Sunday, July 31, 2011

"Troubled" NFL Receiver Brandon Marshall Diagnosed with Borderline Personality Disorder

A brief article in USA Today led me to the original story from the South Florida Sun Sentinel by Omar Kelly - it details Miami Dolphins wide receiver Brandon Marshall's disclosure that he has been diagnosed with borderline personality disorder.

First of all, full respect to Marshall for coming forward about this, even though some might see it as an effort to rehabilitate his image (and win more endorsement deals). The stigma of mental illness in this country is still quite large and pervasive, so stepping up this way takes courage.

Secondly, even bigger respect for disclosing that he suffers from an illness generally perceived to be a female mental illness (and the diagnosis is 75% women, which does not mean that men are immune). It takes courage in the world of hypermasculine professional football to admit you have what is considered by many a "woman's illness."

Finally, borderline personality disorder (BPD) is one of the most confused and confusing diagnoses in the DSM - it was originally conceived in psychoanalytic circles to designate someone who is on the borderline between neurosis (boundaries and defense mechanisms are too rigid) and psychosis (boundaries and defense mechanisms are too fluid).

The "practical" definition has become a catch-all for those most difficult of clients - the ones who love you one day and are reporting you to the state board the next - while the DSM definition has become more precise.

Most recently, it has become more clear that BPD may actually be complex PTSD (C-PTSD) in many clients - and there is a grassroots effort being waged to make the change in terminology, if for no other than removing the terrible stigma associated with being labeled borderline.

This definition of C-PTSD comes from an article on the Veteran's Administration website (which is a huge step toward helping our combat veterans):
What are the symptoms of Complex PTSD?

The first requirement for the diagnosis is that the individual experienced a prolonged period (months to years) of total control by another. The other criteria are symptoms that tend to result from chronic victimization:
  • Alterations in emotional regulation. May include persistent sadness, suicidal thoughts, explosive anger, or inhibited anger.
  • Alterations in consciousness. Includes forgetting traumatic events, reliving traumatic events, or having episodes in which one feels detached from one's mental processes or body.
  • Changes in self-perception. May include helplessness, shame, guilt, stigma, and a sense of being completely different from other human beings.
  • Alterations in how the perpetrator is perceived. Examples include attributing total power to the perpetrator, becoming preoccupied with the relationship to the perpetrator, or preoccupied with revenge.
  • Alterations in relations with others. Examples include isolation, distrust, or a repeated search for a rescuer.
  • Changes in one's system of meanings. May include a loss of sustaining faith or a sense of hopelessness and despair.

What other difficulties do those with Complex PTSD tend to experience?
  • Survivors may avoid thinking and talking about trauma-related topics because the feelings associated with the trauma are often overwhelming.
  • Survivors may use alcohol and substance abuse as a way to avoid and numb feelings and thoughts related to the trauma.
  • Survivors may also engage in self-mutilation and other forms of self-harm.
These are essentially the same symptoms as BPD, but without the terrible stigma of being "a borderline." In this perspective, the issue is an attachment disorder resulting from repeated trauma that has created extreme challenges with self-identity and affect regulation - it's not personality disorder, a diagnosis that most people feel is intractable.

So, here is the article on Marshall - look at how some of his life events line up with the C-PTSD diagnosis.

Brandon Marshall diagnosed with borderline personality disorder

Dolphins receiver says proper diagnosis and treatment for a psychological disorder saved his life

, July 30, 2011

Brandon Marshall has been holed up in the theater room of his new Southwest Ranches home for the better part of five days.

The home is grand and gorgeous, but the theater room is the world's loneliest. Even its sole occupant is unable to see himself.

He has been calm and introspective for hours talking about his disturbing childhood, dysfunctional family and the incident earlier that April week that led to the arrest of his wife Michi Nogami-Marshall for allegedly stabbing him during a domestic dispute.

Then, as if a switch had been flipped, Marshall's fuse is lit. The Miami Dolphins' star receiver becomes agitated — then deflated — after watching his lesser-known contemporary Calvin Johnson in a national television commercial.

