Tag Archives: Borderline Personality Disorder

Welcome to Me (and My BPD?)

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JC Schildbach, LMHC

How important is it that movies and television shows get “academic” concepts right?

Sure, superhero movies, action flicks, and even horror movies routinely violate the laws of physics to create interesting visual sequences, and frequently make up pretend science-y explanations for strange phenomena.

But what about when the academic concept is a mental health diagnosis that is supposed to be central to a character’s actions?

Okay, there are numerous representations of people with mental illness in television and film that are just as ludicrous as, say, toxic chemicals causing superpowers, a plague of giant ants, or an out-of-shape ex-cop (or really anybody) outrunning an explosion.

So what about when the academic concept is a mental health diagnosis that is supposed to be a driving force behind all of the main character’s actions in a film that is comedic, but with serious intent? It would probably behoove the movie-makers to get that right? Right?

In Welcome to Me, written by Eliot Laurence, and directed by Shira Piven, Kristen Wiig stars as Alice Klieg, a lottery-winner who decides to channel her newly-won millions into a sort of variety show all about herself, ostensibly due to the effects of her Borderline Personality Disorder.

Wiig, to her credit, plays a fairly credible person with traits of Borderline Personality Disorder. And the film does not shoot for a lot of cheap laughs or cheap thrills at the expense of those with mental health issues (of course, feel free to disagree with me on those points all you want).

Unfortunately, the film botches some really big clinical points in a really big way.

Spoiler alert!  Spoiler alert!

The first truly jarring error is when Klieg describes her history of mental illness (to a TV audience assembled for an infomercial on nutritional supplements). She says, “When I was 16, I was diagnosed with Manic Depression. In my 20s it was called Rapid Cycling Bipolar Disorder. Now it’s just called Borderline Personality Disorder.”

Excuse me?

Now, it’s true that “Manic Depression” was once the common term for Bipolar Disorder. But “rapid cycling” is a modifier or course specifier for Bipolar Disorder that generally means a person is having abbreviated episodes of depressive and manic states that are running fairly close together. And by “fairly close together” I mean four or more episodes of mania, hypomania, or depression in one year—not “mood swings” multiple times a day.

As the good people at PsychEducation explain, once mood shifts get close enough together, they can become indistinguishable from relatively normal emotional states. Bipolar Disorder is not just some condition of simple emotional lability or emotional dysregulation, although plenty of people use the term “bipolar” incorrectly in this fashion (hopefully not anyone who is actually diagnosing and treating people, though).

Emotional dysregulation is, however, a common component of Borderline Personality Disorder. It is also relatively common for people who are ultimately diagnosed with Borderline Personality Disorder to have been incorrectly diagnosed with Bipolar Disorder prior to the Borderline Personality Disorder diagnosis.

So, if Klieg, had said “First I was diagnosed with Manic Depression, which is now called Bipolar Disorder. Then they diagnosed me with Rapid Cycling Bipolar Disorder. Then they determined the appropriate diagnosis for my condition is Borderline Personality Disorder,” then the explanation would have made a great deal more clinical sense.

As it is, Klieg’s dialog implies that Borderline Personality Disorder is just the new name for Bipolar Disorder. This is completely wrong.

Klieg (played by Kristen Wiig) intrudes on her own skit, startling the actors and the audience.

Klieg (played by Kristen Wiig) intrudes on her own skit, startling the actors and the audience.

Another major problem with the film is the portrayal of the treatment that Alice is receiving from Dr. Daryl Moffet (played by Tim Robbins). It’s troubling enough that Dr. Moffet repeatedly mentions the brand-name drug Abilify—in the sense that a movie about a person with a mental illness essentially uses dialog as a form of pharmaceutical product placement. But what’s even more disturbing is that Borderline Personality Disorder is not itself treated with medication.

Sure, plenty of people diagnosed with Borderline Personality Disorder are prescribed various medications to address other things they might be dealing with, like anxiety, depression, or poor impulse control. They may even be prescribed mood stabilizers depending on the severity of their emotional dysregulation, or anti-psychotic drugs, depending on the severity of their thought disturbances. But the personality disorder itself is not going to respond to a specific drug.

