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#29 – “The Borderline States” – An Essay by Lloyd Ross, Ph.D., Therapist with 40 Years’ Experience Treating People Labeled BPD

I recently emailed Dr. Lloyd Ross, a clinical psychologist from New Jersey with 40 years’ experience treating individuals labeled borderline. I asked him for his views on the DSM model of BPD, the causes of borderline states, what is the best treatment for BPD, and can it be cured. Here are highlights of his responses, with my emphases in bold:

Highlights of Lloyd Ross’ Viewpoints on BPD, excerpted from his essay below:

On therapists who don’t want to work with people labeled BPD:

Lloyd Ross: “To avoid their own discomfort, poorly trained therapists describe borderline individuals as untreatable. Well trained therapists do not have that opinion. Well trained therapists have done well with these individuals, provided the therapist knows both what to expect and what he is doing.”

On good outcomes for people labeled “BPD”:

Lloyd Ross: “With proper insight oriented therapy, people labeled as borderline do go out in the world and function quite well in relationships, employment, etc. Like the rest of us, the goal is not to be cured from some non-existent disease, but to simply resolve the issues in our development that stop us from functioning in a relatively comfortable manner.”

On BPD as a medical diagnosis:

Lloyd Ross: “(As a medical diagnosis) the only “borderline states” that have any validity for me are on the border of Mexico or Canada… In addition, there is absolutely no real science behind any of the DSM/ICD diagnoses.”

On how the word borderline can be useful:

Lloyd Ross: “To use the term “borderline” from a developmental point of view is very different… Using the term “borderline developmental issues” enables us to go back in time and try to help the individual to undo, modify, and soften development that did not go smoothly the first time around.

On the developmental approach to working with people labeled BPD,

Lloyd Ross: “Using this model, the therapist works toward a stronger continuum of emotional development so that a person can function in a more whole way. Borderline states are not a disease or medical issue and therefore, nobody is “cured.” People just learn to handle various issues in their lives in a smoother, more comfortable manner for them.

On suicide prevention:

Lloyd Ross: “According to Bertram Karon, Ph.D., one of the world’s most prolific researchers on effective psychotherapy with patients labeled schizophrenic, suicidal, and borderline, ‘The best suicide prevention is effective psychotherapy.‘ ”

On the value of medication in treating people labeled BPD:

Lloyd Ross: “The medication approach (anti-depressants and/or anti-psychotics) is useless in people with borderline, suicidal, and PTSD symptoms. In fact, anti-depressants are probably one of the major causes of iatrogenic (doctor induced) suicide in this country in the past 15 years, especially with individuals labeled borderline.”

On trauma as the cause of borderline states:

Lloyd Ross: “The cause of “Borderline Personality Disorder” as with all of the “made-up” psychiatric diseases, is trauma at various times and stages in a person’s development… The failure of all-good and all-bad perceptions to fuse is the genesis of all pathologically borderline states.

My Interaction with Dr. Ross

So (this is Edward writing again) these were my favorite parts of what Dr. Ross said about BPD; for the full context, see his essay below. I had originally found Dr. Ross because he is a member of ISPS, the International Society for Psychological and Social Approaches to Psychosis, with which I’m also involved. In my first email, I asked Dr. Ross for detailed answers to my questions about what causes BPD, what best treats it, is it curable, and how best to understand Borderline Personality Disorder.  I wanted to see how much his viewpoints agreed with mine, and to share an informative and hopeful professional viewpoint on BPD with readers of this blog.

In response, Dr. Ross decided to write a single essay incorporating his responses to all the questions. That essay, “The Borderline States” forms the main part of this post. I highly recommend reading it to see how a psychologist who’s worked with over 100 people labeled BPD understands the condition. To Dr. Ross, thank you for taking the time and for giving me permission to post your essay here.

For anyone wanting to know more about Dr. Ross, he is a leading member of the International Society for Ethical Psychiatry and Psychology (ISEPP), and is listed halfway down this page: http://psychintegrity.org/isepp-leadership/

LloydRoss1

Lloyd Ross, Ph.D.

Dr. Ross also features in a Youtube interview about helping people labeled schizophrenic here: https://www.youtube.com/watch?v=wyL0jjI93OI . I want to note that Dr. Ross did not edit this video (the silly cartoonish elements, which in my opinion detract from its message, were added by the filmmaker Daniel Mackler). But you can see from the way Dr. Ross talks that he is an experienced, committed therapist.

Lastly, I want to note that Dr. Ross’ viewpoints appearing on my site does not mean that he endorses or agrees with everything else on this site. His viewpoints are his own. Here is his full essay:

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THE BORDERLINE STATES

By Lloyd Ross, Ph.D.

During my 40 years as a clinical psychologist, I have worked with approximately 100 to 150 people who would be considered to fall into the developmental framework of what psychiatry, in its simplistic and arbitrary way, views as borderline. These people were seen by me for at least one year or longer, some multiple times per week, and others once per week. Some were also seen at multiple times in their lives with months or years separating periods of therapy.

Before discussing this topic, I would like to make clear the issue of psychiatric diagnoses of “mental disorders.” I am a clinical psychologist who was psychoanalytically trained from an ego-developmental point of view. I have been in full time practice for almost 40 years and have always avoided psychiatric diagnoses, as I see the various recreations of the DSMs/ICDs as nothing more than an attempt to medicalize things that are not medical to begin with (human behavior, experience, and development). On that basis, the only “borderline states” that have any validity for me are on the border of Mexico or Canada.

In addition, there is absolutely no real science behind any of the DSM/ICD diagnoses. All of them were developed in committee rooms inhabited by mostly elderly white psychiatrists, many of whom represented the financial interests of the pharmaceutical industry. When I do write down a DSM or ICD diagnosis for a patient, and only at a patient’s request, it is usually because they need it to submit their claim to an insurance company (Unfortunately, that is the way things are in this society). The diagnosis I use is almost always “Post Traumatic Stress Disorder,” for several reasons:

  1. It is the closest thing to a real diagnosis in the entire list of diagnoses, in that anyone who is having enough emotional difficulties to seek help has had personal trauma of some sort as one of the factors that caused their difficulties.
  2. From a developmental point of view, the stage of development we are in or approaching when trauma occurs is a good predictor of how, when, and where it will manifest itself in a person’s life.
  3. The term itself, “Post traumatic stress disorder,” is sufficiently vague and innocuous to the public to make the term less of a problem for an individual than terms such as schizophrenia, psychopathic or sociopathic personality or borderline personality disorder, none of which have any real scientific meaning.

I approach human (not medical) diagnosis as a strictly developmental issue. This is because of the influence of Margaret Mahler on my training, with some influence from Donald Winnicott, Edith Jacobson, Anna Freud, Renee Spitz, Heinz Kohut, and Ruben and Gertrude Blanck. I come primarily from Mahler’s framework and was supervised by her. Therefore, any real diagnosis that I do comes from an ego-developmental point of view.

The Causes of Borderline States

When looking at a detailed history of people commonly diagnosed by others as “borderline personality,” I and others have found that these people have experienced emotional trauma at around the time in development when children make and solidify their attachment to the mother figure. To be a bit more specific, it is associated with trauma during that time frame and there is always deprivation around that time frame also. I am sorry for making it such a complicated thing, but when you don’t simply slap a diagnostic label on somebody, but are instead dealing with a real live very unique individual and their complex developmental problems, the issues are no longer simple. In addition, to perceive a human being as literally being a diagnostic category—a “Schizophrenic” or a “Borderline” –dehumanizes that person.

