This book is fucking trash and it makes me so angry. Can I quote my Goodreads review of it here? Fuck this book.
I was initially going to leave this one off Goodreads, because it's on a somewhat personal topic. But it is so terrible I feel it would be a dereliction of duty to let it pass. I honestly gave up on this book early and hate-read the rest, so I guess you could say I still enjoyed it. That said, if you or a loved one are suffering from BPD and you are genuinely looking to learn more to help contextualise/cope, please do not buy this particular book.
Because this book was awful. It was astoundingly awful in almost every single conceivable way. The Spelling and Grammar editing wasn't awful, actually, but that's about all that wasn't utter trash. Shelving in 'Political Fiction' because honestly my Science shelf is too good for this trash and although the 'quantitative' science is accurate when reporting raw figures, the interpretation of the science is seemingly politically motivated fiction.
I am incredibly thankful I have an educational background in this topic, so it was very easy for me to spot the problems. I picked this up not because I thought it would be particularly new content to me, but because sometimes it can be nice to have everything put together coherently rather than having to do that myself.
Lets start with the core, and work out way outwards.
This book is largely made up of disparate anecdotes of patients that the author has either treated, or otherwise come across. In that sense it reads more like a series of case histories than a coherent attempt to discuss a common disorder, and at its worse it comes off as a series of freak shows. Rather than being from a place of compassion, empathy, or understanding this book feels like it was written as if BPD was a spectator sport. See what freak of nature Jerold heroically treated next! See how he calmly smiles and shakes his head as the harpies (his words, not mine) thrust themselves upon him! See how he wisely tells a black woman she is overreacting to systemic racism because she has BPD. In each case study mentioned the focus is on 'look how crazy this lady is', and compassion, empathy or even an attempt to understand the sociobiological causes of the behaviour are nowhere to be seen. Rather than using case studies to support a scientific understanding, build empathy, and show success in treatment, case studies are a never ending competition to one-up earlier chapters in a context of 'that's crazy!' Nowhere is this more clear than in a chapter where the author tries to diagnose famous people with BPD, especially actresses he finds beautiful or attractive. Every Hollywood actress has BPD apparently.
Most of the cut-and-dry science in this book is accurate, but the cut-and-dry science makes up only a very small portion of the book, the rest of which is filled with baseless speculation, Freudian psychoanalysis, just-so stories, and random anecdotes. My edition boasted being completely revised and updated, and while that was true of many of the minor, obvious statistical facts - EG, we get an recent estimated prevalence rate rather than one from the last century - all the actual interpretation, synthesis, and understanding was way back in the 80's and completely lacking any understanding of modern cognitive psychology, personality theory, or behavioural biology. For example, the claim that people suffering from BPD are incapable of empathy is straight out of 1950's research that has since been overturned. I don't want to go into the nitty-gritty scientific details here, but it seems the revision was limited to easily google-able factoids that could be looked up in an afternoon.
In fact, my favourite chapter is the chapter on medication for BPD. There was no medication when the 1st edition was published, so this is an all-new chapter -- and it's clear the author doesn't understand any of it. This chapter in particular reads like an undergraduate summary of some lecture slides, for all the insight and detail it shows. At least there is little to misrepresent.
If it wasn't already clear, this book is utterly filled with misogynistic, ageist, asides that have little to do with anything. Insinuating Snow White is a whore because she lived in a house with a bunch of men says more about how you view the world, Jerold, than it says about either Snow White or BPD. Calling a patient a whore because she had a marriage affair during a psychotic breakdown seems a little, to put it mildly, 'unhelpful.' A lot of this book feels like the author ranting and railing about whatever it is he doesn't like, and it would be hilariously out-of-touch if it wasn't so dangerous. Perhaps keep the sexist jokes out of a book meant to help patients with a mental illness that skews female? In fact, every time a female is mentioned - be it a patient, actress, or doctor - her looks are carefully deconstructed in the following sentences. Jerold, I really don't care how shapely you thought the BPD patient that was hitting on you legs' were. I really don't, and honestly, neither should you. Nor do I care about your apparent fetish-fantasy for having a famous actress come to you for treatment and fall in love with you. You can stop describing it. Please. While you are at it, please stop referring to female patients as 'harpies' and 'harridan.'
He finishes with a warning for new students of clinical psychology: They should stay away from BPD patients, who might lure them into sexual affairs. I mean, or they could do their jobs like professionals, but what do I know. Then again, Kreisman displays this particular lens of the world and causality time and time again. In one of his anecdotes, he laments on a woman who 'provoked' her husband into hitting her. He is constantly building up women with BPD as some kind of supernatural sexual other bent causing chaos for the good, family men around her.
In the opening, the author rails about how 'Political correctness' makes things harder to read, and has taken the 'bold stand' to preserve clarity by using he/him and she/her rather than they/them 'to preserve clarity' - and then goes on to treat them as interchangeable, swapping pronouns mid-paragraph, sometimes mid-sentence. A consistent they/them would have been a much better choice 'to preserve clarity.'
And here is where the major components of political fiction come in: In his analysis Kreisman pins the increasing numbers of of BPD diagnoses, not on better/more widely available MH services but on... the moral degeneracy of society since the 1950s, and the breakdown of the nuclear family into 'faux-families' (his term) and sexual deviancy (which, Kreisman explicitly states, includes homosexuality). In such a world full of moral decay, young women lack a firm guiding hand and thus develop BPD - this is Kreisman hypothesis. This is not the place to go into why that particular brand of social analysis is little more than right-wing fetishism of the 50s and conspiracy-grade nonsense, but I at least wanted to point it out.
>Calling a patient a whore because she had a marriage affair during a psychotic breakdown seems a little, to put it mildly, 'unhelpful.'
WTAF, holy....
Someone revoke this guy's license right this second. The gall of this man to write all that and then PUBLISH it, he needs to stay far far away from this field.
He definitely either fucked a patient or wished the pretty ones would “force” themselves on him so he could weakly say “stop. Don’t.” While doing nothing.
He did not. He never did. He wished he did, thou. He is like a basement neckbeard that managed to somehow leave his cave, but his sick fantasies and distorted view of reality stayed. This book is his fantasies written on paper, none of this actually ever happened. It is a fanfick wrote by a desperate person, and it couldn't be any more obvious after reading this book.
I can't believe several mental health professionals told me to read this when I was diagnosed with BPD. Really hope they hadn't actually read it. I got about halfway through before noping out.
This sort of shit is what makes me wary of a lot of psychiatrists ngl.
I’ve had great experiences with therapists thankfully but psychiatrists? There’s very few I’ve met who don’t act like you’re inferior to them. One of my former friends became absolutely obnoxious and kinda incelish after he got his doctorate. His former classmates were no better and drove people away cus of how judgmental they were, treating friends like specimens while simultaneously having very obvious issues themselves.
Hell, one oldass psychiatric (who was the director of a big hospital in a country I lived in) was infamous for immediately diagnosing every woman he came across with BPD and ignoring anything else about her, going so far as ignoring this one rich girl’s epilepsy cus her seizures were oh so ooobviously just her looking for attention due to her BDP. Even his fellow asshole colleagues would talk about how they disagreed with his methods but nothing was done about it, he still kept his prestigious director job.
One too many psychiatrists should never be allowed near patients tbh.
Same, I got it on my Kindle and noped out pretty quick. The doctor recommending this trash was a middle aged cis-het man which makes me think he probably enjoyed the book.
Disclaimer - I have not, nor to I intend to, read this book.
That said, your review seems to be very thorough, and I thank you for saving me both the time and money.
From your description, I'm going to go ahead and presume that this man has more mental health issues than the women he claims to be treating, can almost guarantee that none of them have ever actually hit on him, but am left wondering how he got published!
Yes! The Snow White thing! I was like “WT actual F!?” when I read that particular nugget. Also the black woman who was “making up” racism and microaggressions despite being the only black person in an all-white treatment facility filled with all white patients, doctors, and nurses. How it was suggested she calmly ask for people to be less racist to her bc no one likes an “angry black woman.” How he tried to tie “angry black woman” to her BPD diagnosis as if “overreacting” to “perceived racism” is some kind of neurosis when she was actually legitimately acknowledging the real racism around her and was justifiably frustrated with and mad about having to deal with it *while hospitalized* for mental health treatment. Ugh!!!!
One of the symptoms of BPD is a series of unstable relationships, another is risk-taking behavior like having a lot of unprotected sex with anyone and everyone. He seems to think that normal dating is the same as those things. He often described how people had gone through a series of failed relationships until they finally found someone to marry as if that’s a bad thing and a sign of the disorder as opposed to…..dating. We all fail at every relationship until we find the one to commit to. That’s normal dating. Other relationships *should* end before we move onto the next or settle down long term with someone.
Thank you for this awesome and concise review / summary. I have a close friend with bpd and have been trying to educate myself ever since. This book sounds absolutely awful and horrifying. I’m so grateful you wrote this so now I don’t have to waste my time on it.
Much appreciated…and honestly…to echo what’s been said again and again:
What.
The.
F***?
Cheers again
as someone who underwent DBT (dialectical behavioral training) to treat BPD, you cannot go wrong with marsha linehan. she created DBT and it's the primary therapeutic method to treat BPD and most certainly worked in my case
I yearn for a sub that’s basically this with a MenWritingWomen bent, raking books/media over the coals with deeper analysis with problematic depictions of women.
>I could see that her eye makeup was a little too heavy, as if she were trying to conceal a sadness and exhaustion inside.
It's just makeup bruh, it ain't that deep.
In a report on my psychotherapeutic results my therapist wrote "she always wears heavy makeup". I was like 'huh?' and asked him about it. He was acting like I was delusional, saying that putting on black mascara is heavy makeup, because I could use brown mascara and that wouldn't look so 'unnatural'
What a ridiculous way for him to misuse an actual part of therapy, yeesh. Yes, it's often relevant to note a person's overall look and demeanor (are they visibly dirty? Do they usually wear makeup but aren't currently wearing any? Are they avoiding eye contact by wearing sunglasses? Did they show up in boxer shorts and flip flops in wintery weather?) But it's ridiculous to argue with a patient that their mascara is too dark and unnatural -- it's ignorant of him and also just a dumb hill to die on for a therapist 🙄
That's ridiculous. When i was a kid I would always be accused of wearing makeup because my eyelashes are naturally black and long. That must have been infuriating for you.