It's the kind of gig Marshall always has desired, but will never receive because of a troublesome past, riddled with emotional outbursts and public disputes dating back to his days at UCF.

These days it's difficult to convince himself — much less the world — he's not volatile. It's hard to persuade people you're not a ticking time bomb when you've blown up so many times before.

Marshall has received counseling five different times, sometimes by NFL order. But all they really led to was more frustration.

"Count to 10! What's that going to do?" Marshall says. "I'm still angry when I'm finished."

Tick … tick … tick

Four years of therapy never helped Marshall gain a better understanding of his issues or how to deal with them. Until now.

After three months of treatment and therapy, psychological and neurological exams at Boston's McLean Hospital, the training ground for Harvard University medical students, Marshall believes he's finally at the root of his struggles.

He has been diagnosed with borderline personality disorder, or BPD.

"BPD is a well understood psychological disorder. It's not a form of misbehavior," said Mary Zanarini, a professor of psychology at Harvard Medical School, who treated Marshall this summer.

BPD is a mental illness that studies say is more common than schizophrenia and bipolar disorder, but is rarely diagnosed because of misperceptions in the mental health community, and the challenges of providing a proper treatment plan.

The disorder is marked by difficulties with relationships and self-image and controlling moods and emotions.

During Marshall's treatment at McLean, he learned how to defuse the bomb inside of his head. Now with the tools and a new perspective he's returning to the real world, to the NFL, to a marriage he admittedly broke, and to a wife who feels vilified. He must use the skills he's learned to survive, if not thrive.

He has informed the Dolphins of his diagnosis and said he is revealing his story with the goal of creating more awareness of BPD and advocating for better treatment and medical coverage for a treatment program that cost him $60,000.

"By no means am I all healed or fixed," Marshall said, "but it's like a light bulbs been turned on in my dark room."

Tick … tick …

In 2010 Marshall landed a $50 million contract in his home state, and married a beautiful and educated woman whom he says completes him. Life was supposed to be great. But all the luxuries and privileges meant nothing because Marshall sparingly enjoyed himself off the football field.

He said he was depressed. After being scorned by so many loved ones, he was scared to trust. He never opened up to Michi and often lashed out at her.

Sometimes the emotion Marshall struggled to contain surfaced on the field. Following an outburst during a team meeting it was Ricky Williams who recommended Marshall seek help at McLean, where Williams received treatment for his well-known personal struggles.

Marshall initially held sessions over the phone, then visited Boston every few weeks in January and February to sit down with clinicians. After his altercation with Michi — he admits he trapped her in a closet to keep her from leaving — he knew he needed more intense treatment.

"It wasn't till I got here that I understood why I was so unhappy, why I was so miserable," Marshall said. "But understanding is merely the beginning of the journey."

Marshall underwent three types of treatment. He met on a daily basis with clinicians and fellow BPD patients for at least four hours a day learning how to properly process his emotions. He's discovering things like mindfulness, radical acceptance, distress tolerance, which comes naturally to most, but doesn't to someone suffering from BPD.

"Anytime there's conflict it's a challenge," Marshall said. "What I'm feeling or trying to get across is right, but I'm reacting wrong. My actions or what I'm saying is not effective or productive and it makes the situation worse."

Tick …

The therapy Marshall has received at McLean has helped him learn how to process his emotions, and it's helped him to get at the root of his disorder.

Even though the charges against Michi have been dropped, his marriage needs plenty of work before it's repaired. But Marshall's first priority is to develop a BPD treatment plan for himself in South Florida and continuing to make positive progress.

"Before this ordeal I kept asking God to show me my purpose. He gave me this," Marshall said. "I'll be the face of BPD. I'll make myself vulnerable if it saves someone's life because I know what I went through this summer helped save mine."

His goal is to advocate for advancements in BPD research and treatment, and he plans to fight for effective BPD screening in the mental health community because he'd love to see fewer people crippled by what he's learned is a treatable disorder.

"Brandon's doing an extraordinary job of coming forth," said Jody O'Malley, his case manager at McLean. "He's using what he's learned to touch other people's lives who are dramatically impacted by loved ones who have borderline personality disorder."