The cause of “Borderline Personality Disorder” as with all of the “made-up” psychiatric diseases, is trauma at various times and stages in a person’s development. That is why taking a carefully detailed history of that person’s development, events in his life, and memories in his life is so important. All extreme mental states, whether with someone diagnosed as schizophrenic, borderline, neurotic, etc. which are meaningless terms, are the result of things gone awry or not having been negotiated at various stages in development, resulting in trauma.

Even if a child seems to progress just fine, if and when trauma occurs, it lingers or appears dormant. When, even years later, that trauma is reactivated by another trauma, that person seems to exhibit or feel the original trauma again without ever connecting the two. That is why I use the diagnosis “Post Traumatic Stress Disorder” with insurance companies, for everyone, and not just those who come for help. There is no human being that I have met who has never experienced trauma, although the ramifications for some are more disturbing than for others.

A Personal Example of Trauma

I will give you a vivid example of trauma in myself. From the time I was five years old, until I was ten years old, I was ordered by my parents to come home from school immediately, without lingering with my friends, to babysit my grandmother because I left school at exactly 3:00 P.M. and the lady who took care of my elderly grandmother left at exactly 3:00 P.M. My grandmother was a very nice roly-poly lady who only spoke Polish and Yiddish, was blind except for being able to see shadows, and was able to walk from her chair to the bathroom to the bed by feeling along the wall. I, on the other hand, did not speak Polish or Yiddish.

My grandmother was alone for the five minutes it took me to get home and I would run all the way because I was told that if anything happened to her, it would be my fault, a rather heavy burden for a five year old. I would sit with her in a second floor apartment with very little communication and stop her from trying to cook. I would lead her to the bathroom and to the bed so that she didn’t fall, and sometimes would make her tea, watching that she didn’t spill it on herself. Either my aunt or my parents would come home between 5:00 P.M. and 6:00 P.M., but quite often, they went shopping first or had something else they had to do, and I would be stuck with my elderly grandmother for two to five hours. Also, since she couldn’t see, she kept all the lights off to save money so the apartment was usually dark.

When I turned ten years old, I was offered a part-time job and because work was so important to everyone in the family, when I got the job, my babysitting for my grandmother was over. What I remember most about the babysitting was that everything was always dark and boring. One day, I was very bored, and I could hear my friends playing ball in the street below. I opened the window and sat on the ledge, playing catch with a friend who was in the street. Someone called the police because they thought I was a jumper and they yelled and screamed at me.

After getting three advanced degrees, and spending a year in a horrific war, I came home and met my wife to be. I was always relaxed, mellow and calm, yet at the same time I could be cutting and sarcastic, all of which I admired in myself. After getting married, several days per week I would work late and come home when it was dark. When the lights were on in my house, there was never a problem, but if I came home to a dark house, I would feel enraged and walk in complaining, arguing, and finding fault with everything.

Since I was in my own training analysis at the time, I brought it up, thinking it had something to do with my time in Vietnam. I finally made the connection between the rage that I felt when forced to stay in a dark house watching my grandmother, and the rage I felt when I approached my house with the lights off. Having made that connection, I no longer became enraged when the lights were off, but I didn’t feel wonderful either. My wife and I discussed it and she kept the lights on for me, just like motel 6. Another point is that learning the connections don’t necessarily take away all the feelings but they do put you in much better control of those feelings.

That is a relatively minor cause of Post-Traumatic Stress Disorder. Who is a victim of it? Everyone, unless their childhood was just perfect, wonderful and magnificent, and so far, I haven’t met anyone who falls into that category, although I never met Donald Trump.

Understanding Borderline States Developmentally

I would like to discuss development at this point because most of the people seen by psychotherapists fall into this particular phase, including those with the arbitrary junk-science diagnosis of borderline personality. In normal development, when a child approaches the end of the first year or year-and-a-half of life, he/she begins to recognize that he is not one with his mother, but is really a separate person. This infantile recognition marks the beginning of the end of the “symbiotic” phase of human development and the very beginnings of the “practicing” sub-phase, sometimes better known as “the Terrible Twos.”

The practicing sub-phase is an early part of what we often refer to as the “separation-individuation” phase of development, which is so critical to our development that Margaret Mahler describes it as “the psychological birth of the human being.” In fact, she wrote a classic book just about that phase of human development. During the practicing sub-phase, the child’s mission in life is to prove that he is a separate, autonomous human being, while at the same time not losing his mother. He does this by exploring his world, by trying to do things independently from his mother, and by oppositional behavior, (saying “NO”.)

Sometimes, this phase of development can seem like a battle against parental figures, hence the name “terrible twos.” Problems that develop in the early parts of this phase of development which a child is unable to successfully negotiate often result in what they call “borderline issues” because they develop during the beginnings of the quest for reality on the part of the child, which occurs right on the border of these two stages. Let me go on with a description of the next part of the child’s emotional development.

The Identification Process, Splitting and Fusion in Childhood Development

While beginning the Separation-Individuation phase of development, the child begins to identify himself with others. This is also the beginnings of object-relationships. Since the primary object for all of us is mother (whoever mothers us, which could be the actual mother or a mother-substitute) a child will view his mother in very black and white terms as he begins the identification process. Mother in her nurturing role is seen as “good mother.” However, when mother says no to the child, restrains him in some way or frustrates him, mother is then seen as “bad mother.”

From a child’s point of view, “good mother” and “bad mother” are really two different people. This view occurs because of the absolute black and whiteness of the child’s thinking process at this age and is a normal age appropriate distortion of reality. The process is called “splitting.” When mother gives me what I want, she is “good mother” but when she doesn’t give me what I want, she is “bad mother.” These are totally two different people to the child.

Over the next year or two, depending upon intervening variables as well as the child’s developmental progress, the image of the “good mother” and “bad mother” slowly start to come together in a merging process. At a certain point, these objects “fuse” and we no longer see our mothers as a split object, one mother good and the other mother bad. When these objects fuse into one object, one mother, we begin to entertain a different, more sophisticated perception of mother. Now, mother is seen as basically “good mother” who sometimes is not so good. However, both the good and the bad are housed in the same person.

This is a much more benevolent view of mother and allows for imperfection. Since mother is the “primary object,” the first person that a child identifies with, his perception of mother is vital to his perception of himself. Once the good and bad objects are fused, the extreme view of the child is softened. He now also looks at himself and is able to perceive that: “I’m basically a good child, but sometimes I do bad things. Even so, I’m basically a good child.” This benevolent perception does two things. First, it brings us in closer contact with reality, and secondly, it softens out perfectionism both toward ourselves and toward others.

When Fusion Doesn’t Take Place, or What Causes BPD

The failure of all-good and all-bad perceptions to fuse is the genesis of all pathologically borderline states. Please be aware also that I am using the word pathology to simply indicate development gone awry or developmental stages that were not properly negotiated by the child for multiple reasons.

Sometimes, due to external issues that limit or skew a child’s development, or because of internal developmental issues, a child is unable to fuse the good and bad objects into one unified whole. In that case, the split object remains and the child continues to perceive dual mothers; one totally good and one totally bad. Under such conditions, when the child identifies with the primary object (the mother or mother substitute) and then looks in the mirror, he sees either a totally good person or a totally bad person with no redeemable good qualities, a rather harsh view of oneself. Under the above conditions, the child’s development makes him a potential candidate for suicidal thoughts, feelings, and actions as well as borderline personality issues.

In the so-called “borderline personality, the core issues precede the problematic object relations and there are also introjective insufficiency problems with good and bad objects. Most people dealing with this issue feel an “annihilation panic” based upon the relative absence of positive introjects that pretty much explain the “borderline” person’s feeling that he is existentially at risk.

