Professor Michael Kaess Dear ladies and  gentlemen, dear colleagues, it is my pleasure that   I have Louisa here today. She was a former patient  in our early intervention service, and she agreed   to answer a few questions from the perspective of  a former peer adolescent diagnosed with borderline   personality disorder. So, thank you very much,  Louisa, for being with us. Louisa, would you mind,   in the first instance, to briefly tell us when  you were seeking help for your problems in our   service, when you were diagnosed with borderline  personality disorder and what happened after that? Louisa Gyger Sure. So, I started going to therapy  when I was about 16-years-old. More specifically,   I was also in the Institution of [inaudible  – 01: 09], but at the place where I was,   they haven’t done, like, diagnostic at this  time. So, it wasn’t much about what are my   diagnoses? More like what is my problem and  “How can I help you with that?” But then,   after several times of being to therapy and seeing  that it isn’t working, I switched to Bern to get   my diagnosis. So, I was about 17-years-old when  I got my BPD diagnosis. I’m now 20-years-old,   so it was about three years ago, and yeah,  that’s also when I started doing the DBT, sorry. Professor Michael Kaess: Dialectical behavioural  therapy, yes, when you went into our programme.   So, may I just briefly ask you, how are you  doing today and what are you doing now? So,   what – how did the years after  your treatment work for you? Louisa Gyger: Well, as you already said, I’m  doing peer work with mostly 13-16/17-year-old   patients who have diagnosis like I do. Mostly,  they have also borderline, but some of them have   other things, like ADHD or depression.  So, that’s something I did after I was,   like, done with therapy. And also, I’m doing,  next to that, a school, which will lead me to   studying psychology in about two years, so, yeah. Professor Michael Kaess: Yeah, so you’ve   successfully completed your degree in school  and you are now doing secondary education and… Louisa Gyger: Yeah. Professor Michael Kaess: …probably,  one day, you will become a Therapist. Louisa Gyger: Yeah. Professor Michael Kaess: Yeah, which at  the moment, you’re still a peer worker.   So, can you – maybe I think what  is probably very interesting for   the people who listen to this is what –  how does it feel to have a diagnosis of   borderline personality disorder, or better to  say how did it feel because you do not suffer   from the disorder anymore? And what were the  core symptoms or problems you were facing? Louisa Gyger: Well, I would say I was actually  pretty happy about getting the diagnosis,   like, not because I was sick, but  because I could finally name it,   ‘cause there were so many things that didn’t feel  right to me and now I could, like, say, okay,   it’s because of that and I can work on it. So,  at the – very briefly, at the first moment,   I was, kind of, happy, but after being  diagnosed and get – you get to talk with   people about it and you realise that there is  a big stigma about it. So, that was, kind of,   hard for me at the beginning because I had to  learn, again, how do I tell people that not   everyone with this diagnosis is, like, the same? I  actually met people who were, like, “No, we can’t,   like, be in a friendship or – more, because I’ve  met someone who has BPD and it didn’t work out,   so I’m not going to even try it with you.”  That’s also why I, kind of, started, like,   in my group of friends or school, to do, like,  quite some similar to charity work. It’s more   like to educate them on these things, just for,  also, me to not be, like, put in the stigma. Professor Michael Kaess: Yeah. So, that’s  interesting when you say you ‘educate’ friends   and people around you. Would you mind telling us  how do you educate them? So, what do you tell them   about borderline personality disorder? What are  the core things that you tell people about BPD? Louisa Gyger: So, maybe I have to  say first, that I’m in a school who,   like, you go there if you want to  work in a social job later on. So,   most of the people are quite social and open to  learn things about mental health. But mostly,   I talked first about the symptoms and I would  say a lot of the people could, like, understand   how it feels on a – on somehow of the levels, but  not quite as hard. Like, they knew what I meant,   but I just, like, had to tal – tell them, “Yeah,  okay, feel” like “feel sad for me. It’s a lot   more or it comes – like, if you are grieving  for someone, this kind of pain, I have that   after a little incident.” So, mostly, I did it  with, like, everyday things that they can, like,   really understand that it is – in every situation  you have to control yourself for not slipping. And also, I think after, like, the