Monthly Archives: March 2015

#24 – How I Triumphed Over Borderline Personality Disorder

I recently rewrote my story of struggling with and overcoming the borderline diagnosis. The account below describes the beatings I endured as a child, periods of extreme hopelessness, encounters with stigmatizing psychiatrists, an argument that conceptualizing BPD as a life-long disorder can be harmful, analysis of how I deconstructed the borderline label, a very brief account of my therapy, and some of my proudest achievements in work and love.

Although it’s brief for a life story, I hope you find this account encouraging. I’m not better or fundamentally different than anyone else who gets labeled BPD, and given sufficient support anyone with “borderline” symptoms can do very well.

How I Triumphed Over Borderline Personality Disorder

Welcome to my story of recovery from Borderline Personality Disorder (BPD). This story will illustrate how I went from fearing this dreaded diagnosis, to being hopeful about it, to finally no longer believing in its validity.

Here are two early encounters with “mental illness” that show how I grew to fear psychiatric labels:

Vignette #1 – When I was eighteen, my mother and I sought professional help after years of emotional abuse at the hands of my father.

In our first session, the therapist said, “It sounds to me like your father has a personality disorder…You know, there are normal people, there are those who are a little bit outside our societal norms, and then there are people who are really beyond the pale. In this last group are the ones we call ‘personality disordered’. These people are very difficult to help, and many therapists consider them ‘untreatable’.”

Being unfamiliar with “personality disorders”, my mom and I didn’t know what to make of this. But despite my father’s abuse, I disliked this therapist’s cavalier labeling of someone he had never met.

Vignette #2 – At age twenty, I became suicidal and had to be involuntarily committed to a psychiatric hospital. The following example comes from a group therapy session inside the hospital:

“Mood disorders are biologically-based mental illnesses,” the psychiatrist announced authoritatively, surveying the fifteen young adults in front of him. “But while these disorders might be biological, it doesn’t mean you can’t manage them effectively.”

My mind reacted explosively: How the hell could you possibly know this? What evidence do you have? I desperately wanted to shout at him. But I remained silent, slouching backward in my chair.

These snapshots encapsulate the hopeless viewpoint with which psychiatry assaulted me. It would take everything I had to break free from the resulting fear and despair.

How I Became “Borderline” – A Very Brief History

As of this writing, I’m twenty-nine years old. I grew up in a family of four on the east coast of the United States. My father worked a demanding financial-sector job, and my mother taught school part-time while caring for my younger sister and me. Our childhood was marked by isolation, emotional deprivation, and physical abuse. Starting when I was six, my father regularly beat me for small infractions such as arguing with my sister, outside of which he remained emotionally distant. He often sat on our living room couch staring into space for hours at a time.

Two memories of the abuse stand out. On one occasion, when I was around ten, my father, who was about 6’3 and 225 pounds, chased me to my room, broke my locked bedroom door off its hinges, and attacked me with fists to my face. On another, he picked me up and threw me ten feet across a room onto the sharp edge of a table. He would usually follow these incidents by telling me that he loved me, but would then return to his catatonic-like state on the couch. My mother tried to protect me, but was too afraid and insecure to be of much help. Child services were never contacted.

By my late teens, I felt depressed, scared, and helpless. Despite doing well in school – I was a good student who enjoyed playing tennis and violin with school groups – I had no close friends, and didn’t know how to talk to girls. The growing pressure to leave home and function as an adult felt incredibly threatening. At the same time, my father’s mental health was deteriorating further – he had to be hospitalized multiple times for manic episodes and suicidal depression.

As our family life broke down, things felt increasingly hopeless. I felt furious at my parents, and suffered intense mood swings of rage, emptiness, depression, and terror. I wanted to get help, but couldn’t trust anyone enough to open up about what I was feeling.

Eventually I became suicidal, and after concocting a plan to kill myself, which almost succeeded, I was involuntarily hospitalized. This episode led to the diagnosis of Borderline Personality Disorder, given to me by a psychiatrist at the hospital. I spent two weeks at the hospital in a shocked, barely coherent state, getting little help from superficial group therapy and heavy medications. The only good thing was that I stopped being actively suicidal.

The First Phase – BPD: A Life Sentence?