In other words, in the so-called “borderline personality, it isn’t just the all-good, all-bad splitting that is a problem, but the paucity or insufficiency of positive introjects. Therefore, in people who are labeled borderline, the negative introjects predominate. Also, in come cases, they are able to solve the introject problem by, in a sense, becoming their own object or mother, thereby being able to comfort themselves without the need for anyone else. In the psychiatric establishment, these individuals are referred to as “psychopathic” or “sociopathic” personalities. They don’t need mothering because they can self-comfort.

Let’s go back for a moment to clarify what the mother-introject is. In normal development, the child internalizes a mental representation of the mother figure and the way in which she makes the child feel. Negative introjects always come from abuse that has taken place at around this time. (Sorry if I am blaming the mother figure but that is the way it goes.)

Gerald Adler, also a student of the ego-developmental model, extends this work further. He describes ideal treatment as an attempt to establish and maintain a dialectic therapeutic relationship in which the therapist can be used over time by the patient to develop insight into adequately holding onto positive introjects. In this manner, the arrested developmental process is set in motion to correct the original developmental failure. This is called the “Deficit Model” in that the focus is on what is missing in that person’s development. Therefore, the core of borderline issues precede the destructive internal object relations. The issues involve abuse, the absence of a positive introject, and an overwhelming constant feeling of being at risk, primarily due to the insufficiency of positive introjects.

Treatment for the Borderline, Suicidal or PTSD individual:

In this section, I would like to consider a number of treatments for these people and then the treatment of choice.

Electroconvulsive Shock; (ECT):

ECT, in short, involves placing two electrodes on the skull over the frontal area of the brain and then administering voltage that is comparable to being hit by lightening. This does several things. First, it causes a brain seizure which is not very pretty to observe. To avoid looking like a scene out of the movie “One Flew Over The Cuckoo’s Nest,” psychiatrists first administer sedative drugs to mute the external manifestations of the electric shock such as thrashing, broken bones, etc.

However, when they do this, to cosmetically improve the look of the treatment, they also have to increase the voltage, thereby creating greater cell damage and cell death in the brain, flatness of personality and affect, and slower thinking processes. This damage is similar to what occurs as a result of long-term heavy alcohol use, only more rapidly and in more focused areas, particularly the frontal lobes of the cortex or the cognitive and feeling areas of the brain. Keep in mind that ECT is similar to a motorcyclist head injury or explosion in that it is a “traumatic head injury,” only it is being caused by a physician. One of the side effects of killing off brain tissue in the frontal lobes is apathy, flatness of personality and affect, and slower thinking processes.

As a result of all this brain damage, suicidal thoughts (all other thoughts as well) are deferred and drastically slowed up. Therefore, ECT may temporarily defer suicide or soften the borderline issues, but it does not prevent it and when a person slowly and partially recovers from the shock, he may realize the lesser functioning he is left with permanently, an even greater motivation for suicide. ECT also significantly and drastically disrupts any psychotherapeutic process that is being carried on. Earnest Hemingway was “cured” of suicidal tendencies by ECT.

Bio-psychiatric Treatments:

The medication approach (anti-depressants and/or anti-psychotics) is useless in people with borderline, suicidal, and PTSD symptoms. In fact, anti-depressants are probably one of the major causes of iatrogenic (doctor induced) suicide in this country in the past 15 years, especially with individuals labeled borderline. Also, feeding a patient cocktails of neuroleptic (anti-psychotic) drugs acts simply as a temporary chemical restraint, often called a “chemical lobotomy.” In that sense, these drugs mimic ECT. I do not consider either real help for any individual and they make insight oriented therapy almost impossible.

Insight Oriented Psychotherapy:

According to Bertram Karon, Ph.D., one of the world’s most prolific researchers on effective psychotherapy with patients labeled schizophrenic, suicidal, and borderline, “The best suicide prevention is effective psychotherapy.” He goes on to say: “Of course the most effective way to prevent a suicide or a homicide is to understand the psychodynamics and deal appropriately in therapy with these issues.”

There are also a number of things that need to be confronted in any psychotherapeutic situation with a suicidal, borderline, or homicidal patient. Among them are his anger and rage, his and the therapist’s loss of control, and in a child, the significant parental issues, the patient’s developmental history, the ways in which the patient transfers his feelings (mostly bad and angry feelings) to the therapist, as well as other issues.

From the therapist’s perspective, he must be able to handle the transferential rage and aggression as well as his own feelings of lost control and counter-transferential issues. Finally, the therapist needs to deal with his own fears of the patient’s potential for suicide. Untrained,

fearful therapists, when they hear that a person has suicidal issues, get frightened and immediately refer to a psychiatrist, as though a psychiatrist has some magical powers to treat this problem. Unfortunately, when a therapist does this, the message to the suicidal person is “I am afraid of you and am not equipped to deal with your issues. The therapist is then immediately written off by the suicidal person.

Many therapists also do not want to work with people diagnosed as borderline for two reasons. The first is the rage that gets directed at the therapist. Borderline development results in a huge need to get rid of the aloneness they feel which results in rage that makes the therapist cease to exist. The counter-transference from an untrained therapist is a feeling of “I’m wasting my time here.” The second is that the amount of support needed is greater than with other kinds of development. You cannot resolve splitting until a strong positive relationship exists between the person and the therapist. In treatment, the unrealistic idealization of the therapist that the borderline person feels must be slowly worked through and discussed before it is relinquished and replaced by a more realistic view. The therapist’s goal is to slowly build up the earlier foundations of the ego structure through the relationship so that what is established is a not-so-harsh superego and thereby, less black and white pain in the face of imperfections and losses.

It should be understood that using this model, the therapist works toward a stronger continuum of emotional development so that a person can function in a more whole way. It is not a disease or medical issue and therefore, nobody is “cured.” People just learn to handle various issues in their lives in a smoother, more comfortable manner for them.

A Brief Word on Narcissism

Narcissism is often a component of borderline development. Narcissists are particularly hard to treat. They find it difficult to form the warm bond with a therapist that naturally evolves with most other patients. Instead, they often become cold or even enraged when a therapist fails to play along with their inflated sense of themselves. A narcissistic patient is likely at some point to attack or devalue the therapist, and it is hard to have to sit with such people in your office unless you are ready to accept that.

But narcissism is not limited to the most extreme cases who make their way to the therapists’ office. A healthy adjustment and successful life is based to some degree on narcissism. Healthy narcissists feel good about themselves without needing constant reassurance about their worth. They may be a bit exhibitionistic, but do not need to play down the accomplishments of others to put themselves in a good light. And although they may like adulation, they do not crave it.

Normal narcissism is vital for satisfaction and survival. It is the capacity to identify what you need and want. Pathological narcissists, on the other hand, need continual reassurance about their value. Without it they feel worthless. Though they have a grandiose sense of themselves, they crave adulation because they are so unsure of themselves that they do not know they have done well or are worthwhile without hearing it from someone else, over and over. The deeply narcissistic person feels incomplete, and uses other people to feel whole. Normally, people feel complete on their own.

”Narcissistic vulnerabilities,” as psychoanalysts refer to them, make people particularly sensitive to how other people regard them. You see it in marriage, in friendships, at work. If

your boss fails to smile when you greet him it may create a withdrawn, anxious feeling. If so, your self-esteem has been hurt. A sturdy self absorbs that so it’s not unbalanced. But if you’re vulnerable, then these seemingly small slights are like a large trauma. On the surface, extreme narcissists are often brash and self-assured, surrounded by an aura of success. Indeed, they are often successful in their careers and relationships. But beneath that success, feelings of inadequacy create the constant need to keep inflating their sense of themselves.