No doubt, plenty of people suffering from Borderline Personality Disorder would love it if there were a drug that would make all their symptoms go away.  Different forms of ‘talk therapy’–most notably Dialectical Behavior Therapy (DBT) developed by Dr. Marsha Linehan–can help people with the disorder develop coping skills to address the various fears, emotional disturbances, and behaviors that are common to the disorder, much better than any pill or cluster of pills is going to manage the range of symptoms.

Beyond the issues of medication, there is a scene where Dr. Moffet tells Klieg that he tried to have her put on a psychiatric hold because he thinks she is a danger to herself. Surprisingly, and probably just to get in a bit of expository dialog, Klieg has to ask him what a psychiatric hold is—despite the ongoing implication that Klieg’s decision to stop taking her medication will lead her to be forcibly hospitalized–an implication that wouldn’t generally exist if such a thing hadn’t happened previously.

Perhaps even more surprising is that Moffet thinks Klieg has done something to warrant psychiatric detention. I can’t imagine there are many places where wasting one’s lottery winnings on a self-indulgent TV talk show would be seen as evidence of being a danger to oneself, even if one is doing things like illegally broadcasting phone calls during that show, or otherwise slandering people. But, really, the people running the TV show should have been aware of the legal problems in all that, and should have put a stop to it.

Still, Klieg’s having gone off her medications is a theme throughout the movie, and one which causes great alarm each time someone hears her speak of it—as if the other characters really know what she is being medicated for, and with, and what the obvious, disastrous consequences will be. It is a theme that culminates in a scene, where Klieg dazedly takes a nude stroll through a casino, apparently in some psychotic, or perhaps dissociative, state. She has to be subdued by cops and hospitalized.

And while such a situation is arguably possible for a person with Borderline Personality Disorder, such occurrences are not generally core features of the disorder, and portrayals of such are certainly not going to contribute to greater understanding of the disorder, particularly when they are shown as a natural consequence of not taking one’s medications—I mean one’s Abilify.

Overall, Moffet’s connection to Klieg is largely unexplored. Mostly he just harps on her about how she should get back on her medication—I mean her Abilify. When he (rightly) gets irritated at her for including him in her TV show, Moffet terminates his services with Klieg, by simply handing her a list of other providers.

One would think Dr. Moffet would, at the very least, try to make sure Klieg was actually in contact with another provider, after trying to process with Klieg about how she violated what should have been some clear boundaries, and why he cannot continue to treat her. Given that a fear of abandonment is a core component of Borderline Personality Disorder, and that self harm, suicidal thoughts, and suicide attempts are common among people with Borderline Personality Disorder (in fact, it would have been much more clinically accurate for Klieg to end up in the hospital due to a suicide attempt or self-harm episode after feeling abandoned by her best friend, and her treatment provider, and possibly lashing out at them, than due to a psychotic episode—or whatever that was—from quitting her medications), Moffet’s ‘here’s-a-provider-list-and-a-few-snippy-comments’ therapy termination seems grossly incompetent.  Due dilligence anyone?

And while I’m not advocating for depicting people with a particular mental illness in some format that allows viewers to check the symptoms off a list—that’s ‘disorder of the week’ TV-movie territory—the portrayal of Klieg suffers from being too timid in presenting her struggles. While Klieg is fairly off-putting to many of the people in her life, the filmmakers seemed wary of making her too off-putting. For the most part, she really only lashes out at people from her past through skits on her television show, while recklessly upsetting those around her by being self indulgent or impulsive. The filmmakers tried to keep Klieg quirkily unpleasant, in the kind of realm where one might believe that the right medications can keep her likable enough.