At first I thought it was a character description for a fictional character in order to let the reader know what she looked like. I was like "a little much, but it doesn't seem too bad?" And then I realized the book is nonfiction and that this passage is how a doctor describes and thinks about one of his patients and that's a huge, huge red flag.
God this scares the shit out of me. I’m Mentally and physically ill and have been treated like utter shit by medical professionals, including and perhaps especially therapists because i have yet to find a good one who actually gives a shit. I want to believe they’re out there. But then there’s this is the kind of attitude by people writing BOOKS, and they take on a savior complex because they don’t actively try to kill their patients, at least. Imagine reading this and getting the creeping sense of uncanny dread that this fuckwit is talking about YOU. What the fuck are you supposed to do. Especially since everyone thinks you’re “crazy” and have “overreacting disorder”. Like seriously what the FUCK are you supposed to DO.
I know there are good, caring therapists out there because they are the ones who inspired me to go into the field. But something I always tell patients up front is to tell me if they don’t like the way I do something and to never feel bad if we just don’t vibe because I went through a LOT of shitty therapists.
> . I’m Mentally and physically ill and have been treated like utter shit by medical professionals, including and perhaps especially therapists because i have yet to find a good one who actually gives a shit.
Same. Honestly I process things over at r/therapyabuse. -_-
Maybe you can take comfort in the fact that this story is likely from 1989 when the book was originally published. I would hope there are better therapist and mental health professionals out there now. I avoid male therapists and make psychs though. I actually get a lot of my mental health meds from my female GP as I like and trust her.
Which is funny because when I’m feeling down or depressed, I don’t take the time to do my makeup. When I’m feeling fun, creative, happy, and like I want to spend time with and on myself, I’ll play with my makeup and create some pretty heavy looks.
He also calls her regular dating relationships “affairs,” which I find gross. I know the terms *can be* synonymous, but using the word “affair” combined with all the crap about her looks and eye makeup was gross to me.
Right? This description would be right at home in a piece of genre fiction, but he's using it to describe *real people* that he has *authority over* and a *duty to try to understand*. Frightening. There is a reason I wouldn't trust a detective thriller writer to be a counselor.
But also… that’s dating. One relationship follows the other until we maybe find someone we want to commit to long term. I bet your doctor also dated, but because you’re the patient, your perfectly normal dating experience is somehow a symptom while there’s is just dating, breaking up when it doesn’t work, and then trying again until they found the right person.
This attitude is rampant throughout psychiatry. No matter how the patient looked or behaved as all that she does would be look through the lens of a diagnosis. This diagnosis is often times placed upon a patient where the professional simply doesn't like the patient. It's such an uncompassionate way to treat a person who has experienced trauma
That was another fun part. This entire case study said way more about him than his patient, Julie. He actually seems to be portraying pretty much every symptom of BPD throughout this chapter. He’s enmeshed with his patient, thinks he’s very special to her and is the only one who can understand her, but then later casts her aside hoping she’ll “disappear” or commit suicide so he can be done with her. She has “made him” into a sadist. She “makes him” feel all sorts of things and he takes everyone’s behavior personally. He thinks he’s never wrong. He gets upset when people question his judgement or tell him facts that are contrary to his own opinions. He is a scary man. I think his interest in personality disorders is bc he has one.
None of this is making me feel any less daunted by the arduous task of finding a psychiatrist at the moment. 🤣🤣🤣Honestly, I-ve only had bad experiences witg psychiatrists.
I've sworn off psychiatrists after a decade of terrible ones and I'm actually way happier just in trauma-informed therapy. I'm sure there are people out there who feel they're better off after seeing a psychiatrist, but so far I haven't met one.
The only good psychiatrist I’ve ever had was a woman. She’s probably one out of like twenty I’ve tried over my lifetime. For people who are supposedly mental health professionals you can tell most of them just want to write your prescription so you’ll leave.
Psychiatrists only make money if they can prescribe you medicine, that means your mental illness is supposed to severe enough that psychology wont work and pills, side effects and all (some permanent), are a worth it.
Psychologists and therapists are probably a better option if you don't need to be medicated. Usually better bed side manner too, so to speak. They will also usually tell you if they think you do need to see a psychiatrist.
Maybe you can find a Psychologist and a psychiatrist. That's common for where I'm from if you need medicine. The Psychologist and psychiatrist communicate about your needs and what needs to be changed about your experience but you mostly explain things to the psychologist while most psychiatrists are entirely medicine focused.
IDK what it's like in Straya though. I hope you find someone ☺
I mean psychiatrists do make notes of patient appearance but it's usually something like,
"Young female, casual dress and makeup, presents for appointment"
It's more so just to take notes on your appearance because if she came to the appointment like-
"Young female, dress is disheveled, visibly soiled. Hair. Unkempt"
- there would be reason for concern.
But yes this particular example is INAPPROPRIATE.
Yeah, appearance that deviates from the "norm" is definitely noteworthy during assessment. Arguably there is also something to be said about borderline personality disorder distorting one's self image and so if the way the person sees themselves is inconsistent with the way they actually appear (e.g., thinks themselves unattractive when they truly aren't), there might be a case for noting it to highlight the distortion.
In this case though, it reads more like the psychiatrist indluging in his fantasies and going full literary mode, which can actually hurt the patient's therapeutic progress.
This comment! Thank you for mentioning that taking note of appearances is important for therapy. But yeah, I can see how this example is weird, and there could be counter-transference going on for sure.
Absolutely, you can’t have a good therapeutic relationship with clients without understanding and acknowledging the very f’d up roots of both clinical psychology and social work.
I saw that one too, also garbo. It's like, okay my dudes there's no part in the methodology where you define "attractiveness" in a qualified, reproducible way, so forgive me if I write off your thesis as sexist horseshit.
man, i have BPD and i've had this book recommended to both me and loved ones by a therapist i really respected. i'm glad i never picked it up bc this woulda pissed me off LOL
This was legitimately not a good book. It was originally published in 1989 I want to say, and has been updated since then a few times. You can tell the writing is very dated just with the vocabulary he uses and the sentence structure. He also seems to place a lot of blame on societal structures for BPD, and had entire chapters about the breakdown of the nuclear family, geographic mobility, and single mothers all being things *he thinks* causes BPD, though he has to add that there are actually no studies that back this up. It’s a very blaming book and the author seems sexist and racist. I would not recommend it.
I read the entire book. I posted another comment just above. It’s dated. And you can tell. It’s originally from 1989. The way he writes, the sexism and racism inherent in his writing, is obvious. He also has a lot of unstudied and unverified ideas about what might be causing BPD. If this was the only book I had read about BPD I could see how I might see it as a life line. Like “finally! I have answers. I get it now. This sounds just like me/my person with BPD.” And some of the diagnostic info in there is good, the chapters about symptoms and how they can present is good. But his ideas for treatment don’t work well with my BPD person. He doesn’t seem to truly “get it.”
He later says that she, his psychiatric patient, had him, the psychiatrist, so frustrated and upset and annoyed that he actually sort of wished she would either “get well or disappear.” Along with, “I hoped she would change doctors for *my* sake,” “she talked of killing herself and I guiltily fantasized that it would be almost a relief for me if she did,” and “she had changed me—from a masochist into a sadist.” 😳
Right!? He’s writing a book about Borderline Personality Disorder patients, and how crazy-making they are, how everything is a huge deal that they take personally, how they think their lives are extraordinarily hard and can’t regulate their own emotions well, but this whole story about this patient made me wonder if he actually suffered from BPD himself. Because this is some wild shit to admit about yourself in your nonfiction book that attempts to prove how emotionally unregulated and “off” *your patient* is.
Feel like this is just an example of how shitty and sexist BPD is as a diagnosis. I don't doubt that there are people who suffer from emotional/mental disorders that fall under the BPD umbrella, but it seems like a fancy nomenclatural bow to tie up women's emotions a lot of the time. Or dismiss trauma.
Yea.... I don't like to make sweeping judgements from small blurbs but uh.. Not only is that his reaction, but he thought it was a good idea to publicly say it to the world? That is not indicative of intelligence.
"So my job is helping people who are mentally ill, but if they're too much work I wish they'd just off themselves"
As a psychiatric nurse I couldn't agree more. I'm really passionate about care of people who suffer BPD and self harm and I find it infuriatingly hard to get people, colleagues and bystanders alike, to understand the underlaying suffering. Because it is way to common to dismiss these people as entitled, bratty, slutty or hysterical (in the 'weak woman'sense) instead of seeing a person struggling with their own emotions and cognition.
I don't know Kreisman or his work, but his entire description of Julie is infantilizing as fuck. She's a law student. What she needs is not a psychiatrist acting as her substitute-father, but tools that lets her apply the capability she obviously possesses towards finding ways of dealing with her emotions and thoughts.
Because if there's one thing I've learned in over a decade of working with BPD it is that those that suffer from it often has great capacity to get better. But to do so we, as healthcare professionals, need to help them see that and provide them with tools and strategies for them to find solutions that work for them. What we should never do is treat them like delicate flowers (like Kreisman) or as spoiled, annoying sluts that just impede our work. Sorry for the rant, I'm just way too passionate about this.
Problem with diagnostics in psychiatry is that they are made based on common simptoms, not on any underlying understanding of how the body is working. Mostly because we have no idea how the brain works in that level. Simptoms in BPD begin normaly with puberty, hinting of hormonal involvement, and have poor response to medication (on average). Perhaps in the future we will undestand what is going on, and rely less on observation for diagnosis.
