Yes, it's BPD boyfriend, but with chronic pain. advise me!

Sorry about the long content.....

I’m seriously concerned about my boyfriend who is suffering from various mental conditions plus chronic illness. He has been diagnosed with borderline personality disorder, depression, bipolar disease and also has experienced hallucinations. Moreover, he has multiple health issues like severe slipped disc in his spine and neck, recurrent severe pain in his leg with unknown cause that sometimes leads to paralysis. He is only in his early 20s.

He has made a suicidal attempt over the summer, and still tells me of suicidal thoughts which sums up to 3-5times a day (+has a history of suicidal attempt in year 4).He has been to going to a hospital for one year (presumably getting all possible medical help). He says that biggest trigger to his suicidal thoughts is excruciating pain he experiences in the morning from his spine and leg. He says lying down on the bed is the only way to minimise pain. He finds himself helpless when he has deal with his unresponsive leg, especially because the cause is not known.

Although he has been seeking medical help for a year, he is not compliant with his medications for mental health, or even simple pain meds like paracetamol. He generally dislikes taking medicines because he experiences headache from them and often becomes ‘blank’. He also believes that meds are ineffective-(accounting from his stories with meds, I think that he may have a rare ultra-rapid metaboliser genes). He also refuses to go to a counselling therapy as he considers himself to be an expert patient (knowledgeable in psychology and has wide experience of counselling people with major depression), hence ‘feels stupid’ when talking to a psychiatrist. Even though it may be a biased account from him, his family seems to be unsupportive of his illnesses, often neglecting them.

Summary:
1. He has fully sought professional medical help, but concluded it useless
2. He is not compliant with meds, nor tells his doctor about his headache or possibility of being an ultra-metabolizer.
3. Reason for suicidal attempt is deeply integrated with his mental problems, not just simply triggered by pain. He didn’t understand at the time why he wanted to commit suicide.
4. Until yesterday, he was at a stage where he would self-suggest that he was fine and was going to overcome these problems.
5. Yesterday, he went back to stage zero, where he realised what the cause/trigger for suicidal attempt was. Though I am not certain, he stated he summoned memory of his past traumatic event and sad days.

He does not rely on anyone or trust anyone, including me- but I am the only one that he talks to about his private problems. I would like to be more sympathetic and helpful. However, since this boyfriend is in a different country (Canada), communication is limited; thus it is difficult to convey that I do care about him. Additionally, because I have never had any friend or myself in such situation, being empathetic and sensitive is extremely hard. Many times I offended him without intention of doing it so. Any advice how I can be helpful?

It is pretty common for Borderlines to resist treatment hence why the prognosis for Borderlines is generally not good. Your boyfriend is never going to get better if he continues to refuse medication and therapy.

One thing my uncle always tells me that makes me feel better about taking medications is this: Like a diabetic has to take insulin to function, people with mental illness have to take medication for their mind in order to function. It's really important that your boyfriend gets help otherwise he may succeed in his attempts to commit suicide one day.