Wednesday: Trying a New Psychiatrist for First Time in 10 Years – What to expect?

Wednesday will feel just like any other day here in Costa Rica, except I will be going to the hospital used by medical tourists and visiting a new psychiatrist. The main purpose of the visit will be obtaining a holdover supply of Clonazepam. In past blogs I’ve described the rather unpleasant feelings associated with coming off Clonazepam that made me feel tired and irritable.

Due to my wonderful health insurance in the USA 😉 I can only get 30 pills per calendar month. I rely on myself to refill the prescriptions in time and on my parents to mail them to me. When there are inevitable delays shipping them to San Jose, I spend a few days feeling pissy and unable to sleep. Hopefully the doctor will take pity on me and write a prescription for 7-10 dosages that I can use while I wait for the mail to arrive. To be clear I’m not trying to doctor shop or get whacked on Clonazepam. The purpose of the visit is practical and reasonable. Luckily all the other meds I take for BPD are readily obtainable in Costa Rica WITHOUT a prescription. Yes, that’s right – WITHOUT a prescription. Costa Rica’s public health policies are much better than those in the USA.

Of course, I can’t just walk in and say, “Hi I have BPD, here’s what my USA doctor has me on, I’d like a Rx for some more Clonazepam, thanks”, and walk out the door in 10 minutes without interacting with the doctor. Every psychiatrist – especially the good ones – do their due diligence. It’s possible I may have to see this guy 3 or 4 times before I can actually get the extra meds I need.

Naturally, the real anxiety I have is dredging up my life all over again for someone else to analyze. I talked to my doctor in the USA over the Christmas holiday about seeing a different shrink and she was positive about it. She even said that if I didn’t feel like getting into the cess pool that is at the center of my BPD, I should set some boundaries that the doctor can work with. I greatly respect good doctors and the services they perform for the community. If I’m really going to get my money’s worth, it’s in my best interests to put my best foot forward and be proactive in my treatment, no matter who prescribes it.

It will be my first “get-to-know-you” session with a new Psychiatrist in 10 years, and maybe he’ll have some ideas that will help me. On the other hand, I have a few worries…

  1. Changes in medication regimen – I was referred to this new doctor after I visited a sleep clinic last summer. At the time I was concerned that I was waking up feeling as if I had lived another day in my sleep. I also suffered from overly vivid dreams and occasional night terrors. The sleep doctor analyzed my test results and concluded that I essentially needed to whip myself into shape and stop taking long naps during the day. In addition, he suggested a psychiatric consultation regarding my medications.

    What if the new doctor suggests taking another med? What if he suggests stopping one or more meds completely? Frankly I’m nervous that he’ll want to experiment with me during a crucial time in my life as I plan to move back to the USA. I’d prefer the doctor to get to the point regarding any new or tweaked medication regimens so that I don’t waste time feeling like crap. Then again, if he suggests something that makes me feel radically better, I feel it’s worth the risk to get another opinion on all the anti-depressants and mood control meds I’m on.

  2. Cultural expectations and/or differences regarding male BPD – In Latin American countries including Costa Rica, many men take on a “machista” persona. It’s basically a glorified version of the typical American macho guy with the twist of being able to have a “piece on the side” in addition to whatever woman you’re already dating or married to. Machista Latin men are also very vocal in public when they see a woman they find attractive. These guys will beep their horns, make a sexual remarks, and even whistle at women.

    BPD is primarily diagnosed in females: 2/3’s to 3/4’s of all new BPD cases involve women. What is this doctor going to think when he sees a “Joe Average” type American guy walk in his office and start to complain about his Depression and BPD? Will he think I’m effeminate? Will he give me lecture and a “man up” mantra to live by? Despite Latin America’s beneficial social health policies, there is still a stigma attached to mental illness, particularly for men. Will he even know how to talk to me? I might be his first male BPD patient in a long time! Will he understand where I’m coming from when I describe stereotypical American experiences I went through that helped contribute to my current condition?