In the year after my hospitalization, I extensively researched my “illness”. Most readers will be familiar with the core “borderline” traits:  they include black and white thinking (“splitting”), self-damaging behaviors, impulsivity, fear of abandonment, and unstable interpersonal relationships.

Through interactions with psychiatrists, internet forums, and pop psychology books, I found out the following “facts” about Borderline Personality Disorder:

  • BPD is a life-long mental illness; it can be managed but not cured.
  • Due to their reputation for being manipulative and demanding, most “borderlines” are avoided by therapists.
  • Twin studies show that 50% or more of vulnerability for BPD is transmitted through genes.
  • Brain imaging reveals that the brains of borderlines differ significantly from the brains of “normals.”
  • Borderlines suffer from a constitutional deficit that prevents them from regulating their emotions normally.

As a young person, I didn’t know how to evaluate these data. If a person had “Ph.D” or “M.D.” by their name, I tended to believe what they said. When I was already vulnerable, these ideas heightened the terror. I became possessed by the fear of being a “hopeless borderline”, of having a life-long mental illness that was impossible to cure. I was not only facing formidable challenges in reality – like my father’s abuse and a lack of social skills – but was further impeded by the intense anxiety and hopelessness surrounding the label “BPD”.

Questioning The Pessimism

By the time I was twenty-one, my parents had divorced and I’d chosen to live with my mother. For two years after my hospitalization, I was unable to work or attend college. Much of my time was spent at home, severely depressed, isolated, and brooding about being a “hopeless borderline.”

At this time, I was seeing a psychiatrist once a week for fifty minutes a session. Over a two-year period, he prescribed me twelve different antidepressant and antianxiety medications. We kept trying different pills, with nothing helping much. If I had known then what I know now – that many psychiatric medications are little more effective than placebos – I would never have taken so many.

To his credit, this psychiatrist tried to “do therapy” with me. Unfortunately, I was in such a traumatized state that I could not take in his empathy nor understand my family history. However, I gradually became aware that someone wanted to help. I noticed that although my psychiatrist knew I had been labeled borderline at the hospital, he never used this label on me.

This experience with the kind psychiatrist built up a sliver of hope. I realized that I felt a little better after talking to him, and wondered if that feeling could become stronger. Sometimes I would have the thought, “Maybe there is really nothing wrong with me.” Part of me wanted to fight, to become alive, to feel like a real person. When I had the daily thoughts about borderlines being doomed, a voice inside my mind started saying, “They are lying to you!” I wanted to find out what this meant.

Over time, I felt increasingly angry about the way borderlines were stigmatized. How could borderlines be so bad? Had none of them ever been “cured”? What if the things I’d read about borderlines were untrue, or the result of therapists who didn’t know how to treat them?

The Second Phase – “Borderlines Can Do Well”

With these doubts surfacing, I began to research BPD in greater depth. Up to that point, I had received most of my information from the hospital staff and internet forums where people spoke negatively about “their borderlines.”

I decided to go on Amazon and look for new information. The books that influenced me the most were older psychoanalytic texts. Their authors included Gerald Adler (Borderline Psychopathology and Its Treatment), Jeffrey Seinfeld (The Bad Object), James Masterson (e.g. The Search for the Real Self), and Harold Searles (My Work With Borderline Patients).

As I read about borderlines in long-term therapy, I was shocked to realize that many borderlines had fully recovered. The case studies showed people starting out hopeless and nonfunctional, but becoming able to work productively and enjoy relationships. It was crystal clear from the narratives that these “borderlines” were coming to trust others, working through their pain, and coming alive. I finally had some hope. Given enough time and support, former borderlines could improve greatly and even be “cured”.

I remember thinking, “Wow, a lot of what I’ve been told about BPD is completely wrong; this is not a hopeless condition! If other borderlines can recover, why can’t I do it?”

This burst of hope inspired me to seek help. I pursued psychodynamic therapy, interviewing several therapists and finding a kind psychologist who had worked with many trauma survivors. I went to see her twice a week for several years.

Gradually, painstakingly, I made progress. Through reading accounts of borderlines recovering and discussing the fears around diagnosis with my therapist, my anxiety and hopelessness lessened. I formed a really good bond with this therapist, coming to trust someone deeply for the first time. Being “reparented” and taking in her love was the most important step in my becoming well for the first time (I would call it “recovery”, but I had never been well before).

