BPD and the Problem of Pain

In December of 2009, I was in a bus accident. I was rushed to the hospital via ambulance, taken in via wheelchair, and treated for back and neck injuries. The problem is the injuries, initially thought to be muscular injuries, were worse than they appeared--my spine had been knocked out of alignment. I never healed up right from that.

The pain was bad enough, but little did I know that my problems were really going to begin when I sought treatment for it. If you have a psychiatric disorder, you are almost always assumed to be drug-seeking: which leads to the problem of pain.

[caption id="attachment_612" align="alignnone" width="170" caption="Medical treatment can be difficult for a psychiatric patient to obtain."][/caption]

Borderline personality disorder and substance abuse

Substance abuse is one of the symptoms of borderline personality disorder (BPD). While it may or may not be present in one person's case, it is common enough to warrant suspicion on the part of the doctor, and this suspicion affects what kind of medical treatment is received. In my case, X-rays weren't taken for almost a week after the accident--the doctor just examined me for any visible wounds and sent me home.

I have no history of prescription drug abuse. Yet I was treated as if I did when the pain became worse. I was on Darvocet, a relatively mild narcotic painkiller, yet it didn't help. The pain became so bad I started dissociating, and even hallucinated on one ocassion. I begged for medical treatment, only to have the outpatient psych staff at my cluster apartment order me to stay away from the emergency room, doctor's orders. My primary care provider, who was surprised to learn that he'd given such orders (if you get my drift), eventually had to vouch that yes, I was hurt, and yes, I needed medication.

Yet I spent a week in excruciating pain and in medical treatment limbo because of the chance I might abuse the painkillers--despite no history of doing so, and in spite of the fact it would have been easy to monitor my use of painkillers.

It's more common than you think

Forty-nine percent of people with schizophrenia reported that doctors took their physical symptoms less seriously if they were aware of the patient's psychiatric diagnosis. That is, if they can get to see a doctor. My primary care provider told me he sometimes had to get involved to make sure his patients with psychiatric diagnoses got medical treatment. That's just in an outpatient setting. Getting medical treatment in an inpatient setting is very difficult.

During one stay in inpatient, I began suffering from severe pain in my lower right abdomen. I asked for medical treatment; staff gave me some aspirin. It got worse. Staff told me to lie down. It got worse. Staff told me to lie down and put a washcloth on my forehead. When that made things worse, an irritated staff member finally let me go to the emergency room, where I was diagnosed with a kidney infection.

A similar thing happened when I was at Richmond State Hospital. I began suffering from back and foot pain. My requests for medical treatment went unheeded. I went through this for four months, receiving treatment only after I was transferred to Larue D. Carter Memorial Hospital. There, I was diagnosed with muscle spasms and fallen arches, given physical therapy and Ibuprofin, and was able to recover in about a week.

It could have been worse--I knew a patient with appendicitis who was denied treatment until it burst, and upon his return to the psych ward, staff allegedly would not give him prescribed painkillers.

The right to manage pain

Why is it like this? Why is it inhumane to make a dog live with chronic pain, but legal and standard practice to make a human being do so? Why do we, as mental health consumers, have no right to manage pain?

While there are psychosomatic ("in your head") illnesses and people who lie or even self-injure to get painkillers, this is the exception, not the norm. These cases can be figured out and treated accordingly. But in cases where a simple blood test is needed, or a simple X-ray, why is it okay for a "normal" patient to get these tests and not a psychiatric patient?

The most important thing we can do is try to educate our doctors. We can tell them that hypochrondia and addiction are not part of our symptoms. We can give them permission to talk to our psychiatrists. We can learn to manage chronic pain by repeatedly asking for help doing so.

Doctors are human beings, and as such are prone to believing the same myths about mental illness--that we're faking it, that we want to get high, and so forth. Only education can get them to challenge the stigma of mental illness, and to treat us like any other patient. We have the right to manage pain, but we have to work for that right by educating those around us.