Understanding BPD: Old School Vs. New School Inpatient Treatment (BPD Part II)

September 15, 11:38 AMMental Health Issues ExaminerEthan Elgin

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Knowing the difference between Old School and New School

As mentioned in an earlier article, there can typically be a divide in inpatient psych staff on how to treat patients with Borderline Personality Disorder. From what I have borne witness to in my experience, this usually boils down to “The Old School” and “The New School” methods of treating patients with these disorders. Note that while I will try to identify the difference between the two, I am not asserting one is better than another or that there is a “right or wrong” method of treatment. There is, however, a consideration that should be put in place when assigning certain staff to people with BPD or other Axis II disorders.

The Old School: The Old School staff are typically people who have worked in the field for a good number of years. Typically dating back to the days when Institutionalization and heavy medication were the preferred method of treatment. Crowd control is the forte for many people who fall into this category. They often utter phrases like: “people who are actually sick” and revert to “Pull yourself up by your bootstraps”, for people who seem high functioning, but suffer from something deeper and less immediately apparent such as depression or BPD. While this philosophy is not necessarily helpful to people with a BPD diagnosis; I have seen their experience be helpful to people with biologically based brain disorders such as Schizophrenia or dementia, though often times their methods or general intolerance of the more Axis II based disorders can be crippling to a patient or even set them off in a worse direction.

The New School: In the past 20 years advancements and massive strides have been made in identifying and treating people with mental illness. People who were not around during the days of the institutionalization and over medication of patients, typically take a broader more understanding view of BPD. At the forefront of these staff are typically occupational therapists who rely on methods other than medication or deep analysis (though it is not limited to this). Many of the people from the “New School” are well versed on new treatment and therapy such as Neuro-feedback, sensory integration therapy, EMDR, CBT, DBT,  or other hands on, non medication based treatments. Because of the lack of experience with institutionalization, they do not see the resistance to treatment by Axis II patients as a power struggle that must be won. Moreover, it can be perceived as a challenge with which to find their way around and work with what is available to make the treatment work.

Again, while this is not to say that one way is better than the other; often times it takes the combination of both the New and the Old to make a healthy milieu. Though certain considerations should be in place when considering who will be the primary staff for Axis II patients. Working through this will hopefully reduce staff splitting, power struggles and overall rebellions at times too. While the goal is to unify treatment for patients, it should be viewed that the person who works most with a particular patient goes a long way in helping reach that goal. The right combination of understanding, patience, medication and therapy can often times do unexpected wonders; making the inpatient experience as theraputic as possible.