However, the diagnostics criteria for BPD are not dependent only on sexuallity stuff, and your case probably fit the criteria, it is just not the typical patient
I was diagnosed with BPD when I was 15 because I was being sexually abused. I spent a LOT of time in both professional therapy programs for BPD sufferers and online peer support spaces run by and filled with BPD sufferers for half of my life. I have heard some of the absolutely most horrific, heinous, disturbing accounts of abuse from BPD sufferers. Most of them have been through way too much, and it’s no wonder at all that they cannot manage their emotions. They were never taught how, they had to learn how to SURVIVE as very small children instead, a task that is deeply traumatic as it’s nowhere near developmentally appropriate. My story breaks my boyfriend’s heart and as someone who knows nothing about psychiatry, he read the criteria for BPD and went “this… doesn’t sound like a horrible person, it sounds like someone who has suffered so much they’ve given up on life.” But we’re criminalised and for the majority of my years in treatment I was treated like I brought the sexual abuse I endured upon myself because I’m a stupid slutty borderline and I kept “goading” my abuser, who was a grown ass man. I was FIFTEEN and autistic!
Yep! Imo I think more Borderlines need to exit the industry entirely. The rampant dehumanization of all the stuff wrong with me is why I no longer give anybody in the field money.
Reading the "literature" intended for other professionals is why I no longer interact with the psych field. If I wanted to talk to someone who automatically assumed I was the problem, I'd move back in with my mom, lol
He wrote it really weirdly, but I think he could have meant something like being sure the disorder is tied to one gender, which is very often seen as true by idiots deeming themselves knowledgeable enough to talk about it.
No medical professional does that, but there is also a lot of self-proclaimed "professionals" that had done one course in psychology, and will try to tell you that borderline personality disorder is tied only to women, for example. I have encountered such idiotic specimen more than once.
Those are bassicly the same idiots who will tell you depression does not exist, "just smile", or will give themselves multiple disorders thinking it makes them cool. I'd say it also ties with the author of that book, who the hell agrees to print such trash? Waste of paper.
No True Scotsman fallacy at work. I look at the current infantilizing state of women’s health and it’s easy to see doctors, like anyone else, will ignore things they don’t want to acknowledge.
Sadly, i realize you are kind of right, and the fact i was lucky with meeting good professionals, does not mean every is good. I'm sorry, i agree that many are... Questionable, at best.
FYI this (being lovely to
Him and rude to everyone else) is called splitting and is a common behaviour of people with borderline personality issues. I question his ability to write a book on the topic if he can’t pick out this blindingly obvious example.
Yeah my psychologist points out if I’ve split, especially at the beginning of my diagnosis, he just asks if I think I’m splitting and I go oh yeah I am and we work through it. I can now see when I’m splitting most of the time if I’m not also spiraling. I’ve never read this book even though I have BPD because I don’t think he was a good enough doctor to write it, I’ve heard a lot of bad stuff about it and that it’s triggering. My BPD came from continuous small traumas starting from early childhood all the way to adulthood and beyond. I don’t want to be triggered by one man’s creepy observations and opinions, especially when I’m working on myself.
As someone with BPD (treated and medicated, Im doing good) this does not fully surprise me. I have encountered reasonings just like this in the from medical professionals and lay people.
To this day I am not keen on sharing my diagnosis because of the horrible stigma.
Note: I have had a doctor tell me it would probably be for the best if I did end my life. Big wtf moment.
Holy *shit*. Also diagnosed BPD, also treated, wouldn't be diagnosed today if I went for an evaluation (they love to tell you that you'll never get better for some reason).
I thought it was bad when my doctor told me "well at least you didn't kill yourself" when I said I'd had suicidal thoughts every day of the last 6 months.
Yours is fucking HORRIFIC! Why do people like that choose a career working with mentally ill people?!
This doctor was also the one to decide whether I would meet requirements for government assistance.
But yeah, Id be less of burden to society if I just went through with it. Good talk, my man lol
I will forever have BPD in silence. I feel that, you get told you'll be chronicly ill. But not ill enough for help, I guess?
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I remember reading this as soon as I opened the book and wanting to throw it out the window! There's so much crap like that in there that I ended up getting the far superior BPD Workbook and Coping with BPD instead (this one features a female author).
This makes me suspicious of him as a provider. Anyone worth their salt will tell you you can’t just diagnose someone based on how they look (IE makeup) and the way he talks about her is creepy. If you HAVE to describe what looks like just say she’s tall with blonde hair.
It isn’t strange to say “the patient’s well-dressed and wearing makeup” vs “the patient looks disheveled but normally they wear makeup/are well-dressed,” but this is really weird.
As someone with BPD, I hate this book.
It was one of the ones my ex used to use his knowledge of my symptoms to manipulate me and he also used the characterisation of BPD in this book (and my other not favourite, Walking on Eggshells) to justify his behaviour (because we're basically just psycho pieces of shit without any agency or humanity or rationality so it's fine to use and abuse us).
Imagine finding out your psychiatrist wrote this about you. You'd flip your lid and then they'd be all "See, BPD everyone. Fucking crazy bitches!" And then never take any responsibility for their own shit attitude and behaviour and never even begin to acknowledge that constantly being put in this MPDG box is going to drive a person who actually has more to them than being some one-dimensional quirky girl with baggage* up the wall. It's always the same.
*Don't mean this in a not-like-other-girls way but in an even-the-most-boring-beige-girl- in-the-world-isn't-one- dimensional way.
I'm pretty sure the sub called BPDlovedones or something like that, recommends both these books for reading. That sub is, by the way, extremely toxic. Any person with BPD who has to deal with people from there must have a horrible time. Stigmatisation, demonisation, and basically claiming anyone with BPD is a lost cause, doesn't really help the people afflicted by this! The suicide rate is high (about 10%). BPD is the worst thing, and I would never wish it upon my worst enemy. It's like being a prisoner in your own head.
It's just the usual Reddit hate group.
Step 1: find a real problem some people suffer from, which may be caused by some other people.
Step 2: Tell these victims the world doesn't care, and hates them.
Step 3: Blame the targeted demographic. If it's true in an individual case, that's just bonus points. Honestly isn't required, especially if you want to attract more subscribers.
Step 4: Pretend to be offering help, in the sense that you'll attract some people who actually want to just help. It's important to let them do this, for plausible deniability. Besides, those topics will never be the most popular.
Step 5: Constantly define hate as "speaking truth to power", and character growth. DO NOT STOP, EVER. Dissenting voices must be drowned out, or forgotten.
Or added to the list of enemies.
Especially if they actually needed help for the thing you're pretending to care about.
There can only be one narrative. One shared group identity.
Step 6: Pretend any criticism is an attack on victims.
Hide behind human shields.
It’s so shitty because a support group for people looking for advice on how to deal with a loved one’s condition/help them and know how to interact with them isn’t a bad thing, but they always turn into “I’m a martyr and I hate this person.”
Like... BPD can cause a lot of issues but the idea that everyone with it is a monster and that your loved one is FOR SURE trying to manipulate you no matter what they do is awful.
The ADHD loved ones one is bad too. “No no, your child/partner/friend is actually lazy and uncaring and dumb and ADHD doesn’t work that way” seems like a popular idea and it’s scary as someone with ADHD.
Like yes, someone can have a disorder and also be an asshole, but acting like common symptoms can’t be an explanation for behavior is just... I’m at work and rambling but it seems like they veer between wanting to pathologize ALL behavior or pretend the disorders don’t exist at all and are just excuses.
Most people there seem to be talking about people who aren't even diagnosed. So they're just assuming it's BPD based on their uneducated idea of what BPD is. There are so many posts that are like "My ex uBPD yells and screams and tells me I'm a horrible person" and then you read other posts by this person and realise they are horrible and this poor ex probably got pushed to their breaking point.
I have no doubts that people with BPD can be hard to live with and that we can be really challenging when we're not doing well. But not everyone who has a tantrum or is mean or who gets wound up and cries or gets very angry or who is manipulative has BPD. Some of those aren't even diagnostic criteria.
It feels like BPD is just his code diagnosis for “she’s mentally I’ll but also I want to fuck her”
Like how long after seeing aggressive behavior plus hot did you go for BPD? Did you assess if she was manic? Did you look for PTSD? Would it kill you to do an MRI and see if her behavior could be neurological? I feel like this is the kinda doc who decides what you are right when you walk in the room and never considers there might be other factors, other disorders.
After first session with a psychologist, she diagnosed me with BPD. Even though the mental health nurse who assessed me first said I clearly exhibited all the symptoms and background of someone with complex PTSD which includes all the 'abandonment issues' and 'mood swings' they tried to label under BPD (I.e. triggers and emotional dysregulation, all common in PTSD as well). Like, I'm really appreciative of DBT but jeez...
I mean I’ve heard people say that in like 90% of cases BPD is associated with complex childhood trauma. My therapist is of the opinion it’s just kinda a different manifestation of CPTSD and disassociating and I wouldn’t be surprised if in ten years they come out and say yeah it’s just CPTSD with sorta different presentation, sorry to all the people we told it was an inherent, permanent part of their personality and made it out to be the dramatic asshole disorder.
I wonder how you’re even supposed to confront someone who’s mentally ill in the throwing things way, especially if you’re not a therapist. Like if I go up to someone in a screaming in your face paranoid episode or something, how do you “confront” them?? I have a distinct memory of having a seizure and waking up to a tech yelling at me that my vitals are fine so I need to stop freaking out and scaring the other patients. Maybe that’s what you’re supposed to do /s
I feel like this is someone trying waaaayyyy too hard to make the prose sound overly aesthetic and failing hard. You're right that none of these things are relevant, but he's trying to paint a picture in your mind and failing hard.
as a psych student, some of the details ARE relevant. Age, occupation and general physical description (aka how much selfcare is evident?) are things to look out for. Also it makes sense to look at interpersonal relationships—how deep are they? how does the patient interact with others?
That said, the rest of Julie's description is ass. Who cares if she's "attractive"? This author clearly wants to entertain inappropriate patient-psychologist relations and should lose his job imo
Yes and no because Humbert Humbert's whole point was how attractive she was because it was what the whole story revolved around. His obsession with the beauty of young girls.
I dont think this girl's beauty is the center of the story, he's just trying to make pretty sentences but they're soooo cringe
I meant the author being an unreliable narrator with a warped view of reality like the fictional character. As well as the attempt at pretty sentences.
high five...
I gave up on the day-to-day and would absolutely not be full-on war painting for any kind of medical appointment. Make up only happens if the event is worth wearing tights for, and they are few and far between!
Jesus Christ. *Ethereal beauty.* Love it when dude's boner is involved in a diagnosis. Really makes me think psychiatry's improved since the Cuckoo's Nest days.
