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Not a new story as such but I'd like to hear more voices from the Afghan people to get an understanding of what it's like to have foreign troops stationed in their country.
Perhaps people who've lost loved ones at the hands of our forces and the Taliban. Maybe speaking to some Afghan refugees in this country. At the moment I eel the news focuses much too tightly on British losses which doesn't help us reallyunderstand what's happening out there and what the real prospects for peace are.
Thanks for listening.
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Hello JimJay1
PM reporter Hugh Sykes is heading to Afghanistan soon - will pass on your comments.
You might also be interested in this piece in The Observer today
http://www.guardian.co.uk/world/2009/aug/09/life-in-afghanistan
More on Hugh here
http://www.bbc.co.uk/blogs/pm/9ehugh-sykes/
thanks
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This comment was removed because the moderators found it broke the House Rules.
Sorry this goes into such enormous detail at such great length...but discrimination is still a very common experience for students with disabilities (although I prefer the term 'different abilities') since Richard Branson, Anita Roddick, James Lovelock, Pierre Curie, Einstein...et cetera... are among the many 'disabled' people who changed the world.
We have so much to give, and now we demand our human rights....
Rosemary
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This comment was removed because the moderators found it broke the House Rules.
almost five hours in moderation?
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Make that eight and a half hours!
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Rejection email received exactly nine hours after original posting:
"omments posted to BBC blogs may be removed if they contain links to other websites which break our Editorial Guidelines
The URL(s) which failed were:
(For example do not link directly to pdfs, or other documents that need software installed to view them)
[space entirely blank]
Please read the BBC blog and message board external links Editorial Guidelines page, for more information:
http://www.bbc.co.uk/messageboards/newguide/popup_editorial_guidelines.html..."
This is patently untrue. There was no "improper" link, no pdf, etc.
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Sorry about the problems you're having - will try and get it sorted.
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Thanks Jennifer.
Good luck
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Well, I suppose you already know that the electricity, gas, water and phone companies, the town halls, shops and banks, post offices and police stations have, in the last 20 years, all become distant machines that talk to you by computer, and that it is now impossible to build a relationship of mutual trust and respect in our dealings with them, and that they have all ceased to function as agents of social cohesion.
And I suppose you already know that all our small towns seem to be run by gangs, very respectable, established gangs with patrons and secret handshakes, whom the police and lawyers will not touch, who officiate upon every board and are able to include and exclude those whom they choose - and that this is the model and the motive for upstart gangs on every disenfranchised estate.
Not much of a story to get hold of, though. It's just the way things are, the elephant in the room that keeps sitting on everybody.
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Living on the Borderline
I was diagnosed as having borderline personality disorder in January 2008. At this time I was a middle manager in a local authority. This is the story of my gradual transition from gamekeeper to poacher.
Had I been waiting for some manner of surgery or medical intervention, then my treatment, in line with department of health directives, would have started within 18 weeks. However, since I have a mental health problem, the time between referral and treatment is not dictated by any such directives. Psychiatric waiting lists are locally managed with no clear guidelines to ensure consistency or equity of care.
“So what do you think I’ve got?” I was terribly earnest. This diagnosis had been a long time in the making.
“I don’t like labelling people,” Dr. Brown, my psychiatrist, was just as intense.
“But if you were to give me a label?”
“Well then, Mr. Young, I’d have to say you display many of the traits of Borderline Personality Disorder.”
Had I been one of my less knowledgeable colleagues or a member of the general public I might have thought, “Oh, that’s all right then – I’ve nearly got a personality disorder,” or, “Borderline Personality Disorder, what the Hell’s that?”
That, however, was not the case.
The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which is used by the American Psychiatric Association, describes BPD as a cluster of symptoms. If a patient displays 5 or more of these then they can receive the diagnosis:
1. Frantic efforts to avoid real or imagined abandonment. [Not including suicidal or self-mutilating behaviour covered in Criterion 5]
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). [Again, not including suicidal or self-mutilating behaviour covered in Criterion 5]
5. Recurrent suicidal behaviour, gestures, threats, or self-mutilating behaviour such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness, worthlessness.