If they do not get the praise they need, narcissistic people can lapse into depression and rage. Thus, many workaholics put in their long hours out of the narcissist’s need to be applauded. And, of course, the same need makes many narcissists gravitate to careers such as acting, modeling, or politics, where the applause is explicit. Many difficulties in intimate relations are due to narcissism. Marriage brings to the fore all one’s childhood yearnings for unconditional acceptance. A successful marriage includes the freedom to regress, to enjoy a childlike dependency. But in marriage, a couple also tend to re-enact early relationships with parents who failed to give them enough love. This is particularly hard on those with the emotional vulnerabilities of the narcissist. All narcissists fall within the borderline spectrum of development, but not everyone in the borderline range of development is narcissistic.

In summary, a therapist who is not trained well will usually not want to work with a borderline person for all the reasons mentioned above. To avoid their own discomfort, they describe them as untreatable. Well trained therapists do not have that opinion. It is not a “mental illness,” (disease.) Rather, it is a breakdown of a developmental phase that we all go through and involves issues such as splitting, negative introjects, probably early abuse, suicidal issues, and narcissistic issues.

Well trained therapists have done well with these individuals, provided the therapist knows both what to expect and what he is doing. Because it is not a disease, no one is cured. However, with proper insight oriented therapy, people labeled as borderline do go out in the world and function quite well in relationships, employment, etc. Like the rest of us, the goal is not to be cured from some non-existent disease, but to simply resolve the issues in our development that stop us from functioning in a relatively comfortable manner.

Finally, the term “borderline,” when used as a medical or psychiatric diagnosis, is both useless and harmful in that it is suggestive of some evasive disease. To use the term from a developmental point of view is very different and can be helpful in understanding what in a person’s development, was not negotiated properly or fully successfully. Using the term “borderline developmental issues” enables us to go back in time and try to help the individual to undo, modify, and soften development that did not go smoothly the first time around. This is something that is being done all the time by private-practice therapists, but not by what I call “the mental health industry.” However, that is a topic for some other time.

Below, I have listed a few books that should be helpful in understanding the treatment issues with individuals who are dealing with borderline issues. I have also included several books that support my opposition to the medical model approach.

Bibliography

Adler, G. (1977). Borderline Psychopathology and Its Treatment. Northvale, N.J.:Jason Aronson.

Breggin, P.R. (1994). Toxic Psychiatry. New York: St. Martin’s Press.

Jackson, G. E. (2005). Rethinking Psychiatric Drugs. Bloomington, Indiana: Author House.

Jackson, G.E. (2009). Drug Induced Dementia: A Perfect Crime. Bloomington, Indiana: Author House.

Blanck, G., & Blanck, R. (1972). Ego Psychology: Theory & Practice. New York: Columbia U. Press.

Colbert, T.C. (1996). Broken Brains Or Wounded Hearts. Santa Ana, California: Kevco Publishing.

Ferenczi, S. (1950). “Introjection and Transference.” In Sex In Psychoanalysis: Selected Papers. 35-93. New York: Brunner/Mazel.

Freud, A. (1936). The Ego and The Mechanisms of Defense. London: Hogarth Press.

Freud, A. (1965). The Writings of Anna Freud, Vol. VI: Normality and Pathology in Childhood Assessments of Development. New York: International Universities Press.

(Hartmann, H., Kris, E., & Loewenstein, R. (1949). “Notes on the theory of aggression.” The Psychoanalytic Study of the Child, ¾, 9-36.

Jacobson, E. (1954). “The self and the object world: Vicissitudes of their infantile cathexes and their influence on ideational and affective development.” The Paychoanalytic Study of the Child, 9, 75-127.

Jacobson, E. (1964). The Self and the Object World. New York: International Universities Press.

Karon, B.P., & VanderBos, G. R. (1994). Psychotherapy of Schizophrenia: The Treatment of Choice. Northvale, New Jersey: Jason Aronson, Inc.

Kohut, H. (1972). “Thoughts on narcissism and narcissistic rage.” The Psychoanalytic Study of the Child, 27, 360-401.

Mahler, M. (1960) “Symposium on psychotic object-relationships: III. Perceptual differentiation and ‘psychotic object-relationship’.” International Journal of psychoanalysis, 41: 548-553.

(51) Mahler, , M. & LaPerriere, K. (1965). “Mother-child interactions during separation-individuation.” Psychoanalytic Quarterly, 34: 483-498.

(52) Mahler, M. Pine, F., & Bergman, A. (1975). The Psychological Birth of the Human Infant. New York: Basic Books.

(55) Masterson, J. (1973). “The mother’s contribution to the psychic structure of the borderline personality.” Paper read at The Margaret Mahler symposium on Child Development, Philadelphia, May, 1973. Unpublished.

#27 – The Kleinian Approach to Understanding and Healing Borderline Mental States

ParallelPsychModels1

A diagram showing some common psychodynamic approaches to understanding BPD. Read more to understand how this continuum works!

In earlier articles, I discussed the following ways of conceptualizing borderline mental states:

  1. Fairbairn’s Object Relations Approach, including the bad object, the internal saboteur and the moral defense.
  2. Harold Searles’ Four-Phase Model, including the out-of-contact phase, ambivalent symbiosis, therapeutic symbiosis, and individuation.
  3. Gerald Adler’s Deficit Model, which discusses the quantitative predominance of all-negative memories and the deficits of soothing-holding experience.
  4. Donald Rinsley’s Borderline-Narcissistic Continuum, which illustrates how BPD and NPD represent states of psychological developmental arrest that flow into one another.

If you are looking for explanations of why borderline mental states develop, what keeps people stuck in them, and how to become free from BPD, please check out the pages above. In my opinion these object-relational approaches explain BPD’s etiology and how to become non-borderline better than CBT or DBT approaches. The latter approaches typically focus on short-term symptom management rather than transformation and cure of BPD.

Today’s post will add another approach, the Kleinian Approach to Borderline States. Kleinian theory focuses on the Paranoid-Schizoid Position and the Depressive Position.

What do these words mean, and why are they useful in understanding borderline conditions?

Melanie Klein: An Early Psychoanalytic Pioneer

To start with, why is this approach called Kleinian?

The Kleinian Approach to BPD is based on theories developed by Melanie Klein, an early 20th century psychoanalytic theorist. Klein grew up in Austria and received psychotherapy as a young woman from Sandor Ferenczi, a Hungarian psychoanalyst who was himself an innovator in understanding schizophrenic and borderline individuals.

Klein studied psychoanalysis in Berlin and London, eventually becoming a renowned therapist of emotionally troubled children. Working with children enabled her to see processes of all-good and all-bad splitting occurring live in the therapy sessions. Having often been severely neglected or abused, the children misperceived Klein as all-good or bad based on their past experience with “bad” parents and their need for a “good” parent-substitute.

Melanie Klein noticed that the more abuse and neglect the child had experienced, and the worse the relationship between child and parents, the more severe the splits in the child’s perception of the therapist tended to become. This meant that, despite the fact Klein tried to treat them well, children with worse parents tended to more unrealistically perceive Klein as an “all bad” mother figure. This transference (transfer of feelings from past people onto present people) is related to how borderline adults tend to misperceive potential friends or lovers as uninterested and rejecting.

Klein also noticed that as they improved in therapy, children who had initially utilized all-bad splitting became attached to her as a good parent figure, growing emotionally to the point where they could trust her and feel concern for her wellbeing (reparation). Children from healthier families often started therapy at this more advanced position, allowing Klein to observe a more positive mode of relating from the beginning.

From these two different ways in which the children related, Klein posited two primary orientations toward perceiving the world as seen from the child’s perspective. She called the first, developmentally earlier, more dangerous and isolated way of experiencing the world the Paranoid-Schizoid Position. She called the second, later, more secure and dependent orientation the Depressive Position.