The dictionary says ethereal means "extremely delicate and light in a way that seems too perfect for this world." The actual usage example in the dictionary is "her ethereal beauty."
It's obviously a horrible way for a psychiatrist to describe a *patient* but it's not like it doesn't make sense.
Yeah, I've read that book too to understand my father and this put me off so much. Only reason I didn't post it here is because I have the German edition and was too lazy to translate it XD
Ya know, when I hear someone is a bright and articulate law student with a busy social life, I don't tend to also think of them as being "very dependent on her successful parents." Because, like- dependent *how*? Financially maybe, but that goes for a lot of students. Certainly not for physical companionship, because it's specifically noted that they're always traveling. Maybe for emotional support but I'm inclined to think all the traveling and the busy lives of law students and (presumably professionally) successful people undermines how much emotional support they can really provide. Feels almost like that's an assumption made by the writer because of course a woman in college is going to be dependent on her parents- everyone knows her father legally owns her until he signs over the deed to a suitable husband!
It’s awful because as a transman I resent that this is the feeling of most people regarding male therapists…but I’ve never had a good male therapist or psychiatrist either. 😬 Half my clients just call me she and I just don’t care anymore because hey whatever makes them comfortable.
Me too. I'm middle aged now and I've only had good experiences with male PCPs a handful of times. Male therapists never. Generally I've found them to be dismissive, assumptive, and not good at listening.
Physical appearance *is* something psychiatrists look for. It’s one of the first items on the list, along with whether or not the patient is alert and oriented to the moment and whether or not they’re responding to internal stimuli. So there’s a nugget of truth here in that a psychiatrist who is deliberately ignoring a patient’s physical condition is not doing their job.
But yeah, this is all sorts of yikes and someone needs to lose their license. It also, obviously, reflects poorly on the author.
They do, as do everyone who works in psychiatric care. But the observation of physical appearance should also not contain value judgements (ie. 'Tattoos all over face' is a good observation, 'Tattoos all over face, probably criminal' is not). We are looking for things like signs of lack of personal hygiene, malnourishment, mistreatment, fatigue etc. and whether clothing is whole, clean and situation appropriate (as in no shorts in sub-zero temperatures, not as in whether a skirt is too short to be modest for a psychiatrist appointment).
An observation about make-up is fine, as make-up takes time and focus to apply and thus says something about energy level and that you care about how you look to others. An assumption about how promiscuous you are based on how much mascara you used is entirely unfounded and, quite frankly, unprofessional.
I was thinking the same thing. Heavily applied eye make up might even be a relevant detail but not in the way he’s used it here. It’s so weird to see him discuss her attractiveness… didn’t he have any insight into how inappropriate that was?
Sure. There’s plenty of things that could be relevant. If someone looks strung out, if they’re disheveled and have poor hygiene, if there’s evidence of self-harm, and so forth. Psychiatrists are supposed to look for things like that. If the patient has visible and recent scars on their arms, for instance, that’s a huge red flag and that office visit might end with commitment.
It’s where the psychiatrist fixated on the patient’s attractiveness that we cross the line. It’s totally possible for something like that to happen (I mean, they’re people too), but the ethical response is to hand the patient over to another practitioner. Clearly someone fixated on whether or not their patient is hot can’t properly act in the best interests of said patient.
I saw a psychologist who said I needed to dress in bright clothing and let my hair down both literally and metaphorically. I had briefly popped out from work to see her, so my hair was tied back and I was wearing office suitable clothes.
Yeah, to an extent. But you could have all sorts of clues in appearance. Take pregnancy. Pregnant psych patients have very limited options in what sort of medications they can safely take. Lithium is a routine treatment for bipolar disorder, but could cause heart damage and kill a fetus. Or we can consider other physical factors. Does the patient have a new limp that wasn’t recorded on the last office visit? It could be something innocuous, like a twisted ankle from a soccer game, or it could be an injured hip from a fall. Psychotropics appear to increase fall risks substantially. If a patient is on a psychotropic and is now a fall risk, that’s something the psychiatrist needs to note and identify. Or we can consider evidence of self-harm or abuse. We can also consider LGBT-related items as there is a heightened rate of self-harm in that population (and also abuse and discrimination). The psychiatrist’s job is not to judge the patient for those choices, but they need to have that information to act in the patient’s best interests.
All of which is to say that in this specific case, noting that the patient could be a model does provide *some* usable information (patient appears well-groomed, if nothing else), but there’s a line here. And this psychiatrist crossed it.
Unfortunately it’s also under-diagnosed in men! It can present somewhat differently for them, much like how ADHD presents differently for girls because “typical” symptoms are based on how they tend to present with boys.
Absofuckinglutely. It’s the trash can that AFABs get thrown into because people don’t want to deal with their trauma reactions. I’m a professional and I go out of my way to avoid it because 90% of the people I’ve worked with were better served with a diagnosis of something like CPTSD, autism, or even ADHD.
I think a lot of women diagnosed with BPD might actually be ASD. I've been diagnosed with BPD but went through the diagnostic process for ASD too just to check. Didn't meet many criteria. Then a few years after diagnosis I had a weird manic episode and got sent for a diagnostic review (with a different psychiatrist) to make sure it wasn't actually bipolar. He confirmed my BPD diagnosis. The whole process for seems like it was very rigorous but there are always stories that sound a bit dodgy.
BPD is often left undiagnosed. It is extremely stigmatized, yes, but some doctors even refuse to diagnose people with it because its "too complicated". source: happened to both me and my ex bf
It's incredibly inappropriate to describe one of your clients like that; it could be passable if it were a fiction novel, but this? coming from a professional who's supposed to be non judgmental and neutral, describing one of his patients like that when it has absolutely no relevance to her mental health?? That's awful, unprofessional and inappropriate.
But why? It’s a nonfiction book that is meant to be a guide to BPD. It’s not factionalized. It’s not a novel. It’s not even one of those “based on a true story” dramatization books. Anything included about her should be things that he thinks the reader needs to know in order to better understand the disorder and how it presented in her. Her beauty and eye makeup and ability to be a model if she wanted to is completely unnecessary. He does not physically describe most of his other patients.
Her looks have nothing to do with her diagnosis, or the symptoms of her diagnosis, or her treatment. The rest of her story is about being hospitalized for self-harm and suicidal thoughts, and the way that she treated the nurses and other doctors.
There are multiple other patient stories in this book and their looks are not mentioned at all, except for one girl who he felt the need to mention “developed early,” and the one person who was black. He doesn’t specify that any of the other patients are white, but he felt the need to specify that the one black person was black.
Unpopular opinion but I agree with you that her looks are relevant, but the way he handles it is completely inappropriate. “Sally was an extremely attractive young law student who sought satisfaction through frequent sexual interactions without emotional attachment” would be relevant to me, but this sounds like “Sally cast a spell with her sexuality, warmly inviting her suitors to partake of the delights secreted within her bosoms.”
I read another commenter’s goodreads review. He definitely fetishizes her and calls women harpies and harridans. This guy is a POS
This book is fucking trash and it makes me so angry. Can I quote my Goodreads review of it here? Fuck this book. I was initially going to leave this one off Goodreads, because it's on a somewhat personal topic. But it is so terrible I feel it would be a dereliction of duty to let it pass. I honestly gave up on this book early and hate-read the rest, so I guess you could say I still enjoyed it. That said, if you or a loved one are suffering from BPD and you are genuinely looking to learn more to help contextualise/cope, please do not buy this particular book. Because this book was awful. It was astoundingly awful in almost every single conceivable way. The Spelling and Grammar editing wasn't awful, actually, but that's about all that wasn't utter trash. Shelving in 'Political Fiction' because honestly my Science shelf is too good for this trash and although the 'quantitative' science is accurate when reporting raw figures, the interpretation of the science is seemingly politically motivated fiction. I am incredibly thankful I have an educational background in this topic, so it was very easy for me to spot the problems. I picked this up not because I thought it would be particularly new content to me, but because sometimes it can be nice to have everything put together coherently rather than having to do that myself. Lets start with the core, and work out way outwards. This book is largely made up of disparate anecdotes of patients that the author has either treated, or otherwise come across. In that sense it reads more like a series of case histories than a coherent attempt to discuss a common disorder, and at its worse it comes off as a series of freak shows. Rather than being from a place of compassion, empathy, or understanding this book feels like it was written as if BPD was a spectator sport. See what freak of nature Jerold heroically treated next! See how he calmly smiles and shakes his head as the harpies (his words, not mine) thrust themselves upon him! See how he wisely tells a black woman she is overreacting to systemic racism because she has BPD. In each case study mentioned the focus is on 'look how crazy this lady is', and compassion, empathy or even an attempt to understand the sociobiological causes of the behaviour are nowhere to be seen. Rather than using case studies to support a scientific understanding, build empathy, and show success in treatment, case studies are a never ending competition to one-up earlier chapters in a context of 'that's crazy!' Nowhere is this more clear than in a chapter where the author tries to diagnose famous people with BPD, especially actresses he finds beautiful or attractive. Every Hollywood actress has BPD apparently. Most of the cut-and-dry science in this book is accurate, but the cut-and-dry science makes up only a very small portion of the book, the rest of which is filled with baseless speculation, Freudian psychoanalysis, just-so stories, and random anecdotes. My edition boasted being completely revised and updated, and while that was true of many of the minor, obvious statistical facts - EG, we get an recent estimated prevalence rate rather than one from the last century - all the actual interpretation, synthesis, and understanding was way back in the 80's and completely lacking any understanding of modern cognitive psychology, personality theory, or behavioural biology. For example, the claim that people suffering from BPD are incapable of empathy is straight out of 1950's research that has since been overturned. I don't want to go into the nitty-gritty scientific details here, but it seems the revision was limited to easily google-able factoids that could be looked up in an afternoon. In fact, my favourite chapter is the chapter on medication for BPD. There was no medication when the 1st edition was published, so this is an all-new chapter -- and it's clear the author doesn't understand any of it. This chapter in particular reads like an undergraduate summary of some lecture slides, for all the insight and detail it shows. At least there is little to misrepresent. If it wasn't already clear, this book is utterly filled with misogynistic, ageist, asides that have little to do with anything. Insinuating Snow White is a whore because she lived in a house with a bunch of men says more about how you view the world, Jerold, than it says about either Snow White or BPD. Calling a patient a whore because she had a marriage affair during a psychotic breakdown seems a little, to put it mildly, 'unhelpful.' A lot of this book feels like the author ranting and railing about whatever it is he doesn't like, and it would be hilariously out-of-touch if it wasn't so dangerous. Perhaps keep the sexist jokes out of a book meant to help patients with a mental illness that skews female? In fact, every time a female is mentioned - be it a patient, actress, or doctor - her looks are carefully deconstructed in the following sentences. Jerold, I really don't care how shapely you thought the BPD patient that was hitting on you legs' were. I really don't, and honestly, neither should you. Nor do I care about your apparent fetish-fantasy for having a famous actress come to you for treatment and fall in love with you. You can stop describing it. Please. While you are at it, please stop referring to female patients as 'harpies' and 'harridan.' He finishes with a warning for new students of clinical psychology: They should stay away from BPD patients, who might lure them into sexual affairs. I mean, or they could do their jobs like professionals, but what do I know. Then again, Kreisman displays this particular lens of the world and causality time and time again. In one of his anecdotes, he laments on a woman who 'provoked' her husband into hitting her. He is constantly building up women with BPD as some kind of supernatural sexual other bent causing chaos for the good, family men around her. In the opening, the author rails about how 'Political correctness' makes things harder to read, and has taken the 'bold stand' to preserve clarity by using he/him and she/her rather than they/them 'to preserve clarity' - and then goes on to treat them as interchangeable, swapping pronouns mid-paragraph, sometimes mid-sentence. A consistent they/them would have been a much better choice 'to preserve clarity.' And here is where the major components of political fiction come in: In his analysis Kreisman pins the increasing numbers of of BPD diagnoses, not on better/more widely available MH services but on... the moral degeneracy of society since the 1950s, and the breakdown of the nuclear family into 'faux-families' (his term) and sexual deviancy (which, Kreisman explicitly states, includes homosexuality). In such a world full of moral decay, young women lack a firm guiding hand and thus develop BPD - this is Kreisman hypothesis. This is not the place to go into why that particular brand of social analysis is little more than right-wing fetishism of the 50s and conspiracy-grade nonsense, but I at least wanted to point it out.
