(First, a glossary: BPD = Borderline personality disorder. DBT = dialectical behavior therapy. EDs = eating disorders. EMDR = Eye Movement Desensitization and Reprocessing. Educational resources below.)

The topic of health care reform is all over the news in this election year, with presidential candidates sharply divided on how best to curb government healthcare spending.  I've tried to set limits on the amount of news I see, because anger's a tough emotion for those of us with BPD. Watching the candidates scream at each other and fight amongst themselves feels too much like being trapped in a bad relationship, and I confess to getting much of my news through a Stewart/Colbert filter. 

But okay.

Deep breath, here we go.

There are non-medical therapies that are scientifically proven to effectively treat a number of mental illnesses. We have peer-reviewed studies and brain imaging studies and anecdotal evidence  that BPD is a biological illness and that DBT helps people with BPD and EDs stop trying to kill ourselves. It keeps us out of emergency rooms. It keeps us from needing ambulances.  Given that an ambulance ride costs $600-$3000, and ending up in ICU after an overdose costs many thousands more, and these things are happening to people with BPD and EDs over and over again -- not to mention the revolving-door ER visits -- why can't we convince everybody once and for all that eighteen months of DBT (and/or EMDR for trauma victims) should be the first-line, immediate treatment upon diagnosis?  We as a nation are spending exorbitant amounts of money on psych meds, and the insurance companies pay for those. Shouldn't we have the option to try the effective talk therapies before we end up on medications with horrific withdrawal symptoms and debilitating side effects and interactions that can kill us?

Not that meds don't work; I'm proof they do.  But I was prescribed two dozen unnecessary ones before I landed on the right one, at outrageous cost to insurance companies, taxpayers and my mind and body.

Today I found out about a girl with an advanced eating disorder  who was just airlifted to a trauma center because her organs are finally failing.  I don't know her whole story, but I'd guess it has something to do with this: after 30 days of inpatient ED treatment, many insurance companies cut you off. This creates a very long, very deadly, VERY expensive cycle of treatment-stabilization-relapse, not to mention needless human suffering.

But what if DBT and EMDR don't work? Then there are in fact TWO (count 'em!) more talk therapies proven to help BPD: schema therapy and transference-focused psychotherapy. If you don't respond to traditional ED treatment, try the Mandometer. If you're the parent of a child with an ED, check out the Maudsley method. There are multiple variations on the theme that talk therapy which a) emphasizes mindfulness, b) systematically challenges the stories you tell yourself every day (reevaluates schemas), c) follows a strict behavior modification protocol and d) gives people with BPD /EDs/trauma issues the skills that will help them implement the new behaviors, at a rate they can handle, which is usually 6-18 months, works. As in, you need less helicopters and ambulances and ICU stays, plus the whole prevention of needless human suffering thing. 

So, to my Congressional representatives and presidential candidates raging about health care reform: one of the few things Democrats and Republicans seem to agree upon, in this government so divided we can barely accomplish anything, is that our health care system is broken and we're spending too much money. So prove to your constituents that you're not just in the pockets of big pharma (though I reiterate my stance that meds do in fact help people) and try these things that are proven to work! Bag your own and save big dollars! We buy factory direct and pass the savings on to you! Double discount dollar days!! We stack coupons!! VISIT US IN HACKENSACK!!!

I will keep yelling this from the rooftops until this is how it works.




Transference-Focused Therapy

Schema Therapy



About the Author

Stacy Pershall

Stacy Pershall is the author of Loud in the House of Myself: Memoir of a Strange Girl (2011; Norton), chosen for the Barnes and Noble spring 2011 Discover Great New Writers program.

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