08/13/2026
There’s an uncomfortable irony in mental health services.
There are no medications licensed to treat “Borderline Personality Disorder” itself.
Yet many of the people given that diagnosis end up taking enough tablets to sedate a rhinoceros , often with repeated changes whenever they’re in crisis.
This new qualitative paper doesn’t argue that medication is always wrong. In fact, participants often described medication as both helpful and harmful.
What it does ask is a much more uncomfortable question:
Are we sometimes prescribing because we don’t know what else to do?
Participants described medication as becoming a symbol that something was being done. New tablet. Higher dose. Different combination.
Meanwhile the things they actually wanted were remarkably familiar:
• Someone who knew them.
• Someone who listened.
• Explanations.
• Consistency.
• Relationships.
Many described side effects not as an unfortunate inconvenience, but as something that fundamentally changed how they experienced themselves. Others talked about medication changes making crises worse rather than better.
One sentence from the paper really stayed with me. The authors suggest medication can become a communicative gesture - something that signals care, action or control, even when the evidence for benefit is uncertain.
That should make all of us pause.
This isn’t an argument against psychiatric medication. Medication can absolutely have an important place in mental healthcare.
It’s an argument against replacing relationships with prescriptions.
If the only response we can offer to overwhelming distress is “another problem, another pill”, we probably haven’t understood the problem well enough.
The problem might also be the availability of pills Vs the paucity of staff
Great stuff from Nick Adams& the wonderful Dan Warrender