  3. Time commitment/consistency of any potential future visits – One of the greatest benefits of being self employed is running my days according to my own plan. This is actually very helpful for therapy because I can schedule regular appointments and not have to worry about getting out of work late or be concerned the boss will give me a demerit when I have to skip a meeting to see my shrink. That said, I had to call 3 weeks in advance for my appointment this Wednesday. Does that mean I’ll only see him once a month time permitting? Would that actually be helpful or harmful? What if he wants to take me on “full time” (for lack of a better term) and require weekly visits to audit my progress with new or changed med dosages? I typically like to have a structured life. Yes, it can be boring. On the other hand, seeing a doctor for mental health treatment once a month or once a week for 3 weeks followed by a long break in between will confuse my senses. What is his standard of care and how available is he to treat my condition?
  4. I realize all of that sounds like I’m a “Nervous Nelly”. Well, check that box too on my sheet of symptoms. Anything new or unknown usually gets one response from me: “NO”. This knee-jerk reaction happens because I’m afraid of social situations involving new experiences or “adventure” style activities. For me, the thought of eating a sandwich made of portobello mushroom and duck meat is scary: I much prefer lettuce and tomato on white bread with a dash of mayonnaise.

    Sometimes in life you have to try that portobello sandwich, even if you’re 99% sure you’ll hate it. I told myself the same thing about coming to Costa Rica in 2004, and I’m still here 8 years later. Change in one form or another can be a catalyst for a better life. Seeking advice from a different doctor might be the spark I need.

Are Borderline Males Unlovable?

Once in a while I do a search for “borderline personality males” using Google, just to see what comes up. BPD is mostly thought of as a condition that women develop. In fact, about 2/3’s of BPD patients in out-patient care are women. That makes borderline men a slightly rarer group, although recent research is pointing towards the existence of more borderline men simply because they were never diagnosed properly during initial mental health reviews. Further, BPD men tend to be more physically violent and confrontational, and this inevitably lands them in jail. Once incarcerated, their BPD is ignored as inmate behavior.

So after typing “borderline personality males” and hitting enter, this interesting page came up: “Borderline Males I’ve Known, and Almost Loved; Surviving the Crash after your Crush“, by Shari Schreiber, M.A. The author takes a lengthy and extremely stern look at past relationships with borderline men. Her article begins with some didactic prose about the cause of BPD and its narcissistic qualities. Then, it delves into the meatier matters of male BPD and how she perceives it in relationships. The following is a quote from her page:

Some of these males present as little boys, ambivalently in need of rescuing or care. Their vulnerability comes across in a way that has you seeing them as open and genuine–but watch out! Don’t believe the hardship stories they feed you, while asking for a “temporary” loan or place to sleep. This type of fellow is discussed (below) in; THE BOY WHO CRIED WAIF. Don’t think for a moment, this guy can’t screw up your life, just because he seems so pitiful. A ‘victim’ type Borderline will resent/harm anyone who tries to be his savior; you’re just kidding yourself, if you think that You’ll be the exception.

This passage pretty much sets the tone for the rest of her article: don’t trust BPD males, don’t love BPD males, don’t even waste your time with them. As a BPD male myself, I find Ms. Schreiber’s language a bit insulting. Additionally, if she is indeed right in her analysis, NO BPD males should have ANY sort of romantic relationship, simply because it will ruin the life of the female involved.

Taking a step back, I can honestly agree with some of the points she makes. I can’t argue the science of BPD, the way we act, or the way in which we approach love. I do, however, strongly disagree that we are unlovable. After wasting nearly a half hour trudging through Ms. Schreiber’s article, I almost thought male sociopaths or those in a permanent state of psychosis were somehow more deserving of love than BPD males. Ms. Schreiber continues:

If you’re a caregiver/codependent type and you think you can help this fellow heal, get out now. This guy had very disappointing and painful relationship experiences with Mother, and you’re not gonna change that for him. Besides, no man wants to fuck his mommy–and if he does, he’s way more screwed-up than you think he is. He left home to get away from her, and he’ll do it to you. A Borderline’s nature is paradoxical; the better you treat him, the faster he has to find fault with you, distance himself or push you away.

