Among the most feared, and often reviled, of all mental disorders, BPD and its extreme symptoms have frequently been labeled intolerable and untreatable. But times and knowledge have changed—much stigma is being replaced with hope and recovery. Helen and Valerie will examine BPD from three perspectives: one who has it; one who has had intimate, difficult relationships with persons who have it; and one who has taught and enlightened hundreds of families and caretakers of those who have it. Join Valerie and Helen as they navigate Borderline Personality Disorder in a dynamic, controversial episode.
Join Helen and Valerie on the Mental Health Hope and Recovery Facebook page and leave a message. Become a part of the community.
Learn more about your ad choices. Visit megaphone.fm/adchoices
Borderline Personality Disorder: Myths and Facts
Episode 20
Helen Sneed: Welcome to Mental Health Hope and Recovery. Hi, I'm Helen Sneed.
Valerie Milburn: And I'm Valerie Milburn.
Helen Sneed: We both have fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to mental health conditions. We use practical skills and inspirational true stories of recovery. Our knowledge is up close and personal.
Valerie Milburn: Helen and I are your peers. We're not doctors, therapists or social workers. We're not professionals. But we are experts. We are experts in our own lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.
Helen Sneed: We live in recovery, so can you.
Valerie Milburn: This podcast does not provide medical advice. The information presented is not intended to be a substitute or relied upon as medical advice, diagnosis or treatment. The podcast is for informational purposes only. Always seek the advice of your physician or other qualified health providers for any health related questions you may have.
Helen Sneed: Welcome to episode 20 Borderline Personality Disorder Myth and Fact Today we're going to explore and attempt to clarify the truth about Borderline Personality Disorder or bpd. It's perhaps the most misunderstood, reviled and feared of psychiatric disorders. I have it and I call it the Mental Illness that Dare not speak its name. We'll offer three perspectives. One who has it, one who has had several intense and difficult relationships with people with BPD and one who is an advocate who has taught hundreds of families and loved ones to deal with BPD in our own ways. We are all experts and on those who have it and those who love and care for them. Now, here are our objectives. To provide background on the history, stigma and current understanding of bpd. To explain unique aspects of bpd, its symptoms and behaviors. To examine treatment methods and outcomes for people with BPD. To explore BPD's impact on families and caregivers. To define the potential for recovery, changes in perception and hope for those with bpd.
Valerie Milburn: We have a wonderful guest today, and Helen, you and I love it when we have a guest with us today. We have Eric Kunisch joining us. Helen and I know Eric well as we volunteer with Eric through our work with the national alliance on Mental Illness, Central Texas.
Eric Kunisch: Thank you, Valerie and Helen. It's just so great to be here with my peers who have done so much for mental health in our community.
Valerie Milburn: Well, Eric, we know that you are a retired paramedic and pharmaceutical rep. And Eric has been married for 49 years and has two adult children, a son, 43, and a daughter who is 40. First, I want to tell everybody about Eric's background in the area of Borderline Personality Disorder. Eric is a volunteer with Family Connections and is going to tell us all about Family Connections later, but for now I'll say it's an organization for friends and family of people with Borderline Personality Disorder. Eric has taught the family connections class 14 times so far and helps Central Texas Family Connection leaders coordinate classes. He has led the local Family Connection support
Valerie Milburn: support group for nine years, is on the Family Connections National Education Committee, and leads the National Family Connections Book Club. Now, Eric's background is a NAMI volunteer. He is team captain of a NAMI Central Texas Walks team with the great name of Radical Acceptance. He's a presenter.
Helen Sneed: I'm on that team.
Valerie Milburn: That's right. Helen's a walk.
Helen Sneed: A Radical Acceptance person.
Valerie Milburn: Yeah. Walk star. Eric is also a presenter at Law Enforcement Crisis Intervention Training. We do that together. He chairs the NAMI Central Texas Advocacy Committee, is on the NAMI Texas Policy Committee, and is a NAMI State Advocacy Network Committee member. And Eric, can you tell us a little about your family's history with Borderline Personality Disorder?
Eric Kunisch: Yes. I think when you have family members, sometimes you can kind of tell from the very beginning that there's something a little bit different. And other times you're, you're kind of surprised. And we were on the latter part, surprised. All seem to be pretty good with my loved ones in the younger years and then teenage years. Then it gets to be tricky about what's the normal teenage behavior and what's beyond that, what's more problematic at some point with Our daughter, we realized that there were some things that could be challenging. And she was diagnosed at 17 with depression. And then it was advanced to bipolar then and next year is Graves disease, which is a thyroid disease that affects mood. And then had some challenges, like so many people trying to deal with pain and suffering, had some substance abuse challenges. And in the late 20s, it seemed like she was hitting all the criteria 9 for 9 in the DSM for borderline personality disorder and had some other things where the bipolar got into more psychotic features, unfortunately. And she went through troubles of some self harm, suicidality and hospitalizations, et cetera. So it kind of hit us. We were like swimming in denial, perhaps like in the river of Egypt called Nile or denial. Then we had it struck. So it hit us by surprise. That was the beginning.
