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Power Abuse in the OR: The Support Staff as Targets and Patients as VictimsJeanne Crane July 2015Knowledge is power: In order to protect your interests you have to understand your risks. As an advice columnist and investigative reporter for a Woman’s magazine (WNC Woman), I am committed to being a public voice. I respond to the needs of women who are denied their power or are targets of power abuse. As a pioneer feminist, I confronted power abuse. My challenge broke through the glass ceiling into the executive suite and freed a generation of women from bondage. My plea for reader’s comments revealed that my generation did not flush out all of the bullies.My readers, in the OR’S of the medical community, have advised me that the patriarchs (“A social system in which men dominate and are regarded as the authority within the family and society”) escaped exposure when Corporate America was held to a higher standard, because they hid under the mantle of “Good Works.” Patriarchal Surgeons/Bullies are not held accountable for their destructive patterns of conduct, because they see themselves (and are viewed) as invulnerable and all-powerful.My research disclosed the fact that their impediments are known and enabled. The medical profession has facilitated discrimination/bullying by allowing “Patriarchal” leadership to thrive. It is defined by the 2014 Ketchum Leadership Communication Monitor of England as: “a ‘macho’ model of solitary leadership -- a command-and-control approach centered on one-way rhetoric, obsessively controlled messaging and solitary decision-making.”READERS CORNER:Dr. Julia informs me that all is not well for women in the OR:She reports that in her field of anesthesiology she is outnumbered 15 to 1…She is not treated with the same respect as her male counterparts, and work assignments are discriminatory…She feels that conditions would improve if the ratio of males to females was more in balance.Dear Julia,I chose to address your concerns because they mirrored my experience. Your circumstances have an even greater impact on society than mine. My challenge freed hostages in the workplace. You are working under the domination of Patriarchs, and they abuse their power to the effect of society at large. We need to tell the world that it impacts their safety when they put their very lives in the hands of a team of professionals whose leader dispenses negative and disabling energy. This creates an environment where morale and efficiencies are diminished. There is no greater circumstance where the balance of power should rule the day.I fail to comprehend how the medical community escaped the watchdogs the first time around.OR Nurse Karen reports why the Patriarchal Surgeons have escaped exposure:It is political by nature. The administration and surgeons share a symbiotic relationship—a co-dependency so to speak. Most of the surgeons are in private practice and are granted operating room privileges. The bottom line is: Surgeons are not held to a higher standard, because the administration is reluctant to withdraw operating room privileges; the surgeons are cash cows and provide major revenues. The administrators recognize the pressure that surgeons are under and offer anger management courses which few take advantage of. (Isn’t that interesting? They obviously recognize that the surgeons are bullies.) She added, sardonically, that they do not have a program for gender discrimination…Women still empty the bedpans while men do the “real” miracles.I asked Karen to rank the doctors on power abuse: Of the 35 surgeons that she works with 75% abuse their power in contrast to only 20% of the anesthesiologists. She worked in a hospital in another state that also oppressed women. She added that the women surgeons are team players.|Dear Karen,Thanks for enlightening us. By understanding the dynamics, it draws us closer to a solution.My goal is to enlighten society to the fact that they suffer the consequences of chaos in the operating room. Every single woman should pay very close attention to these revelations, because at some point in time she will be either a surgical patient or an advocate for one. I am incensed when I realize that our lives are at the mercy of emotionally immature bullies. I am reminded of the Hippocratic Oath, “First, do no harm.” When Patriarchs give reign to their egos (more specifically, their super egos) and connect with their negative emotions, they block access to their higher natures and Divine Guidance. In addition, their disruptive behavior impairs the efficiency of their assistants. The patient then becomes a potential victim of their diminished abilities.Victim Speaks OutIt is important to know and understand your antagonist before his forceful tactics can be neutralized. I just finished reading a memoir written by Sandra M. Gilbert titled Wrongful Death: A Medical Tragedy—1995. Sandra’s husband was a surgical patient at a University of California Medical Center and died needlessly in the recovery room because of the irresponsible attitude and neglect on the part of the surgeon. As further proof that Patriarchs are enabled, his negligence was covered up. Both Sandra and her husband were professors at the University and colleagues of the offenders. It is a dramatic example of our vulnerability; Sandra declares cynically, “When you enter the operating room it’s a crap shoot” (a Gambling Parlor where the odds are stacked against you).This is not a gender war; males are also targets. Women sustain the most impairment because they represent a wide majority of the support staff. It is the same war that I fought—power v/s force. As David R. Hawkins M.D. states in Power VS. Force: “Power gives life and energy… force takes these away.” My battle was won because Knights—powerful men of honor and peaceful warriors—joined in the conflict. There is a need to employ the help of the Knights in the medical sectors. They are legion; we have all interacted with them and benefited from their sensitivity to our needs. They are also incensed by the Patriarchs who tarnish their honorable profession. My research revealed that surgical Knights are vocal about the need to set standards for a fair, harmonious, and safe operating room. The administrators are obviously not listening, which means that society has to be discriminating when they choose a surgeon. If the surgeon is cold, detached and dismissive (forceful) with the patient, it is more than likely that he treats the OR personnel the same way.Surgeons Speak OutDr. Wen Shen’s very lengthy and insightful article titled Bloody Nice: Is the Quest to Build a Kinder, Gentler Surgeon Misguided?