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms
Personally, I display 7-8 of these traits.
In the UK, we use a different diagnostic tool, The World Health Organisation’s “International Statistical Classification of Diseases and Related Health Problems” 10th Revision (ICD-10). In this they talk of a comparable condition, “Emotionally unstable personality disorder - Borderline type”
So what, I hear you cry. Does it really matter that there are different tools and definitions for the same condition?
It does when all of the health professionals I’ve worked with use the American and not the UK model. For a condition where confusion and misunderstanding is already rife amongst the public, health professionals and those who may have attracted the diagnosis, it is essential that there is just one clear definition of BPD that we are all working to.
I recently met an old colleague and friend of mine who I hadn’t seen for a few months.
We soon got chatting and she told me about another friend who had contracted cancer and was dealing with all the treatments attached to that. We both made all the appropriate concerned noises, but, being British, nothing too over the top – we were, after all, in a public place.
Jane had heard that I’d recently been disabled out of social work. Again, all the right, quiet, noises were made. She’d worked with me at the time when I was first told that I had depression.
“Turned out it wasn’t depression after all,” I smiled brightly at her, “I’ve been diagnosed with borderline personality disorder…”
Jane’s hands flew up to her cheeks as her face contorted into an expression that had only previously been seen in Munch’s “The Scream”. She took a step back and squealed.
She may have said, “Oh my God.”
“It’s not a death sentence…” I said in an attempt to dilute the situation.
“Sure,” she said, taking some steps to compose herself, “We’ll speak later…”
And off she went.
The interesting thing about Jane is that she is a mental health officer – the Scottish equivalent of the approved social worker in England.
So what would cause a normally composed mental health professional to react in such a way to that seemingly harmless label, ‘Borderline Personality Disorder’?
Over the years BPD has attracted a number of preconceived notions that are now held by many people working in health and social care:
• People with BPD are dishonest and manipulative;
• People with BPD are dangerous – after all, Josef Fritzl has been diagnosed with a personality disorder;
• BPD is untreatable and the sufferer will have it for life;
• BPD is the ‘Dustbin Diagnosis’ for people who don’t easily fit under the umbrella of one of the other, more well known mental health conditions;
• There are GP’s who don’t recognise BPD as an authentic condition.
It is hardly surprising then, that when I received this diagnosis I thought, “Oh my bloody God…I’m doomed.”
I did what anyone else in my position would have done. I read everything I could get my hands on regarding my condition.
In the meantime I was disabled out of the job that I’d been doing for 15 years. I’d wanted to be a social worker since the age of 12 and had reached the dizzy heights of middle management. My symptoms were now making this role untenable.
At home, my behaviour was becoming more and more erratic and antisocial, causing the downward spiral of distress to my family that fed into my feelings of alienation as a result.
I made the decision to move out. I felt I could no longer expose my children and my wife to my unpredictable symptoms.
Suddenly I was homeless. Suddenly I was going through the humiliation of applying for Incapacity Benefit, Disability Living Allowance and Housing Benefit to supplement my social work pension of £218 per month. The whole process felt degrading, at times I felt pilloried, in the stocks, for an extra £35 per week.
Unexpectedly, my reading had revealed a whole raft of treatments that were available for my condition.
In the States, Marcia Linehan had developed a treatment for BPD, Dialectical Behavioural Therapy, a kind of spin off of cognitive behavioural therapy, that has been used with significant success since 1993. In it she recognises that BPD is a complex condition that requires a variety of approaches to deal with it.
In the UK, Fonagy and Bateman have developed Mentalization, a type of psychotherapeutic intervention that focuses on enhancing the patient’s capacity to think about and regulate their mental states. Again, they are experiencing similar levels of success in the treatment of BPD to Linehan.