For the first time ever I had periods of feeling calm. I felt like Michael Valentine Smith, the Martian man from Stranger in a Strange Land who learns what it is to be human. Becoming able to trust other people, feeling safe in my own skin, appreciating the sun and the flowers and the trees, feeling that I was going to survive, it was all strange, incredible, and bittersweet.

Using online groups like Meetup, I tentatively started to seek out people my age. Feeling more capable, I earned a professional qualification and began teaching sports to young children. The more time I spent around energetic kids, the harder it was to remain pessimistic. Being still a child at heart, I found a talent for relating to children on their level.

The Third Phase: “My Way of Thinking about BPD Doesn’t Make Sense”

In difficult times, I continued to worry about the pessimists who said full recovery from BPD was impossible. I was still thinking of things in terms of “borderlines act like this, borderlines don’t act like that, borderlines can do well, borderlines can’t do well, etc.” The label still felt real.

But with life experience, I began to doubt BPD. I wondered if BPD – the disorder, not the symptoms – really existed at all. The following questions became increasingly problematic:

  • How can therapists reliably determine the degree of a given symptom that warrants its inclusion in a BPD diagnosis? For example, who can say when someone’s relationships are unstable enough, or when a person feels empty enough, to cross the threshold and suddenly become a “borderline” symptom? The subjective, descriptive nature of BPD symptoms seemed like a major weakness.
  • Person A could have only symptoms 1 through 5 from the DSM IV, and Person B could have only symptoms 5 through 9. The people might even be very different in how they express the one common symptom. Do persons A and B really have the same “disorder”?
  • Did researchers have strong evidence that BPD was genetically transmitted, or that brain differences between borderlines and “normal” were caused by biology?
  • Why does BPD have 9 symptoms? Why not 4, or 23, or 87? How was BPD’s existence as a 9-symptom “illness” first inferred?
    (I realize that BPD has magically “changed” in the new DSM V. But in slightly varied forms, all of these criticisms would apply just as much to the “new BPD”; these examples represent the time when the DSM-IV was current).

As far as I was concerned, there were no satisfying answers to these questions.

The Fourth Phase: “I Don’t Need BPD Anymore”

Something felt fishy about the whole psychiatric labeling system. I suspected that BPD, along with the other labels, represented a house of cards that would collapse under close examination. More research was in order.

This time, I discovered a group of writers including Stuark Kirk (e.g. Making Us Crazy), Paula Caplan (They Say You’re Crazy), Jay Joseph (The Gene Illusion), John Read (Models of Madness), Barry Duncan (The Heroic Client), Mary Boyle (Schizophrenia: A Scientific Delusion?), and Richard Bentall (Madness Explained). From their writing and through observing myself, I came to the following conclusions:

  • While all the borderline symptoms are real in different degrees and varieties, BPD itself is not a reliable or valid syndrome. In other words, there is no evidence that the symptoms labeled “BPD” occur together in people more frequently than would be expected based on chance alone;
  • No one can reliably draw a line for any of the borderline symptoms beyond which one is “borderline” and before which one is “normal.” In other words, the subjective, descriptive nature of borderline symptoms fatally undermines their reliability;
  • Twin studies do nothing to prove that “BPD” is transmitted through the genes, this is partly related to the non-validity of BPD and partly to methodological problems with twin studies;
  • There is no evidence that a constitutional deficit in regulating emotions exists in “borderlines”;
  • Because BPD is invalid and unreliable, biological researchers studying “it” are doomed to roam a circular labyrinth. They will continue to generate false hypotheses and misleading conclusions based on the illusory imposition of a “borderline” cluster of symptoms onto random mixes of severely distressed people.
  • Psychiatrists will continue clinging to the existence of “BPD” and other personality disorders. If they were to admit that BPD et al. are unscientific fabrications, their status as “experts” would be undermined.

