I'm not a professional, but think he's untreatable mostly due to his completely non acknowledgement of his disease. The added paranoia and delusion makes him aggressively dismiss any kind of intervention as "conspiracy" against him.
It's sad too see an individual waste his life this way for something that seems treatable, from this report.
Lack of insight is a feature of the disorder, to be able to treat BPD at all is partly to improve this.
Self-insight is developed in childhood in healthy interactions with a caregiver: roughly a parent displays an appropriate emotional reaction to your behaviour which allows you to recognise your own behaviour by observing this emotional reaction. Without an ability to observe yourself emotionally through the mirror the parent provides, you fail to develop an awareness of your identity/emotions/etc.
The process of developing it anew in an adult requires re-running childhood again in a particular kind of way, with a therapist, and have the therapist provide you with the healthy responses that your parent failed to provide. It is, in my opinion, an exercise in retraining the emotions -- particularly developing the reflective frontal-lobe responses and suppressing the fight+flight amygdala responses which is often way out-sized in traumatized people.
Insight into oneself is a trainable faculty like many others, and its deficit is not the end of treatment but the usual starting point.
But he won't start treatment?!
> As a result, the term “treatment resistant” can fuel views of patients as “oppositional” and recalcitrant, instead of expectably symptomatic.
I'm not claiming that the kind of dissociation a person experiences when psychotic can be treated by therapy. Pharmacology is essential, and actually I do think after awhile therapy can be helpful (I have family members who have had psychotic episodes too).
The lack of insight in both cases is a product of dissociation. In a personality disorder this is a "mild" chronic state (compared to psychosis) which is amenable to very long term (years+) therapy, unlike psychosis. It is why BPD people with quite severe dissociation or who have episode of severe dissociation report mildly schizoprenic-like problems with their identity (eg. thinking that they are multiple people, lost time, etc.).
I was assuming his BPD friend had this background state, which would not preclude treatment. Treatment would, in part, be to deal with that.
(per Wikipedia)
beep beep
And what would that particular kind of way be?
Two hints to anyone that might need help with this. If you think you cant feel anything, consider this. What is the feeling of not feeling anything?
Last suggestion: find a pillow and hold it to your chest. Hug the crap out of that thing. See if you can feel the comfort. Your job as a traumatised person is to learn to feel that same comfort when you need it, but without the pillow. Sounds weird but this is what un traumatised person learned to do before they could ride a bike and promptly forgot that they ever learned it. You need to learn it in adulthood. And fortunately its not that hard.
Yeah, this has been the entirety of my experience with people who have personality disorders.