Helen Sneed: Well, Erica, I also want to chime in and say, I'm just so delighted that you're with us today because of your just vast knowledge of this illness and experience with it to begin with. What's in a name? I mean, many people and practitioners can't even agree on what borderline personality means. In the past, those with the condition were considered to be on the borderline between psychotic and neurotic presentation. They appeared to swing back and forth and to make matters more confusing, did not respond to the analytical treatment of the time. A personality disorder is defined by Dr. John Oldham, former president of the American Psychiatric association, as two blocks of personality. Number one, temperament, inborn traits, and number two, character shaped by the environment. There are extreme disturbances in four areas. Identity, interpersonal functioning, impulse control, and regulation of emotions. The implications for BPD are far more complex, with a tremendous wave of prejudices against those suffering from it because they didn't respond to traditional therapy and admittedly could be extremely difficult to treat in the face of the stigma, symptoms and lack of understanding. And, you know, even in the media and the entertainment world, people with BPD were just considered, you know, they were always ruthless and destructive and, you know, occasionally bloodthirsty. I think of, you know, the famous Glenn Close role in Fatal Attraction, who, you know, she was supposed to be a borderline. So this just. You could. You just were up against just such a wall of prejudice. The National Education alliance for Borderline Personality Disorder, which is the great organization that has led the struggle to validate, define and treat bpd, provides a sobering overview. The disorder was only included in the dsm. That's the Diagnostic and Statistical Manual of Mental Disorders was not included until 1980. The clinical diagnosis that became a
Helen Sneed: judgment. DBT and BPD is two decades behind in research, treatment options and public education. Historically, it's been met with widespread misunderstanding and blatant stigma. And the people with BPD were deemed hopeless, untreatable, and be passed on to another therapist as quickly as possible.
Valerie Milburn: Here are some statistics that illustrate the impact of Borderline personality disorder on society. 5.9% of American adults have it. That's 14 million Americans more than those with schizophrenia and bipolar disorder combined. 20% of inpatients in psychiatric hospitals have BPD. 10% of people in outpatient mental health treatment have BPD. Men and women are equally affected. Comorbidity, which is having more than one diagnosis, is common with bpd, with substance abuse, chronic depression, ptsd, bipolar disorder and eating disorders being some of the concurrent diagnoses. And here's a very sobering statistic. 10% of individuals with BPD die by suicide. So what causes bpd? A genetic predisposition. And environmental factors such as an invalidating environment, stressful or abusive childhood or trauma increases the risk. So it's nature and nurture. Dr. Blaise Aguirre of Harvard University and McLean Hospital states it's 60% genetic, 40% environmental stressors.
Helen Sneed: Well, it has a profound impact on our nation whether people know about it or not, just due to the sheer numbers. Now there are current scientific advancements in understanding BPD in the brain and they are very exciting what they might suggest about more treatment someday. Now what I'm going to explain is from Dr. Anthony Ruoco of Montreal University who is a major cutting edge researcher. He finds that emotional dysregulation is the core symptom of BPD and it results in the other symptoms that we'll explore next. His research explains what happens in the brain of a person with bpd. It's very simple. The limbic system is the primitive region of the brain and within it the amygdala responds to fear and emotion. In bpd, the amygdala overreacts to certain emotions and this causes extreme emotional hyper arousal. The more sophisticated part of the brain is the prefrontal cortex, which is responsible for regulating emotion in the brain. But in BPD individuals, their brains, it appears to be significantly underactive. This creates the inability to control or manage emotions. And if that's called emotional dysregulation, in other words, the brakes in the brain are not working. Now the pain and suffering caused by this condition drive the individual to try to stop the pain with extreme behaviors and symptoms, which we're going to talk about in a minute. But Eric I wanted to ask you, we've mentioned stigma and I'm wondering, have you seen changes in the perception of BPD over the years in the psychiatric field or in the general public or just anywhere?
Eric Kunisch: Yes, Helen, fortunately I have. I think we have a long way to go. But in the psychiatric field, definitely that most in the know that there are effective treatments. Some of them dialectical behavior therapy. We call it DBT mentalization, gpm, which is general psychiatric care transference therapy and schema therapy. Some therapists use these techniques and others refer to others. And people with BPD need people, including clinicians who don't abandon them. And clinicians using such treatments such as DBT know that and the general public better more about it. Like there's still some of the fatal attraction type things that we've heard about, but more people are in the know that there are more treatments and there's still lots of work to be done and knowledge deserts. But we're getting better with the public.
Helen Sneed: That's very encouraging because I think that as we've known public opinion can be so important. If you just even look at the change in
Helen Sneed: how people regard something like depression now, it's just so much more accepted, which we hope someday for Borderline Personality Disorder. But talking about trying to deal with it, Valerie has really done research on the symptoms and the behaviors that this illness consent can engender in an individual. I know firsthand. So Valerie, tell us about some of this.
Valerie Milburn: I want to start with a quote by Marsha Linehan, who about 15 years ago outed herself as having BPD. And Marsha Linehan is the creator of one of the most successful treatment methods, Dialectical Behavior Therapy. She was giving a speech and talked about herself having borderline personality disorder. She once said people with BPD are like people with third degree burns. Over 70% of their bodies lacking emotional skin. They feel agony at the slightest touch or movement. That really helped me understand the symptoms and the behaviors. Let's look at some of these symptoms and behaviors they engender. People with BPD engender through emotional dysregulation and acute suffering. And again, we get this list of BPD symptoms from Dr. Blaze Aguirre. These symptoms include fear of abandonment, impulsivity, which is through substance abuse, high risk sexual behavior or eating disorders. Another symptom is anger, which can be sudden outburst or the inability to express anger at all. Other symptoms include bodily self harm, suicidal ideation, chaotic volatile relationships, black and white thinking, unstable identity, paranoia and feelings of emptiness, loneliness and need. Now Helen, you're going to talk about some of these symptoms as you're now going to share your personal battle and fight to live in recovery with bpd.
