Redefining BPD

Redefining BPD

By Edward Dantes

This piece was adapted from “How I Triumphed over Borderline Personality Disorder,” originally published March 26, 2015 at bpdtransformation.wordpress.com.

Editor’s Note:

[to come ~150 words]

When I was 18, 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. Within 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 quite know what to make of this. But as much as my father had mistreated us, I still disliked this therapist’s cavalier labeling of someone he had never even met.

Later, at age 20, I became suicidal and had to be involuntarily committed to a psychiatric hospital. During one group therapy session inside the hospital, the psychiatrist announced authoritatively, “Mood disorders are ‘biologically based’ mental illnesses,” surveying the 15 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 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 and fear of labels with which psychiatry inundated me. It would take everything I had to eventually break free from the resulting fear and despair.

How I Became “Borderline”: A Very Brief History

As of this writing, I am 29 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 frequently beat me for small infractions, but was otherwise emotionally distant. My mother tried to protect me, but was too afraid and insecure to be of much help.

By my late teens, I felt depressed, scared, and helpless. Despite doing well in school, I had no close friends and didn’t know how to talk to girls. The pressure to leave home and function as an adult felt incredibly threatening. At the same time, my father’s mental health was deteriorating, leading him to be hospitalized multiple times for manic episodes and suicidal depression.

Some people with BPD might identify as “borderlines,” but this is rare and a personal choice. Although the term “borderline” is used throughout, this is not the preferred terminology and care should be taken to avoid referring to individuals by their diagnosis.

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 and kept everything buried inside.

Eventually, I became suicidal. After concocting a plan to kill myself—that almost succeeded—I was involuntarily hospitalized. This episode led to the diagnosis of BPD, given to me by a psychiatrist at the hospital.

Phase One: 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 about BPD:

BPD is a lifelong 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 the genes.

Brain imaging reveals that the brains of borderlines differ significantly from the brains of neurotypicals.

Borderlines suffer from a constitutional deficit that prevents them from regulating their emotions like normal people.

As a young person, I didn’t know how to evaluate this data. If a person had PhD or MD by their name, or simply sounded authoritative, I tended to believe what they said. As I was already vulnerable, these ideas heightened my terror. I became possessed by the fear of being a “borderline,” of having a lifelong mental illness that was difficult, if not impossible, to cure. I was not only facing real difficulties, like my father’s abuse and a lack of social skills, but was also impeded by the intense anxiety and negative expectations focused around the label “BPD.”

I became possessed by the fear of being a “borderline,” of having a lifelong mental illness that was difficult, if not impossible, to cure.

A new BPD diagnosis can be confusing, but learning about the disorder itself is often overwhelming. Edward took a systematic, high-level approach to understanding BPD. What helps you make sense of BPD?

By the time I was 21, 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, as I severely depressed, isolated, and brooding about being a “hopeless borderline.” But a sliver of hope survived. Part of me wanted to fight, to become alive, and to feel like a real person. When I had thoughts about BPD being hopeless, a voice inside my mind started saying, “They are lying to you!” I wasn’t sure what this meant, but I wanted to find out.

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?

Phase Two: “Borderlines Can Do Well”

With doubts surfacing, I began to research BPD in greater depth. Up to that point, I had received most of my information from psychiatrists and Internet forums—places 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, ironically, older psychoanalytic texts. The authors included James Masterson (The Search for the Real Self), Harold Searles (My Work with Borderline Patients), Gerald Adler (Borderline Psychopathology and Its Treatment), and Jeffrey Seinfeld (The Bad Object).

As I read about borderlines in long-term therapy, I was shocked to realize that many had fully recovered. Case studies showed people starting out hopeless and nonfunctional, but becoming able to work productively and enjoy relationships. It was clear from the narratives that these “borderlines” were coming to trust others, working through their pain, and coming alive. 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?” I finally had some hope.

I remember thinking, “Wow, a lot of what I’ve been told about BPD is completely wrong; this is not a hopeless condition!

This burst of hope inspired me to seek help. I pursued psychodynamic therapy, interviewed several therapists and found 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. Using online groups like Meetup, I tentatively started to seek out people my age to build relationships and venture out of my comfort zone.