first times,  they got more confident in asking and also,   that really helped me, then, to, like, understand  what things they don’t quite understand. Like,   being close to someone or pushing them away,  that’s one of the things that they didn’t   understand at the beginning, because for a person  who’s not diagnosed, they don’t have this feeling   of okay, I might lose them. So, on one hand, I  could, like, go even closer and they wouldn’t   feel comfortable because I’m so close to them and  I don’t want to let them go, or I going to push   them away so that I don’t get hurt in the first  place. And for them, it’s not that rational to   think about it like that, so that’s something  I really had to talk about quite a lot, yeah. Professor Michael Kaess: But I think you’re little   bit – touched a little bit the topic  of interpersonal instability. You know,   that’s how we professionals lame –  name that, that there is a pattern of,   you know, very close, but often – and intense  relationships who often break. Would you mind,   maybe, also telling me how it feels to suffer  from what we call emotional instability? So… Louisa Gyger: Hmmm. Professor Michael Kaess: …you know, did you  perceive that and how does it – how did it feel? Louisa Gyger: Quite of hard to explain it. It’s  – on one hand, you can’t quite understand the   feelings of someone else. Like, you always  question it. They – like, they can tell you   ten times a day, “I love you,” but you’re still  going to question it. And on the other hand, you   can’t quite understand your feelings by yourself.  Like, sometimes when I’m, like, stressed, I get   anxious or I get mad and I don’t even realise  it because I can’t put it into place and also,   I don’t know where it’s coming from. So, that’s  quite of a, I would also say responsibility you,   like, have with you every day, because you  also have an effect on the people around you. Professor Michael Kaess: Hmmm hmm. So, it’s  really, also, a topic of get – making sense of   your emotions, you know, and recognising  them, but also making sense of them,   understanding them. Yeah, this was  problematic, yeah. And then, a third,   you know, domain of borderline personality  disorder is the lack of self-esteem and also,   what we call identity disturbances. Did you  have anything like that and how did that feel? Louisa Gyger: Oh, well, yeah, I – actually,  I would say that’s, like, one of the symptoms   that were quite obvious from the start on.  Every several month, I, like, changed my   whole personality about my hobbies, the things  I like and I really put a lot of money in it. I   went shopping and then, bought, like, books about  the themes that I’m interested in at that moment.   I bought a different clothing style. I changed,  also, a lot, my hairstyles. I had, I would say,   about every colour in my hair that there is, and  it was also, kind of, frustrating, because I knew   it will change in about two or three months  again, but I couldn’t do anything about it. And also, my family knew that I wasn’t quite –  like, I knew that it’s happening, but I couldn’t   do anything about it, and they were in it too,  and they knew how much money I spent on it,   but it’s – also, they couldn’t, like, put  themselves in it, because it was like a   way of finding myself. And after several month,  it’s changed again, but they never could, like,   say, “Okay, no, that’s not you,” because they  never knew, and it was like the same for me,   because in that moment, I felt like this  person, but then, sometimes, even a week later,   I changed it again. So, it was quite of hard  because my friendships were, like, different   every other month and everything surrounding in  my life. So, that was quite of a struggle next   to school and all the other factors that are,  like, in BPD that was like a really big one. Professor Michael Kaess: Hmmm, I can imagine  that’s also pretty exhaustive, isn’t it? Yeah. Louisa Gyger: Definitely, yeah. Professor Michael Kaess: Interesting,  yeah. So, you told me before that,   you know, in the first instance, when you heard  about, I have borderline personality disorder,   you felt some kind of relief, like oh, yeah,  there is a name and that makes sense and somehow,   that seems to fit. But then, also, you  said that in the following weeks, you   were confronted with quite a bit of stigma,  yeah? Could you describe a little bit more   what kind of stigma that was? So, what did  people say and who stigmatised the disorder? Louisa Gyger: Actually, from – what kind of people  it were, it was, like, throughout every age. It   starts with teenagers, who are very active on  the social media platforms, especially TikTok,   which I wouldn’t say glorifies, but, kind of,  romanticises all these mental health issues,   and you start to feel like, yeah, you just have to  be, like, angry in a situation and you have BPD.   