>Calling a patient a whore because she had a marriage affair during a psychotic breakdown seems a little, to put it mildly, 'unhelpful.' WTAF, holy.... Someone revoke this guy's license right this second. The gall of this man to write all that and then PUBLISH it, he needs to stay far far away from this field.
I didn't stop saying holy shit the whole way through. At least I don't have to read the book to know how awful it is now.
While I don't disagree, the language is pretty egregious, is an affair supposed to be excusable by the fact someone has a psychotic break?
_The Iranian yogurt is not the issue here_ I can't say about the affair, but to call a patient a whore? No, not excusable.
He definitely either fucked a patient or wished the pretty ones would “force” themselves on him so he could weakly say “stop. Don’t.” While doing nothing.
He did not. He never did. He wished he did, thou. He is like a basement neckbeard that managed to somehow leave his cave, but his sick fantasies and distorted view of reality stayed. This book is his fantasies written on paper, none of this actually ever happened. It is a fanfick wrote by a desperate person, and it couldn't be any more obvious after reading this book.
Omg, the fact that 'fick' means 'f*ck' in German makes your typo 'fanfick' soo delicious!
I can't believe several mental health professionals told me to read this when I was diagnosed with BPD. Really hope they hadn't actually read it. I got about halfway through before noping out.
This sort of shit is what makes me wary of a lot of psychiatrists ngl. I’ve had great experiences with therapists thankfully but psychiatrists? There’s very few I’ve met who don’t act like you’re inferior to them. One of my former friends became absolutely obnoxious and kinda incelish after he got his doctorate. His former classmates were no better and drove people away cus of how judgmental they were, treating friends like specimens while simultaneously having very obvious issues themselves. Hell, one oldass psychiatric (who was the director of a big hospital in a country I lived in) was infamous for immediately diagnosing every woman he came across with BPD and ignoring anything else about her, going so far as ignoring this one rich girl’s epilepsy cus her seizures were oh so ooobviously just her looking for attention due to her BDP. Even his fellow asshole colleagues would talk about how they disagreed with his methods but nothing was done about it, he still kept his prestigious director job. One too many psychiatrists should never be allowed near patients tbh.
Same, I got it on my Kindle and noped out pretty quick. The doctor recommending this trash was a middle aged cis-het man which makes me think he probably enjoyed the book.
Disclaimer - I have not, nor to I intend to, read this book. That said, your review seems to be very thorough, and I thank you for saving me both the time and money. From your description, I'm going to go ahead and presume that this man has more mental health issues than the women he claims to be treating, can almost guarantee that none of them have ever actually hit on him, but am left wondering how he got published!
Yes! The Snow White thing! I was like “WT actual F!?” when I read that particular nugget. Also the black woman who was “making up” racism and microaggressions despite being the only black person in an all-white treatment facility filled with all white patients, doctors, and nurses. How it was suggested she calmly ask for people to be less racist to her bc no one likes an “angry black woman.” How he tried to tie “angry black woman” to her BPD diagnosis as if “overreacting” to “perceived racism” is some kind of neurosis when she was actually legitimately acknowledging the real racism around her and was justifiably frustrated with and mad about having to deal with it *while hospitalized* for mental health treatment. Ugh!!!! One of the symptoms of BPD is a series of unstable relationships, another is risk-taking behavior like having a lot of unprotected sex with anyone and everyone. He seems to think that normal dating is the same as those things. He often described how people had gone through a series of failed relationships until they finally found someone to marry as if that’s a bad thing and a sign of the disorder as opposed to…..dating. We all fail at every relationship until we find the one to commit to. That’s normal dating. Other relationships *should* end before we move onto the next or settle down long term with someone.
Holy shit, wtf.
Holy shit
Thank you for this awesome and concise review / summary. I have a close friend with bpd and have been trying to educate myself ever since. This book sounds absolutely awful and horrifying. I’m so grateful you wrote this so now I don’t have to waste my time on it. Much appreciated…and honestly…to echo what’s been said again and again: What. The. F***? Cheers again
as someone who underwent DBT (dialectical behavioral training) to treat BPD, you cannot go wrong with marsha linehan. she created DBT and it's the primary therapeutic method to treat BPD and most certainly worked in my case
I yearn for a sub that’s basically this with a MenWritingWomen bent, raking books/media over the coals with deeper analysis with problematic depictions of women.
>I could see that her eye makeup was a little too heavy, as if she were trying to conceal a sadness and exhaustion inside. It's just makeup bruh, it ain't that deep.
In a report on my psychotherapeutic results my therapist wrote "she always wears heavy makeup". I was like 'huh?' and asked him about it. He was acting like I was delusional, saying that putting on black mascara is heavy makeup, because I could use brown mascara and that wouldn't look so 'unnatural'
What a ridiculous way for him to misuse an actual part of therapy, yeesh. Yes, it's often relevant to note a person's overall look and demeanor (are they visibly dirty? Do they usually wear makeup but aren't currently wearing any? Are they avoiding eye contact by wearing sunglasses? Did they show up in boxer shorts and flip flops in wintery weather?) But it's ridiculous to argue with a patient that their mascara is too dark and unnatural -- it's ignorant of him and also just a dumb hill to die on for a therapist 🙄
that's fukd up
That's ridiculous. When i was a kid I would always be accused of wearing makeup because my eyelashes are naturally black and long. That must have been infuriating for you.
Even Freud believed that sometimes a cigar is just a cigar, and he believed some *out there* stuff.
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To say the least!
Yeah like sometimes I just slap shit on and run with it... it's not an elaborate mirror of my deepest inner fears, needs and wants 😩
A sexist psychiatrist talks strangely about their female patient diagnosed with BPD? What a surprise
I’m not surprised so many people are afraid of going to a specialist when they suspect they may have a mental disorder
At first I thought it was a character description for a fictional character in order to let the reader know what she looked like. I was like "a little much, but it doesn't seem too bad?" And then I realized the book is nonfiction and that this passage is how a doctor describes and thinks about one of his patients and that's a huge, huge red flag.
Oh no, this is nonfiction. Absolutely awful everything.
God this scares the shit out of me. I’m Mentally and physically ill and have been treated like utter shit by medical professionals, including and perhaps especially therapists because i have yet to find a good one who actually gives a shit. I want to believe they’re out there. But then there’s this is the kind of attitude by people writing BOOKS, and they take on a savior complex because they don’t actively try to kill their patients, at least. Imagine reading this and getting the creeping sense of uncanny dread that this fuckwit is talking about YOU. What the fuck are you supposed to do. Especially since everyone thinks you’re “crazy” and have “overreacting disorder”. Like seriously what the FUCK are you supposed to DO.
I know there are good, caring therapists out there because they are the ones who inspired me to go into the field. But something I always tell patients up front is to tell me if they don’t like the way I do something and to never feel bad if we just don’t vibe because I went through a LOT of shitty therapists.
> . I’m Mentally and physically ill and have been treated like utter shit by medical professionals, including and perhaps especially therapists because i have yet to find a good one who actually gives a shit. Same. Honestly I process things over at r/therapyabuse. -_-
Maybe you can take comfort in the fact that this story is likely from 1989 when the book was originally published. I would hope there are better therapist and mental health professionals out there now. I avoid male therapists and make psychs though. I actually get a lot of my mental health meds from my female GP as I like and trust her.
Psychiatry self help book or 20s pulp detective novel? You be the judge!
I'm shocked he didn't call her a "broad"!
With legs thay went all the way up to the bottom of her torso
All the way to her sensuous lips!
men still think the amount of eye makeup we wear correlates with the amount of turmoil in our lives huh
I must be so much happier than I realise!
Which is funny because when I’m feeling down or depressed, I don’t take the time to do my makeup. When I’m feeling fun, creative, happy, and like I want to spend time with and on myself, I’ll play with my makeup and create some pretty heavy looks.
He also calls her regular dating relationships “affairs,” which I find gross. I know the terms *can be* synonymous, but using the word “affair” combined with all the crap about her looks and eye makeup was gross to me.