It will be recalled that my young self had feared BPD as an incurable, genetically-based “illness”. By the time I was twenty-five, my thinking had evolved radically. If the placeholder “BPD” was a nonexistent ghost, then many of these ideas ceased to have meaning. It didn’t make sense anymore to worry about getting better from “BPD.” One cannot become free from a condition that is not diagnostically valid; one cannot be cured of something that cannot be reliably identified; genes cannot cause a fictitious disorder; medication and therapy cannot be compared for the treatment of a speculative phenomenon, and so on.

This is how I think about “Borderline Personality Disorder” now – as a ghost, a fiction, a figment of psychiatrists’ imaginations. In asserting this, I am never saying people’s painful experiences are not real. They absolutely are. But affirming people’s pain is very different from arguing that Borderline Personality Disorder exists as a distinct “illness”.

Further Emotional Growth

As I increasingly separated from the label “borderline”, further emotional growth took place. Based on my work teaching children, I started my own business, which involved advertising, accounting, hiring staff, and communications. I moved into my own house, living independently for the first time, while continuing to socialize more. I was happy a lot of the time.

In my late twenties, I had my first real relationship with a woman. She was an attractive college girl; we had several interests in common and got along well. After the hopelessness stemming from my abuse and the BPD label, loving another person had seemed like an impossible dream. I was glad to be proved wrong – loving her was better than I had ever imagined! This relationship was a first in many ways, teaching me a lot about emotional and physical intimacy.

I realized how, during the long years dominated by fear, despair, and anger, I had missed out on the best things in life. I realized that believing in “Borderline Personality Disorder” had only held me back.

A New Way of Thinking

If BPD didn’t exist, how could I understand my past “borderline” symptoms? The black and white thinking, emptiness, despair, fear, and rage had been very real. To understand them without the BPD label, I needed a new model of reality. I started by picturing distressing thoughts and feelings existing along a continuum of severity.

In my new thinking, each symptom was no longer “borderline” or “not borderline”; rather, my feelings and thoughts were the result of my family experience and everything that came from it. In particular, I needed to understand how my father’s physical abuse and my mother’s lack of emotional availability had contributed to my problems. In this way my past started to hold meaning (whereas, calling myself “borderline” didn’t really explain anything).

I modeled some of my thinking after Lawrence Hedges, a California-based psychologist. He rejects the DSM labels in favor of a system called “Listening Perspectives”. In this model, a person uses different ways of relating to other people at different points in time. Hedges describes these levels as “organizing (a term to replace ‘psychotic’)”, “symbiotic (to replace borderline)”, “self-other (for narcissistic)”, and “independence (for neurotic-healthy)”.

These terms do not denote distinct “disorders”, but rather fluid ways of relating which fade into one another along a continuum, which evolve based on environmental input, and which always involve others. A person will operate in different parts of this continuum at different times and with different people. In this model, one would never “have” a borderline or psychotic “disorder”; the words “organizing” and “symbiotic” would have no meaning outside of a specific relational context. The focus is on understanding and changing restrictive ways of relating, not on labeling or managing “illness”.

I probably lost some people here! This way of thinking is not proven science, but it works for me, and it’s far better than believing in the static, hopeless “Borderline Personality Disorder.” I mostly don’t even think about BPD now, because it’s not worth my time. I’m more interested in real things!

Helping Others Break Free

Two years ago, I revisited some internet forums about BPD that I had first seen as a teenager. To my surprise, these forums were alive and well; more people than ever were discussing such weighty topics as:

  • What’s the best way to manage “your borderline”?
  • You know you’re a borderline when…. (fill in the blank)
  • Can I have borderline, schizoid, and antisocial PDs at once?
  • Are borderlines more sexual than the average person?
  • Why won’t my family take my BPD seriously?
  • Do borderlines have a conscience?
  • Are borderlines more sensitive than the average person?
  • If BPD is biologically based, why do people blame us for our behavior?
  • How do you fill your spare time when you have BPD?

If these weren’t so sad, they would be funny (well, some of them are darkly humorous, but let’s not go there…). Anyway, hundreds of people were discussing how to “live with BPD”, “manage this illness”, “learn to accept my diagnosis”, and other twisted medical-model jargon. The level of distortion inherent in these questions is so massive that I will not even begin to discuss them; the reader can infer my opinion from the preceding paragraphs. It’s tragic that already-traumatized people are fed these lies about BPD being an “illness” they’ll have for life; for many it will only make the path to wellness harder in the long run.

