Tag: Borderline Personality Disorder

In nursing you’re supposed to treat everyone equally and not have favourites. However, we are all human and some people we just click with, for whatever reasons. I loved all my patients, well 99.9% of them, but some are more memorable. Out of the thousands of patients I had the honour and pleasure to work with, these are just 3 of them. I think you’ll like them too.

Jackie

You’d have loved Jackie, you couldn’t help but adore her. This four foot nothing Scottish pocket rocket had a diagnosis of Bipolar disorder and often had me in hysterics as we enjoyed the same dry Scottish sense of humour. She’d use sayings I’d heard old aunties use when I was growing up like “I’m no as green as I am cabbage looking.” meaning I’m not stupid or “Do you peel oranges in your pocket too?” if you were eating sweets/cakes and didn’t offer her one. I’d said to her one day “I bet you were gorgeous when you were young,” and she shot back as she raced past me “Aye, I still am ye cheeky wee coo and I bet you were still offending people when you were young.” Another time she’d just returned to the ward, in her sopping wet slippers, from a few hours leave and told me what had happened as she was coming back through the hospital gates, “A cheeky wee b*stard asked me did a have a spare fag. I opened the box and counted 1, 2, 3, 4 ……16, 17, 18! 18 fags a telt him and not one of them’s spare!” Leaving me smiling, she speedwalked down the corridor to her room, chuckling all the way.

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Bipolar is a mood disorder and can be a life-long mental health problem. It used to be called manic depression and can cause your mood to swing from an extreme high to an extreme low. Manic symptoms can include increased energy, excitement, impulsive behaviour, racing thoughts and agitation. Depressive symptoms can include lack of energy, feeling worthless, low self-esteem and suicidal thoughts. Jackie spoke the above when she was well so in no way am I making a fool of her.

Jeannie

I adored this tiny cockney lady like I did my nana, who she reminded me of. She was about four foot six and no more than 5 stone but boy could she put up a fight. She’d been brought in by her Community Nurse when they said they’d found her depressed and sitting alone in her dirty flat. As Manager of Juniper Ward, Older Adults, I’d arrived one morning and immediately I knew Jeannie was nearby because the stench smacked me right in the face. I wondered which cubby hole I’d find her in today; waiting for me, as she did most mornings. The poor thing had been on the ward ten days and we still hadn’t managed to get her into the bath or shower. She’d screamed and cursed furiously when the word wash was mentioned, more often taking it out on “all the effin foreigners” who “ain’t touching me.” She’d growl in their faces “Learn effin English.” or “Go back to where you bloody come from.” I soon found her and as I bent to give her a hug, I whispered “Jeannie, Sweetheart, I think we need to help you into a shower today, cos I know if you were well enough to look after yourself you wouldn’t want to smell this bad.”

“Smell? Me? You cheeky fucker. It’s you, your nose is too near your own effin arse.” she scowled up at me but I caught her sly grin. I smiled because, despite her fearsome outer shell, I knew she was beginning to trust me. Assuring her all the way, Jeannie let me inch her towards a bathroom and, before she changed her mind, I quickly grabbed another nurse who could help. It was pitiful as she wept when we were undressing her and saw her frail ravaged body. She cried out in shame and my heart bled for her. However, we’d finally managed to shower her and get her some clean clothes and I could have cried when she stood ten feet tall, shimmying into day area like a peacock spreading its wings.

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Now there’s no way that smell was only ten days old; even Jeannie’s silver grey hair stank, it was matted at the roots and had clearly not been washed or managed for years. So why had the community team rang the ward, miscalling our team, saying that Jeannie’s been on the ward ten days now and she’s still in a state.Huh! What had they been doing for the last year or so? I asked them. And why did her family come storming onto the ward, thundering at my door, complaining that we hadn’t done anything with their mum’s hair. “Oh, I agree Jeannie’s hair is in a terrible state Sir, but your mum’s only been with us ten days, and you can see her hair hasn’t been touched for a long time.”

I explained to the buffoon of a son that his mum had the capacity to make an informed decision about bathing/showering or having her hair washed and she’d decided not to accept nursing support in attending to her hair. The Royal College of Nursing (RCN) 2017* states “If a person has capacity to make decisions independently then their decision is binding and the proposed examination, treatment, care or support cannot proceed, even if you think their decision is wrong.”

Eyes rolling. Pft! He tutted and sighed heavily, not quite sure what to say. So I saved him the bother and said “Look, if you’d like to make a formal complaint, I can let you have the appropriate forms -” Ptf! more heavy sighing and “No, it’s alright. No problem and thank you for looking after her anyway. She thinks a lot of this ward and I wouldn’t want to upset her; she can easily fly of the handle.” Really?

