Friday, April 29, 2005

A nice long one

Been a couple of days since I posted, didn't even realize it. Nothing's changed really. Thought I was doing a little better yesterday, but woke up today right back where I was...swimming in misery. This'll be a nice long post since I haven't bothered to come around for 2 days.

I saw Ms. N yesterday. This visit went better than the previous one. Not being in the midst of a panic attack helped. Knowing what I wanted to talk to her about also helped. I didn't bother to fill out a log for her or print out any of this blog so she asked me to summarize my week. Did it in one word, crappy, and left it at that. Wasn't worth mentioning specifics.

I'd brought with me the book I've been trying to read, though I'm having little success getting thru it with my head being so fucked up. She wasn't familiar with it, "Sometimes I Act Crazy" by Jerold Kreisman MD and Hal Straus, though she was familiar with their previous book "I Hate You, Don't Leave Me". I told her I need to start working on overcoming the obstacles in my head. The ones preventing me from doing anything to help myself.

Briefly, this is a follow-up book because their first one offered a fairly bleak prognosis for those with BPD. This recent book offers the latest information and research for borderlines and their families. It also provides action steps at the end of each chapter directed at the borderline or their family that will help them deal with BPD and its symptoms.

Being the obsessive person I am, I typically like to read a book in one sitting. I don't like to read a few chapters, bookmark where I left off and come back to it. But given my current foggy, lack of concentration state I have to because my brain isn't capable of consuming an entire book at once. So to make up for that, I skimmed ahead thru the book so I could see what was going to be coming up. And that's when I found it, under Chapter 12, Prognosis and Directions of Future Research...a list of 'Prognostic Predictors'.

(Sorry if I'm committing copyright infringement by typing this out here, but I have mentioned the name of the book & the authors so I am giving credit where credit is due.)

Prognostic Predictors

Short-Term Predictors
A number of factors have been found to correlate with favorable and unfavorable outcomes of BPD patients over the short term (two to four years). Factors correlating to a positive prognosis include:
- Early and rapid progress in treatment
- Supportive relationships with parents, spouse, and friends
- Friendliness and likability

Factors correlating to a negative prognosis include:
- Chronicity. The longer the symptoms persist, the more likely they will continue to persist.
- Severity. The more serious the symptoms, the less likely they are to remit.
- Comorbidity. The presence of other disorders, such as depression or substance abuse, worsens the prognosis.
- Impulsivity. The more persistently and severely this symptom is expressed, the less likely full recovery can be achieved.
- Age of onset at the extremes. When initial symptoms are observed either in the patient's early adolescence or in his thirties or forties, rates of recovery diminish.
- Impaired relationships with parents. Poor relationships with parents, as a child and later as an adult, predict poor outcome.
-Disability. Patients receiving disability payments have a worse prognosis than those who are financially self-supporting.

Long-term Predictors
Studies that follow the course of borderlines for ten or more years yield specific characteristics that affect prognosis. Positive prognostic signs include:
- Higher intelligence
- Physical attractiveness
- Artistic talent
- Self-discipline
- Involvement in a twelve-step program (AA or NA) if there is a history of substance abuse
- Early, rapid improvement

Negative indicators are:
- Chronic hostility and irritability
- History of antisocial behaviour (more prevalent in men)
- History of severe parental abuse (incest occurs seven times more often in female borderlines than in males)
- Severe, pathological jealousy
- Eccentric, alienating behaviour
- Poverty
- History of substance abuse without involvement of a twelve-step program

After ten or more years, 90 percent of individuals who evidenced one or more of the positive prognostic indicators and none of the negative ones were rated as doing well. Among those who exhibited one or more of the negative indicators without any of the positive characteristics, only 35 percent attained a minimally satisfactory level of functioning.

Ok, so my whole point of bringing this to Ms. N's attention was to address the "no hope for recovery" roadblock. According to this book, which was written utilizing the latest research information on this disorder and supposedly & I quote "refutes the misperception that BPD is untreatable", I'm fucking screwed! My prognosis is even bleaker than I thought based on those prognostic predictors.

I asked her how I was supposed to believe in hope when everything I read and learn about borderline basically tells me I'm fucked, I'm going to suffer til I die and there's nothing anyone can do about it. She read this part of the book and seemed kind of shocked by what it said. She wondered where they got their info. She tried to tell me that the case studies and stuff are flawed because the sample sizes are small and have other limitations. I told her I was aware of that because I've read case studies that admitted they couldn't verify accuracy due to limitations. So then I asked if the info they do have is flawed and there is no absolute proof anyone can get better than why not just kill myself and get it over with.

She was able to counteract every doubtful question I had with something that made sense. Something that at least made me question my own negative answers in order to keep going til Monday when I see her next.

She was concerned about my brain problems, the fogginess and stuff. Asked if I'd talked to my pdoc about them. Told her I wasn't going to bother him with it until my next appointment in June. She said I should make a sooner appointment, but I doubt I will. Why bother the guy when I can just make myself suffer?


Blogger borderline savvy said...

Wow, Sid, that book does have some pretty dire predictions, doesn't it! I'm glad your t could counter the negatives with some positives. I'm also glad she gave you enough hope to keep you going until you see her next.

I'm with her--get an earlier appt. with you pdoc. I can't tell you how much better I feel going off of Zyprexa. My brain fogginess is lifting big time, and so my capabilities to do things has increased greatly -- and to do them well. Which has increased my self-esteem over all (that little incident aside). It's not just you who suffers. It makes it difficult on your daughter to have a mom who's foggy. Please remember that.

I'm really proud of you for doing the reading/research and for finding out opposing views to it. I've ordered the first book, but now I'm wondering if I should read it because it might set off triggers.

Keep up the great work!
Big hugs,

1:00 AM, April 30, 2005  
Blogger Polar Bear said...

I've read that first book - I hate You Please dont leave me. Didn't think much of it actually. You're right in that it offered pretty bleak prognosis for BPDs.

I may try to pick up their second book - thanks for sharing that a bit.

But in the end, I'd just like to say that it doesnt matter what they say in books. Those people that are sampled are not YOU. And you are unique in your own way. No one has a right to suggest in any way that you have a poor prognosis. Your chances of recovery and how well you do will depend on you.

I may sound like I'm sprouting nonsense - I mean look at me, Sid. Im in the same boat, struggling like you too. But I hope that you hold some hope in YOUR heart for yourself.

I think the fact that we are still all here present and accounted for, counts for something. And proves that we want to keep on fighting.

3:43 AM, April 30, 2005  
Blogger Jennynyc said...

Thanks for the book reviews.

(From a crazy bookworm)

8:27 PM, May 01, 2005  

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