These two positions can be understood as regions along a continuum of increasingly healthy and integrated personality development, the early, paranoid-schizoid part of which anyone can get stuck in given enough trauma and deprivation, and the later, depressive part of which anyone can reach given sufficient positive resources.

The Paranoid-Schizoid Position

The paranoid-schizoid position is the way of experiencing one’s emotional life that corresponds with what are commonly labeled “borderline” mental states or “schizophrenic” mental states. In my understanding, borderline and schizophrenic states of mind are not different in kind, but only in degree; schizophrenia represents a more severe version of the splitting, self-fragmentation, and primitive defenses seen in borderline states. As discussed in the many psychodynamic books linked to in earlier posts, both borderline and schizophrenic states are fully reversible and curable with sufficient help over a long period.

Back to the topic at hand. Why is the “paranoid-schizoid” position called that and what does it mean? The “paranoid” part refers to misperceiving external others who are neutral or mainly good as “all-bad”, as paranoid people tend to do, and the “schizoid” part refers to the tendency to withdraw and isolate oneself from meaningful emotional interaction with others, as people who feel threatened and unsafe tend to do. When a person’s entire personality is centered around misperceptions of others as “bad”, and when a person isolates themselves interpersonally in a way that tends to perpetuate these misperceptions by not allowing in good corrective influences, they are operating in a “paranoid-schizoid” mode.

The term paranoid-schizoid is not meant to be pejorative, only descriptive. I think a better, more empathic term for the paranoid-schizoid position in adulthood would be something like, “The Adult Worldview of the Traumatized Child”, so please keep that in mind when reading these labels.

To Klein, the paranoid-schizoid position represented the earliest way of experiencing the world for a young child who is trying to test whether or not the external environment is safe and supportive. If parents and other important relationships mainly nurture and protect the child, then the child’s mind will develop a feeling of basic trust in others and of basic security in the world. This security will help them gradually move from the paranoid-schizoid to the depressive position. If neglect, abuse, trauma, and excessive stress predominate during childhood and early adulthood, if bad experiences tend to outweigh good experiences, then the person will get stuck in or regress back to the paranoid-schizoid position. In experiential terms, such a person will continue to feel unsafe and to distrust others relatively indefinitely, and may not even know what they are missing.

Core Features of the Paranoid-Schizoid Position

The paranoid-schizoid position features:

  • Lack of basic trust in others’ good intentions (“the basic fault” as discussed by Michael Balint).
  • Predominance of all-bad splitting, i.e. viewing others as rejecting and oneself as unworthy.
  • Predominance of feelings of aggression and envy over love and gratitude.
  • High levels of anxiety, a constant feeling of insecurity at the core of one’s being (“ontological insecurity” as discussed by R.D. Laing).
  • Frequent acting out – drinking, drugs, sex, food, etc – to defend against overwhelming negative emotions and lack of self-soothing ability.
  • Tendency to isolate oneself and withdraw emotionally and physically. Related lack of awareness of others as psychologically separate from oneself.
  • Lack of subjective sense of self.
  • Use of primitive defenses to block awareness of what a precarious emotional state one is really in, including denial, avoidance, splitting, projection, and projective identification.

My Emotional Experience of the Paranoid-Schizoid Position

These descriptions are highly technical and removed from real experience. So here is how I experienced the paranoid- position, i.e. the out-of-contact and ambivalent symbiotic phases, emotionally:

  • As my being a tragic, pointless character from Dante’s Inferno, The Myth of Sisyphus, or Kafka’s Metamorphosis, doomed to endlessly repeat the same self-defeating behaviors.
  • As being alive and dead at the same time – alive physically, but dead emotionally and dead because no one knew the real me.
  • As being unable to trust or confide in anyone, because nobody cared and nobody had time.
  • As waging a constant battle to keep my terror and rage controlled enough to survive.
  • As having no idea how normal people handled relationships and problems so easily, resulting in intense envy.
  • As continuing to live emotionally in “the house in horrors” (my name for my childhood home with its physical abuse).
  • As being a cork on a stormy ocean on which you could never tell where the next rogue wave was coming from.
  • As being very aware of negative inner thoughts and very unaware of what was going on around me. These bad thoughts felt to me like persecutory demons.
  • As having to preserve as much energy as possible to defend against potential threats and dangers. I often thought of myself as an emotional warrior, spy, antihero, or survivor.
  • As being willing to do almost anything addictive or distracting rather than feel the bad feelings and the lack of love.
  • As a vengeful, hateful, evil person who wanted to take revenge on those who hurt me and strike back at the world to feel some power and self-control (It is, I think, this type of paranoid-schizoid experience in young men that leads to many mass shootings).

These experiences are correlates of periods when the all-bad self and object images were mostly or fully dominant over the all-good self and object images. For many years this paranoid-schizoid nightmare was my predominant way of experiencing myself and the world.

Kleinian Theory Compared to Other BPD Models

The paranoid-schizoid position correlates with the following elements of other psychodynamic approaches to borderline states:

The Four Phases, the Structural Deficit, the Borderline-Narcissistic Continuum, and the Paranoid-Schizoid and Depressive Positions are all analogous ways of describing a continuum of early emotional development. They can be diagrammed as follows:

PSPvsSearlesPhases3

These “primitive” (meaning developmentally early) mental states are consequences of the quantitative predominance of bad self/object images along with a structural deficit or quantitative lack of positive, loving memories. In other words, they result when someone has many more bad than good experiences with other people, and/or when the absolute quantity of good experiences is severely lacking.

The lack of love in the past, combined with present fears that keep a person from getting help, can keep an adult frozen in the paranoid-schizoid position for long periods. In this situation, partly out of a fear of being totally alone or objectless, the person will maintain a closed psychic system of all-bad internal relationships which feel like tormenting inner demons, monsters, and ghosts. The paranoid-schizoid state can feel like an inner hell or prison.

How All-Bad Splitting Perpetuates the Past in the Present

The psychoanalytic writer James Grotstein discussed the persecutory inner representations of the paranoid-schizoid individual as acting like a “band of merciless thieves” or “gang of brutal thugs”. These internalized relationships attack the vulnerable part of the person that wants help by “warning” or convincing them that other people are untrustworthy, uninterested, dangerous, and rejecting, even though this may no longer be true in the present.

These all-bad identifications are seen when borderline people tell themselves, “I am worthless”, “Nobody wants to help me”, “Other people are always too busy”, “Things never work out for me,” and so on. There is sometimes a large grain of truth to the negative perceptions about others, but the individual also colors what they perceive and how they “self-talk” to make things seem worse than they are. In other words, they only perceive the all-bad aspects and spit out the all-good aspects of external reality. In this way they treat themselves as did people in the past who rejected or neglected them. This is what I call “perpetuating the past in the present.”

These paranoid-schizoid inner objects or memories can be understood as schemas, i.e. models of representing past experience in relational terms. These models actively (and often negatively) influence the ability to perceive reality accurately and to take action in the present.

Examples of Paranoid-Schizoid Experiences in the movies Psycho, Memento, and Beauty and the Beast

Several dramatic films illustrate how past attachments to “bad people” (and more importantly the internal memories and self-images based on them) block potential relationships to new good people and serve to keep a person in the paranoid-schizoid position.

1 – Psycho: Norman Bates, the main character in Alfred Hitchcock’s horror movie Psycho, exemplifies the paranoid-schizoid position. Because he fears his mother will be jealous, Norman is unable to tolerate the presence of Marion, the lovely young woman who comes to visit his motel. In reality Norman’s mother is long dead, her rotting body sitting in a rocking chair in the manor house. But her remembered voice is alive and well in Norman’s mind, guiding his actions and ordering him to kill off the threatening “good” Marion. Norman constantly experiences the paranoid-schizoid position, always feeling in danger and unable to trust outsiders.