So, it wasn’t quite taking this serious. That was  something, then also, elderly people who didn’t   have, like, the knowledge about it and weren’t  quite open to learn. So, it was also, kind of,   hard to explain to sometimes Teachers,  sometimes family members, what’s, like,   happening and why I struggle with some things,  because they weren’t open enough with it. And if we, like, go back to the teenagers, there’s  also – like, I met people, or it – there were   people in my friend group and when I talked about  their – with them about my disorder, they were,   like, “Oh, that’s so relatable,” like, “I got that  too,” which at the beginning, make me feel like I   wasn’t taken quite serious. But on the other hand,  I didn’t want to take them not serious because   it could be that they have BPD, too, but it was  because of social media, so stigmatised that it’s   so little, that you can, like, see over it. It  was always, like, should I say something or not?  Professor Michael Kaess: Hmmm, and it’s  quite interesting, because what you say,   from how I understand it, is that there is a  problem in insensitivity towards the diagnosis,   but also, some hypersensitivity, you  know, if people think, like, oh, yeah,   this is BPD and this is BPD, which obviously, does  not feel very validating, as well. Is that right? Louisa Gyger: Yeah. Professor Michael Kaess: Yeah, okay, thank  you. So, let’s go, in the last five minutes,   perhaps to the question of treatment.  You said that after being diagnosed,   you then also received early intervention  for borderline personality disorder,   specifically dialectical behaviour therapy.  I’m not asking you about all the components and   I referred myself about, you know, DBT many times,  but for me, it would be, actually, very important   to understand what was the most effective  components of treatment for you, personally? So… Louisa Gyger: Well, I would say, actually, like,  the group therapy. Maybe I have to say I did DBT,   like, two times and the first time I  did it, I was in inpatient treatment,   so I knew all the people from the group therapy,  I lived with them. And on one hand, it was, like,   they really – it’s like a good feeling  to know that you’re not alone and also,   see, like, the different personalities of the  people and still know they have the same disorder,   but we’re not all the same. Which, like, helps  you out – helps you to get out of that, also,   that stigma. Maybe it wouldn’t have been that if  I wasn’t in inpatient treatment, because it can   be quite hard to open up to other people, even  though when they have the same diagnosis. But   it was definitely that in the first time I did it  and probably, also, like, including the parents. I must say some – like, with one side  of my family, I still don’t have, like,   a very good bond, but it helped it – for them  to understand me in – if we just talk about,   like, this diagnosis, because they – I  couldn’t explain it to them at this time   and they also didn’t understand it.  So, having someone in between, who,   like, clarifies the things in between that and  also, like, meeting the parents of the other   patients in inpatient treatment was quite  of – interesting and also, helpful, yeah. Professor Michael Kaess: Hmmm hmm. Okay, and  besides treatment, you know, was there any things   that were particularly helpful for your recovery?  So, who or what supported you on your path? Louisa Gyger: I would say that it was clarified  that if something’s not working for you,   it’s okay. Because at the beginning, I was  like, okay, so we have so many skills and,   like, three of them are helping me and the others  are, like, bullshit for me. So, at the beginning,   I was, kind of, anxious to tell someone about  that because I thought maybe something’s even   more wrong with me. I was, like, so in that focus  in it that they’re trying to help me and I can’t   even let them help me. So, ‘cause of the therapy,  they, like, told me, “Hey, it’s okay, if it’s not   working, it’s not working, everyone is different.”  And then, I also saw the things that are working   for me aren’t working for someone else, which was  totally fine. And I think, like, talking about it   and saying, “Okay, that doesn’t mean that it’s –  that you’re not going to get out of this therapy   and being, like, in a better position than you are  now.” Like, you can still get the help you need,   even though when you sometimes feel like  things aren’t quite that good for you, yeah. Professor Michael Kaess: Thank you. Is there,  despite the helpful things, also things where   you said – I mean, we are educating Mental Health  Clinicians here, so is there any things that you   experienced that were not so helpful or maybe  things that you missed, where you’re today, you   know, reflecting on your mental health problems,  said, oh, nobody helped me with this or with that? Louisa Gyger: Hmmm, actually, I had like a little  therapy session when I was about 12-years-old   because my parents knew that I was doing  self-harm and they wanted me to go to therapy   and it was like, kind of, old lady who was, like,  pretty harsh, especially for a teenage girl who   doesn’t even know why she’s cutting herself.  