The LIS1 tv-show illustrates how people with borderline personality disorder are misunderstood within healthcare.
NRK deserves credit for depicting a clinical example of borderline (emotionally unstable) personality disorder, one of the most misunderstood mental health conditions in the healthcare system.
In the third episode of LIS1, we meet Johanne following a suicide attempt in which she jumped from the third floor. The helplessness she encounters is painfully familiar to far too many.
The series illustrates how arbitrary help can be. Whether someone receives appropriate follow-up or is passed from pillar to post often depends on who they meet or where they live.
LIS1 shows how such treatment trajectories can be shaped by misunderstandings and language that risks making things worse rather than better.
For some, encountering a clinician like Petra can be important. But the desire to help is not enough. It must be accompanied by knowledge, clinical direction, and access to the right help.
To ensure equitable access to treatment for people with personality disorders, a national guideline will soon be launched.
People diagnosed with a personality disorder struggle from an early age to understand themselves, regulate intense emotions, and maintain close relationships. Many live with a persistent feeling of being wrong, “too much”, unlovable, and a deep-seated fear of abandonment. The pain this causes can become all-consuming.
Self-harm and suicide attempts are not about drama or seeking attention. They are expressions of a psychological pain so overwhelming that existence feels more unbearable than the fear of death.
Something happens to us when we encounter individuals who struggle with repeated suicide attempts. Especially when the help does not seem to work. It is in this state of helplessness that phrases like "these girls are good at not dying" or dismissals of it all as "drama" can take hold. Not because anyone is indifferent, but because distance can keep one’s own helplessness at bay.
The problem is that this distance confirms what patients fear most: that they are too much, a burden to others, that no one can bear them, and that they do not deserve care. For someone struggling with shame, self-hatred, and fear of rejection, the distance can act as fuel to the fire.
The result is a vicious circle: the more rejected and mistrusted the patient feels, the more challenging the therapeutic relationship can become. The more challenging the relationship, the harder it can be for clinicians to meet the patient with composure, respect, and curiosity. This exacerbates the symptoms for the patients symptoms and the helplessness for the helper.
Johanne describes a suicide attempt triggered by being overwhelmed by a profound inner emptiness, which seemingly came on suddenly. When the doctors do not ask her to elaborate on the experience, they miss a vital opportunity for Johanne to feel genuinely heard.
Before any measures are initiated, Johanne needs to be given space to talk about it. Where did the emptiness come from? What happened in the hours and days before? What became so unbearable? And what usually helps, even if just a little?
When patients in acute crisis are allowed to share their experiences before helpers go into action mode, two things happen: clinicians gain a stronger basis for assessing risk and needs. The patient can experience being met as a person, not a problem to be managed. This can alleviate some of the pain that brought her to where she is.
Johanne's parents plead for her to be admitted. That wish is easy to understand. It is a natural response to the fear of the parents and healthcare professionals. However, the attending physician is right: Johanne needs long-term follow-up outpatient follow-up, not inpatient care. Hospitalization alone rarely provides lasting improvement for individuals with personality difficulties.
What matters the most is not where Johanne will be in the coming days, but whether she receives, or can be referred to, treatment that addresses what she struggles with. There is good reason to believe that Johanne is not currently receiving evidence-based treatment.
But effective treatment does exist. It is delivered in outpatient settings and addresses each individual's personality difficulties. That is difficulties with self understanding, affect regulation and in close relationships. The therapist is active and curious. The connections between feelings, thoughts, and events are explored together with the patient. Additionally, the treatment is structured, predictable, and sustained over time.
In acute and overwhelming crises, admission may be necessary. However, an admission should be used purposefully: to create stability, establish a clear clinical picture, and connect Johanne to the appropriate treatment.
Many do not have access to effective treatment where they live. It is not enough to assert that the patient needs long-term outpatient follow-up. A plan must also be in place.
Someone must investigate what treatment options are available, who holds clinical responsibility, and what the plan is when the next crisis occurs. Without this, she and her parents may remain trapped in the same vicious circle of fear, acute measures, and new rejections.
We know that self-harm, suicide attempts, and the need for admissions decrease when the right treatment is in place. This is often the first thing to change. One of the most impactful things healthcare services can do is to ensure treatment tailored to the individual's personality pathology.
On 4th May, the national clinical guideline will be released. It will oblige services to meet patients like Johanne with updated knowledge, genuine understanding, and evidence-based treatment.
Ingeborg Ulltveit-Moe Eikenæs, Leader
Eivind Normann-Eide, Specialist Psychologist and Senior Advisor
Åse-Line Baltzersen, Senior Advisor
National Competence Centre for Substance Use and Addiction Disorders, Severe Concurrent Mental Disorders, and Personality Disorders