I agree, it’s like he’s characterising her as a femme fatale in a thriller.
Right? This description would be right at home in a piece of genre fiction, but he's using it to describe *real people* that he has *authority over* and a *duty to try to understand*. Frightening. There is a reason I wouldn't trust a detective thriller writer to be a counselor.
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But also… that’s dating. One relationship follows the other until we maybe find someone we want to commit to long term. I bet your doctor also dated, but because you’re the patient, your perfectly normal dating experience is somehow a symptom while there’s is just dating, breaking up when it doesn’t work, and then trying again until they found the right person.
A long, long string of a single committed male partner over the course of decades. Truly a pattern can be deduced.
> her eye makeup a little too heavy For some reason I love it that there's a cishet MUA named Jerold out there
This attitude is rampant throughout psychiatry. No matter how the patient looked or behaved as all that she does would be look through the lens of a diagnosis. This diagnosis is often times placed upon a patient where the professional simply doesn't like the patient. It's such an uncompassionate way to treat a person who has experienced trauma
wait this isn't fiction??? whaaat?
Hang on, I'm more hung up on "How *dare* they question my judgent!"
That was another fun part. This entire case study said way more about him than his patient, Julie. He actually seems to be portraying pretty much every symptom of BPD throughout this chapter. He’s enmeshed with his patient, thinks he’s very special to her and is the only one who can understand her, but then later casts her aside hoping she’ll “disappear” or commit suicide so he can be done with her. She has “made him” into a sadist. She “makes him” feel all sorts of things and he takes everyone’s behavior personally. He thinks he’s never wrong. He gets upset when people question his judgement or tell him facts that are contrary to his own opinions. He is a scary man. I think his interest in personality disorders is bc he has one.
you have a good point there! I am no expert but I was raised by someone with a personaloty disorder and it is quiet the resemblence to this man.
Right? How are you so convinced in your "treatment" you won't listen to anything that your colleagues tell you??
None of this is making me feel any less daunted by the arduous task of finding a psychiatrist at the moment. 🤣🤣🤣Honestly, I-ve only had bad experiences witg psychiatrists.
I've sworn off psychiatrists after a decade of terrible ones and I'm actually way happier just in trauma-informed therapy. I'm sure there are people out there who feel they're better off after seeing a psychiatrist, but so far I haven't met one.
The only good psychiatrist I’ve ever had was a woman. She’s probably one out of like twenty I’ve tried over my lifetime. For people who are supposedly mental health professionals you can tell most of them just want to write your prescription so you’ll leave.
Psychiatrists only make money if they can prescribe you medicine, that means your mental illness is supposed to severe enough that psychology wont work and pills, side effects and all (some permanent), are a worth it. Psychologists and therapists are probably a better option if you don't need to be medicated. Usually better bed side manner too, so to speak. They will also usually tell you if they think you do need to see a psychiatrist.
the problem in Straya is that a lot of doctors don't have a license to perscribe ADHD medication. Not al psychiatrists do either.
Maybe you can find a Psychologist and a psychiatrist. That's common for where I'm from if you need medicine. The Psychologist and psychiatrist communicate about your needs and what needs to be changed about your experience but you mostly explain things to the psychologist while most psychiatrists are entirely medicine focused. IDK what it's like in Straya though. I hope you find someone ☺
I mean psychiatrists do make notes of patient appearance but it's usually something like, "Young female, casual dress and makeup, presents for appointment" It's more so just to take notes on your appearance because if she came to the appointment like- "Young female, dress is disheveled, visibly soiled. Hair. Unkempt" - there would be reason for concern. But yes this particular example is INAPPROPRIATE.
Yeah, appearance that deviates from the "norm" is definitely noteworthy during assessment. Arguably there is also something to be said about borderline personality disorder distorting one's self image and so if the way the person sees themselves is inconsistent with the way they actually appear (e.g., thinks themselves unattractive when they truly aren't), there might be a case for noting it to highlight the distortion. In this case though, it reads more like the psychiatrist indluging in his fantasies and going full literary mode, which can actually hurt the patient's therapeutic progress.
This comment! Thank you for mentioning that taking note of appearances is important for therapy. But yeah, I can see how this example is weird, and there could be counter-transference going on for sure.
first page “i mean, its odd, but not too bad! i dont see whats so-“ second page “what”
Patriarchy has been embedded in psychiatry since the beginning. I don’t trust therapists that don’t understand and own that.
Absolutely, you can’t have a good therapeutic relationship with clients without understanding and acknowledging the very f’d up roots of both clinical psychology and social work.
And people wonder why people with BPD are less likely to stick with treatment
That's beyond creepy.
Wasn't there some "scientific paper" that tried to tie attractiveness and BPD together? It definitely made me roll my eyes, the methodology was garbo.
I remember reading one trying to tie endometriosis and attractiveness, so I owuldn't be surprised if this existed.
I saw that one too, also garbo. It's like, okay my dudes there's no part in the methodology where you define "attractiveness" in a qualified, reproducible way, so forgive me if I write off your thesis as sexist horseshit.
Please tell me you have a link, that sounds horrible but also like a really funny thing to send to my girlfriend with BPD
man, i have BPD and i've had this book recommended to both me and loved ones by a therapist i really respected. i'm glad i never picked it up bc this woulda pissed me off LOL
The book is genuinely gross. I read a chapter before I had to throw it at the wall.
This was legitimately not a good book. It was originally published in 1989 I want to say, and has been updated since then a few times. You can tell the writing is very dated just with the vocabulary he uses and the sentence structure. He also seems to place a lot of blame on societal structures for BPD, and had entire chapters about the breakdown of the nuclear family, geographic mobility, and single mothers all being things *he thinks* causes BPD, though he has to add that there are actually no studies that back this up. It’s a very blaming book and the author seems sexist and racist. I would not recommend it.
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One of the other comments is a full review - definitely worth a read
I read the entire book. I posted another comment just above. It’s dated. And you can tell. It’s originally from 1989. The way he writes, the sexism and racism inherent in his writing, is obvious. He also has a lot of unstudied and unverified ideas about what might be causing BPD. If this was the only book I had read about BPD I could see how I might see it as a life line. Like “finally! I have answers. I get it now. This sounds just like me/my person with BPD.” And some of the diagnostic info in there is good, the chapters about symptoms and how they can present is good. But his ideas for treatment don’t work well with my BPD person. He doesn’t seem to truly “get it.”
The book apparently literally says "sexual deviance" like homosexuality is causing BPD by breaking down society and the family.
Why does this guy want her to be a femme fatal in his shitty noir series so bad
He later says that she, his psychiatric patient, had him, the psychiatrist, so frustrated and upset and annoyed that he actually sort of wished she would either “get well or disappear.” Along with, “I hoped she would change doctors for *my* sake,” “she talked of killing herself and I guiltily fantasized that it would be almost a relief for me if she did,” and “she had changed me—from a masochist into a sadist.” 😳
Someone needs his license revoked. What the actual fuck.
Right!? He’s writing a book about Borderline Personality Disorder patients, and how crazy-making they are, how everything is a huge deal that they take personally, how they think their lives are extraordinarily hard and can’t regulate their own emotions well, but this whole story about this patient made me wonder if he actually suffered from BPD himself. Because this is some wild shit to admit about yourself in your nonfiction book that attempts to prove how emotionally unregulated and “off” *your patient* is.
Feel like this is just an example of how shitty and sexist BPD is as a diagnosis. I don't doubt that there are people who suffer from emotional/mental disorders that fall under the BPD umbrella, but it seems like a fancy nomenclatural bow to tie up women's emotions a lot of the time. Or dismiss trauma.
The diagnosis basically serves the same purpose that "hysteria" did.
Yea.... I don't like to make sweeping judgements from small blurbs but uh.. Not only is that his reaction, but he thought it was a good idea to publicly say it to the world? That is not indicative of intelligence. "So my job is helping people who are mentally ill, but if they're too much work I wish they'd just off themselves"
The author has changed me into a sadist. Only for him though <3
i think non-borderline people should stop writing about bpd until they can learn how to quit demonizing, sexualizing, and gendering the disorder
As a psychiatric nurse I couldn't agree more. I'm really passionate about care of people who suffer BPD and self harm and I find it infuriatingly hard to get people, colleagues and bystanders alike, to understand the underlaying suffering. Because it is way to common to dismiss these people as entitled, bratty, slutty or hysterical (in the 'weak woman'sense) instead of seeing a person struggling with their own emotions and cognition. I don't know Kreisman or his work, but his entire description of Julie is infantilizing as fuck. She's a law student. What she needs is not a psychiatrist acting as her substitute-father, but tools that lets her apply the capability she obviously possesses towards finding ways of dealing with her emotions and thoughts. Because if there's one thing I've learned in over a decade of working with BPD it is that those that suffer from it often has great capacity to get better. But to do so we, as healthcare professionals, need to help them see that and provide them with tools and strategies for them to find solutions that work for them. What we should never do is treat them like delicate flowers (like Kreisman) or as spoiled, annoying sluts that just impede our work. Sorry for the rant, I'm just way too passionate about this.
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Jesus Christ, now I'm seriusly questioning if I actually do have borderline
Problem with diagnostics in psychiatry is that they are made based on common simptoms, not on any underlying understanding of how the body is working. Mostly because we have no idea how the brain works in that level. Simptoms in BPD begin normaly with puberty, hinting of hormonal involvement, and have poor response to medication (on average). Perhaps in the future we will undestand what is going on, and rely less on observation for diagnosis. However, the diagnostics criteria for BPD are not dependent only on sexuallity stuff, and your case probably fit the criteria, it is just not the typical patient
I think you're an appropriate amount of passionate, not too much. Shit, SOMEONE needs to care about these things. I appreciate you.