Helen Sneed: Well, thank you, Valerie. Yes, I'm going to do that as best I can. Although some of it is really sort of so mind boggling in its intensity or whatever that it can be a hard story to tell. But I'm going to try. To begin with, I'm a writer and I have relied on words my entire life is just a basic form of communication. But the diagnosis of BPD outstripped my ability to describe it with language. But there's a photograph from the Vietnam War. A little girl running down a dirt road straight into the camera. She is naked, her little face contorted with agony and terror. She is screaming. There are other people around her, but they're not even paying attention. She is utterly alone. I call her the Burning Girl. And at its very worst, this is what BPD feels like to me. Burning, burning, burning. All alone. I already had four other diagnoses. Bipolar, anorexia, bulimia, clinical depression and ptsd. But nothing prepared me for the stigma and animosity towards bpd. It is a mongrel diagnosis, as if overnight I had turned into a mad dog. I was sly, manipulative, rageful, irrational, had no credibility and I was treated with a surprising lack of compassion or hope from professionals. It was as if I had been thrown on the trash heap. My main doctor was a PTSD specialist. That's post traumatic stress disorder. She was all about trauma, but she wouldn't even use the term borderline. She said it was too pejorative, which it was. But she maintained that BPD was so like PTSD there was no need to deal with it separately. Only later, in working with BPD specialists and using their techniques did I come to see the truth. Now, comorbidity. This co occurring illnesses is common with BPD and each illness has its similarities and each is unique. So sorting through them can be a real uphill task. But I became aware of the fact that for me, borderline personality disorder was the underlying condition. And all the other illnesses sprang from my inability to regulate my hideous thoughts and emotions that left me in a state of emotional agony for months on end. Now, I was lucky to live in New York City. Very lucky. Professionals and cutting edge techniques were available to me. Although I beggared
Helen Sneed: myself, I could pay for treatment most of the time. However, my condition was so complex that I was turned away from the outpatient program at Bellevue Hospital. Now most people have heard of Bellevue. It was considered to be the most notorious lunatic asylum of its time in America. So I was there. And the head of the program told me none too kindly that I was too sick for his staff and trainees to handle. Surely you understand, Helen, the well being of my trainees must come first. Yes, it must. But to be deemed too sick for Bellevue, it was one of the low points for me. I almost killed myself. That night was so bad. But I think what Valerie was talking about earlier is that symptoms tell the tale. And in certain areas, my symptoms were atypical for bpd. To begin with, I was literally incapable of expressing anger toward another person. So I was well behaved in public and had many friends and colleagues. I only unleashed my fury and despair on myself alone in my New York apartment. Now, one of the most intense symptoms was self injury. I want to talk about it because so few people understand why a person does it. And there's this need to want people to understand. Yet I'm very afraid of telling the truth about my condition because I worry that I'm going to trigger someone or sound as if cutting was an acceptable behavior. Here's a warning. Self injury is the most destructive, reprehensible action I have ever experienced. And I wouldn't wish it on my worst enemy. Here's how it happened to me. I was so distraught that I cut daily for weeks on end. I cut by day because it helped me to control my emotions enough to get out of my apartment. And by night, it helped me regulate the pain and solitude and kept me from killing myself. Now, no one wants to act this way. I mean, I knew that my symptoms were grotesque and inconceivable. But there's a quote from Proust that helps explain it. He said, to wisdom and kindness, we make promises. Pain we obey. So when I was out of control, I was obeying excruciating pain and trying to stop it as best I knew how. It's just that nothing worked. I did make a number of suicide attempts because it just looked like the only way out. But I want to say here, cutting is not a form of manipulation. It is a form of communication, an attempt to be understood. I would look at my hidden, disfigured arm and know that I had the means to express the agony. This is what it feels like. I never showed it to anyone, but I had that truth. I was wearing it on my body. I would never have had a chance to recover until I gave up cutting. It was the hardest thing I've ever had to do. Self injury is a diabolical symptom because it's never the answer to suffering. It only prolongs it. My other chief symptoms were impossible to control. For years, eating disorders escalated wildly. A major factor was my terrifying lack of consistent or positive identity. Underneath it all, I had no idea who I was. I hated myself unrelentingly. It never stopped, and it ran like poison through my veins into my brain. Although I developed a strong and convincing public Persona, to me it was just a lie that others might discover at any moment and I would be ridiculed and abandoned. My fear of abandonment was so acute that several doctors asked me if I had actually ever been left anywhere in my childhood, which I hadn't. I should say here that I discovered my own cure for fear of abandonment. Here's what it is. Leave first. Which I practiced all my life, especially my adult life when I could. Jobs, romance, opportunities. I left before I could be found out to be a fraud and a repulsive, flawed person. After years of decay and worsening illnesses, my PTSD doctor told me I was hopelessly sick. I would never recover, and I would never work again. Well, I was so shocked, I told her, I will devote the rest of my life to proving you wrong. Our therapeutic relationship ended so horribly that it was another time
Helen Sneed: when I almost killed myself. But one thing kept me alive. Dialectical behavior therapy. Dbt. It was the turning point. I guess you could say that I used it hourly until I could find a DPT therapist and slowly made tremendous progress toward recovery. I joined a gym and completely changed my diet and eating habits. This resulted in physical strength and the loss of £90. I found a new psychiatrist who prescribed a new medication that began to work within days. It was a miracle. Like dbt, it helped me to control the excessive emotions that had driven me all my days. And I could get the work done in therapy. Finally, now, as I've said, I was lucky. I enrolled in a unique DBT job training program, brilliantly designed and taught exclusively for people with borderline personality disorder. It was a joy. First of all, I had a destination. I had structure. And I got to work with and mentor my peers in our classes. And it was these professionals who ran the program who gave me my first opportunity to speak publicly at high profile events about my BPD story. Now, another real turning point for me. For the first time in a decade, I felt like my old self again. And this led to more activities, more action, volunteer work, and my creation of a play that was produced off Broadway and very well received. But the Most far reaching and priceless advancement came in my relationships. I began to reconnect with my old friends, make new ones, and through their love and generosity was swept back into the world again. Somehow I had stumbled and fought my way into a life of meaning, fulfillment and the first happiness I had ever known. So that is my story. But I wish you could see the extraordinary people I met along the way. Those of us who used to be called borderlines. If you could see the striving of these men and women, the desire to work, participate, contribute, laugh and love. To live life fully out in the community, to belong. These are my people. If they can survive bpd, just think what they could give the world.
