Q. Dr. M:
Thank you for being willing to address this question. My sister was placed in a state facility for anorexia nervosa, PTSD, and BPD. She used to set fires, jumped in front of a train, serious suicide attempts, and self-mutilator (as a young teen in early 1980). Prior to the hospitalization she was found eating her shoes and ingesting non food items. What exactly is a primitive borderline personality? If a person has no will to survive, does that mean they only have a death instinct? Do you know any good material on such cases? She ended up hanging herself in the maximum security hospital.
A. I am truly sorry about your sister. Her suicidal acts are not even "thoughts" in the true sense of the word. The type of illness she had, is accompanied by suicidal ideas and acts in the same way a flu is accompanied by fever. Suicide is a logical biological behavior and a characteristic symptom of her illness. Likewise, the self-injury is what she was supposed to do. Part of the chemistry. To extend our flu example, it is like a cough or achiness in the joints. A symptom of the illness.
I mean it in all seriousness when I say that suicide or self injury is a logical symptom of the illness. If any of these behaviors were under volitional control, she would not have chosen them. Chances are she wore a coat in the winter, cooler clothes in the summer, and drank water when she was thirsty. All of us want to feel good, and we do things to make us feel better. Thus, her winter coat to decrease the cold, summer shorts to feel cooler, and drink of water to quench a dry throat. All other aspects of her life, except those you are supposed to have with BPD, were volitionally controlled to diminish discomfort and increase pleasure. Cutting or hanging is out of context with the rest of her choices, and not under volitional control any more than blood sugar can be "thought down" in diabetics. Talking to borderlines before effective medication is like trying to talk away a flu or diabetes. It never has, nor never will work.
My best guess is that your sister had a really bad case of BPD. The moniker of primitive means she had very coarse and basic BPD behaviors. Truly unfortunate because chances are we could have helped her a lot now. I always tell my patients that suicidal thoughts are not thoughts. They are like a fever with the flu, and should not be acted upon since this thought is imposed on one, and will pass with effective pharmacological interventions. And, it almost always does.
Trying to find a good consumer book on pharmacotherapy, psychotherapy, and intervention programs in BPD is virtually impossible. I am writing one now, and hope to have it complete by April of 2000.