— appeared in a July 14, 2014 article of the Pacific Standard (Page on psmag.com). He is a surgeon at the UCSF Medical Center. The theme of his article was how to tame the Patriarchs without losing their results—how to find a balance between confidence and arrogance, leadership and dictatorship, harmonious teamwork and taking charge when chaos erupts…While he states that the culture has changed and the residents are disciplined if they yell at underlings or throw instruments in the operating room, he does not reveal that the majority of the infractions are by private practice surgeons who are immune to penalties… He admitted that some surgeons come awfully close to personality disorders such as narcissism, obsessive-compulsiveness and paranoia. (The “Faith to Persist” phase of my journey includes my experience with an “Obsessive Compulsive,” and the atmosphere around him was chaotic. Why don’t training programs weed out personality disorders?)...There is also substantial disagreement on how invasive the bullies are. Nurse Karen puts the figure at 75/25 against the odds while Dr. Shen says that there are a little more than half of the surgeons that he would want to operate on him or his family…He asks the question, “Can we carve away the toxic personal qualities that have plagued us for centuries while retaining the guts and perfectionism that are the foundation of our professional ethos?” My answer would be: A tame/emotionally stable surgeon is a healer, because he has an open channel to his Higher Power. God Calling say’s it best: That spirit which, if given a free entrance, and not barred out by self, will enable you to do the same works as I did.Dr. Marty Mackey is a surgeon at John’s Hopkins and an associate professor of health policy at the John’s Hopkins School of Public Health. He helped pioneer the life-saving surgical checklist: Book Summary - The Checklist Manifesto by Atul Gawande, 121912His 2012 book— UNACCOUNTABLE: What Hospitals Won’t Tell You, and How Transparency Can Revolutionize Health Care—holds all of the answers. “This book should be read by all people, not just doctors and health administrators, so they can make wise decisions when it comes to choosing where, when, and who will provide health care for themselves and their loved ones.”He states that Mayo Clinic’s strong hospital culture of quality, safety, and patient-centeredness is rooted in a strong tradition of listening to employees. He adds that not reporting incompetence among peers is part of medical culture that has been around for centuries, and Dr’s and nurses crave administrative crackdowns. He proves the positive affect of anonymous employee surveys regarding competency. When the lower level employees are encouraged to express their concerns, safety accelerates dramatically… Medicine is poorly policed. Getting fired takes an action so egregious or offensive to hospital administration that he has only seen it twice among all of the hospitals in which he worked or trained…State Medical Boards are responsible for disciplining Physicians… the more revenue a doctor brings in, the weaker the hospital’s incentive to look into local allegations (a validation of nurse Karen’s revelation)…A powerful tool in the quest for accountability is the camera. If applied widely, videotaping has the potential to transform medicine by adding accountability to a poorly documented and poorly monitored health system; videotaping gets 100 percent enthusiastic support from nurses.Bully Surgeon Profile“A man convinced against his will is of the same opinion still.”—Dale Carnegie.I am of the mind that a goodly proportion of surgeons have personality disorders that are attracted to the practice of surgery, because they view it as a profession that they can perform with tight boundaries—limited patient interaction and dictatorship/bullying of the support staff. They misapply the advice that they receive in training that cautions them to detach emotionally from the patient. Their antisocial tendencies and emotional boundaries cause them to disengage from everyone to a point of force if necessary. With that mindset I recognize why the bullies have never been reformed—it is counterproductive to their temperaments and feelings of entitlement. No matter how efficient they are at their profession it doesn’t make up for their emotional inadequacy, because it diminishes the effectiveness of the support staff.Drastic measures of reform have not changed the bullies: appeals by benevolent surgeons, Supreme Court support of litigation against a bully surgeon, wrongful death litigation by a victim’s wife, and pending legislation addressing bullying. The only way to protect the victims of abuse is to be pro-active by forcing reform until hospital administrators establish zero tolerance by monitoring performance and enforcing accountability.The following are examples of how the bullies can be banished as females begin to fill the vacancies: Nurse Karen stated that the female surgeons that she encountered were all team players. Dr. Makey revealed that female surgical students outnumber males, and Dr.Shen acknowledges that a slow shift in the gender makeup of the surgical workforce has resulted in a welcome influx of new perspectives and leadership styles.Bully case verdict a warning to doctors:Excerpts from an article published in the April 9, 2008 issue of the Indiana AuthorityJoseph Doescher was a hospital operating room perfusionist, the person who operates the heart/lung machine during open heart surgery. He alleged that Dr. Daniel Raess, a cardiovascular surgeon, aggressively charged him “with clenched fists, piercing eyes, beet-red face, popping veins, and screaming and swearing at him.” Doescher testified that he backed up against the wall and put his hands up, fearing that Raess was going to hit him. Although Doescher’s legal claims were intentional infliction of emotional distress and assault, the trial strategy was to present Raess as a classic "workplace bully." The jury found for Raess on the intentional infliction of emotional distress claim, but for Doescher on the assault claim