I formed a strong bond with this therapist, coming to trust someone deeply for the first time. For the first time ever, I had periods of feeling calm. Being “re-parented” by my therapist, taking in her love, was one of the most important steps in my recovery.

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.

Phase Three: “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. The label still felt real. I was still thinking of things in terms of “borderlines are this, borderlines are that, borderlines can do well, borderlines can’t do well, etc.” 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 nature of BPD symptoms seemed like a major weakness. For instance, Person A could have symptoms 1 through 5 from the DSM-IV, and Person B could have symptoms 5 through 9. The people might even be very different in how they express the symptom they share in common. 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 borderline and “normal” were caused by biology?

Why does BPD have nine symptoms? Why not 4 or 23 or 87? How was BPD’s existence as a nine-symptom “illness” first inferred?

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

Phase Four: “I Don’t Need BPD Anymore”

Something felt fishy about the entire 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 Stuart Kirk (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 a few conclusions.

While all the borderline symptoms are real in different degrees and varieties, I felt BPD itself is not a reliable or valid syndrome. In other words, I found 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. Additionally:

While my younger self had feared BPD as an incurable, genetically based “illness,” by the time I was 25, my thinking had evolved radically. If the placeholder “BPD” was a nonexistent ghost, then many of the things I’d feared ceased to have meaning. It didn’t make sense anymore to worry about getting better from BPD.

This is how I think about “Borderline Personality Disorder” now: as a ghost, a fiction, a simulacrum, 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 BPD exists as a distinct “illness.”

For Edward, labels don’t help. But some experience immense relief in putting a “face” to BPD. What might be the pros and cons of each?

Further Emotional Growth

As I increasingly separated from the label “borderline,” I continued to grow emotionally. 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 proven 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 more deeply 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 individual, unique difficulties in relating to and adapting to the world. 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 who rejects DSM labels in favor of a system called “Listening Perspectives.” In this model, a person uses different modes of relating 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.” Rather, they describe fluid ways of relating that fade into one another along a continuum, evolving based on environmental input, and involving other people in the external world. They are not intended to be scientific. 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–experiential context.

This way of thinking is not proven science, but it works for me, and it’s far better than believing in what I consider the static, hopeless “Borderline Personality Disorder.” Most of the time now, I don’t even think about BPD. 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?

How do you fill your spare time when you have BPD?

Can I have Borderline, Schizoid, and Antisocial Personality Disorders at once?

Why won’t my family take my BPD seriously?

Do borderlines have a conscience?

Are borderlines more sensitive than the average person?

Are borderlines more sexual than the average person?

If BPD is biologically based, why do people blame us?

You know you’re a borderline when . . .

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 many other people so diagnosed; it has 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. All of them want to understand their problems and get better. They are essentially good people with good hearts.

My message to them is that you don’t have to understand yourself through the label of BPD. In my experience, full recovery and healing from so-called “borderline” symptoms is absolutely possible.

For some reason, people tend to like these ideas a lot better than the prospect of managing a lifelong “personality disorder.”

Edward Dantes is a young professional living near Washington, DC. He was diagnosed about 10 years ago and suffered from all nine symptoms of BPD. He is currently functioning and feeling well, and no longer meets criteria for the diagnosis. Edward now works to encourage other people struggling with BPD that full recovery is possible.

Unedited Phase Four:

[H1]Phase Four: “I Don’t Need BPD Anymore”

Something felt fishy about the entire 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 Stuart Kirk (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 a few 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. Additionally:

  • Twin studies do nothing to prove that BPD is transmitted through genes. This is partly related to the nonvalidity 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 troubled people.
  • Psychiatrists will continue clinging to the existence of BPD and other personality disorders. If they were to admit that BPD and other disorders are unscientific fabrications, their status as “experts” would be undermined.

While my younger self had feared BPD as an incurable, genetically based “illness,” by the time I was 25, my thinking had evolved radically. If the placeholder “BPD” was a nonexistent ghost, then many of the things I’d feared 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 simulacrum, 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 BPD exists as a distinct “illness.”