She leaps from rightfully defending a co-dependent personality to suggesting that BPD males look at sex through a quasi-incestuous lens. Not once since I’ve been diagnosed with BPD (after 11 years) have I ever considered having sex with a woman as a means to mend relations with my mother. She’s right that BPD males do have problems with their mother, but these are the fault of the mother, not necessarily the borderline male. Her bombastic and dramatic use of inaccurate language is a bit disturbing, to say the least.

Love is blind. When you’re with a Borderline, you’ll see only what you want to see about this guy–and you won’t begin to wake-up until he drops you on your head, and you’re drowning in so much pain and shame, you can barely breathe. Even then you won’t leave, because you’ll keep hoping for the good times to return–but beware! This male can turn your world upside-down and inside-out, to where you can hardly remember or recognize that woman you used to be, before he came along.

Love is definitely blind, everyone knows that. This axiom of human existence is part of the attraction process and affects everyone, whether they are mentally ill or not. To suggest, however, that a BPD male with good intentions is out to ruin his partner’s life is hyperbole at its worst. It takes two to tango. If you think your life is becoming unbalanced by your BPD partner – or any other type of partner – you should leave. To suggest that a BPD male is pining to destroy his partner’s existence and exploit her for sex or one sided companionship is a horribly pessimistic sentiment. Personally, I think it’s over-the-top and cruel.

One day I hope to have a mutually beneficial relationship with a woman, and when that happens, I will do everything in my power to make sure it works, not self destructs.

Your borderline lover is hypersensitive–to well, just about everything. This guy will have you feeling just horrible about hurting his feelings, even when you know you didn’t mean a thing by that silly, offhand comment you made about one of his relatives. He’ll sulk, become distant, or angrily bust your ovaries over some stupid little oversight, to where you’ve begun walking on eggshells around him, just to avert these agonizing occurrences! Molehills become mountains, and no matter how careful you are, you’re gonna step on a land mine–and there isn’t a darned thing you can do about it. It won’t be long, before the joyful parts of yourself (like your sense of humor) die off.

Ok, yes, BPD males are hypersensitive and temperamental: this much we know from the DSM-IV. Unfortunately for Ms. Schreiber, these statements somewhat contradict what she concluded earlier on in her diatribe about BPD men wanting to mend relations with their mothers. “Walking on eggshells” – yes; but “the joyful parts of yourself (like your sense of humor) die off” – that’s a bit much. Any woman that allows herself to be a doormat will get this sort of treatment, regardless of the mental health problems her partner has or does not have.

This man-child can’t tolerate any form of rejection. If you’re not in the mood to make love, he’s inclined to personalize your unwillingness to immediately fulfill his libidinal needs. He’ll guilt you for abandoning him, not caring about him or “being withholding”–even when it’s right after he’s been abusive, and you’re trying to recover emotionally and/or physically! This discord typically provokes his rage, which lands you right back into an abusive cycle. The BPD male has unresolved primal needs, due to lack of bonding with Mother during infancy; the only way he’s able to experience closeness, is through sex and touch. Grown adults have the ability to connect intimately in other domains of their relationships (spiritual, emotional, cerebral, etc.) but the infantile Borderline has difficulty with mature interplay, and may rely solely on sex as a means of connecting. You’ll feel objectified in this type of relationship.