and awarded him $325,000.In a 4-1 decision, the Indiana Supreme Court upheld a $325,000 verdict against a cardiovascular surgeon accused of being a “workplace bully.” Previously, the trial and appellate court decisions in the case had received nationwide attention because of the interest in the concept of “workplace bullying.” Raess v. Doescher, No. 49S02-0710-CV-424, Indiana Supreme Court (April 8, 2008).Pending legislation:There are compelling strategies developing to challenge bullies by establishing the destructive effects to the health of the victims of their abuse. It is a proposed state law called the Healthy Workplace Bill (HWB) that “plugs the gaps in current state and federal civil rights protections.” The bill has been introduced in 29 states. It describes bullying as: repeated, malicious, health harming mistreatment that takes the form of: verbal abuse, threatening, intimidating or disruptive interference or sabotage (I experienced malicious, disruptive and intimidating interference and sabotage.)…Technically bullying is a form of violence—psychological violence.Drs. Gary and Ruth Namie have founded an organization called the Workplace Bullying Institute (WBI). History of WBI | Workplace Bullying Institute (a must read). WBI is also the catalyst for the U.S. Legislative Campaign for legal reform, advocating passage of the anti-bullying Healthy Workplace Bill. Dr. Gary is the National Campaign Director of HWB. The following link is an engaging video by Gary that details the emotional affects of bullying and appeals for support of HWB: http: //www.healthyworkplacebill.org/takeaction/share.php·· UpdatesOn March 12, 2015, the Utah Senate unanimously passed HB 216 on a vote 24 ayes -0 nays -5 not voting. The bill introduced by House Rep. Keven Stratton and sponsored in the Senate by Todd Weiler, sailed through both House and Senate committees and floor votes in both chambers. The bill becomes law with Gov. Gary Herbert’s signature.New York returns to lead the nation with a complete Healthy Workplace Bill in the Assembly — A 3250. The bill provides legal redress for employees harmed by abusive conduct. It rewards proactive employers who voluntarily protect workers with adequate policies and procedures with a litigation prevention mechanism. It defines the phenomenon and applies to employers in both private and public sectors. Our State Coordinators continue to set the highest bar for comparison. A 3250 has 80 co-sponsors. The Senate companion bill is in the works.Bottom LineNothing will change until the medical hierarchy is forced to support the need for rules of conduct. Hopefully my disclosures and visions will attract the attention of the administrators, and they will become willing partners to the regeneration of an honorable profession. A “worst case scenario” (as in my case) will necessitate the need to file a claim of discrimination or bullying. A fire-proof (accurate and specific) lawsuit charging the hospital and surgeon will lead to a peace treaty/settlement offer that will contain a protocol. Once rules for the game are legally mandated, it will set a precedent for the entire medical community.Readers note:If this report raises your consciousness (What I think about, I bring about.—Daily Word), it should confirm the need to do your homework when faced with surgery, and to spread the word.

In keeping with my frequent diaries on mental illness, rage, and obsessive hatred, I thought it was time to talk about the Borderline Personality Disorder (BPD). The BPD combines many of the traits discussed in previous diaries, and condenses them into a toxic brew. This is an especially good topic for the holidays, when many of us will be dealing with family members that we have been able to avoid for most of the year.BPD is one of the most common mental illnesses affecting 3% to 5% of the population. Borderline symptoms frequently occur with other problems like Bipolar disorder or substance abuse, creating a personality that is extremely toxic to the people around. They are obsessed with control, and when BPD is combined with other mental health problems, they are the Energizer Bunny of emotional and physical bullying. BPDs have an extremely high rate of suicide, and BPD may be a leading cause of suicide.The BPD used to be described as "borderline psychotic" because they are subject to psychotic fits of rage. Actually the BPD combines the characteristics of many mental illnesses, especially the other Cluster B (Dramatic, Emotional, or Erratic Disorders) Personality Disorders. Although the BPD can be very resistant to entering treatment, the cliche and cartoon-like structure of their personalities is leading to more effective cognitive therapies. But they will probably only reach therapy after "hitting bottom" through addiction, repeated suicide threats, or self mutilation ("cutting.") Cutting used to be considered a sure sign of BPD, but this was probably an oversimplification.They may also hit bottom and require hospitalization for depression as a result of relationships with addicts, who the BPD may find irresistibly attractive. If they are driven to despair by their relationship with addicts, they may find help through Al-Anon. You can find more information about this in my previous diary What is a Codependent Dry Drunk?BPD see themselves as always being the victim of other people. They constantly accuse the people closest to them of acting maliciously against them. These accusations change constantly, and the BPD doesn't really to"believe" the accusations they make or even try to keep track of them like a good liar. Although their accusations are often incoherent and contradictory, they make up for that with the tremendous number of lies they tell and the theatrical emotionality of their stories.Their accusations that others are sabotaging them are often merely projection (pot kettle black) of their own efforts to sabotage and betraycoworkers, spouses, and children. Ultimately, the only person really sabotaging the BPD is probably themselves through antisocial actions and substance abuse, although they are also emotional "shit magnets" for abusive personalities. They may reject any romantic relationship that is not abusive, but they will still describe their partner as abusive to gain sympathy and lure new partners. They will go to absurd lengths to provoke a fight so they can claim to be the victim.Besides