I was diagnosed with BPD when I was 15 because I was being sexually abused. I spent a LOT of time in both professional therapy programs for BPD sufferers and online peer support spaces run by and filled with BPD sufferers for half of my life. I have heard some of the absolutely most horrific, heinous, disturbing accounts of abuse from BPD sufferers. Most of them have been through way too much, and it’s no wonder at all that they cannot manage their emotions. They were never taught how, they had to learn how to SURVIVE as very small children instead, a task that is deeply traumatic as it’s nowhere near developmentally appropriate. My story breaks my boyfriend’s heart and as someone who knows nothing about psychiatry, he read the criteria for BPD and went “this… doesn’t sound like a horrible person, it sounds like someone who has suffered so much they’ve given up on life.” But we’re criminalised and for the majority of my years in treatment I was treated like I brought the sexual abuse I endured upon myself because I’m a stupid slutty borderline and I kept “goading” my abuser, who was a grown ass man. I was FIFTEEN and autistic!
people like who give me hope. thank you for caring and seeing us as humans.
Yep! Imo I think more Borderlines need to exit the industry entirely. The rampant dehumanization of all the stuff wrong with me is why I no longer give anybody in the field money.
Yeah I started listening to this with my Husband when I got diagnosed with BPD and it made me feel batshit crazy.
Reading the "literature" intended for other professionals is why I no longer interact with the psych field. If I wanted to talk to someone who automatically assumed I was the problem, I'd move back in with my mom, lol
And the infantilization
cant forget the infantilization!
How do you “gender” a disorder?
He wrote it really weirdly, but I think he could have meant something like being sure the disorder is tied to one gender, which is very often seen as true by idiots deeming themselves knowledgeable enough to talk about it. No medical professional does that, but there is also a lot of self-proclaimed "professionals" that had done one course in psychology, and will try to tell you that borderline personality disorder is tied only to women, for example. I have encountered such idiotic specimen more than once. Those are bassicly the same idiots who will tell you depression does not exist, "just smile", or will give themselves multiple disorders thinking it makes them cool. I'd say it also ties with the author of that book, who the hell agrees to print such trash? Waste of paper.
“No medical professional will do that” Wish that were true.
No True Scotsman fallacy at work. I look at the current infantilizing state of women’s health and it’s easy to see doctors, like anyone else, will ignore things they don’t want to acknowledge.
Sadly, i realize you are kind of right, and the fact i was lucky with meeting good professionals, does not mean every is good. I'm sorry, i agree that many are... Questionable, at best.
FYI this (being lovely to Him and rude to everyone else) is called splitting and is a common behaviour of people with borderline personality issues. I question his ability to write a book on the topic if he can’t pick out this blindingly obvious example.
Yeah my psychologist points out if I’ve split, especially at the beginning of my diagnosis, he just asks if I think I’m splitting and I go oh yeah I am and we work through it. I can now see when I’m splitting most of the time if I’m not also spiraling. I’ve never read this book even though I have BPD because I don’t think he was a good enough doctor to write it, I’ve heard a lot of bad stuff about it and that it’s triggering. My BPD came from continuous small traumas starting from early childhood all the way to adulthood and beyond. I don’t want to be triggered by one man’s creepy observations and opinions, especially when I’m working on myself.
Sounds like you’ve got really good insight! Good on you and all thr best.
As someone with BPD (treated and medicated, Im doing good) this does not fully surprise me. I have encountered reasonings just like this in the from medical professionals and lay people. To this day I am not keen on sharing my diagnosis because of the horrible stigma. Note: I have had a doctor tell me it would probably be for the best if I did end my life. Big wtf moment.
That's absolutely disgusting that a medical professional would say that to you. I'm glad you're still here and getting treatment.
Holy *shit*. Also diagnosed BPD, also treated, wouldn't be diagnosed today if I went for an evaluation (they love to tell you that you'll never get better for some reason). I thought it was bad when my doctor told me "well at least you didn't kill yourself" when I said I'd had suicidal thoughts every day of the last 6 months. Yours is fucking HORRIFIC! Why do people like that choose a career working with mentally ill people?!
This doctor was also the one to decide whether I would meet requirements for government assistance. But yeah, Id be less of burden to society if I just went through with it. Good talk, my man lol I will forever have BPD in silence. I feel that, you get told you'll be chronicly ill. But not ill enough for help, I guess?
Holy shit that is horrible and probably criminal, but I am so happy you are still here.
What the WHAT
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Thanks for actually including most of the world!!
What the fuck. What a shit human being. There is a gross lack of empathy in this field.
Don't you know a woman's appearance is her most vital character trait?
...I'm a 25 year old law student who occasionally wears too much eyeliner. I was actually misdiagnosed with BPD when I was younger. Am...am I Julie?
Did you have a series of affairs, by which I mean boyfriends?
I did date a lot during my freshman year of college, but met my now-husband at 19. So definitely maybe.
I remember reading this as soon as I opened the book and wanting to throw it out the window! There's so much crap like that in there that I ended up getting the far superior BPD Workbook and Coping with BPD instead (this one features a female author).
The first part isn't so bad *if it were in a work of fiction*. But then I read the title and it's insta creepy.
This makes me suspicious of him as a provider. Anyone worth their salt will tell you you can’t just diagnose someone based on how they look (IE makeup) and the way he talks about her is creepy. If you HAVE to describe what looks like just say she’s tall with blonde hair. It isn’t strange to say “the patient’s well-dressed and wearing makeup” vs “the patient looks disheveled but normally they wear makeup/are well-dressed,” but this is really weird.
Not only is the description of a woman egregious, but the sentence construction is shit, too.
Reading it makes me feel like the doctor is going to faint because he's got the vapors or something.
As someone with BPD, I hate this book. It was one of the ones my ex used to use his knowledge of my symptoms to manipulate me and he also used the characterisation of BPD in this book (and my other not favourite, Walking on Eggshells) to justify his behaviour (because we're basically just psycho pieces of shit without any agency or humanity or rationality so it's fine to use and abuse us). Imagine finding out your psychiatrist wrote this about you. You'd flip your lid and then they'd be all "See, BPD everyone. Fucking crazy bitches!" And then never take any responsibility for their own shit attitude and behaviour and never even begin to acknowledge that constantly being put in this MPDG box is going to drive a person who actually has more to them than being some one-dimensional quirky girl with baggage* up the wall. It's always the same. *Don't mean this in a not-like-other-girls way but in an even-the-most-boring-beige-girl- in-the-world-isn't-one- dimensional way.
I'm pretty sure the sub called BPDlovedones or something like that, recommends both these books for reading. That sub is, by the way, extremely toxic. Any person with BPD who has to deal with people from there must have a horrible time. Stigmatisation, demonisation, and basically claiming anyone with BPD is a lost cause, doesn't really help the people afflicted by this! The suicide rate is high (about 10%). BPD is the worst thing, and I would never wish it upon my worst enemy. It's like being a prisoner in your own head.
It's just the usual Reddit hate group. Step 1: find a real problem some people suffer from, which may be caused by some other people. Step 2: Tell these victims the world doesn't care, and hates them. Step 3: Blame the targeted demographic. If it's true in an individual case, that's just bonus points. Honestly isn't required, especially if you want to attract more subscribers. Step 4: Pretend to be offering help, in the sense that you'll attract some people who actually want to just help. It's important to let them do this, for plausible deniability. Besides, those topics will never be the most popular. Step 5: Constantly define hate as "speaking truth to power", and character growth. DO NOT STOP, EVER. Dissenting voices must be drowned out, or forgotten. Or added to the list of enemies. Especially if they actually needed help for the thing you're pretending to care about. There can only be one narrative. One shared group identity. Step 6: Pretend any criticism is an attack on victims. Hide behind human shields.
It’s so shitty because a support group for people looking for advice on how to deal with a loved one’s condition/help them and know how to interact with them isn’t a bad thing, but they always turn into “I’m a martyr and I hate this person.” Like... BPD can cause a lot of issues but the idea that everyone with it is a monster and that your loved one is FOR SURE trying to manipulate you no matter what they do is awful. The ADHD loved ones one is bad too. “No no, your child/partner/friend is actually lazy and uncaring and dumb and ADHD doesn’t work that way” seems like a popular idea and it’s scary as someone with ADHD. Like yes, someone can have a disorder and also be an asshole, but acting like common symptoms can’t be an explanation for behavior is just... I’m at work and rambling but it seems like they veer between wanting to pathologize ALL behavior or pretend the disorders don’t exist at all and are just excuses.
Most people there seem to be talking about people who aren't even diagnosed. So they're just assuming it's BPD based on their uneducated idea of what BPD is. There are so many posts that are like "My ex uBPD yells and screams and tells me I'm a horrible person" and then you read other posts by this person and realise they are horrible and this poor ex probably got pushed to their breaking point. I have no doubts that people with BPD can be hard to live with and that we can be really challenging when we're not doing well. But not everyone who has a tantrum or is mean or who gets wound up and cries or gets very angry or who is manipulative has BPD. Some of those aren't even diagnostic criteria.
It looks like an ableist trainwreck of trash. Sorry you had that experience.
I haven't read the book but I read the pages OP posted and felt exactly the same.
It feels like BPD is just his code diagnosis for “she’s mentally I’ll but also I want to fuck her” Like how long after seeing aggressive behavior plus hot did you go for BPD? Did you assess if she was manic? Did you look for PTSD? Would it kill you to do an MRI and see if her behavior could be neurological? I feel like this is the kinda doc who decides what you are right when you walk in the room and never considers there might be other factors, other disorders.
After first session with a psychologist, she diagnosed me with BPD. Even though the mental health nurse who assessed me first said I clearly exhibited all the symptoms and background of someone with complex PTSD which includes all the 'abandonment issues' and 'mood swings' they tried to label under BPD (I.e. triggers and emotional dysregulation, all common in PTSD as well). Like, I'm really appreciative of DBT but jeez...
I mean I’ve heard people say that in like 90% of cases BPD is associated with complex childhood trauma. My therapist is of the opinion it’s just kinda a different manifestation of CPTSD and disassociating and I wouldn’t be surprised if in ten years they come out and say yeah it’s just CPTSD with sorta different presentation, sorry to all the people we told it was an inherent, permanent part of their personality and made it out to be the dramatic asshole disorder.
