Turbulent Minds Collide [ABC RN]

Turbulent Minds Collide

– an Australian Psychiatrist – Dr Gordon Parker – has written a fictional work about two persons living with a mood disorder
– one character, Martin, has a deep, biological depression (also known as melancholia which can exist by itself, or it can be the down mood state for someone with Bipolar Disorder) which then develops into a manic high
– Martin meets a young woman, Bella, with Borderline Personality Disorder & they form a relationship – a sexually passionate one week affair – until it explodes
– Martin is hospitalised as a consequence of a manic high – & there is damage – as a consequence – which needs to be repaired
– the reader is confronted with 2 questions regarding a person who is confronted with Bipolar Disorder:
1) who am I – given the years & years of mood swings?
2) when I was in a manic state & did outrageous things, does it mean that such behaviour is latent (& waiting to be unleashed) or can all people do things that are completely incompatible with their personality?
– it took a number of years for Martin to be diagnosed
– the character, Martin, turned to poetry & literature, to understand what was going on
– Hippocrates 2,500 years ago described melancholia – it is a severe physical state – where the person cannot lift their head from the pillow, has no energy generally, are unable to derive pleasure in life, their concentration is foggy – they may also have what is called diurnal variation – I.e. where their mood & energy improves as the day wears on & they go into a high-risk domain thinking about suicide
– when suicide occurs, the person is not being selfish – according to Parker – bit are in fact unable to move beyond the domain of self-focus & the agony of enduring day after day
– manic phase has a number of indicators: such as pressure of speech, associations & creativity of the linguistic associations; the super-sensory nature of bipolar disorder – they taste things, smell things, hear things which are not detected to the same extent when in a so-called “normal” mood; & sex drive/libido tends to go through the roof – all quintessential components of a manic state
– Bipolar Disorder Type 1 – what was once known as Manic Depression
– Bipolar Disorder Type 2 – where the individual has the mood swings, but is never psychotic
– Bipolar Disorder Type 3 – says Parker – certain drugs such as anti-depressants can induce a manic phase – Drs need to manage this
– correct diagnosis means enabling the correct medication to be prescribed
– Borderline Personality Disorder – Parker notes – when first used to describe a person, the term referred to the person being on the “border” of being diagnosed with Schizophrenia – now the term means a person with a particular personality style – it typically has its origins in the form of some terrible trauma in childhood – the most common being sexual abuse, & as a consequence of the trauma, the person’s anxiety is so high they tend to de-personalise & they never develop a clear sense of their identity/who they are – then when the person with Borderline Personality Disorder gets into a relationship with another person in adult life, they end to replay the dynamics – if they were sexually abused as a child by their father (factors are typically more environmental rather than genetic when it comes to BPD) they tend as an adult to get into relationships with older men (according to Parker) & feel a great need to get close to this person (often placing them on a pedestal) before then seeking to bring his person down – this causes “absolute turbulence” / severe consequences in relationships – it is a desperately severe condition for the sufferer & there is a high suicide rate & self-harm is also extremely common (such behaviour is to replay the past according to Parker with the view of trying to resolve past relationships & ultimately meet the “perfect man” – though this rarely if at all happens for the person with Borderline personality traits & style
– Bella wears high top gloves to hide the scars of her self-harm behaviour
– Marsha Linehan’s DBT is cited
– diagnosis of Borderline Personality Disorder is highly controversial, and many believe it to be the most stigmatised of mental illnesses
– Parker believes “personality disorder” diagnosis is often short-hand for a practitioner not liking a person | he believes Drs should not speak in such terms to patients or write to other Drs saying that a patient has a personality disorder, but instead describe the personality traits that are acceptable to a patient without being insulting
– Parker notes also that there is a sub-group of people – within the personality disorders diagnoses of the DSM-5 – who are keen to have a diagnosis & say to others that they have a Borderline Personality Disorder – because of the effect of DBT – thereby allowing themselves to explain to others why their behaviour is so seemingly inexplicable & why there is such turbulence in their life
– Parker notes that Borderline Personality traits are difficult to treat – because such people are often very good at manipulating other people – & their high-rate of dangerous behaviours (multiple overdoses, self-cutting, series of self-destructive behaviours a Parker cites how an argument in a car on the highway, might see the person throw themselves out of the car while it is moving) ; however, Parker also notes that Borderline Personality traits do “burn themselves out over time” – the impulsivity, the turbulence, the self-destructiveness is “settling”
– Bipolar has a red hot domain & a black pit of despair – with a lot of volatility & movement
– Borderline is also a domain of turbulence
[Parker also notes that many psychiatrists report it is extremely difficult to distinguish between Bipolar & Borderline traits/characteristics – he personally; however, does not believe it is difficult to distinguish the two diagnoses]
– Psychiatry operates to a Diathesis-Stress Model – I.e. there is some predisposing factor (environmental or genetic) & the condition will then appear following some acute stressor in a person’s life
– Parker notes how Drs often have “boundary violations” with people who have Borderline personality traits
– Parker’s story captures the noise & intensity & loss of freedom from being hospitalised in a psychiatric ward / they are also people with kind practitioners
– Parker notes also that Bipolar Disorder has not been de-stigmatised with respect to career progression (compared with depression) within the workplace

Source: ABC RN Allin the Mind | Podcast date: 2 April 2017


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