being the eternal victim, many BPDs will strive to be seen as heroes, defenders of the truth and the weak. This involves declaring that "bad" people deserve to be punished and then singling them out for months or years of accusations and abuse. Because rage and abusiveness proves they are good.As some of the comments note, there is a an overlap between narcissism and BPD. The key difference seems to be that the BPD is codependent and the narcissist is counterdependent. In other words, the BPD clings desperately to just about anyone, while the narcissist usually terminates romantic relationships. The BPD is more likely to experience periods of clinical depression and guilt. Although the BPD seems more unstable, hostile, and impulsive than the narcissist, the presence of guilt in the BPD may indicate a greater potential for recovery. The narcissist is more charming, but is also more ruthless and experiences less guilt. Although the BPD has obvious problems, they may have fewer antisocial (sociopathic) traits than a narcissist. Also a borderline is far more likely to threaten suicide than a narcissist.It's probably easiest to start be describing how a BPD acts:Can't be alone, can't stand to be with others, a common neurotic trait.Makes everyone walk on eggshells - this is a a common way of describing other personality disorders as well.Extreme pride and grandiosity - even thought the BPD suffers from a crippling lack of self esteem, they may give the appearance of being armor plated. Whatever criticism reaches them is filtered through layer after layer of denial and distortion. They may be quite proud of their character flaws.Shame and secrecy - There is a general sense that anything the BPD does in private must never be spoken of. In selecting the person for group bullying (in the home or workplace) they will single out the truth teller of the group."Gaslighting" - trying to convince others that they are mentally ill, such as trying to convince them that real abuse did not occur. In Wikipdeia and a personality disorder blog.Projective Identification - playing the victim by constantly trying to provoke others into being angry. This not only fills the emotional needs of the BPD, it can nearly make it impossible for observers to determine which person is ill and abusive. See this diary.Respect me! - pretend my fake emotions are real. This is common in many mental health problems.Conflict in all their relationships. Years of grudgesand score keepingNothing is their fault, especially their own emotions. Other people are to blame for the BPD's feelings, as if everyone else has the power to broadcast directly into the BPD brain. Blame others people for making them feel bad, then blame them others for not making the BPD feel better.Demands that people join in their mental games. Creates a bubble of chaos whereever they go.Don't tell me what to do! Pointless defiance seems to often take the form of denying medical care to their children or parents. Not taking their kid to the doctor is "standing up for themselves" and being told that their kid needs to go to the doctor makes them some sort of martyrConstant ad hominem attacks - other people have horrible flaws. Often the BPD can't quite identify their problem, but the BPD is sure those flaws are in other people and they must be punished.They will pick apart everything another person says, and turn that into an accusation. Living with the BPD is like living through the Inquisition. Their style can be described as "analyze and accuse, analyze and accuse."They will always claim to know what other people thinking so that they always have an excuse for their rage.Punishing "thought crimes" - since they know what people are thinking, they are in a perfect position to actively punish people for thinking bad thoughts and to recruit other to help punish the thought criminal."You think...!" ....For me the BPD lecture that starts out "You think..." is the end of the line because that is the beginning of the onslaught of mindreading and ad hominems. . When I was dating, I would tell people up front that if I ever heard the words "You think..." that I would never speak to them again. Actually, I would give one "get out of jail free" card, but it was still a solid rule for relationships.They really do seem to believe they just know what people are thinking, and they try to micromanage other people's thoughts. This delusional thinking is common in the downward spiral of a power struggle."What do you really mean?" This also overlaps with bipolar. The subject changes because they are substituting words, apparently because they are swapping words and meaning in their head. I recently had to restart a conversation about five times to keep it on topic, and I had to point exactly which words were being substituted. For bipolar people there can be a look of intense concentration as they listen and analyze what you say as if they were trying to listen in a very noisy room. There is an entire inner dialogue going on behind their eyes.They also assume that other people should know what the BPD wants, and they are enraged when other people fails to deliver what they need. This is extremely passive aggressive.They lack personal boundaries, demand to know what other people are thinking or feeling, and are always digging digging digging for evidence to use against others.In addition to mind reading, they also have the ability to "hear" whatever they need to hear in order to justify their own actions. This results in constant "he said/she said" arguments where the BPD is recalling some entirely different conversation.And you can't win - it's Damned-if-you-do-and-damned-if-you-don't, or heads-they-win-and-tails-you-lose, today you were too much of this and too little that but tomorrow it will be exactly reversed.The BPD has a circle of neurotic friendships to provide the attention, validation, and sympathy that they need to survive.Accusations - effortless lying, crying, incoherent but convincing, probably believe their own lies more than most people believe anything.Although they may suffer constant guilt, they constantly try to use guilt against others, and pile guilt on their children. You will never hear them say they are sorry about anything.Obsessed with the "Truth" and accusing other people of lying (more projection, right?). Did you say you were going to take your umbrella when you went out but