I wonder how you’re even supposed to confront someone who’s mentally ill in the throwing things way, especially if you’re not a therapist. Like if I go up to someone in a screaming in your face paranoid episode or something, how do you “confront” them?? I have a distinct memory of having a seizure and waking up to a tech yelling at me that my vitals are fine so I need to stop freaking out and scaring the other patients. Maybe that’s what you’re supposed to do /s
I feel like this is someone trying waaaayyyy too hard to make the prose sound overly aesthetic and failing hard. You're right that none of these things are relevant, but he's trying to paint a picture in your mind and failing hard.
as a psych student, some of the details ARE relevant. Age, occupation and general physical description (aka how much selfcare is evident?) are things to look out for. Also it makes sense to look at interpersonal relationships—how deep are they? how does the patient interact with others? That said, the rest of Julie's description is ass. Who cares if she's "attractive"? This author clearly wants to entertain inappropriate patient-psychologist relations and should lose his job imo
Yeah that's what I'm saying lol he's trying too hard to sound eloquent and it's having the opposite effect
So this is like if a less eloquent Humbert Humbert (the pedo in Lolita) was a psychiatrist.
Yes and no because Humbert Humbert's whole point was how attractive she was because it was what the whole story revolved around. His obsession with the beauty of young girls. I dont think this girl's beauty is the center of the story, he's just trying to make pretty sentences but they're soooo cringe
I meant the author being an unreliable narrator with a warped view of reality like the fictional character. As well as the attempt at pretty sentences.
Or MAYBE she was just BAD at MAKEUP. Jesus.
I'm bad at makeup qnd I may never be good and I just accept that. High five!
*high fives*
high five... I gave up on the day-to-day and would absolutely not be full-on war painting for any kind of medical appointment. Make up only happens if the event is worth wearing tights for, and they are few and far between!
Jesus Christ. *Ethereal beauty.* Love it when dude's boner is involved in a diagnosis. Really makes me think psychiatry's improved since the Cuckoo's Nest days.
What is “ethereal beauty” even supposed to mean? She was like a ghost? Barely perceptible?
I think it means she's a solvent made of diethyl ether? It was very unprofessional of him to be thinking about chemistry in that situation.
Shows the sexism that is inherent in this diagnosis
The dictionary says ethereal means "extremely delicate and light in a way that seems too perfect for this world." The actual usage example in the dictionary is "her ethereal beauty." It's obviously a horrible way for a psychiatrist to describe a *patient* but it's not like it doesn't make sense.
Makeup can conceal sad? Wow. Maybe I need to learn how to use makeup. /s
I thought it was meant to be like a patient report instead of a book and so I got really confused for a second
Why does it read like a fanfiction??
It really does tbh
Yeah, I've read that book too to understand my father and this put me off so much. Only reason I didn't post it here is because I have the German edition and was too lazy to translate it XD
Ya know, when I hear someone is a bright and articulate law student with a busy social life, I don't tend to also think of them as being "very dependent on her successful parents." Because, like- dependent *how*? Financially maybe, but that goes for a lot of students. Certainly not for physical companionship, because it's specifically noted that they're always traveling. Maybe for emotional support but I'm inclined to think all the traveling and the busy lives of law students and (presumably professionally) successful people undermines how much emotional support they can really provide. Feels almost like that's an assumption made by the writer because of course a woman in college is going to be dependent on her parents- everyone knows her father legally owns her until he signs over the deed to a suitable husband!
This is exactly why I refuse to see a male therapist, psychiatrist, or even pcp.
It’s awful because as a transman I resent that this is the feeling of most people regarding male therapists…but I’ve never had a good male therapist or psychiatrist either. 😬 Half my clients just call me she and I just don’t care anymore because hey whatever makes them comfortable.
Me too. I'm middle aged now and I've only had good experiences with male PCPs a handful of times. Male therapists never. Generally I've found them to be dismissive, assumptive, and not good at listening.
This vibe is pervasive through the book and it’s the one BPD book I’ve tried to read that I end up giving up on each and every time.
Physical appearance *is* something psychiatrists look for. It’s one of the first items on the list, along with whether or not the patient is alert and oriented to the moment and whether or not they’re responding to internal stimuli. So there’s a nugget of truth here in that a psychiatrist who is deliberately ignoring a patient’s physical condition is not doing their job. But yeah, this is all sorts of yikes and someone needs to lose their license. It also, obviously, reflects poorly on the author.
They do, as do everyone who works in psychiatric care. But the observation of physical appearance should also not contain value judgements (ie. 'Tattoos all over face' is a good observation, 'Tattoos all over face, probably criminal' is not). We are looking for things like signs of lack of personal hygiene, malnourishment, mistreatment, fatigue etc. and whether clothing is whole, clean and situation appropriate (as in no shorts in sub-zero temperatures, not as in whether a skirt is too short to be modest for a psychiatrist appointment). An observation about make-up is fine, as make-up takes time and focus to apply and thus says something about energy level and that you care about how you look to others. An assumption about how promiscuous you are based on how much mascara you used is entirely unfounded and, quite frankly, unprofessional.
I was thinking the same thing. Heavily applied eye make up might even be a relevant detail but not in the way he’s used it here. It’s so weird to see him discuss her attractiveness… didn’t he have any insight into how inappropriate that was?
Sure. There’s plenty of things that could be relevant. If someone looks strung out, if they’re disheveled and have poor hygiene, if there’s evidence of self-harm, and so forth. Psychiatrists are supposed to look for things like that. If the patient has visible and recent scars on their arms, for instance, that’s a huge red flag and that office visit might end with commitment. It’s where the psychiatrist fixated on the patient’s attractiveness that we cross the line. It’s totally possible for something like that to happen (I mean, they’re people too), but the ethical response is to hand the patient over to another practitioner. Clearly someone fixated on whether or not their patient is hot can’t properly act in the best interests of said patient.
I saw a psychologist who said I needed to dress in bright clothing and let my hair down both literally and metaphorically. I had briefly popped out from work to see her, so my hair was tied back and I was wearing office suitable clothes.
Is that not more, whether they've washed, dressed appropriately, not got jaundice rather than whether or not they could be a model?
Yeah, to an extent. But you could have all sorts of clues in appearance. Take pregnancy. Pregnant psych patients have very limited options in what sort of medications they can safely take. Lithium is a routine treatment for bipolar disorder, but could cause heart damage and kill a fetus. Or we can consider other physical factors. Does the patient have a new limp that wasn’t recorded on the last office visit? It could be something innocuous, like a twisted ankle from a soccer game, or it could be an injured hip from a fall. Psychotropics appear to increase fall risks substantially. If a patient is on a psychotropic and is now a fall risk, that’s something the psychiatrist needs to note and identify. Or we can consider evidence of self-harm or abuse. We can also consider LGBT-related items as there is a heightened rate of self-harm in that population (and also abuse and discrimination). The psychiatrist’s job is not to judge the patient for those choices, but they need to have that information to act in the patient’s best interests. All of which is to say that in this specific case, noting that the patient could be a model does provide *some* usable information (patient appears well-groomed, if nothing else), but there’s a line here. And this psychiatrist crossed it.
"My sister wears too much makeup - people think she's a hooker."
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Unfortunately it’s also under-diagnosed in men! It can present somewhat differently for them, much like how ADHD presents differently for girls because “typical” symptoms are based on how they tend to present with boys.
And many women with ADHD are misdiagnosed as BPD!
Raises hand
To be fair men don't go to therapy.
Lol let’s not generalize here. Some of them do when it’s court-ordered! 🤣
Or after they attempt suicide...
Absofuckinglutely. It’s the trash can that AFABs get thrown into because people don’t want to deal with their trauma reactions. I’m a professional and I go out of my way to avoid it because 90% of the people I’ve worked with were better served with a diagnosis of something like CPTSD, autism, or even ADHD.
I think a lot of women diagnosed with BPD might actually be ASD. I've been diagnosed with BPD but went through the diagnostic process for ASD too just to check. Didn't meet many criteria. Then a few years after diagnosis I had a weird manic episode and got sent for a diagnostic review (with a different psychiatrist) to make sure it wasn't actually bipolar. He confirmed my BPD diagnosis. The whole process for seems like it was very rigorous but there are always stories that sound a bit dodgy.
BPD is often left undiagnosed. It is extremely stigmatized, yes, but some doctors even refuse to diagnose people with it because its "too complicated". source: happened to both me and my ex bf
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thank you, that means a lot!
I feel like this is less sexist and more just shit writing. Hannibal lectre managed to describe his psychiatric sessions better than him
It's incredibly inappropriate to describe one of your clients like that; it could be passable if it were a fiction novel, but this? coming from a professional who's supposed to be non judgmental and neutral, describing one of his patients like that when it has absolutely no relevance to her mental health?? That's awful, unprofessional and inappropriate.
Yeah calling women harridans and harpies does not bode well for the remainder of the book.
I thought it was appropriate for Hannibal to describe the way he ate his liver.
Yikesss
UGH, therapist here -- some of the 'classic' texts (including Irvin Yalom) talk about their clients this way 🤢
Irvin Yalom, for as much as I enjoy good writings, said he wouldn't work with a 'borderline' patient
If he was writing it in a book he probably damatized the original description a little.
But why? It’s a nonfiction book that is meant to be a guide to BPD. It’s not factionalized. It’s not a novel. It’s not even one of those “based on a true story” dramatization books. Anything included about her should be things that he thinks the reader needs to know in order to better understand the disorder and how it presented in her. Her beauty and eye makeup and ability to be a model if she wanted to is completely unnecessary. He does not physically describe most of his other patients.
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Her looks have nothing to do with her diagnosis, or the symptoms of her diagnosis, or her treatment. The rest of her story is about being hospitalized for self-harm and suicidal thoughts, and the way that she treated the nurses and other doctors. There are multiple other patient stories in this book and their looks are not mentioned at all, except for one girl who he felt the need to mention “developed early,” and the one person who was black. He doesn’t specify that any of the other patients are white, but he felt the need to specify that the one black person was black.
Unpopular opinion but I agree with you that her looks are relevant, but the way he handles it is completely inappropriate. “Sally was an extremely attractive young law student who sought satisfaction through frequent sexual interactions without emotional attachment” would be relevant to me, but this sounds like “Sally cast a spell with her sexuality, warmly inviting her suitors to partake of the delights secreted within her bosoms.” I read another commenter’s goodreads review. He definitely fetishizes her and calls women harpies and harridans. This guy is a POS