Heller seems to assert a cause/effect.
One concern I have about Heller, as I said above, is his lack of peer-reviewed publications.
A second concern, as you note, is his claim of cause and effect. It has been known for nearly two decades that certain brain abnormalities (e.g., a reduction in the hippocampal and amydgala volumes) and certain chemical abnormalities are often found in BPDers. Yet, it also is known that such structures and processes are abnormal in persons subject to great stress. What remains unclear, then, is whether BPD is the RESULT of such abnormalities -- as Heller claims -- or, rather, simply the CAUSE of them. And, of course, there also is another possibility: that both the abnormalities and BPD are caused by a third, unidentified factor.
A third concern is the incongruity between his claim, on the one hand, that BPD is a medical problem that can be cured, and -- on the other hand -- that BPD "
is treatable with medication first and then by retraining the brain." See his BiologicalUnhappiness.com website. Indeed, the title of his book --
Biological Unhappiness -- loudly shouts that the underlying problem is a biological one that is treatable with a pill. On closer inspection, however, we are told that the "pill" essentially calms the BPDer down so that therapy can work.
A fourth concern is the nature of that pill. The one he prescribes for most BPDers apparently is Prozac, an antidepressant. Yet, because a BPDer's issues go far beyond depression, there is no evidence Prozac will cure any part of it. My BPDer exW, for example, took antidepressants and did weekly therapy for 15 years -- all to no avail. With regard to antidepressants, Heller claims that
Really? My view as a layman is that Heller, who is an MD -- not a psychiatrist -- is confusing the "mood swings" typical of bipolar with BPD temper tantrums. IME, the vast majority of BPDers do not exhibit mood "swings" because their ten-second flips between
hating you and
loving you are instantaneous -- not a "swing" at all. These flips are event triggered -- not caused by gradual changes in body chemistry.
Granted, about a third of BPDers nonetheless do exhibit "mood swings." But this is not due to the BPD traits. Rather, it occurs because they have bipolar in addition to BPD. A recent study (pub. 2008) found that a third of BPDers also suffer from bipolar disorder.
For low-functioning BPDers -- those with "severe symptoms" -- Heller says he prescribes neuroleptics like Haldol. Well, that is fine I suppose. But psychiatrists all over the country have been prescribing anti-depressants, anti-anxiety drugs, and even stronger medications for decades to BPDers -- without "curing" any of them.
The hangup, of course, is the therapy needed for "retraining the brain," as Heller sometimes concedes. Although excellent therapy programs are available for learning to manage BPD traits (not cure them), it is rare for a BPDer to remain in therapy long enough to make a difference. And, even when they do -- as my exW did for 15 years at enormous cost to me -- they may choose to only play mind games with the therapist.
A fifth concern is the malpractice suit against Heller which apparently was settled in 2008 for about $200,000. See
Dr. Leland Heller - Phone & Address Info - Okeechobee, FL - Family Practice. I don't know what to think about that because malpractice suits do not always mean the doctor provides bad treatment. It could mean, for example, that Heller was so committed to helping his BPDer patients that he was willing to risk his medical license by, say, prescribing a drug to be used in a way that has not yet been authorized. I don't know what happened.