Valerie Milburn: Oh, Helen, thank you so much. Thank you so much for having the vulnerability and the bravery to share your journey. I know you've helped so many people today by doing so and I want to comment on something that must have been so difficult to share and that's your journey with self injury. For years I carried my own shame because of my battle with self injury. And your ability to communicate with me about your battle over the years has really helped me heal. So thank you again for your bravery and your vulnerability for sharing with me over the years and for sharing today because I know you have really helped people.
Helen Sneed: Well, Valerie, if I've helped you, then.
Eric Kunisch: I'm.
Helen Sneed: A happy woman because it's a tough one, you know. And again, getting rid of the shame and the guilt and the need for it, that was, you know, this misguided need.
Valerie Milburn: But.
Helen Sneed: Thank you very much for what you said. I. What we'd like to do is this is where I'm going to really rely on Eric in a minute. We want to now examine the treatment methods and outcomes for people with bpd. We've talked about what it is and how it affects people, what can be done. I found out, very interesting in my research that the Mayo Clinic, the National Education alliance for Borderline Personality Disorder and the national alliance on Mental Illness NAMI had virtually the same criteria for treatment methods. It looks right. Now I know there are probably groundbreaking people in the field, but I was very pleased to see this consensus to begin with. The importance of the right diagnosis can't be overstated. Eric mentioned it earlier. BPD can be misdiagnosed for years. I mean, for me it was for decades. This leads to the fact that you need specialized treatment to get results. I think that again, we're going to talk about this more, but the people, the practitioners do
Helen Sneed: need some training and understanding of the illness and the People that have it. It's also important to get treatment for the other co occurring disorders such as depression, substance of misuse, eating disorders. But this all again it's tall order this illness. I just am happy to see these treatment methods that are giving people so much better opportunities. There's a step before recovery that I had never paid much attention to until BPD and that is remission and that's sort of the cessation of symptoms for a period of time where they may not disappear entirely, but they're muted and they're few and far between. And that must happen really before you can get into recovery, which means living a meaningful life. Here are some specific treatment methods for bpd. Eric mentioned them before and we are not going to be able to describe all of them but there's obviously psychotherapy, talk therapy and a trusting therapeutic relationship I believe is the fundamental building block of treatment. Dialectical behavior therapy, DBT General or good psychiatric management. This is created by Dr. John Gunderson who is also out of Harvard and McLean and he's passed away but he was one of the great, great pioneers of borderline personality disorder. So it's a very interesting way that he's come to put together the treatment. Then we've got schema focused therapy, mentalization based therapy, transference focused psychotherapy and there are others. But today we going to examine DBT because Eric is a real expert and again it saved my life. So Eric, just to start off with, how do you explain DBT to people when they ask you about it for the first time?
Eric Kunisch: DBT in short.
Helen Sneed: Wow.
Eric Kunisch: It's a way of combining, it's kind of, well it's dialectic, it's like two apparent opposites. Like you're trying to establish change but you have to have acceptance first and you combine them as far as emotional, it's kind of like they have a phrase that we have emotion mind, we have rational mind. And a goal is to combine those to wise mind, to having what apparently seems to be opposites, to combine them together. And Marsha Linehan, you know, her first thought, she thought that cognitive behavioral therapy was going to just whip people up and do all fine. And it's done well for a lot of people, but not with our people. And so then she realized that didn't work. So she, you know, got in the other aspect of mindfulness and acceptance. She was thinking people have to be mindful, to be non judgmental, to look at things as they are in the present moment. And from there they can go to acceptance and it is what it is. And at that point try to do some change and have some validation and somewhere down the road maybe do the problem solving or problem management with class family connections is basically DBT lite. I really think it is. And only at the end do we get to that. And it still may be a management, not solving. And most of the people who have loved ones with bpd, we want to fix it. We want to just quickly put that back to the where they were before there was disaster in our minds. Whatever. We want to be fixers and we need to learn ourselves and improve our relationships and understand the person's pain and what's going on much more than we do. Initially.
Helen Sneed: When I first heard about it, the person that told me this definition has stuck with me ever since. She said it teaches you dozens of skills to overcome tidal waves of hideous emotions and thoughts. That's, I guess how I've always looked at it again is the skills are what I mean, you have to get to them and you have to do. And I did read this great quote from Marshall Linehan recently, which she said, she said that the way out of h*** is acceptance.
Helen Sneed: Yes, Acceptance and mindfulness, I know, are the two basic tenets. But I always thought that there were these four basic components. Mindfulness, which you talked about, distress tolerance, interpersonal effectiveness, and emotion regulation were sort of the four basic areas of, well, almost of study since when I had dbt, it was really more like a class or something initially. And also here's an astonishing figure that I wanted to ask you if you've heard this. 77% of participants no longer met the criteria for borderline personality disorder after DBT treatment. So again, I don't know how much treatment they're talking about there that I just picked this up and one of the research things that I was using. But have you heard that it's that. I mean, how effective have you found it to be?
Eric Kunisch: I've found it, Helen, to be in that range. I had heard 70% and kind of in that territory. Of course there's the quality of 70% if they're treated, if the person follows through and all. And sometimes it takes them some time. I think maybe when one of the conversations when you spoke to one of our classes, and by the way, sometimes when we were lucky to have you, they'd say that's the best part of the class when you say thank you. Yeah, it's honest, definitely. And the first time around, it didn't really hit you and it didn't really hit me. Until close to the course, to the end, till I got radical acceptance thing or hit me like this. We're not going to just go back to the way we thought things were going to be that we have. Recovery can happen, but it's going to take some time and it's going to be different. We need to, as people that love you, as a person with bpd, we need to do the same thing as far as improve our knowledge like on dbt, to improve our relationship skills to get it to understand you better and to, as we like to say in our class, to not make it worse.
Helen Sneed: You know, some of the other methods are group therapy, which I have, I found to be very beneficial if the group leader was trained in bpd because it can, you know, again, it gets. Emotions can get pretty high. And you need to have someone trained to know how to deal with that medication. I'd be interested to know what you think of it because, you know, there's not one designated for borderline personality disorder. But I have found it extremely helpful with sort of the sidebars of it. Do you know what I mean? Like insomnia and it helps with depression and it takes the edge off some of the extreme symptoms. But how do you feel about medication?
