and get better. i'd suggest you accept this gift of time and use it to best advantage.

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