So, that’s probably one thing that was quite of   having an impact on me and also, that’s why I only  start to go regularly to therapy when I was 16,   because I had this moment with this lady which  was so not good that I haven’t had, like, the… Professor Michael Kaess: Trust. Louisa Gyger: I couldn’t get myself to go to  therapy again because I was so scared of it. So,   she didn’t have – like, she didn’t give –  gave me, like, a feeling of, “Hey, it’s okay,   we can talk about it.” She more was like, “It’s  not okay, you don’t do that in this society,   and we have to get rid of it,” which  is definitely not effective, because   I had to go to therapy again. Yeah, that was  probably one thing, and I would also say, like,   the only thing – because after going to therapy at  16, I was, like, a little bit older, but also, the   Therapists I had there were a lot more comforting  and open to talk about everything, yeah. Professor Michael Kaess: Thank you. So, I think my  last question would be, and that’s probably also   interesting for the audience, would you consider  yourself having borderline personality disorder   to date – today, or what – you know, what’s left?  I mean, obviously, you did school, you’re going   to work, you’re now – many things have improved,  but yeah, you – we also know about the stigma. You   know, there’s some lifelong persistence of some  things, maybe, so how is that for you? What…? Louisa Gyger: Well, that’s actually something  I did talk about with quite a lot of people   and it’s like I know, or I have the  assumption, if I would go to a Therapist   today and do a diagnosis, I wouldn’t get  diagnosed, because I didn’t fill out, like,   the characteristics or symptoms to be diagnosed.  But I also know that I have a lot more struggles   with interactions with other people and  all these symptoms that are consulted in   BPD because I still have them, like, back in  my mind and I still have to work on it every   day. And it takes longer for me to, like, get  out of a situation than for a normal person,   a person who’s not diag – or who doesn’t have BPD.  And also, with, like, friendships and all the,   like, interactions with other people are still  quite hard, but I know how to manage them. But I   still know I have, as I said, I have to put in a  lot more work than a person who doesn’t have it. So, it’s like I came up with being sober. Like,  I’m still in the spectrum, like I still have it,   but know – I know how to be with myself and  just how to act to not, like, show the symptoms. Professor Michael Kaess: So, it’s an interesting  comparison with being ‘sober’, you know, because   it just means that you’ll probably always need to  invest some effort to, you know, remain stable. Louisa Gyger: Yeah. Professor Michael Kaess: But on the other hand,   you also have the capacity  and the skills to handle it. Louisa Gyger: Yeah. Professor Michael Kaess: Is that right? Louisa Gyger: Yeah, I guess. Professor Michael Kaess: So, very last  question, is there anything from your   side that you would like to tell our future  or current mental healthcare professionals? Louisa Gyger: Oh, good question. It’s probably  to, like, put yourself more into the perspective   of a now on teenager with all these sources  of social media, because that has such a huge   influence on these people and because it gets  – still gets so glorified. Some kids even came   to me and were like, “Yeah, do you think I have  it? Can I get the diagnosis, because I want it,   because it’s nice to have?” And most of these  kids and teenagers don’t even understand how   hard it is, like, to live with a diagnosis like  that and this isn’t spechi – specifically for BPD,   it can also be for depression and other things.  So, you really have to talk with them about how,   like, hard the symptoms are, because mostly of  the time, they don’t think it’s that harsh, yeah. Professor Michael Kaess: Hmmm hmm.  So, thank you very much. I think   what you are advocating for is, you  know, if someone has the diagnosis,   then please diagnose it and treat  it, but also, be very cautious. Louisa Gyger: Hmmm hmm. Professor Michael Kaess: You know, and do  rigorous diagnostic assessment and be careful. Louisa Gyger: Yeah. Professor Michael Kaess: Yeah. Thank you very  much, Louisa, that was fantastic. I thank you. Louisa Gyger: Thank you.