Eric Kunisch: Definitely that's important. They say BPD rarely stands alone and I think sidebars is a good example. It helps some of the other things that's going on. So things like DBD or mentalization can do their work for them. And I know a lot of people, a lot of stories that are kind of like yours. The first time the person didn't go for it. My loved one, she took dbt, the group four or five different times, but she took enough in each time. It's almost like she took the whole class. And we talk DBT back and forth and it works for other things that are not just great, your other symptoms. And I think Valerie is talking about Blasikare. He's got a book, DBT for Dummies, and he's on MSNBC and basically said he thinks that works for everybody. Or as I like to say, tongue in cheek, you should put it in the drinking water. It's that good. And I've had people in class go like, well, somebody with BPD has lots of pain and suffering. And if this works for them, for people that don't have it, I found that it's easier in my workplace or with other people I know that I deal with.
Helen Sneed: I think you should be taught in every high school in America, dbt because it just teaches how to regulate your emotions and get on with people and all good things. All good things. I'm a little biased.
Eric Kunisch: That's a good bias. I think you're accurate.
Helen Sneed: There's some other things with healthy lifestyle, diet, exercise and sleep, which I think we all know are terribly important. Hospitalization. Now
Helen Sneed: as far as I know, there's not a hospital that specializes in borderline personality disorder and if there is, there's not enough of them. But I think it's helpful in extreme instances. It was for me. If someone's really out of control with a self injury or suicidal, I think that the hospital becomes absolutely necessary. Then here's something, Eric, that you contribute to immeasurably which is informed and educated caregivers and relationships. Because I just think people without informed caregivers and loved ones, I don't know how they can get through it. So did you find that lifestyle that any of those things were helpful in terms of exercise and eating properly and sleeping enough and all that? Do you think that people can use that effectively?
Eric Kunisch: Sure, I think having a regular routine, that's a healthy routine. There's acronyms like snap, sleep, nutrition, activity. People don't get off into the corner and there's various things. I think the lifestyle is very important and to have people in your environment that can validate what you're doing.
Helen Sneed: Okay, well where do you think or can you tell us where people, you know, people who are fighting bpd, where can they reach out? I mean there's you know, the, the big organizations, you know, NAMI and the nea BPD and. But do you know of places, other places that they can, they can go for, for help just to get advice or you know, whatever?
Eric Kunisch: Well, I mean I see big picture ones and little ones as far as advice is to find therapists to treat BPD and want to treat bpd. I mean I still know a few people who haven't been active as therapists and they go like oh no way would I. There's, they're hopeless and all. So you don't want somebody that's a therapist like that, that you want people that understand BPD and will not abandon the person and will refer if they don't know BPD as much as somebody do. Like there's DBT associates in various towns, groups of them and there's mentalization, there's a couple good people to teach the family connections class to do mentalization and we're fortunately have several therapists that do that. But find people that believe in treatment and encourage your loved ones when possible, take something like Family Connections. Now that we have Zoom, it's more available and read some of the good books. Alan Frusetti worked under Marshall Linehan and he created the Family Connections program with Perry Hoffman that we both. Unfortunately she's passed. But she was wonderful.
Helen Sneed: She was.
Eric Kunisch: Yes, she was. And now there's more telehealth. So there's going to be less, hopefully less treatment deserts for the people with bpd and also their loved ones have more access to read and attend places that will help.
Helen Sneed: That's good to know. One thing that I wanted to mention and I believe it's been launched and it and I think Valerie, you know about this is the new suicide helpline, which is 988-right?
Valerie Milburn: Right.
Helen Sneed: Yeah. You guys know about. I think it just was launched a week or so back or it's really new but you know, it's again, it's like 91 1. But if you have any questions about suicide, if you're feeling that way, you can get through immediately to a professional. Right.
Valerie Milburn: Right. It's a mental health crisis line. If you have a mental health emergency, if you have a physical health emergency, you dial 91 1. And now if you have a mental health emergency, a crisis of any sort that's mental health related, you dial 988.
Eric Kunisch: And as advocates, we should probably keep on working on that. That's only the good beginning of 988 and it needs to be spread out so people use it more.
Valerie Milburn: Yes, this is just the beginning and it took a lot of work. I know. I wrote letters to my representatives, federal representatives and a lot of us wrote a lot of letters and took a lot of work to
Valerie Milburn: get 988 passed. The 988 legislation passed.
Eric Kunisch: Yes.
Helen Sneed: Go all in on fall with Abercrombie kids. Their newest drop of on trend outfits are ready for everything from the bus stop to family bonfires. And it wouldn't be fall without football. Gear up. The kids with officially licensed NFL tees and sweatshirts. Shop Abercrombie kids this season in the app online and in store. When did making plans get this complicated? It's time to streamline with WhatsApp, the secure messaging app that brings the whole group together. Use polls to settle dinner plans, send event invites and pin messages so no one forgets mom's 60th and never miss a meme or milestone. All protected with end to end encryption. It's time for WhatsApp message privately with everyone. Learn more@WhatsApp.com your teen adjective used to describe an individual whose spirit is unyielding, unconstrained, one who navigates life on their own terms, effortlessly. They do not always show up on time, but when they arrive, you notice an individual component. Confident in their contradictions. They know the rules but behave as if they do not exist. The new fragrance by Miu Miu, defined by you. Well, I think now we get to we're going to look at the flip side of the coin and that is the impact that this illness, this disorder has on families and caregivers. I have to say that I don't know of any other mental disorder where there is so much support, well, almost treatment available for the people who are on the other receiving end of it because it is so difficult. Now, Valerie, do you want to tell us about some of this? Because I can see how it would help someone tremendously to be educated and to have a support in this area if they had a loved one.