After seeing these forums, I started a website telling my story of hope and critiquing the medical model of BPD. This project has allowed me to learn from other people so diagnosed. Talking with them has only reinforced my conviction that people labeled “borderline” don’t have the same “illness”. Rather, they are unique individuals, most of whom have had very difficult lives. Almost all of them want to understand their problems and get better; they are basically good people with good hearts. I would never want to label any of them “borderline.” My messages to them are,

1) Full recovery and healing from so-called “borderline” symptoms is absolutely possible, and
2) You don’t have to understand yourself through the invalid label “BPD”.

For some reason, people like these ideas a lot better than the prospect of managing a life-long “personality disorder”.

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Coda

I will finish this article with a scene the movie Inception:

“You mustn’t be afraid to dream a little bigger, darling.” My goal is for more people to be able to say that to the idea that they can’t overcome the borderline label. The “enemies” in this movie could symbolize my fears of having BPD for life and never becoming truly well.  To be able to dream bigger, I had to explode these distortions with more positive experiences and with better data, as symbolized by Tom Hardy’s big gun!

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#23 – The Borderline-Narcissistic Continuum: A Different Way of Understanding “Diagnosis”

For the purpose of understanding psychiatric problems in a more nuanced and optimistic way, here is a diagram from Donald Rinsley’s book Treatment of the Severely Disturbed Adolescent:

CAM00157Update

Please click on the picture to see it larger. Each row corresponds vertically to the rows above and below in describing degrees of emotional development, and each row describes emotional growth over time from left to right. The majority of the text in brown is Rinsley’s own diagram; the bottom additions in white are mine.

Donald Rinsley was among the most respected authorities on borderline and narcissistic conditions in the second half of the 20th century. He was a psychodynamic therapist who ran a psychiatric hospital for severely troubled adolescents in Topeka, Kansas in the 1960s, 70s, and 80s. He later worked extensively with personality-disordered and psychotic adults in an outpatient psychotherapy practice.

I believe that much can be learned from studying Rinsley’s diagram. It explains how psychiatric diagnoses were originally understood in psychodynamic theory – as problems in relating and functioning that occur along a continuum of severity and merge into one another. In other words, psychiatric conditions are not distinct disease entities; there are no clear lines that separate one from another.

At the upper and lower ends of each “disorder”, one cannot confidently say that a person is, for example, a higher level borderline versus a lower-level narcissist, since the conditions fade into one another. Note how the arrows denoting each region don’t stop before running into each other; they overlap.

Here are explanations of the diagram’s different rows.

Row 1: Mahler’s Phases of Child Development: Autism-Symbiosis-Differentiation-Practicing-Rapprochement-Object Constancy.

In this row, Rinsley lists phases of healthy child development that, when interrupted, can cause arrests in emotional development – i.e. psychiatric problems. Roughly, autism (which does not refer to autism as understood today) refers to the earliest period when a baby is unaware of the external world and feels fused with its mother at a body-level. Symbiosis is when the child starts to relate in a back-and-forth need-fulfilling way with its mother.

During differentiation, the baby realizes that it is separate from its mother psychologically as well as physically. In practicing, the child discovers and explores the external world via its newfound ability to walk. And in rapprochement, the child develops a good relationship to the mother as a separate person and faces conflicts around dependency/attachment and independence/autonomous functioning.

In these descriptions, “mother” is synonymous with “caretaker”, “parental figures”, and “the external world of people”. In the object constancy phase, the mother is finally perceived as a mixture of good and bad qualities, meaning that splitting is overcome,, and the child is increasingly able to regulate their emotions. It is this achievement that is lacking in borderline conditiions. For progression through these phases to occur, it is crucial that good-enough mothering be consistently available; otherwise the child can get “stuck” in a certain phase.

There is one area where I disagree with Rinsley. I don’t think it’s possible to put the phases of infantile development into a neat timeframe (as Rinsley attempts to do by saying that object constancy takes over in healthy toddlers at around 24 months, for example). I think children’s development is highly individual and that aspects of these phases continue to be worked on long after the first few years of life, even in emotionally healthy children.