It strikes me, though, that the particular diagnosis is largely unimportant to the story, particularly considering how botched the presentation of the diagnosis-specific information is, and how the “off her meds” theme plays out. The film would have worked just as well (or just as poorly, depending on one’s view) knowing that Klieg was in treatment, and on medications, without having to name a particular psychiatric problem. I don’t think the movie would have suffered if, rather than naming any specific disorder, the characters referred only to Klieg having been in therapy, or hospitalized, or on medications. Hell, without the specific diagnosis of Borderline Personality Disorder, the repeated mentions of Abilify might have been at least slightly less problematic.

At the very least, avoiding the naming of a diagnosis could have provided grad students and armchair psychologists with an exercise in identifying possible diagnoses and rule-outs. As it is, I suppose the film could at least provide valuable material for discussion about whether the Borderline Personality Disorder diagnosis seems correct, the kinds of errors Dr. Moffet makes, and about the need to make sure that clients and the people comprising their support system understand their diagnoses and treatments—that whole ‘psychoeducation’ piece that therapists are supposed to do.

Of course, I suppose having a character with a non-specified mental illness would open up the filmmakers to other complaints—such as portraying people with any old form of “mental illness” as psychotic and needing to be on medications, lest they burn through millions of dollars producing a TV show and end up running around naked in public—rather than suggesting that such a problem is specific to lottery winners with Borderline Personality Disorder.

All that said, I didn’t hate the movie.  I adore Kristen Wiig.  And, like I said, she does a credible job with the material.  The movie also mostly avoids the more exploitative angles of both comedies and dramas involving people with mental illness.  It’s just that they could have had a much richer story if they hadn’t relied so heavily on the medication angle.  Coping adequately with Borderline Personality Disorder takes a great deal of personal work, not just popping a pill–I mean, an Abilify.

And one last thing. I noticed that there was no clear indication from the credits that anybody had been consulted about the accuracy of the Borderline Personality Disorder information. So, I just wanted to float it out there that I’m willing to accept some of that Hollywood money in order to go over scripts and make sure they don’t make a mess out of their clinical details.

*Welcome to Me is currently available streaming on Netflix and Amazon.com, as well as in a variety of other places.

Self-Infantilization or Supportive Compromise? On the Controversy over Safe Spaces

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JC Schildbach, LMHC

In her March 21 piece for the New York Times, “In College and Hiding From Scary Ideas” Judith Shulevitz mocks, among other people and things, Brown University student Katherine Byron for setting up a “safe space” for students who might be “triggered” during a debate between Jessica Valenti and Wendy McElroy that was likely to include a discussion of rape culture.

Shulevitz reported that the safe space “room was equipped with cookies, coloring books, bubbles, Play-Doh, calming music, pillows, blankets and a video of frolicking puppies, as well as students and staff members trained to deal with trauma.” Nothing is said about why such items and personnel might have been present, or what the theory behind such a ‘safe room’ might be, other than Shulevitz’s own assumptions about how college students of today are over-parented and overly-sensitive.

Shulevitz goes on to say that, “Safe spaces are an expression of the conviction, increasingly prevalent among college students, that their schools should keep them from being ‘bombarded’ by discomfiting or distressing viewpoints.” Shulevitz does not provide anything other than anecdotal evidence about the alleged increasing prevalence of such a conviction.

On top of that, one major thing that gets lost in Shulevitz’s piece is that the debate between Valenti and McElroy went on. The ideas were not silenced. No speaker was banned.

Instead, Byron, and those who assisted her, offered a place where audience members could go if they became uncomfortable, not necessarily with the ideas being expressed, but with the content of the discussion, which presumably included descriptions of how rape is depicted in popular culture, as well as how rape and rape victims are treated in the news media, by law enforcement, and in other areas of their lives.  The safe room was established by the Sexual Assault Task Force, first and foremost, to afford a safe space for trauma victims–not a refuge from ideas.

All the comfort of the joys of childhood...