Valerie Milburn: Yes. Eric and I are going to take this on. Looking at the impact on families and caregivers, people who are in a relationship with someone who lives with borderline personality disorder. And I have firsthand lived experience with bipolar disorder, anxiety disorder, post traumatic stress disorder and substance use disorder. Now, those diagnoses are my own journey with mental illness and my fight to live in recovery. But my experience with BPD is different. This experience is through several intense, difficult relationships with other people, people who live with bpd, my relationships with them. I've been affected deeply by several people who live with bpd. And I have compassion, grief and scars associated with these relationships. And preparing for this episode has been both difficult, healing, very healing. But I've had to remember some traumatic times. I've also found more compassion for an understanding of those people, loved ones, people I care for, those that I've had relationships with. And one of the most important things I learned is summed up in a quote from Paul Mason, the author of Stop Walking on Eggshells. Taking your life back. When someone you care about has borderline Personality disorder. And the quote is, the behaviors you witness in the person you love are usually unconscious. They are designed to shield the person from intense emotional pain, not to hurt you. This person will help. This knowledge will help you separate the person from their disease. And this quote has helped me tremendously. And all the things we've just heard have really helped me a lot. And there's another quote that I want to get both Eric and Helen, both of your comments on. It builds on Helen, what you said earlier about the research the brain research, the scientific research. The quote is also from Mason. And it says it's common to struggle to understand the thoughts, feelings and behaviors of someone with bpd because we assume someone with BPD processes thoughts and feelings the way we do. They simply don't. Comments on that from both of you?
Eric Kunisch: Well, I think there's, from another book, loving somebody with BPD, Sherry Manning. She talks about,
Eric Kunisch: she talks about SeaWorld and dolphins and that dolphins in Houston, for example, they may learn their skills, training, whatever, but then if you move them to San Antonio, they don't have the skills in that location that you have to teach them all over. And she says in some ways the person with BPD has seemingly good skills somewhere, like maybe in the workplace or maybe in their home, but the other way around, they don't. And people just, I mean, people that don't understand it will go. People just. You have this figured out. It's another thing whether you get stigmatized with manipulation. And it's not manipulation. They can't always transfer one skill to another environment. And it gets me as far as Marshall Linehan said, by definition, manipulation is artful deceit. And the person, people are in so much pain. It's more like they're in desperation and they're so. It's like you feel like you're, you feel more like you're being pushed rather than manipulated in my mind. And there's a good reason why the people are so desperate because of the pain they have. And I say that and I go, look, look at Helen and my loved one. Other people, I don't know the pain, but I believe it's really there.
Valerie Milburn: Well, Helen, did you have anything you wanted to say about that?
Helen Sneed: Well, I have tremendous ambivalence because part of me immediately bristles and becomes defensive. You know, it's because I want to go, but I was so well behaved. How can you, how can you say this? But, but I do think, and especially having read what I can't think of the name the researcher in Canada has learned. Dr. Ruoco, I do think that my brain and my emotions just respond differently to the same stimulus that someone else does. So, yes, I have to. I guess I have to agree with it. But it's not easy.
Valerie Milburn: No, it's not easy. But for me, it was very helpful. I mean, I know my brain doesn't function the same because I have bipolar disorder. And it just helped me to understand that we go about things, we look at things differently because of who we are, no matter what, what our differences are. And that just helped me a lot. And then there was another quote that I found very that brought me to a lot of compassion. And this one's from Rachel Ryland and she wrote a book called Get Me out of Here My Recovery from Borderline Personality Disorder. And this is her quote. I always had this insatiable hunger for something I couldn't define except to call it the bottomless pit of need. Something that made me scared to get close to anybody for fear they'd discover I was rotten and disturbed. This just really helped me understand how much I wanted to learn these skills. I'm about to talk about. Eric, I'm going to share some tools and skills for having a supportive relationship with someone who lives with bpd. You already talked about how important it is to develop a better relationship and learn these skills and tools. So as a starting place, could you share some of the things you have found most challenging for families and caregivers over the years you've done this work?
Eric Kunisch: I think the challenge initially is again, they want to, we want to fix it. We don't understand. We want to just go from where they are to back where we think that they should be. We were shooting coulda, woulda shoulding on people. And so that's a common thing. And so that's why Marshall Linehan says you've got to get to mindfulness, to just break it down to the present moment, be non judgmental and then slowly work, build up to try to understand. And we have our own mistakes that we make. We don't understand and then we slowly get better. Like when I'm doing a class, I say, of all the mistakes you've made, I've either made them or I've thought about them and I continue to make them. What helps is by practice I catch them a little quicker than I used to. And I have to assume that I'm still going to be an imperfect person. Kind of like Renee Brown's gift of imperfection. I don't always find it a gift, but I have to admit that yeah, I screwed up and I need to
Eric Kunisch: try to repair. And that's kind of where I go on that on the tools is using the tools, trying to validate. And when you invalidate, trying to try to go back, they say you have to validate three times before you say anything that's going to be possibly controversial if you're going to step ahead. So those are some of the things on the tools challenges.
Valerie Milburn: That's a good tool.
Helen Sneed: Can I ask a question?
Valerie Milburn: Yeah.
Helen Sneed: Eric, you said Are you saying that one of the major problems for families is that they, because they don't understand it initially, they just want to, we all want to wave a wand, you know, go back to, you know, go back to the way things were. So it sounds like that the, one of the first things for them is acceptance. Is that right? That they have to learn acceptance? Yeah, I'd say that's not going to happen, you know.
Eric Kunisch: Yeah, I'd say it's like nuance, like I'm going to hide behind Marsha Winhan's wisdom. She says be mindful and kind of, you know, getting rid of all your preconceptions and then at that point you can go to that next step, acceptance. And you have to have acceptance before you get the change. So I'm agreeing that I think she would say go back to the very be the Buddha as best as you can.