Further, there is individual and group psychotherapy. There are therapeutic communities where individuals are removed from mainstream society and placed in what is deemed to be a more validating environment to enable them to focus on their needs.
Although there is no specific BPD drug, pharmacology has a great deal to offer the BPD sufferer. There are a raft of drugs that can be taken in therapeutic doses to stabilise mood and emotions to enable the BPD sufferer to make the most of their talking treatments.
The shocking thing for me was that neither I, nor my health and social work colleagues had any notion of what was around to support this client group.
A huge problem for the professionals working in this area is motivation. When one believes that a condition is untreatable and merely manageable, then one is a damn site less likely to pull out all the stops in an attempt to help treat it.
So suspicion, fear and resignation reign where, at the very least, there should be hope.
In January this year, NICE published guidelines on the treatment and management of Borderline Personality Disorder. In it they outline all of the above diagnostic tools, treatments, therapies and medications that are being used with varying levels of success to help combat this condition. They talk of the need for more research so that patients, tax payers and health trusts can get more bangs for their buck.
Therein lies a major problem. Health trusts want to put their money into the most effective treatments. Research is an expensive luxury that they are reluctant to plough the taxpayer’s pound into without there being a promise of clear results.
On top of this the NICE guidelines are exactly that – Guidelines. In a world where professionals are more inclined to follow protocols that are mandatory as opposed to discretionary, they are much less likely to read through the 476 pages of the guidelines when there is no obligation to.
Which leaves me, as the Gamekeeper turned Poacher, on a discretionary waiting list waiting for a discretionary therapy whilst taking discretionary medication with a diagnosis that isn’t recognised by all the relevant bodies.
That said I feel I have been desperately lucky. After a year on a waiting list I am now receiving group psychotherapy alongside a small therapeutic dose of Quetiapine, which takes the edges off my self-harming and suicidal thoughts.
People who attract the label of Borderline Personality Disorder need to be in a position where they receive a clear diagnosis along with a prognosis. From this they should be enabled to make an informed choice as to what treatments would best suit them.
In a world where 1 in 3 of us will be profoundly touched by some manner of mental illness at some time in our lives, it really is time that psychiatric services were given the same recognition as the other health and social care services.
Because of the complex range of issues in the BPD sufferer’s life, they can place a high demand on health and social care services if they continue unmanaged.
“People with borderline personality disorder may engage in a variety of destructive and impulsive behaviours including self-harm, eating problems and excessive use of alcohol and illicit substances. Self-harming behaviour in borderline personality disorder is associated with a variety of different meanings for the individual, including relief from acute distress and feelings, such as emptiness and anger, and to reconnect with feelings after a period of dissociation. As a result of the frequency with which they self-harm, people with borderline personality disorder are at increased risk of suicide (Cheng et al., 1997), with 60 to 70% attempting suicide at some point in their life (Oldham, 2006). The rate of completed suicide in people with borderline personality disorder has been estimated to be approximately 10% (Oldham, 2006). A well-documented association exists between borderline personality disorder and depression (Skodol et al., 1999; Zanarini et al., 1998), and the combination of the two conditions has been shown to increase the number and seriousness of suicide attempts (Soloff et al., 2000).” NICE guidelines January 2009.
Research is required now to explore the efficacy of the variety of therapies used in the treatment and management of BPD. Without effective support, BPD sufferers will place a higher demand on services completely outweighing any perceived financial savings made from placing them on lengthy waiting lists.
Finally, comprehensive multidisciplinary training is required to ensure that health and social care professionals are aware of the spectrum of treatments and therapies available to BPD sufferers. This will ensure that service users receive the input they require and the professionals will achieve more of the job satisfaction they crave as a result.
The status quo is not an option. Without radical change now BPD sufferers will continue to demand a disproportionate amount of services without receiving the input they require.
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