changed your mind because the sun came out? Then you lied.Being right in negative and pointless ways, pedantic arguments.Although seemingly armor plated with narcissistic certainly, they will also plunge into periods of depression and self loathing at regular intervals.I believe that some BPD are capable of being charming in a superficial way, like a narcissist. The stereotype of the Jekyll-and-Hyde lover who romantically woos their mate during a whirlwind romance, then becomes abusive as soon as they are married is probably more narcissistic. This is an area I'll be reading more about, and tprobably an area of some controversy.Urge to betray and sabotage their own relationships and destroy other peoples relationships.The BPD will often be in a series of abusive relationships. But being a "shit magnet" for abusive partners lets them deny their own deeply masochistic and sadistic tendencies that are directed at every living person within range.Constantly accuses others of thinking bad thoughts. Think you are safe by just sitting quietly in the corner - well the BPD will pronounce judgment on your thoughts, including the things you never did and never even said. A good response is "If you can read my thoughts, then can do this from another zip code. Here's your car keys, now get the fuck out."Another theme of BPD discussions online is the BPD need to humiliate others. Public sexual humiliation may be comically overdone, like cuddling with your best friend at a party. Remember, they want to get a reaction so they can play the victim, so it's probably better to just tape the episode and put it on YouTube. But beware, they may have already taken a selfie of them tongue-kissing your boss under the mistletoe and put it on Facebook. Because that's just how they roll.Use of projection is obvious - the BPD constantly accuses others of being angry, negative, and abusive. And their accusations against others is a projection of their own guilt.BPDs tell people details about their life very soon after meeting them, especially stories of how abused they were. Why tell people this right away? Other people are tricked into believing that they are saving the BPD. It's important to remember that these stories frequently aren't even true. Often the person the BPD claims is abusing them is actually supporting them financially and emotionally, and the BPD is enlisting henchmen in their efforts to betray their real supporter. The classic scenario is the wife that pus the BPD husband through law or medical school, and then he abandons her after graduation, but a couple years later he has become a drug addict.Sex and romance are important to the BPD. Rushing into sex in a relationship is typical of the BPD. First, it's part of the overly-intense hot phase of the hot/cold BPD relationship. But it's also a way of filling the vacuum in the relationship, concealing the lack of actual emotional connection with the other person. Through sex and male schlock romanticism, the BPD imitates their idea of what a human being would be. Like "Dexter," a BPD is a "human imitator" to compensate for the odd gaps in their personality, which is like a pie that has a had a couple big slices removed. The behavior, even their chronic rage, has a flat repetitive and robot like quality. This might be an aspect of "splitting" that their personality consists of limited actions and reactions that are repeated as simple scripts that usually run in the same order and can't be modified.Perhaps one of the reasons they skip from relationship to relationship is that is too easy for other people to figure out their limited and predictable behaviors, even the sadistic ones.The BPD is an adult child trying to raise a real child with a the lack of a real bond between them. The BPD may feed the child when it's sleepy, try to play when it needs a clean diaper, put it to bed when it's hungry. It's so easy to make a child miserable when empathy is missing, and it's even better when it creates the chance to say "DON'T TELL ME WHAT TO DO" or wail "YOU THINK I'M A BAD PARENT." Of course it's even better if the child has a health problem, so this can be used to generate sympathy. A BPD parent may drag a healthy child from specialist to specialist for years insisting that the child has some serious problem that is only visible to the BPD parent. They are also often trying to force the child to drop out of high school or college so they never leave home. Narcissists have a similar lack of connection to their children, but the narcissist has more of an investment in being seen as a super parent with super children. The narcissist may force the child to excel to glorify the parent, while the BPD is probably more likely to undercut the child and keep them dependent on the parents.For people who know them, the BPD stories of heroism and victimhood can't conceal that BPD's are often extremely controlling, abusive, sadistic, manipulative, amoral, and dishonest. They are obsessed with controlling others, physically, mentally, and emotionally. Most of their relationships will end with a power struggle in which the BPD seems to be demanding unconditional surrender, except they are probably already in the process of abandoning the relationship or being abandoned.When the BPDs romantic relationship inevitably turns into a power struggle, BPD symptoms become a terrifying uncontrolled spiral into madness with a high probability of violence. Seemingly minor unresolved disagreements his will often tip the BPD over the edge from functioning at a fairly normal level to becoming an emotional mess with psychotic episodes that lead to violence, arrest, suicidal gestures, and treatment in a mental hospital. Other big risk factors include the death of a parent (where there was typically a long running power struggle) and the growth of child (with the typical power struggles).Their most stable relationships are friendships with other people who also have problems with anger and low self esteem, except these neurotic "frenemies" encourage the BPDs worst traits and actively discourage the BPD from seeking treatment.The DPB May Be Codependent, Addicted, And Have Multiple Mental IllnessesThe BPD is very good at deceiving bystanders, because they appear to have a narcissist's grandiosity and a sociopaths lack of conscience. In reality the BPD has very low self esteem, tremendous fear of abandonment, extreme