Valerie Milburn: Yeah, as best as we can. Well, there's a wonderful book called the Essential Family Guide to Borderline Personality Disorder by Randy and there's some tools in this book that are for taking good care of ourselves in relationship with someone who has bpd. But these are just great tools for taking care of ourselves in general. They're common sense, they're things I need to do all the time and I'll just run through them. And they are to obtain support and find community. And I think we've given some examples of how to do that, particularly through the family connections class. To get a handle on our own emotions, to practice mindfulness which we've talked about. To have a sense of humor, to focus on our own wellness. Another one is to uncover what keeps us feeling stuck. I need to uncover what keeps me stuck by owning my own choices, by helping without rescuing. That's a very important thing for me to do. And to learn to handle fear and obligation and guilt. Also to learn to communicate, to be heard, always putting safety first. To learn active listening skills, to understand non verbal communication and to validate as you just said, Eric. And the other one is to reinforce the right behaviors. And that's something I have tried to do. Eric, comments on the tools I just listed. Any others you want to throw in.
Eric Kunisch: Those are tools. And that acceptance of your. Both of you were talking and asked me about. That's huge. We talk about radical acceptance of my class last night. We were hitting that. That's one of the hardest, hardest skills. It's an important skill and we have to keep turning our mind back to it and get away from the if only, if only and getting off the path. And that's one of the reasons why Marsha Linehan realized this. Just trying to change the behavior wasn't going to do it. He had to get into the acceptance and then go from there and validate and eventually problem solve or build a life worth living, as she said in her memoir, the title of it.
Valerie Milburn: And another thing I found out in my research is something, Eric, you already brought up and that the most important thing is knowledge that all the experts agree that the first thing to do to make relationships strong is to get educated on the disorder itself, to learn about bpd because it's impossible to know how to support someone who lives with any type of a disorder or how to take care of yourself while doing so without first understanding it. And the other advice I found very helpful is that we need to give up the notion that we can, should or will change someone else. And I found that letting go of this belief gave me the power that is truly mine, the power to change myself. And this is a priceless power and freedom. I just want to reiterate the ideas that I found most important in self care from the research I did and it was to keep a sense of humor, to join a support group, find a
Valerie Milburn: friend or family member who will support you. And Eric, you talked a lot about ways to do that. And most importantly, celebrate small steps in the right direction and appreciate the things you enjoy about the people in your life, people who live with borderline personality Disorder and all the people in our lives. What do you think, Eric, about any of these strategies for self care in relationships with someone who has BPD or any other self care strategies? Relationship strategies I haven't mentioned.
Eric Kunisch: I think you've covered a whole lot. And we have little cards sometimes remind us of these things. We used to hand them out in classes. Now that we're doing virtual, we're not doing it, but some things about rights of relatives, basic assumptions, things like interpret things in the most possible way or benign interpretation and there is no one absolute truth. And trying to do the best you can in the moment and that's not always going to be perfect. And everyone needs to try harder. And sometimes harder means like what you said, it could be a small thing, it could be baby steps or maybe slower. So I'm just kind of augmenting, I think what you're saying, Valerie.
Valerie Milburn: No thanks. I think we've given some pretty good tips and there's just one more area of communication strategies and skills that I wanted to hit on and these are just excellent communication strategies. And skills in general. And I use these in my relationships. I use some of these with my husband all the time. One is to be aware of timing and having a communication, to postpone conversations to calmer times, which is something I've learned to do in all my communication. Don't get drawn into another person's extreme reactions and prepare for discussions. I've been known to actually write notes before I have a difficult discussion with anybody. Eric, you talked about validation. And also, while it's reasonable to ask someone to change their behavior, it's not reasonable to tell someone how they should feel. I just want to add that I wish I had known and implemented these skills and strategies and tools in my past relationships with people in my life who have bpd. But my continued and future relationships will be healthier and less tumultuous now that I know these skills and I desperately want this improvement in my relationships.
Eric Kunisch: Sounds very good, Valerie.
Valerie Milburn: Thank you, Helen. You're going to take us into our last objective, which is to define the potentials for recovery and the changes in perception and the hope we have in this area.
Helen Sneed: Yes, I again have. This is. We love this. This is our positive section. And despite all the sort of grim statistics and whatever that we've gone over today, there is reason. I mean, if you have to have borderline personality disorder, this is the time to have it, because there are increasing options and increasing help out there. So to define the potential for recovery and the changes in perception and then just to look at. So where do we find our hope? I just jotted out a couple. The potential for recovery and changes in perception are like the chicken and the egg. You know, one that you can't do without, can't do one without the other. And they need each other. I don't really know which one came first. Here's one. There are brilliant, compassionate, committed professionals who have joined the battle and there are more of them coming in. There are young researchers that are coming in because, you know, for, well, for several decades, people just said they're hopelessly sick. They don't respond to treatment, so why even do research now? It's just a whole new day. With that, there is a wider understanding in the psychiatric field that BPD is treatable and recovery is possible ways to go, but at least it's getting out there. Here's an exciting one. Research, science, neurobiology, are all making incredible advancements and are making up for lost time again, the lost decades. The most fascinating stuff is coming down the pike. Here's a really important one. I Think that gives me such the potential for recovery almost lies for me in this next bullet. DBT and other treatment methods put the power for recovery in the hands of the patient. You know, you can practice discipline and autonomy in the face of the greatest suffering, and you can do it on your own. And so having that, all
Helen Sneed: those skills that I use without, without even thinking, without even blinking in my life now, it allowed me to save myself, to save my own life. And that really is the point, you know, because you can't just continue to cling to others. You have to be able to step out and take charge and have agency. And that's one of the things that gives me the most hope. And so I think that the hope comes from the belief that BPD can be overcome. They're proving it now. We're seeing it. See, I'm sitting here talking to you guys. It's not a life sentence. So, Eric, what advice do you have for people who are fighting BPD today? You know, in terms of optimistic, you know, things to tell them about how they, you know, why should they keep fighting?
