How I Got Involved

In Europe during the 1800’s a high percentage of women hospitalized for childbirth died of infections (“puerperal sepsis”).  Most women were understandably terrified of medical care for their deliveries.  Doctors of that era prided themselves on how much pus and blood were on their coats.  A young physician, Dr.  Semmelweis, went against the experts of the day by assuming the pus was a problem.  He insisted on clean apparel, handwashing, and cleaning instruments.

The experts were appalled – what right did this doctor have to go against their opinions!  Scientific studies had not been performed to prove his conclusions, and therefore he had no right to wash his hands and coat.  Despite the lack of approval and scientific studies, Dr.  Semmelweis could not ignore his experiences and successes – he continued to practice cleanliness against their advice.  The experts refused to believe him even after he could prove his theories.  Dr.  Semmelweis believed his experiences were too important to ignore, particularly when the risks of not practicing cleanliness were so high.

In retrospect, he was clearly right.  There are many examples in medicine and other fields of how trusting one’s observations and new ideas have solved previously un-solvable problems.  There have also been times when the observations have been wrong and disastrous results occurred.

Sometimes a new perspective is needed to fix problems.  New ideas, open to investigation and criticism, are a cornerstone of progress.  Other fuels for progress are necessity (the mother of invention), luck, looking for something else (serendipity), and persistence.

I believe my approach to treating biological unhappiness also has a fresh new perspective, as did by Dr.  Semmelweiss’s approach.  In 1988 I first learned about the Borderline Personality Disorder (BPD) from a psychologist.  I had known nothing about it previously – which gave me an unbiased perspective.  The information given to my by the psychologist showed me clearly that the BPD was a medical problem masquerading as an emotional one.

I started having success treating this supposedly “untreatable” disorder, and searched the medical literature about it.  While almost everything in the literature had a “psychoanalytical” approach, there was some impressive and important medical research – particularly by Dr.  Rex Cowdry and his colleagues at the National Institute of Mental Health.  This research showed the BPD did indeed have a biological basis.

I learned what I could from the medical research, and combined with observation and experience, I was able to develop a medical “model” for treating the BPD.  It worked.  I searched for, and found, many additional approaches that gave borderlines who wanted to get better the opportunity to recover.

My perception of the BPD and it’s treatment changed dramatically during a telephone call with a psychiatrist.  Despite my frequent referrals to him, he refused to admit a suicidal borderline to the hospital because he wouldn’t take care of borderlines.  I found out that almost all psychiatrists felt the same way.

The borderline disorder is incredibly common (likely 4-8% of the population), yet it is mostly ignored by the mental health community.  Even though the BPD is a major factor in substance abuse, eating disorders, suicide and psychiatric admissions, it was rarely acknowledged.  Common disorders like attention deficit disorder, the BPD and the obsessive compulsive personality disorder are frequently left off of psychiatric examinations and reports.  Primary care physicians rarely receive any information about these topics.

My patients were getting dramatically better, and wanted more information.  Very little was available.  It seemed the mental health community wanted to ignore or abandon those suffering from the BPD.  I literally had patients get on their hands and knees and beg me to write a book about the BPD.  I did.  “Life at the Border – Understanding and Recovering from the Borderline Personality Disorder” was printed in 1991.  Even though I was “only a Family Practitioner,” it became a reference book at the National Institute of Mental Health and on their recommended reading list.  Without my participation, my book was written about on the Internet, and many patients and their loved ones have contacted me about it.

I’ve now treated thousands of borderlines.  Many are doing great.  Most are doing much better because of their medications.  Some aren’t doing better at all.  There are various reasons, but the most important are “co-morbidties” (what else is wrong) and how badly the person genuinely wants to be better.  Some don’t want to be well, they just want the pain to stop.

I have discovered that other neurological disorders are also common and are destroying lives.  Attention Deficit Disorder has gotten the “attention” it deserves recently, particularly in the book “Driven to Distraction” by Drs.  Hallowell & Ratey.  Melancholia (chronic low level depression) has started to get scientific interest.  The Obsessive Compulsive Disorder has also received attention.  Oversensitivity to rejection and criticism has not.  Neither has an inability to enjoy life, nor the Obsessive Compulsive Personality Disorder.

All of these neurobiological disorders, and others such as depression, cause enormous pain and misery.  They are biological causes of unhappiness.

In my practice I routinely see all these problems.  The medical model I work with has shown enormous promise.  Patients literally beg me for information – particularly about the other causes of Biological Unhappiness.  That’s why I wrote this book.

I’m not a magician – I can’t help everybody and there are still disorders that have no easy answers.  There are many people who will benefit from this book, however.

I’m sure that, if nothing else, you will find this book very interesting and enlightening.

Leland M.  Heller, M.D.


I am not, nor have I ever been, in the employ of any pharmaceutical company.  There has been absolutely no funding for this book from anyone other than me.

Pfizer, the manufacturer of Zoloft, did fund a study comparing Zoloft with Prozac in treating the borderline personality disorder.  While Zoloft sometimes worked, the results were so dramatic in favor of Prozac that I now only use Zoloft for treating premature ejaculation in men.

Eli Lilly, the manufacturer of Prozac, has been particularly frustrating to work with.  They have consistently refused to fund research regarding the use of Prozac for treating the borderline personality.  They have helped some indigent patients get Prozac free of charge, and they do deserve credit for helping those individuals.