sensitivity, and depression, and this drives their obsession with control. Many of you will have realized that this low self esteem and frantic need to control others is what laymen call "codependency." In the BPD, this codependency is often a shopping cart of multiple mental illnesses in the same person.BPD is generally diagnosed more frequently in women, but many male BPDs may avoid diagnosis by going to prison, committing suicide, or being murdered. BPD is often made more complicated and intense by being present with other conditions, such as depression, bipolar disorder, and substance abuse. Borderline traits can be present in people that are functioning normally, but they are definitely a risk factor for addiction. The untreated addict on his way to "hitting bottom" is essentially a BPD.In these cases of multiple mental illnesses, the BPD may make the hair on the back of your neck stand up. In Junkie, William Burroughs describes a couple characters that seem to be BPDs with speed or heroin habitsWhitey combined the sensitivity of a neurotic with a pyschopath's readiness for violence. he was convinced nobody like him, a fact that seemed to cause him a great deal of worry...I noticed another man who was standing there looking at me. waves of hostility as suspicion flowed out from his large brown eyes like some sort of television broadcast. The effect was almost like a physical impact.Indeed, a couple times I have been in the next room when a BPD entered the building. Even when there was not a sound, it seemed as if a wave of pure malevolence came right through the walls like some sort of microwave energy weapon.DefensesThe BPD's use of projection as a defense is constant and out of control. Everyone else is "crazy" and "yelling at them" and "criticizing them" and being "negative." These are of course their own traits, and they insist that it is everyone around them. If a BPD is in the home or office, the whole group is likely to be involved in daily debates about who is "nicer."In a relationship with a BPD, the two of you may agree that one of you has a mental problem, but you'll never agree on which one it is. The BPD is president of the "everyone is crazy but me" club. Not only do they project all their flaws onto the other person, they will also manipulate the person into the role of the bad guy around the clock (projective identification), and they will "gaslight"there partners (try to convince them they are crazy).When the BPD says "I'm sensitive" it doesn't mean they cry at pretty sunsets and sappy movies. It means they have a hair trigger and propensity towards violence. The BPD excuses their anger by claiming that they "care too much." If you sigh the wrong way, it's "abusive," if you taped a "Kathy" cartoon to the refrigerator, that was "abusive" also. And that's why they BPD hit you! It's your fault, not theirs, because you are the abusive one with your damn "Kathy" cartoon. Hitting you was justified.The BPD must frame their criticisms as ad hominem attacks on the other person's character. Since the BPD has deep flaws of character and personality they will project those problems onto other people. Politics is also great for BPDs because other people are going to be labeled "Marxists" or "racists" or "baby killers" or "sexists." It really doesn't matter where you are on the political spectrum, the BPD has a grab bags of personalized political attacks. The BPD claims that their victim is mean to some group of people, and since the BPD doesn't have any evidence, these attacks are justified by the victims fantasy sins against imaginary people.Splitting as a DefenseSplitting is another defense of the BPD. Although the definition of splitting has evolved over time, it is described as fragmented object relations (intimate relations) and a fragmented ego (the view of the self).Splitting in object relations means seeing others as "all good" or "all bad." Often relationships start with excessive intimacy with the "all good," then transition into violent hatred where their lover is now "all bad" and the BPD is back in the role of the victim. The "split" is that the BPD believes two entirely contradictory things and acts as if both things are true. Of course, this could reflect real events and not BPD splitting, but if it happens repeatedly, the BPD "victim" probably really is as crazy as their supposedly abusive partner, and the "victim" may actually be a serial abuser and stalker.The fragmented ego has inconsistent beliefs about oneself. Is the BPD a victim or are they the enraged avenging vigilante angel of justice? Is it possible to be both? Is it possible to be both victim and avenger over and over through the years while being enraged at both family and strangers? It's probably a mentally ill idea, but the BPD depends on having multiple contradictory ideas which are both utterly false. The BPD bounces back and forth between these two false self images, which also facilitates projective identification, a defense that is both deeply primitive and astonishingly devious. Those ideas are at least possible in the real world (even though they are false in the case of the BPD), and bystanders are often convinced that the BPD is both victim and avenger. But at the bottom is a "psychotic nucleus" of things that the BPD doesn't dare say out loud and can't stand to have challenged. This might be something like "Other people are responsible for my emotions, and if I am unhappy it is only because someone has deliberately hurt me every day of my life." Challenging this belief is "abusive," reduces the BPD to incoherent rage, and may result in a physical attack. Physically running away is also a defense, and challenging the splitting will often cause the BPD to jump into their car (often drunk) and flee into the night.Other psychotic traits on which the BPD can be challenged are their rage and sadism as well their belief in punishing people for their bad thoughts. If the BPD pronounces judgment on your thoughts, including the things you never did and never even said, a good response is "If you can read my thoughts, then you can do this from another zip code. Here's your car keys, now get the fuck out."To the observer, splitting looks like an impenetrable wall of contradictory and irrational gibberish. The BPD can make their incoherent beliefs work to their advantage by turning these beliefs into breathless, tearful accusations. Because