Pardon me, Ms. Schreiber, I believe that as a thirty-something male, I fully realize that a female might withhold sex simply because she is tired, had stressful day, or wants to read a book instead. Do I feel rejected? Maybe, but I’m not inconsolable. This type of sexual banter goes both ways. Yes, even we men, the standard bearers of non-stop libido, are not interested in sex. Do we then conclude that a lover’s negative reaction is the result of severe childhood trauma? There are many reasons for the way people behave. BPD is certainly an explanation for many of them, but among those trying to improve themselves, it isn’t ALWAYS the case.

Passive aggression in the Borderline man, means that he usually fights like a girl. Rather than direct verbal expression about how he actually feels, he’ll throw cunty, bitchy, sarcastic comments your way. These are often muttered under his breath–but sometimes, they’re loudly hurled at you during a battle and it’s impossible to defend yourself. Either way, it’s dirty fighting.

I actually laughed reading this. Shreiber really can’t make up her mind about how her men should react to her. On one hand, we could have a physically violent, psychotic, masochist male, or on the other, a “cunty” male who makes sarcastic comments. I don’t really regard making “bitchy” remarks as “dirty fighting”. Pick one of the following: be at the receiving end of one of my insensitive remarks, or be at the receiving end of my fist? I even think Ms. Schreiber would know the better of these two.

As she concludes her article, she makes another point that actually is really more of a statement about a woman having problems, versus the male borderline that she’s met:

If you’re persistently drawn to narcissistic men, there were serious deficits in consistent, nourishing support and affection during your childhood (usually with Mother), that set you up for distressing, confusing relational dynamics in your adult life. Your abandonment issues aren’t about the father who left when you were an infant or small child, they’re about emotional deficiencies in the parent who raised you! This relationship template from your girlhood keeps you choosing the ‘Mr. Wrongs,’ until you’re ready to tackle some inner-healing work.

Now she’s bashing you, her kind reader, after umpteen paragraphs of pyscho-babble drivel. If YOU end up in relationships with BPD males, surely YOU have problems, too! It seems almost impossible to win with this lady! Who does she think she is?

My conclusion for any female in a relationship with a BPD male: keep your guard up, know your boundaries, and be honest. Honesty and true love will communicate your feelings to ANY partner, mentally ill or not. If they do not respect your honesty and committed emotions, than the relationship is over. It has nothing to do with wanting to screw one’s mother, selfish seductive conquests, or passive-aggressive behavior.

The catch?

If you read Ms. Schreiber’s “About Me” page, she offers a free first consultation over the phone, but does not do email therapy. Hint, hint, she’ll charge you for any further advice. This reminds me of one of those “Make a killing in Real Estate in 15 minutes” info-mercials at 3:00 AM in the morning. First she bullies you over with exaggeration and bullsh*t, then she offers a modicum of hope if you’re willing to hand over your checkbook.

Nice work Shari, I’m feeling great about my recovery as a BPD male thanks to you!

Have Borderline Personality And Are Lonely? Adopt An Animal

One component of BPD I struggle with is isolation. I tend to push myself away from others for stupid reasons, most often being that I feel I am in competition with them. As a result, I don’t connect well with people and don’t maintain friendships unless I really work hard at them. Some people thrive around others and get their energy from being social. I don’t. People tire me out, wear me down, and get on my nerves. Yet, when I’m not around others I still feel a haunting sense of loneliness that never seems to go away.

One facet of the BPD diagnosis is an inability to be alone for extended periods of time. Essentially, “normal” people can tolerate loneliness better because they know, in time, that it will be possible to interact with others again. For Borderlines, being alone often feels like being sentenced to isolation for an eternity. On top of that, most Borderlines feel they will never be able to reconnect with others again. I believe this realization – true or false – comes from a general fear of abandonment that is at the heart of BPD. If things like love, friendship, solid familial relationships, or a validating environment were withheld from you during your upbringing, it follows that similar situations in your later years will trigger the horrifying sensation of abandonment. “Normal” people don’t have this fear because they were well equipped emotionally as children, even if they prefer to be solitary as adults.