While Norman is actively psychotic, a parallel process plays out in less disturbed borderline mental states. Norman’s acting out of the way he imagines his mother would reject his wish for a positive relationships is disturbingly similar to how some older borderline adults keep sabotaging potentially good relationships even after their abusive parents are gone.

Memories of disappointing interactions with parents and peers therefore “warn”, discourage, and forbid the borderline person not to trust and enjoy relationships with friends and lovers in the present, because if they do they would be betraying their past bonds to “bad” parents (for which they often blame themselves) along with risking rejection by the potentially good new person. These unconscious identifications with all-bad memories of others explain the repeated frustrations that many people labeled BPD have with keeping friends and sustaining romantic relationships.

Check out the Psycho Trailer.

2 – Memento: In the Christopher Nolan movie Memento, Guy Pearce plays a man, Leonard, suffering from an unusual problem:  He cannot form any new memories. This disability occurs after he is beaten by thugs who killed his wife. Therefore, Leonard is unable to remember or trust anyone new he meets. He becomes at the mercy of others who take advantage of his limited memory. The constant sense of paranoia that Leonard exhibits, along with his great difficulty in discerning what is real and what is a deception, brings to mind the paranoid-schizoid mental experience.

People in severe borderline states experience similar difficulty in trusting others, usually not because they are amnesiac, but because they are terrified that being dependent and close will result in rejection or abandonment. In other words, they believe that the present will repeat the past, i.e. that new potentially good people will turn bad, just as parents and peers rejected them before. These inner identifications with bad objects (objects meaning memories of past experiences with others), combined with a lack of past good object experience to rely on, results in the extreme sensitivity to imagined rejections that borderline people experience.

I remember watching the Alien movies starring Sigourney Weaver as a boy and being terrified by the scenes where a human suddenly turned into a monstrous alien and devoured a fellow colonist. I think these scenes unconsciously reminded me of my father’s sudden transformations into a violent “monster” who physically beat me, which fed my expectation that other adults would turn on me if I trusted them.

Check out the Memento Trailer.

3 – Beauty and the Beast – This classic Disney children’s movie features another example of the paranoid-schizoid position. Due to his selfish and unkind nature, the Beast has been condemned to live alone in his castle. He can only be redeemed if he learns to love, and earn another’s love in return, by the time the last petal falls from a magic rose. Rather than seeking someone to love him, the Beast becomes hopeless, withdrawing and isolating himself inside his castle. When beautiful Belle tries to penetrate his “closed psychic system” of all-bad expectations, the Beast is at first aggressive and untrusting, not believing that anyone could love his true self.

Gradually, the Beast is able to permit himself to be vulnerable and experience closeness with Belle. This move toward dependence, attachment, reparation of past harms done to Belle, and realization of the love he has been missing out on, represent the Beast’s movement from the paranoid-schizoid to the depressive position. Gaston and his henchman represent the all-bad objects that serve to impede reunion with the hoped-for good object, and the Beast must courageously fight them off to defend his loving relationship with Belle (i.e. to securely reach the depressive position).

Check out the Beauty and the Beast Trailer.

The Reunion Adventure – The Transition from Paranoid-Schizoid to Depressive Positions

The timeless theme of reuniting with a lost good person by fighting past inner demons and their external representatives repeats in many classic stories, including Homer’s Odyssey, the Star Wars movies, the epic films Gladiator and Braveheart, Disney’s Aladdin and the Lion King, The Crow starring Brandon Lee, and the novel Ulysses by James Joyce.

To see the repeating narrative, the reader need only think of how the heroes in these stories are separated from those they love by evil forces (“bad objects”) before having to fight for reunion with the lost beloved person. Joseph Campbell provides many additional examples in his book The Hero with a Thousand Faces. This epic battle comes alive in long-term psychotherapy of borderline states, when the battle is to overcome all-bad projections onto the therapist in order to trust and depend on the therapist as a new good person who can help the client move from the paranoid-schizoid to the depressive position.

The Paranoid-Schizoid Position and DSM Diagnoses

Different degrees and permutations of the paranoid-schizoid way of relating are commonly (mis)labeled as: Borderline Personality Disorder, Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder, Bipolar Disorder, Schizoaffective Disorder, Schizophrenia.

I don’t believe in the validity of these labels as distinct illnesses; rather, people should be viewed as individuals with strengths and deficits along a continuum of ego functioning. If they are used at all, labels like “borderline” should be viewed as a cross-sectional working hypothesis which loosely describes the problems a person has at a given time. Labels like borderline emphatically do not represent a life-long incurable illness. In my view, DSM labels should be abolished since psychiatrists are unable to use them as descriptions of pathological ways of relating with which people can work creatively and from which healing is possible.

Instead of something descriptive and hopeful, the labels become perversely distorted into “lifelong mental illnesses” which may have a genetic or biological cause. This is ridiculous since no evidence exists that these diagnostic labels are reliably discrete from each other, nor that biology or genes cause the behavioral, thinking, and feeling problems to which they refer. It’s offensive, harmful, and arrogant for psychiatrists to misrepresent problems of thinking, feeling, and behaving to vulnerable people in this reductionistic, pessimistic way.

Therefore I again encourage readers to consider dismissing labels like Borderline Personality Disorder from your mind. Instead, consider thinking of individuals as experiencing different degrees of borderline mental states at different points in time and of borderline states as being reversible and curable.

The Depressive Position and Healthy Personality Organization

Since much of psychology is focused on what is wrong, pathological, symptomatic, or immature, I now want to focus on maturity, wellbeing, and psychological health, using these questions:

How do many people become emotionally healthy, i.e. able to regulate their feelings and self-esteem, to work productively, to form families, become loving parents, have intimate friendships, etc.?

Are emotionally healthy people just born that way, or does childhood experience matter, and if so how much?

Why are healthy people not borderline?

How can borderline people become healthy?

These are complicated, contentious issues. In most cases the answer to the first three questions is that emotionally healthy people have had many more good than bad interpersonal experiences during childhood and early adulthood. Compared to people who are labeled “borderline”, healthy people usually had more opportunities for trusting, secure, long-term relationships with family, mentors, and/or friends.

These good relationships helped them to overcome the paranoid-schizoid position and the splitting defense – which when not prolonged are normal parts of every child’s development – and to develop the capacities for ambivalence, self-soothing, and intimacy. In one sense, emotionally healthy people were simply lucky – lucky as helpless children to be born into families where love and security were readily available.

I believe that that healthy adults usually had parents who, while they were not perfect, were good enough most of the time. They were “good parents” in the sense of empathically responding to the child’s needs, comforting the child when vulnerable, and supporting the child’s independent activities. These parents themselves usually had a considerable degree of healthy personality development; i.e. the parents themselves did not make heavy use of splitting, and were able to accurately perceive their children as mostly good and only slightly “bad”.

In other words, non-borderline parents tend to raise non-borderline children, and borderline parents are more likely to raise future borderline children. NAMI won’t like to hear that parents can cause BPD, but sometimes the truth hurts! As suggested by the ACE Study below, poor  parents do more frequently raise “borderline” and “schizophrenic” children. That doesn’t mean poor parents are “bad people” or that they should be blamed for their children’s problems. Of course they shouldn’t.

Rather, the passing of abuse and neglect from generation to generation is a tragedy for which no one should be blamed, and the maximum amount of support should be given to such parents to help understand and change destructive patterns.