they have contradictory beliefs, the BPD can inflict an endless stream of abuse on anyone around them with this damned-if-you-do-damned-if-you-don't, heads-I-win-tails-you-lose strategy.BPDs Love Authority And Structures They Can ExploitBPDs are often able to convince other people that the BPD is the real victim, and the BPD will work to divide any group of people and recruit allies. Their goal is usually to create a "black sheep" for the rest of the group to abuse. Despite this, they are capable of being seductive and ingratiating, and they can successfully work their way into positions of authority where they can use the institutional power in sadistic and destructive ways. Being 'right" is important to the BPD personally and professionally, but they are often "right" in ways that are pointless and destructive.The BPD is often the low level henchman of a narcissistic administrator. The narcissist and the BPD share common personality traits, so even though they have little empathy for others, they understand their common backgrounds. The BPD can idealize the narcissist, while the narcissist can put down (devalue) the BPD.911 calls are a favorite of the BPD, and they will always be first to make an official complaint. If you rent from them or share a house, they will claim there were huge damages. They will remodel their house and send you the bill. They will also bill for work that was never done, and simply try to extort money. The BPD will literally stalk someone, then the BPD will claim they are actually the victim. They are often in civil lawsuits, family courts, and probate fights. Probably a significant chunk of the US economy is consumed by the junk legal actions of BPDs. After all, don't most civil actions feature someone frantically lying their ass off?Celebrities With Borderline Personality DisordersThis is actually very tough, because to spot the BPD we have to find people that have sabotaged themselves, often with drugs and alcohol. And then it's a question of whether or not they were actually mistakenly self medicating some other problem like bipolar disorder. But Amy Winehouse, Lindsay Lohan, and Courtney Love call come to mind. Actually, the best examples may be the rogues gallery of former child stars that completely ruined their lives. Many of them had no chance to go through normal stages of development as teenagers, so they are stuck as self-destructive adolescents. indeed, being borderline has been described as "being 14, forever."Is Karl Rove a BPD or maybe a mixture of narcissist and BPD? He certainly has the backround: A flaming gay father that abandoned his family, mother that committed suicide (which he disputes), growing up as a non-Mormon minority in Utah. He has made a career of ginning accusations against people. But he seems to lack a reputation for public rage, abd his flair for associating himself with important people seems to indicate narcissism rather than NPD.How about George Zimmerman, a cop wannabeewith anger management problems who always calls 911?Authority figures are surrogate parent figures who serve as stand-ins for the BPDs negligent or abusive birth parents. Coworkers are the siblings who compete for the parents illusive affections and competitors for the family's meager resources. The fact that none of this may be true has no effect on the BPD, who remains locked in a state of child like rage with extremely limited reasoning ability. They will always by crying foul and demanding that authorities intervene on their behalf.The BPD love rules and loves to accuse others of breaking the rules. They also like to make up rules that don't exist, and even if those rules change hour by hour, breaking the rules will bring years of punishment.The Successful BPDProfessionally, a BPD can do well. Indeed, how many times have we seen successful, highly motivated people turn out to be shockingly cruel to their families. This also includes many prominent social activists of both the left and right who are unbelievable shits to their own families. Mitch Snyder helped the DC homeless but abandoned his family and killed himself. Politically, it doesn't matter if the BPD is on the left or right. Politics is merely a way for them to vent their petty authoritarian urges.In the workplace, the BPD can do well as a manager in any environment where there are rules that encourage the BPD to play "gotcha" as the micromanager. That's especially true today, when employee turnover is often considered a good thing. Likewise the stalk, harass, gather evidence, and accuse style is ideal for the HR department in a company that wants to downsize through "attrition."However, the BPD is often a failure as a leader because they are too busy creating office politics and playing gotcha to focus on actually getting stuff done. But the BPD might be the classic failure who "falls upward" from failure because they will always "kiss up (to the boss), kick down (at the underlings)." Above all the BPD shifts the blame to others while claiming to be the savior, and the BPD recruits henchmen that will be alibis for the BPDs tales of self sacrifice and heroism.Borderline Personality Disorder And Related Personality Disorders (from the DSM)BPD usually has components of related personality disorders:Borderline Personality Disorder -Experience a pervasive pattern of unstable interpersonal relationships and have difficulties with moods and self-image. Impulsiveness is also extremely common. Often have intense episodes of anxiety, depression and irritability lasting from a few hours to several days. May direct anger outward in the form of physical aggression, but may also engage in self-destructive behaviors such as drug abuse, eating disorders or suicidal gestures. These behaviors are often intended to manipulate others. Usually have poor self-identity that leads to overly intense relationships with others. These interactions are generally filled with conflict, and the individual with borderline personality will vacillate between idealizing other people and undervaluing them. Tend to become angry and frustrated when other people fail to meet unrealistic expectations.Histrionic Personality Disorder-Generally need others to witness their emotional displays in order to gain validation or attention. Often display exaggerated symptoms of weakness or illness and may use threats of suicide to manipulate others. Also, many