Row 2: States of Self-Object Fusion or Differentiation

In this row, Rinsley indicates whether a person sees themselves and others as fused (indistinguishable from each other; this is a psychotic state), split (self images experienced as separate from images of other people, but viewed as all-good or all-bad, a borderline state), or integrated (seeing a mix of good and bad qualities within both self images and images of other people, a neurotic/healthy state). Roughly, fused self/object images relate to “psychotic” states, split images to “borderline” or “narcissistic” states, and integrated images to “neurotic” or healthy states of minds.

Row 3: Specific Diagnostic Categories

Here Rinsley lists diagnostic labels that correspond vertically with the phases of child development and self-object differentiation from the higher rows: Autistic-presymbiotic schizophrenia, symbiotic schizophrenia, bipolar disorders, borderline personality, narcissistic personality, neuroses, etc. I will not describe specifically what these diagnoses mean; the reader who is familiar with DSM categories will recognize them.

The crucial thing is that the diagnoses overlap along a spectrum and thus are not distinct illnesses. Rinsley conceptualized diagnoses as morphing into one another as treatment progressed; for example, one could start treatment at an upper-level schizophrenic, become a “borderline” a year or two later, then become narcissistic, and finally end up functioning at a neurotic, essentially healthy level after several years.

As conceived by Rinsley, diagnoses never represented fixed “illnesses” that one had to have for life. Treatment could change diagnosis; there was the prospect of transformation. American psychiatry has fallen far from this viewpoint with its current pessimistic views of rigidly separate “mental illnesses” that one can only “manage.”

This reminds me of how many years ago, I attended a National Alliance of Mental Illness meeting. At this session people talked about how mental illnesses were “brain diseases” that one could “learn to live with”. Even back then I thought that was a pathetic, limiting idea. Who wants to just “manage their illness” when they could become truly well? Having realistic hope that one can transform oneself  is so much more motivating! In my opinion NAMI is not to be trusted, due to their reliance on drug company funding. This funding implies a tie to the hopelessness of the disease categories of modern-day psychiatry.

Row 4: Major Diagnostic Categories

Here Rinsley lists the broad diagnostic regions: firstly, psychoses, which include schizophrenias, bipolar disorders, and some lower-level borderline conditions. These conditions represent emotional arrests in the earliest developmental periods. They include people who have fused images of themselves and other people; i.e. the person cannot distinguish between themselves and other people at an emotional level (and they see themselves and others as all-good and all-bad).

The second group is characterological (personality) disorders. These include the borderline, narcissistic, and also schizoid disorders. These also exist on a continuum and flow into one another. They feature splitting as their primary defenses Such people can emotionally perceive differences between themselves and other people, but they still see themselves and others as all-good or all-bad. The shorthand “G (S O)” with the space behind S and O mean that good self and object images are perceived as separate from each other, but are not integrated with bad self and object images. By contrast, in the psychotic conditions, with S-O, the dash between S and O means that the person experiences a lack of separation or differentiation between images of themselves and other people; they cannot emotionally tell where they end and other people begin. This “fusion” phenomenon occurs in some people who gets labeled with severe borderline conditions, which are partly psychotic, but it is a chronic condition in schizophrenic states.

Finally, in the last major diagnostic group, the psychoneuroses, the psychic structure gets reorganized so that splitting is eliminated and the person can see good and bad qualities coexisting in both their self-image and in their images of others. The shorthand S (G B) means that good and bad qualities are perceived together in oneself and others without splitting.

Row 5: Quality of Internalized Self-Object Images

This row describes how supportive or comforting the person’s internalized images of other people are. The more positive experiences a person has had, the further to the right hand of this continuum they are likely to be. Unstable archaic images refer to states where a person feels psychologically unstable because they are not comforted by sufficient positive memories / internalized good experiences. This corresponds to psychotic conditions and to lower level borderline states. This deficit is the reason for the commonly cited inability to regulate emotions in Borderline Personality Disorder. I wrote about this in my article on Gerald Adler’s insufficiency model:

https://bpdtransformation.wordpress.com/2014/04/30/15-heroes-of-bpd-gerald-adler/

The “stable archaic introjects” refers to when a person uses splitting, but the positive images are predominant most of the time over the negative, so the person can regulate their feelings better. This corresponds to higher level borderline and narcissistic conditions.