Andrea

This thirty-nine year old lady had a Borderline Personality Disorder (BPD). People who suffer from BPD struggle to regulate their mood and emotions, which results in them being unstable – sometimes for long periods at a time. It can cause problems in relating to other people, and often makes controlling impulses difficult. Unfortunately, some people with BPD are more at risk of experiencing suicidal thinking and self-harm attempts.

Many, though not all, patients who have BPD are known to have experienced parental neglect or physical, sexual or emotional abuse during their childhood. The symptoms of a personality disorder may range from mild to severe and usually emerge in adolescence, persisting into adulthood (NHS 2019).

Andrea had suffered many of the abuses at the hands of her mother and the men she took home. She had known her mother had given birth to several other children, both before and after Andrea, most of whom were adopted. Her young life had been chaotic, frightening and devoid of any love or kindness from her mother.

At the age of sixteen she met and fell in love with a young man and they ran away to Gretna Green in Scotland to get married. (In England you have to have parental consent if you wish to get married. However you can get married in Scotland at 16). Andrea felt loved, happy and secure, feelings she’d never known existed.

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The young couple managed to get a one bedroom council flat and their happiness continued until one day her mother came to visit for the first time. She stank of cheap alcohol and cigarettes, as always, and she still treated Andrea with utter contempt saying she’d only come to get a look at her flat and this new fella.

She’d barged past Andrea into the sitting room, took one look at Andrea’s husband and said “Ere, you ain’t adopted are ya?” When he said yes she chuckled and asked his date of birth. “Oh my gawd! ‘Ere Andrea, I think you’ve only gone and married your flippin’ bruvver.” she said, laughing . Neither Andrea nor her husband could speak so her mother continued unabashed and guffawing “Everyone’s been tellin’ me how alike you looked and it got me thinkin’ -.”

It was true. Andrea’s world was turned upside down, the reality sank in and their marriage was annulled. The first of many suicide attempts followed and in between them her behaviour was erratic, she self-harmed and had many hospital admissions. She was given a range of diagnosis over the years and had been described a variety of antipsychotics and mood stabilisers which either didn’t work or the medications weren’t being managed correctly.

I first met Andrea on an acute ward where I initially thought her rather threatening and sullen, responding to any communication with one word answers. She was left alone for days by the staff and I wondered how this could be therapeutic, but nurses just said “She’s always here. She’s only on the ward for respite, she doesn’t need anything.” So I watched as Andrea stomped from her bedroom to the smoking room and back, to the dining area and back and to the medication room and back, glaring at everyone she passed and talking to no one.

I’d always said good morning or afternoon to Andrea, as I did with every patient, and wasn’t sure what else to say to her. I knocked on her open door one morning and asked if I could come in. “Everyone else just walks in anyway.” she muttered. I told her I wasn’t quite sure, as a new nurse, what to say to her but I’d like to get to know her. “At least you’re honest.” she smiled a little “No one else bothers.” I was sad but shocked and angry, I suppose. I asked her about the myriad of scars trailing like train tracks all the way down from her shoulders to her wrists and she showed me her legs which were also ravaged by years of cutting and slicing.

Myth: Self-harm is attention seeking

One of the most common stereotypes is that self-harm is about ‘attention seeking’. This is not the case. Many people who self-harm don’t talk to anyone about what they are going through for a long time and it can be very hard for people to find enough courage to ask for help. https://www.mentalhealth.org.uk/publications/truth-about-self-harm

Andrea explained how the cutting started as a way to alleviate the disgusting thoughts and feelings she gets. She told me she enjoys the pain and watching the blood trickle because it gives her something else to think about for a while.

We started spending more therapeutic time together and it wasn’t long before Andrea and I had built a great professional and therapeutic relationship. After a while, we disregarded her ancient care plans and developed new ones which involved Andrea in the planning, risk management and reviewing of her care. We developed goals specific to her to maximise coping mechanisms, medication management, engagement with services and social integration prior to her discharge but to be continued in the community. She began to engage more with her peer group and attended a variety of therapeutic groups. She even joined me on the hospital’s mixed football team and proved to be a terrific goalie.

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Once I’d left that ward I often bumped into Andrea and always had time for a ciggie and a cup of coffee with her. On one of these occasions she quipped “This is all we all need; a ten minute dose of Nurse Nancy on the NHS each day.”

Could you be that nurse? The one that makes a difference. Could you be non-judgemental, kind, caring, compassionate and be a real listener where you actually hear the patient behind their story? We desperately need good mental health nurses to work for the NHS in the UK.

*Royal College of Nursing (RCN) 2017 Principles of Consent Guidance for nursing staff