The ACE Study – How Adverse Childhood Events Increase Risk of Psychiatric Diagnoses

What evidence is there that childhood neglect and abuse correlate with increased mental illness diagnoses? The recent Adverse Childhood Events (ACE) Study of 17,000 people has explored the connection between childhood trauma and psychological disorder diagnoses. This study polled a large sample of people seen in hospital and medical settings to examine how frequently different childhood experiences co-occurred with physical illnesses and mental health diagnoses. The ACE study shows that childhood emotional, physical, and sexual abuse are directly linked to likelihood of both physical illnesses and psychiatric disorder diagnoses in a dose-response fashion.

In other words, the more abuse and neglect a person reports in childhood (a higher “dose amount”), the more likely a person is to be labeled depressed or schizophrenic in adulthood. In my way of thinking, more childhood abuse and neglect increases the chances that a child will become developmentally frozen in the paranoid-schizoid position and experience borderline or psychotic mental states as an adult.

Here are details on The ACE Study.

Drawing from the ACE Study, one can deduce that the less frequent and severe are a person’s experience of childhood abuse or neglect, then the less likely the person is to experience “borderline” or “psychotic” mental states as an adult. Although the survey didn’t cover it, I’d bet that a strong group-level relationship exists between having had reliable, loving parents (as the child experienced and perceived them) and an absence of adulthood mental health diagnoses. It makes sense because families with less abuse and neglect also tend to have more love, safety, closeness, and support (I could be wrong about this, but I doubt it. Let me know what you think in the comments).

Further Sources on Healthy Childhood Emotional Development

I’ve now digressed again from the topic of healthy personality development. The point I’m trying to make is the obvious one that loving, secure human relationships are crucial to healthy personality development. Rather than discuss this in further detail, I wish to refer the reader to sources with more knowledge than I.

Some good writers on healthy emotional development, i.e. on what helps young people become navigate past the paranoid-schizoid position (avoiding borderline mental states) and enter the depressive position (and reach psychological maturity) are:

1) Donald Winnicott (e.g. Maturational Processes and the Facilitating Environment). Drawing on his experience as a English pediatrician-therapist, Winnicott wrote beautifully about the healthy emotional development of children. Winnicott viewed psychotic states, including severe borderline conditions, as the “negative” or mirror image of healthy emotional development. They illustrated for him what happens when healthy parenting and secure childhood emotional development break down or never become firmly established.

Winnicott’s book is available for free as a PDF on this page.

2) James Masterson (e.g. The Seach for the Real Self). The American psychiatrist Masterson wrote mainly about borderline and narcissistic personality problems but always discussed what happens in healthy development contrasted with borderline/narcsisistic development. Masterson explained how the borderline/narcissistic personality could become healthy via internalizing self-parenting functions that they had missed out on in childhood.

Check out Masterson’s book on the search for the real self.

View a Youtube interview with Masterson.

3. Heinz Kohut (e.g. How Does Analysis Cure?). German psychoanalytic pioneer Kohut developed the field of self-psychology, which emphasizes how crucial empathic parental responses are to the young child’s healthy emotional development. He developed the ideas of idealizing relationships (referring to how children need a strong, safe figure to protect them) and mirroring relationships (how children need a supporter for their independent functioning).

It is instructive to understand how these relationships fail to occur between parents and future-borderline children, and why such relationships do not immediately develop when borderline adults go to psychotherapy. From Kohut’s work one can see that if most borderline adults had received adequate mirroring and idealizing responses earlier in life, they would likely be normal, healthy people today.

Here is an Overview of Self-Psychology.

4. Lawrence Hedges (e.g. Working the Organizing Experience; Interpreting the Countertransference). Hedges is a California-based psychogist who recasts schizophrenic and borderline disorders as “organizing” and “symbiotic” ways of relating. He has a beautiful way of writing about how certain “potentials” for relateness never get activated and become frozen in borderline and psychotic mental states.

In the link below, which is a free e-book download, the sections “Borderline Personality Organization” (pg. 98) and “A Brief History of Psychiatric Diagnoses” (pg. 175) may be of interest. Hedges’ writing is not about healthy personality development per se, but he constantly discusses what positive elements are missing in the relational development of psychotic and borderline individuals.

Access a free e-book copy of Hedges’ Relational Interventions.

5. Allan Schore (e.g. Affect Regulation and the Repair of the Self, The Science of the Art of Psychotherapy). Schore is an American neuroscientist who writes about how reliable, secure attachments to caregivers are crucial to the developing child’s brain, and how attachments to parents directly modify how genes express or do not express themselves. Schore does fascinating brain scans showing how the child’s brain reacts to good and bad relational influences. He also shows why nature and nurture cannot be separated and quantified in such myths as, “BPD is 50% genetic.”

Here is an Interview with Allan Schore on Youtube summarizing Attachment Theory.

6. Ed Diener (e.g. Happiness: Unlocking the Mysteries of Psychological Wealth). Diener is a sociologist who researches how social conditions on a national level promote psychological wellbeing. Good parents and mentors are extremely important for psychological wellbeing, but factors beyond family relationships a lot too, like poverty, educational opportunities, diet and exercise, safety at a national level, freedom of speech, economic inequality, etc. Diener shows how these factors correlate with psychological wellbeing for national populations.

As you might guess, people in Iraq, North Korea, and Zimbabwe really are far less happy than people in Sweden, Australia, and South Korea. While advanced nations have their own problems, Diener shows how some poor countries suffer such severe instability that they are almost “paranoid-schizoid” worlds, in which people constantly feel threatened and are unable to actualize their potential for wellbeing.

Here is Diener’s Book on Wellbeing.

Compared to the simplistic, symptom-focused descriptions of Borderline Personality Disorder in the DSM , I believe so much more can be understood from these etiological depth approaches to borderline conditions and healthy emotional development.

Returning to the Kleinian theory, how does the Depressive Position fit into healthy emotional development?

Key Characteristics of the Depressive Position

The Depressive Position, although it might sound negative (like “depression”) actually refers to increasing psychological attachment, closeness, and maturation. It was called “Depressive” because Melanie Klein focused on how the young child experienced guilt, depression, loss, and increased concern for their parents’ wellbeing as they emerged from the paranoid-schizoid position. These “depressive” feelings emerged as the child became more aware of the mother as a separate person and realized how their actions could negatively affect her.

But the real thrust of the depressive position lies in these characteristics:

  • Increasing security in positive emotional attachments to other people (development of basic trust).
  • Predominance of all-good splitting followed by capacity for ambivalence.
  • A richer, nuanced, three-dimensional view of oneself and others.
  • Predominance of love, gratitude, reparative urges, and guilt over aggression, envy, hatred, and vindictiveness.
  • Increasing ability to self-soothe, tolerate frustration, and maintain self-esteem.
  • Repression replaces splitting, denial, and projection as primary defense.
  • Increasing awareness of others as psychologically separate from oneself.

This link from the Melanie Klein Trust explains the depressive position in more detail.

My Experience of the Depressive Position and Therapeutic Symbiosis

As stated before, a lot of these descriptions are technical and removed from real experience. So here is how I experienced the early part of depressive position, i.e. therapeutic symbiosis, emotionally:

  • As the end of a war in which I was a survivor emerging from the ruins, realizing that the whole battle had been going on in my mind, not the outside world.
  • As an incredible realization that I was not in danger, people could be trusted, the world was safe.
  • As emerging into real life after years in emotional hibernation.
  • As seeing the world and other people in color for the first time.
  • As “the halcyon (blessed) days”, my term for this period in my diaries.
  • As the sense that everything was right between me and my therapist, that I was like a blessed child and she was like a loving mother.
  • As a regression to being the playful, carefree child that I had never been able to be in my actual childhood.
  • As an overpowering sense of loss about how many years had been lost to misery and fear because of my parents’ abuse.
  • As feeling like a savior because I had saved myself by finding good people, just like the Beast found Belle to free himself from the curse.
  • As a feeling that I had become a self, a real spontaneous person for the first time.
  • As being able to enjoy other people and experiences, finally.