Eric Kunisch: Well, some of the things we've already talked about, like you were talking about 77 to 70% recovery with treatment. There's lots of research on DBT about that. There's some on mentalization, and some of the other things have proven to be effective. There's lots of things going forward, and there's more skills like other people can be, like their family members can get on board as far as reinforcing some of the good things going ahead. Some of those things that we've talked about and one of the things you say at the end of your podcast, sometimes I'm getting ahead of myself, but I love the onward. So I'm sorry, it's spoiler alert there. Keep on going. I think Churchill said something. If you're going through h***, don't stop. Don't be stuck in miserable feelings. Just keep on going.
Helen Sneed: Keep going.
Eric Kunisch: It's looking better and better. The more people know and the more more we refine our DPT and other skills.
Helen Sneed: Is what would you say gives you the most hope? This just now, as you're as sort of as we're just talking here, is there one thing you can identify?
Eric Kunisch: I think that the skills and the skills work with other disease states because we have. Our people often have other disease states. Distress tolerance skills. With my love, when she's got other things that are really scary and kind of like the bipolar voices type things. And you find some of these skills, they work too so there's in other places and just I think that gives me the hope. And maybe number one, what gives me the most hope is people like Valerie and you. You particularly, as far as the BPD that you've been working so hard and you've done so much volunteer work for the rest of us. You're kind of like Marsha Linehan that decided that she wanted to go back into h*** and pull some other people out. You've done it.
Helen Sneed: Well, thank you. I guess I should just flip that very quickly and say that, you know, you kind of brought me into this whole thing and working with your family connections and you're including me in that and treating me like a rational person instead of, you know, some crazy woman. Just made all the difference in the world to me. And that's the kind of treatment that I hope for everyone who has this illness. And we know Valerie's one. We know Valerie's perfect.
Eric Kunisch: Well, if you're crazy, so is Marshall Linehan. We may need some more crazy people to just keep on going onward.
Valerie Milburn: Okay, well, I think like I said, we have said earlier when we were talking about doing this podcast together, we have a mutual admiration society going among the three of us. I think we all work really hard to make living with a mental health condition possible, to do well, to do it in recovery and to help others. And I know that's our goal in this podcast. And Eric, you have brought much to the conversation and really enriched it, brought a lot of knowledge and a lot of hope. And we just thank you so much for joining us today.
Eric Kunisch: You're so welcome. Thank you for your bravery and persistence. Y' all are, to me braver and
Eric Kunisch: my daughter and other people are than myself, I think, in so many ways. So thank you.
Valerie Milburn: Thanks, Eric.
Helen Sneed: Well, we really, really appreciate it. And this subject of BPD is so vast and fast breaking that we won't close, but rather stop for now. Dr. Blaise Aguirre states his belief about recovery. He said the person can recover if they can see their own greatness, that they are as essential to the universe as anyone else. I'd love that. Marshall Linehan put it this way. It is hard to be happy without a life worth living. This is a fundamental tenet of dpt. What is important is that you experience your life as worth living. One that's satisfying and one that brings happiness. From these two great experts who have helped thousands comes a beautiful message for every individual with bpt. It is what I wish for all of us who have it now. Valerie will lead us in a mindfulness exercise.
Valerie Milburn: Yes, I will. We will close this episode in our traditional way with a mindfulness exercise. And Marsha Linehan, who we have quoted a lot, stresses the importance of mindfulness in the treatment of bpd. So I'm happy to close as we always do. And what is mindfulness? I always give a definition. Mindfulness is a mental state achieved by focusing one's awareness on the present moment while calmly acknowledging and accepting one's feelings, thoughts and bodily sensations without judgment. Today's mindfulness practice is called Practicing Mindfulness and Self Compassion. This is an ideal mindfulness practice for those of us who struggle to show ourselves compassion, even if we may be quick to extend compassion to others. It's also a great way to practice mindfulness by bringing awareness to emotions and staying in the moment with those emotions. So let's begin. Close your eyes if you can. Settle in and breathe as always. Let's begin with a few diaphragmatic breaths. Whether your eyes are open or closed, let's steady our breathing with two diaphragmatic breaths. When you do this on your own, take as many breaths as you need to become calm and centered. I usually take 10 diaphragmatic breaths to start my mindfulness and meditation practices. Let's breathe. Inhale through your nose, expanding that balloon in your stomach as you inhale. Hold it for a second or two. Exhale through your mouth, pulling in your stomach as you do. Forcefully exhaling again. Inhale through your nose, expanding that balloon in your stomach as you inhale. Exhale through your mouth, pulling in your stomach, forcefully exhaling your stomach all the way in. Keep this slow, steady breath going. Begin our self compassion exercise by moving a hand to your chest or giving yourself a hug, or resting your hands on your knees. Let's take an important step of acknowledging a difficulty in your life right now. Choose something that is not overwhelming. The aim here is not to become overwhelmed, but rather to acknowledge the difficulty as real while giving yourself permission to feel it. So what is something difficult but not overwhelming in your life right now? While holding this difficulty in mind, repeat the following statements out loud. This is difficult. Difficulty is part of being human. May I love and accept myself
Valerie Milburn: just as I am now? Continue to take a few slow, deep breaths and feel this self compassion. Open your eyes or gently bring yourself back to the present. Look around the room, get settled, and thank you for doing this mindfulness exercise with me.
Helen Sneed: Well, thank you, Valerie. It's interesting that it's something that we focused on so much today as being part just a critical part. Well, I guess the very basic part of recovery in many people's estimation. I also want to thank Eric for giving so much today. You are so generous with your knowledge and with your compassion and with your experience. I think we all learned a lot and you're just terrific. I want to thank our audience for listening and giving us the chance to discuss BPD due to a phenomenal response to our first episode about aging and mental health. In our next episode we'll continue the discussion with an expert on the impact of aging on our mental health. Please join us for an eye opening conversation. Until then, I leave you with our favorite word and Eric's Onward.