Lastly, differentiated self and object states refer to the ability to see good and bad in the same self or other-image. In this way people can consistently be perceived as mixtures of good and bad. This makes truly mature relationships possible based on genuine caring and interest in the other person, as opposed to mainly using people for what they can do for you (as with narcissistic conditions), or being so deficient in supportive introjects that one has trouble comforting oneself or trusting others at all (as in borderline and psychotic states).

Row 6: Seinfeld’s Phases – Out-of-Contact, Ambivalent Symbiosis, Therapeutic Symbiosis, Individuation

In this row, I listed Jeffrey Seinfeld’s four phases in a way that corresponds vertically to the horizontal continuums in the rows above. Borderline states are associated either with the upper part of the out-of-contact phase, or more frequently, with the ambivalent symbiotic phase. As one progresses into the therapeutic symbiotic phase – corresponding to being able to trust and feel supported emotionally by other people consistently – one stops being “borderline” and progresses toward healthier narcissistic and neurotic levels of functioning. It occurs to me that it’s too bad these words still sound pathological and negative. Again, we need better words to describe challenges in relating and functioning, words to give people hope of becoming fulfilled and well, not just managing an “illness”.

Please see the article below for a detailed description of Seinfeld’s four phases. Understanding the relative strengths of positive and negative self/object images explains how schizophrenic states can evolve into BPD, which can evolve into NPD, which can evolve into neurosis/healthy personalities, etc. Really, all of these conditions represents problems with adapting and managing life problems; rather than “brain diseases” Given sufficient support, all of these conditions can evolve or morph into one another along the left-to-right continuum of emotional growth. Here are Seinfeld’s phases:

https://bpdtransformation.wordpress.com/2014/02/08/four-phases-of-bpd-treatment-and-recovery/

And here is an example of how a young woman progressed through the four phases, starting in the lower-level out-of-contact “borderline” phase”, progressing through the narcissistic phase, and finishing in the neurotic-healthy part of the spectrum:

https://bpdtransformation.wordpress.com/2014/08/17/18-heroes-of-bpd-jeffrey-seinfeld/

Row 7: Common DSM levels and Hedges’ phases

In this row, I put common DSM labels – schizophrenia, BPD, NPD, neurosis, etc. These are not truly valid illness categories, but they have some meaning if understood as part of a developmental continuum.

Below these labels, I put Lawrence Hedges’ descriptions of the four developmental levels which Seinfeld described in his phases. I haven’t written about Hedges yet, but he is my favorite psychodynamic writer along with Jeffrey Seinfeld. His descriptions of people’s problems are much more empathic, human, and hopeful than the DSM labels. More on Hedges in a later post.

CAM00157Update

The equivalencies for the bottom row would be roughly as follows:

Schizophrenia/lower borderline (DSM) = Out-of-contact (Seinfeld) = Organizing Experience (Hedges)
Lower-to-mid level Borderline PD (DSM) = Ambivalent symbiosis (Seinfeld) = Symbiotic Experience (Hedges)
Higher-level Borderline through Narcissistic PD (DSM) = Therapeutic symbiosis (Seinfeld) = Self-Other Experience (Hedges)
Neurosis-Healthy = Individuation (Seinfeld) = Independence Experience (Hedges)

Conclusion

My goal in this article was to give the reader a taste of how psychodynamic theorists think about schizophrenia, borderline, narcissistic, and neurotic-healthy mental states as existing along a continuum of emotional development. This viewpoint is different than the rigid DSM categories which dominate American psychiatry today.

In my opinion, this spectrum or continuum based approach, while not perfect, is more informative and realistic than rigid DSM categories. Since it is developmental, it implies the hope that one can grow beyond frozen emotional development to become emotionally mature. That’s why it’s my rough guide for thinking about “borderline” and “narcissistic” states, although I try not to use those words too much!

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I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or are trying to help a borderline individual, I would be happy to listen to your story and provide feedback if possible. Feel free to provide constructive criticism of this site also.

This article is the opinion of a non-professional layperson, and should not be taken as medical advice or as the view of a therapist who is professionally qualified to treat Borderline Personality Disorder or any other mental health condition. Readers should consult with a qualified mental health professional before undertaking any treatment.

– Edward Dantes