suffering from histrionic personality disorder use sexually provocative behaviors to control others or gain attention.Narcissistic Personality Disorder - An exaggerated sense of one's own abilities and achievements. A constant need for attention, affirmation and praise. A belief that he or she is unique or "special" and should only associate with other people of the same status. Persistent fantasies about attaining success and power. Exploiting other people for personal gain. A sense of entitlement and expectation of special treatment. A preoccupation with power or success. Feeling envious of others,or believing that others are envious of him or her.Antisocial Personality Disorder - Often act out impulsively and fail to consider the consequences of their actions.Display aggressiveness and irritability that often lead to physical assaults. Have difficulty feeling empathy for others. Display a lack of remorse for damaging behavior.The various antisocial personality disorders can't stand to have someone actually understand them. Nobody can be permitted to identify their antisocial actions and the complete separation of the glowing self image versus their destructive and sadistic actions. Of course, the BPD would want that discussion to be a confrontation where they can play the victim. But even if this is done with empathy, the antisocial personality type is likely to respond to empathy as if it were attempted rape. Having empathy for a BPD is probably the best way to eject them from your life.Are BPDs A Type Of Psychopath?There's considerable controversy and infightingabout how to compare BPDs to psychopaths. BPDs tend to lack the psychopath's carefree confidence, lack of guilt, and social isolation. The BPD is guilty (which the project onto others), dependent, and clings desperately to others. It has been suggested that the true psychopath is born that way, while the BPD is the result of abusive parenting. But it's also been suggested that the BPD lacks the narcissism of the psychopath.Psychopathic Personality Inventory: Factors and Subscales[1] PPI–1: Fearless dominanceSocial influenceFearlessnessStress immunityColdheartednessAlso assertiveness, narcissism, and thrill-seeking.PPI–2: Impulsive AntisocialityMachiavellian egocentricityRebellious nonconformityBlame externalizationImpulsivenessColdheartednessAlso aggressiveness, substance use, antisocial behavior, negative affect, and suicidal ideation.BPDs Respond To Articles About BPDsIt's interesting to read articles about BPD where there are comments from BPDs. Since they are obsessed with what other people think about them, I guess it is no wonder that they would show up in the comments. Typically, their comments go like this:YOU HAVE NO IDEA WHAT YOU ARE TALKING ABOUT - Ok, there's the BD "appeal to authority" even if someone understands BPDs because they have been shackled to an abusive BPD for decades. Also it's pretty common for mentally ill people to see themselves as unique and special.I KNOW MORE THAN YOU - and there we see the BPD narcissismYOU MUST BE THE CRAZY ONE - Another BPD favoriteBUT I'M SPECIAL AND SUPERIOR - Actually we don't see as much of that as we would with bipolar people.I'M THE REAL VICTIM HERE - And isn't that the essence of the BPD, that in the midst of all the mayhem and pain, and despite the shattered lives they've left in their wake, they are the real victim? Remember, Daddy only drinks because you cry.YOU JUST HAVE BIAS - you know, sometimes the amount of bias against a specific mental illness corresponds to the body count it leaves.--------------------------------------------------------------------------------------------------------- Walking Dead Update ----------------------------------------------------------------------------------------------------I think Daryl's older brother Merle Dixon is the BPD of the series. Horribly abused as a child, he ends up in prison. When he is with the group, he is constantly divisive, undermining and pitting people against each other. He does this even though it might threaten his own survival and that of his brother. When Merle says "I don't know why I do the things I do. Never did. I'm a damn mystery to me." he shows a primitive level of disorganization in his personality. But he does a feel a bond to his brother, and he avoiding murdering people before the end of the world.Eventually, he ends up serving the Governor, who is a two faced narcissistic sociopath. The Governor wants to be a benevolent leader of Woodberry while secretly indulging in various forms of sadism, including torture and rape (in the graphic novel).Personalities like this constantly feel the urge to betray their comrades. Merle eventually betrays the Governor by killing members of Woodberry, and the Governor later betrays his group in the same way. Merle has ambushed and killed a number of innocent people for the Governor, and it seems that he has a sense of guilt and wounded pride over this. He sacrifices himself in a heroic, defiant death, which is the fantasy of so many mentally ill shooters planning to die "in a blaze of glory."The Governor is Machiavellian when he takes over his new group by ingratiating himself with with the leader then assassinating him. He is also able to manipulate weaker personalities, He kills a group member who shows a sense of morals because the Governor knows that this person would question his authority. Then he has a heart to heart with his victim's brother, and the governor talks about how their fathers used to beat them half to death. The governor is able to show fake empathy for the BPD henchman.After he kills the leader and dumps his body in the lake, the brother asks if the group will believe their story about how the leader was killed by zombies. The Governor says:People believe what they want to believeThey love a hero.Again, that is a narcissist's view of life, but the narcissist is able to bond to the BPDs because of their common emotions and background. .He decides that he'll kill anyone, and he he justifies that by saying he is doing it to protect his adopted family, whose daughter reminds him of his dead little girl. They are willing to eliminate anyone because they are freeing up resources for their own family. A rational creative person would think about growing the pie instead, but the narcissist or BPD probably knows deep in their hearts that they can't increase productivity.