Q. In light of Mr. Pheil's observations that persons truly disabled by BPD can "remember" incorrect interpretations of reality from the psychosis during dysphoria, believing them to be real, and that it is difficult to interpret which of their memories are "suspect" and which are not, I wonder how accurate much of the reported statistics about childhood histories really are. 

Question: How often are histories of abuse or neglect incorporated into statistical findings based on information gathered only from patients' reports and perceptions without any corresponding reports and perceptions from siblings, parents, or others who were around as well? 

Discussion: I am hurt by the pain many members of the mental health community unwittingly inflict on loving, supportive, and affirming parents. (The counselor I have been talking with is certainly not to be included here. She is very competent and caring and yesterday copied much of the material I had printed from the Sanctuary). Statements and statistics about etiology which point fingers at others' behavior as possible causative factors should be well-researched, put in the proper context, and "handled with care" before being reported. Whenever possible, an attempt to separate reality- based accounts of abuse from potentially distorted perception- based accounts accounts should be made. This task must be extremely difficult and often impossible. Perhaps the words "per patient perception" should appear in more places. If family members (already worn ragged, nervous, frightened and confused from the relentless demands of dealing with an illness or disorder which affects the behavior of their loved one) are to be involved, supportive, and emotionally strong enough to do what's best to help on the road to recovery, perhaps the words in research articles and other places could be carefully crafted to help instead of hinder them. The way in which causative factors are reported sometimes lacks compassion, fairness, and common sense.

A. I will side step this one, but give you a pragmatic answer. If there is a problem in a patient, it needs to be addressed. Whether the problem arose because of abuse or genetic underpinnings or both is irrelevant. Treatment is needed to resolve the existing problem.

Talking about the past has not been shown to be effective in any kind of controlled trial. Medications and cognitive therapy have. Always do something that works.