All the comfort of the joys of childhood…

Perhaps Shulevitz’ mocking of the “safe spaces” is particularly disappointing because she has written other pieces on trauma and its impacts, most notably, a November piece in The New Republic, called “The Science of Suffering” which explored research into how PTSD can potentially be transmitted from generation to generation.  In it, Shulevitz includes this succinct and powerful description of PTSD:

Provoke a person with PTSD, and her heart pounds faster, her startle reflex is exaggerated, she sweats, her mind races. The amygdala, which detects threats and releases the emotions associated with memories, whirs in overdrive. Meanwhile, hormones and neurotransmitters don’t always flow as they should, leaving the immune system underregulated. The result can be the kind of over-inflammation associated with chronic disease, including arthritis, diabetes, and cardiovascular disease. Moreover, agitated nervous systems release adrenaline and catecholamines, both involved in the fight or flight response, unleashing a cascade of events that reinforces the effects of traumatic memories on the brain.

Shulevitz’s New Republic article describes research into, among others, Cambodian refugees who suffered through brutal conditions of war. And maybe this is where Shulevitz’ disconnect arises: her inability to see how a sexual assault in the modern-day USA could lead to similar forms of psychological and physical response as living through a years-long period of war somewhere else in the world.

But PTSD just as powerful as that experienced by those who have been through war can arise out of a sexual assault or rape. PTSD is not measured and assigned on some scale where those who experienced the longest, and arguably worst, trauma have the ‘most’ or most severe PTSD.

Complaining of the “self-infantilization” (a term Shulevitz credits to Judith Shapiro) demonstrated by things like the Brown University safe room, Shulevitz also neglects to explore other potential psychological issues stemming from sexual assault, particularly for those who were assaulted repeatedly at a young age. To be clear, I am not assigning a specific causal relationship here (i.e., if this happens, then that is the result, and/or, because a person exhibits this behavior, this particular thing has happened to them) but issues such as Borderline Personality Disorder are often tied to a history of having been sexually traumatized.

Strangely enough, complications associated with Borderline Personality Disorder can include shortcomings in one’s ability to develop into an emotionally mature adult.  Along with the repeated hospitalizations, there are frequently tendencies toward anxiety and overreaction to stimuli, impulsivity, fear of abandonment, hostility and perceptions that one is being personally attacked, and difficulties in forming long-term, stable relationships—issues which might, along with PTSD symptoms, be addressed (at least in the immediate sense of a perceived threat) by the “safe room” tactics that Byron deployed.

Rather than exploring the potentially positive effects of the safe room, though, Shulevitz instead uses it, and other alleged examples of “hypersensitivity” at universities, as evidence that today’s college students aren’t tough enough to handle the real world, and that today’s parents are coddling their children too much. But ongoing PTSD, personality disorders, and other psychological manifestations of trauma are not the result of overly-attentive parenting—and are more likely to be exacerbated by the opposite—a lack of attentiveness and support by those who should be providing it.

Still, Shulevitz pats herself and her peer group on the back for being much “hardier souls” than today’s college students–which includes an explanation that, in her day, college students only censored speakers for the right reasons. She writes, “I’m old enough to remember a time when college students objected to providing a platform to certain speakers because they were deemed politically unacceptable.” Shulevitz isn’t particularly clear on how “politically unacceptable” is markedly different from ‘ideas that make some people uncomfortable.’

Perhaps this is a good time to reiterate that Byron and her Sexual Assault Task Force didn’t actually stop anybody from speaking at Brown, but set up a space, off to the side, out of concern for those who might be interested in hearing the debate, but weren’t too confident that they would respond well to it. If anything, it represents a form of compromise much more than a form of censorship.

So maybe the safe room isn’t the perfect answer. Maybe it seems funny and easy to mock as a form of “self-infantilization,” particularly to those who aren’t all that interested in finding out what it’s supposed to mean or accomplish—those people who, as Shulevitz puts it, haven’t learned “the discipline of seeing the world as other people see it.”

Then again, maybe today’s college students aren’t really that different from past generations of college students—and are just exploring different ways of addressing concerns that didn’t exist in the past—or, rather, were ignored in the past.

Because heaven knows, none of us from older generations ever did anything questionable while we were in college, or came up with ideas that older generations might mock, as we tried, in an atmosphere of rapidly evolving technology, culture, and scientific understanding, to navigate a complicated passage into adulthood.