I was getting kids for the literacy program when I saw a crowd gathering in one of the poorer neighborhoods of our community. An older woman was flailing about; three other ladies attempted to restrain her. I told my kids to hurry along without me and approached to see if it was a medical emergency. Of course the kids stayed to watch, as they do.
As I got closer I became more confused and still couldn’t tell if it was a medical issue or a fight being broken up. The woman appeared on the verge of passing out yet was thrashing about so forcefully that it was difficult for the others to contain her. When they finally got her under control they made her drink from a cup of water and she settled down a bit. That was when it dawned on me. “That’s what happens with Shadia! She’s emotionally disregulated and they convinced her to drink something to break the cycle. Like we do!”1
Just as the woman appeared to be getting a handle on herself, a younger man started yelling. He was so out of control that I couldn’t understand him, but my initial assumption was that the older woman was the target of his anger. He stomped over to a house that had recently been demolished, grabbing and rejecting various objects like he was looking for a weapon. Soon he found a huge sledgehammer.
I had begun shadowing him once he moved into the house, so now I was in-between a man with a sledgehammer and his exit. “Crap, so this is the situation where I try to act nonviolently and get brain damage.” Thankfully, someone with enough confidence that they wouldn’t be his intended target rushed in and grabbed him around the waist, giving me a chance to put my hand on the head of the sledgehammer. When a second man came in to help restrain his body, I got two hands on it and wrested the hammer out of his grasp. I walked back to the demolished house and found a decent place to hide the thing under some boards.
Meanwhile the older woman had thrown herself at the young guy and was clinging to him. From their words I began to garner that this disregulated woman was the young man’s mother and the issue had something to do with a woman, but not any woman here. She was trying to stop him from something or other. The woman once again became quite emotional, but her actions appeared to be positive in that it was keeping him from doing anything crazy stupid.
The two guys still physically holding him in place might have also been a factor.
There are a lot of questions about what causes borderline personality disorder, but it is clearly passed down through families. The connection is likely genetic but could also involve attachment issues (untreated borderline parents may not be good attachment partners for their infants, therefore leading to borderline offspring). My guess is that a passed-down mental health issue was what we were seeing here: a mother and son who both were unable to effectively control their emotions.1
Studies of BPD in America have found that borderline (also called Emotionally Unstable Personality Disorder) is present equally in women and men, potentially comprising as much as 2% of the population. This was not the initial assumption, as women are diagnosed with the disorder three times more often than men. For the longest time it was unclear what happened to borderline men.
Now the mystery has been partially solved. Many of the men who suffer from BPD are in fact in jails and prisons. One 2007 study found that 30% of inmates qualified for diagnosis of borderline. It’s a stark example of the problems that undiagnosed and/or untreated mental health issues cause for those who suffer and their communities.
Now that I’m intimately aware of how BPD expresses itself, I’ve seen a number of families who appear to demonstrate its symptoms. The older teenage boy I was teaching to read, with a younger sister and a mother who both act in similar ways. The mother of another of my young students. The mother and grandmother who live in the home across from us, and one of their nieces. In each case their lives are severely impaired by an inability to deal with others in a healthy way in certain situations when their emotions are triggered.
Borderline Personality Disorder has often been stigmatized as “untreatable”, sometimes even by professionals. This is not at all true, as Dialectical Behavioral Therapy and other programs have proven effective in helping those who suffer. Many people who undergo targeted therapies no longer even qualify for a diagnosis after a year or more of treatment. However, there are two major ingredients necessary for improvement – a patient who knows they have a problem and wishes to commit to getting better, and an empathetic therapist who has been trained in the specific therapies that can help them.
Unfortunately, basic awareness of mental health is rare in our community. And therapists trained in these techniques are completely unavailable.
As bad as untreated BPD is in American life, imagine if you lived in chaotic, crowded slums, in a community with no understanding of mental illness.2 I see the struggle every day for my neighbors with borderline, bipolar disorder, depression, PTSD, addiction, and other mostly undiagnosed mental issues. It is traumatic both for the people who suffer and those who love them or cross their path.
And how can they get help? My state has approximately 1 psychiatrist for every 1,400,000 residents, and even fewer psychologists and mental health counselors. That is not a typo. Even if only 1% of residents suffered from mental issues, every psychiatrist would have to take on a caseload of 14,000 patients in order to treat them. So the vast majority of people with mental health issues here receive no professional treatment at all.
This country could try to train more psychiatrists, of course. But do you know what happens after a psychiatrist gets trained and gets experience at their job here? In many cases they take the first offer they get of a job in America, or New Zealand, or the UK, or wherever else is hiring. Those Western nations pay far more than this country can, even though they already have about 1 psychiatrist for every 8,000 or so residents.
So the supply of psychiatric care continues to move away from the country that already has over a hundred times less access. It’s a nice gig, if you can get it. Moral concerns aside, most people when given the choice prefer to move to the higher-paying job. American immigration law gives a huge priority to these “brain drain” immigrants, and the current administration wants to skew the balance even further.
Which of course will simply mean that those nations with the most help will get more, and those with the least will continue to lose what they have. And you wonder why people are desperate to get in.
This is your global economy on capitalism.
 I am of course aware that no one should diagnosis a mental health issue based on a casual interaction, especially not an amateur like me. My comments on the situation are only a suspicion, not a conclusion. Regardless of the particular nature of the issues though, it was abundantly clear that the family could have benefited from some sort of counseling or psychological assistance, and from the way other community members were acting towards them I can strongly suspect that these were ongoing issues.
 It should be noted that for all of America’s resources, it doesn’t seem to have reduced the frequency of mental health difficulties. In fact, there is some evidence that the inequality of America’s wealth gains may in fact be making mental health issues worse and that mental health issues are on the rise. However, it is still clear that those who do suffer from mental health issues in America, especially treatable mental illness, have far more professional resources available to them than those who suffer in most of the world.