I have also come to the conclusion that thrusting myself into a highly social environment will not help me either. Part of my non-Borderline personality prefers time alone to recharge and reflect. When I took the Meyers-Briggs personality test, I came out as highly introverted. I need time to be me in thought and action even if it means I must step away from a romantic relationship or family life for a couple hours each day. Setting aside time for myself is a pressure release valve of sorts. Once that pressure is released, however, any further time alone begins to feel like solitary confinement.

Thus, the challenge of balancing one’s emotional needs with those around them is a constant juggling act, made even more challenging if BPD is put into the mix. Ask a street juggler to juggle three tennis balls and he/she will do it easily. That’s like asking the most social person you know to interact with others at a party. Ask the juggler to add in a flaming torch, and suddenly the juggling act becomes exponentially more difficult and dangerous. This is way I see BPD playing into social relationships and how we interact with others.

Last year I blogged about finding an abandoned kitten on my street. When I first heard her screaming outside my apartment building, I went around my neighborhood looking for her litter mates and/or a distressed mother cat. I also asked neighbors if they had lost a pet. Sadly, this kitten was never found by her mother and was most likely left on the corner by a human who didn’t have the ability to care for her. In Costa Rica, it’s common for unwanted animals to be dropped off in more prosperous neighborhoods because people will adopt them off the street. Otherwise, they end up in shelters and will eventually be euthanized. Well, days later after first hearing the kitten’s cry for help, I adopted her and took her in. The thought of someone abandoning her disgusted me and I knew I needed to step up and do something about it.

To my surprise, having another creature in my apartment actually helped me perk up a bit. Esperanza has lived with me for 1.5 years, and I take good care of her. Granted, we don’t have intense discussions about politics or analyze the failing world economy. We do, however, keep each other company. Having a cat also gives me small chores to do each day (cleaning litter box, feeding her, letting her out, etc.). This helps keep me out of bed and focused on reality in a healthy, productive manner.

There are days, though, when my BPD gets the better of me and I get mad at her. When I act this way she tends to fight back and both our tempers flare for an hour or so. Still, I’ve never once thought of getting rid of her or sending her to a shelter. The thought of abandoning her goes right to my core and it scares me. I know she’s just a cat. All the same, I could never stop caring for her because abandoning another human or animal is despicable to me.

Ultimately my cat distracts me from the BPD thought process that tends to throb in my mind like a migraine headache. Similarly, I’d be equally distracted if I had a roommate or live-in girlfriend. Although no human companions are readily available, my cat helps fill the void of isolation with some much needed variety, which is, after all, the spice of life. Instead of lying in bed feeling like I’m the last human on earth, I have a cat that will run in and curl up next to me for an afternoon nap. It’s just enough company to feel a little more happy and less alone.

As with any life changing decision I urge caution and careful consideration before moving forward. In the case of adopting an animal, you’re going to have to prepare yourself to spend money on food, veterinary care, and pet toys. The animal might also be traumatized, scared, and nervous about meeting someone new. Additionally, you will have more chores and will need to find a kennel for your pet when you leave town for a few days. Don’t adopt a pet as a passing fancy. Like humans, they have minimum needs that must be met. They also need to feel loved and appreciated.

That said, if you feel lonely and are prepared to take on some additional responsibilities, I highly suggest adopting an animal from a nearby shelter. Talk it over with your family, your psychiatrist, or someone you know who has pet. Once settled in your home, shelter animals are extremely grateful for a second chance at life. Best of all, you will feel very good about making a difference in the world while at the same time making a proactive decision to lessen the effect BPD has on your life.

Always carefully consider adopting an animal. Some may have behavior problems. Some may have been abused. Others might be sick and will require substantially more care than any other animal. I urge you to talk to people with pets and see how it impacts their day-to-day life. If you had pets as a child, make sure you remember all the good and bad things that came with having them in your home. In most cases, the good you do adopting animal will far outweigh any inconvenience they might cause.