I'm not sure if this is the right place to be writing about this, but I've been wanting to get these thoughts off my chest and you all seem so supportive and welcoming, so thank you for making this space.

Disclaimer: these are my own personal thoughts and views and do not to reflect the views of the general physician/healthcare community.

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I have a really hard time with patients that have BPD. But it's not because I think you're difficult or attention-seeking. It's because I can see myself in your shoes. I've been there. I've been the one staring at the wall, overwhelmed with this feeling of numbness and chronic suicidality, wanting everything to just go away. I have blamed my partner countless times for not understanding how much mental anguish is going on my mind as if he were capable of mind reading. I constantly work myself into a panic and subsequently start to feel guilty for blaming others for what is inherently my own undoing. I have felt so hopelessly lonely, thinking that there can't be anyone in this world who could ever understand me. I make one mistake and I catastrophize immediately, thinking that I'm useless and not worthy of love or respect.

And so when you tell me *you're suffering*, that *you just can't cope*, I believe you. I'm there with you. And I just want to hold your hand until you're in a safe place. But that's not always what's best for you. Just like it wasn't always what was best for me.

As doctors, we always tell our patients to go to hospital when they're in crisis, when suicide or self-harm is heavy on their minds. But the evidence shows that long hospital stays are not helpful. In fact, it provides a false sense of security for patients with BPD - they can cope well when they're in that environment with a routine and with supportive allies, but the real world is not like that. In the real world, we have to find our routine, to find people that will care for us in our time of need. And these things don't come easy. They take time and lots of hard work. Lots of failures. Mistakes. Broken relationships. Until we finally find something that works.

I try to validate my patients, but I have to be so careful not to absolve them of all responsibility. We have to be responsible for our own actions. For the harm that we cause - intentionally or not. We have to make that effort to make things right when we're the ones that have made it wrong. To stand our ground when all we want to do is run away.

If you're out there struggling, please keep trying. We do care. We are listening. But we can't always let you have your way. And I know it's hard in the moment to see that we care when we hold you responsible to your feelings, to your actions, and to your own future. But we're trying too.

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If you're reading this, let me know what the most helpful thing a physician has ever done for you.