These feelings are correlates of the period when all-good self and object images begin to outweigh all-bad self and object images, i.e. the phase of therapeutic symbiosis as described by Harold Searles. In this stage the formerly borderline person achieves a healthy narcissistic level of object relations and reaches the depressive position.

Why Don’t Some People Reach the Depressive Position?

In severe borderline mental states, a person remains fixated psychologically in the paranoid-schizoid position as described above. Viewed from various vantage points, the borderline person tries to become healthy, functional, securely attached, and able to regulate their feelings but may fail because:

  • They have a quantitative deficit of internal positive memories that healthy people use to soothe themselves (Adler’s structural deficit), but don’t yet have the resources in their daily life (friends, family, therapist, etc) needed to repair this deficit.
  • They are simply unaware of the positive relationships they are missing (Searles’ out-of-contact state).
  • They are scared of trusting and depending on others due to past trauma which they fear new people may repeat, and thus choose to remain attached to their internal all-bad relatoinships (Fairbairn’s object-relations model of the attachment to the bad object, Searles’ phase of ambivalent symbiosis).
  • Their use of primitive defenses like denial, avoidance, acting out, projection, projective identification, leads them to unconsciously repeat self-destructive patterns.

This is only a brief attempt to answer the question about why some borderline individuals remain in the paranoid-schizoid position. I am still optimistic that healing and progress out of the paranoid-schizoid position is possible with appropriate insight and help.

Final Thoughts On Recovery From Borderline States and Progress to the Depressive Position

My own experience and research suggests that the single most crucial thing for recovering from borderline states in a long-term, dependent, loving relationship with somebody. It could be a therapist, a friend, a family member, or some combination of these. Feeling safe and loved by others for years is what enables children to become healthy adults, and it is also what enables once-borderline adults to become healthy adults. There is no substitute for internalizing the self-soothing and self-organizing functions of a loving, mature outside person. As I described in an earlier article, I experienced these healthy relationships for the first time with my therapist and a few key friends.

In normal childhood development, there is a “healthy” or normative paranoid-schizoid experience called the practicing phase, in which the child jubilantly explores the world and is relatively unaware of mother’s separateness. For most children, the parents and environment are supportive enough that the children don’t get stuck in a pathological paranoid-schizoid position that later becomes a borderline adult mental state.

Rather, most healthy children progress out of the normative paranoid-schizoid position into the depressive position at a relatively young age. These children are unlikely to regress and become borderline unless they encounter some overwhelming prolonged stress in later life. For children who are constantly neglected and abused, the risk is much greater that they will psychologically retreat and stay in the pathological paranoid-schizoid position, which leads to experiencing a chronic borderline or psychotic mental state in adulthood.

Again, it should be remembered that “normal”, healthy people would often have become borderline adults if they had experienced sufficiently severe abuse and neglect in earlier life. In Kleinian terminology, anyone can get stuck in the paranoid-schizoid mode of functioning when subjected to enough prolonged stress. People opearting in borderline mental states are not fundamentally different than the rest of us – they are just as human, but more unlucky in some ways.

With sufficient insight and resources, borderline people can become weller than well, i.e. become free from borderline symptoms, study and work productively, have intimate friendships and relationships, and experience joy and meaning. After they have become psychologically mature, life challenges still present themselves, but former borderlines can handle them with confidence as the capacities for ambivalence, regulating feelings, and maintaining self-esteem are developed in the depressive position.

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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

#26 – Why BPD Should Be Abolished, and What Should Replace It

Do we want people to believe that BPD is a real psychiatric illness that they must manage for the rest of their lives, or do we want to promote a message of hope which says, “You can become free of your emotional distress and live the life that you want”?

By presenting BPD as a severe mental illness which can be managed but not cured, the medical model of the BPD label utterly fails to promote hope. Additionally, the medicalized concept of BPD is scientifically broken: It does not describe a valid illness which is consistent across a population.

Why do we keep using BPD if there is so much wrong with it? Is it possible that we would be better off without BPD?

And if BPD is should be abolished, what should replace it?

This article addresses how to replace BPD.

To this question, my first answer is “Nothing” – that we should simply abolish BPD – and my second answer is “Emotional Dysregulation Susceptibility Syndrome”, which I will explore as a hopeful alternative. Let’s discuss these options.

Background: The Medical Model and My Opposition to NEA and “Make BPD Stigma Free”

My central conceptual argument is that Borderline Personality Disorder as defined in the DSM is an unreliable, invalid concept. Given its current popularity, it’s not easy to fight against the prevailing notion of BPD as a valid mental illness. But after speaking to many people who also experience BPD as a flawed, discouraging concept, I am more resolute in this view than ever. If you are unfamiliar with the argument against BPD, please see here, especially Myth #5:

https://bpdtransformation.wordpress.com/2014/08/07/five-myths-about-bpd-debunked/

While I prefer to understand people without labels, due to practical considerations I contend that BPD should be replaced by a more hopeful label. This new label should refute the myth of BPD as a life-long mental illness and emphasize vulnerability to stress along a continuum.

My position against BPD directly opposes the thinking of many in the psychiatric establishment, including large organizations like TARA BPD, the Treatment and Research Advancements Association for BPD, and NEA BPD, the National Education Alliance for BPD.

TARA and NEA assert that BPD is a “serious psychiatric illness”, one which they can reliably investigate and for which they will create improved treatments. In my opinion, these medicalized viewpoints represent poor research and outright misinformation.

Let me list and critique some of National Education Alliance BPD’s main positions. I hope the reader will sense how badly NEA’s claims on BPD, which often border on outright lies, fail to meet the criteria for good science and basic common sense.

My Response to NEA’s Misinformation about BPD

(Source – http://www.borderlinepersonalitydisorder.com/what-is-bpd/bpd-overview/)

1) BPD is an “illness”.
NEA’s position: BPD is a single illness which causes unstable mood and behavior.
Edward’s response: BPD is not one unitary entity that causes anything. BPD is not a single illness because the symptom-cluster that supposedly represents BPD cannot be reliably identified by any biomarkers (genes, brain scans, etc.) nor reliably identified by different psychiatrists across a population, as the NIMH recently admitted.
The way a person understands their world based on past experience leads to unstable mood and behavior.

2) Genes are involved in causing BPD.
NEA’s Position: Scientists generally agree that genetic and environmental influences are likely to be involved in causing BPD.
Edward’s response: This is misleading on so many levels it’s hard to know where to start. Again, BPD is not one reliable entity. And there is no evidence that genes “cause” any of the distress-experiences denoted by the BPD misnomer – such thinking involves the mistaken assumptions that genetic and environmental factors work as separable influences in a quantifiable manner. I have written about these distortions extensively in my article on twin studies (#4).

3) Brain scans provide evidence that biological factors cause BPD.
NEA’s position: There is evidence that biology is a factor in causing BPD, due to imaging studies in people with BPD showing abnormalities in brain structure and function.
Edward’s response: Does NEA think the public cannot understand basic cause and effect? Of course seriously distressed people have observably different brains than “normals”. That doesn’t mean biology or genes cause these differences; neglect, abuse, and lack of love, which are much more prevalent in those labeled “borderline”, inevitably lead to different brain functioning. But that doesn’t even mean those things cause BPD or that BPD is real. Never take a difference for an illness.

4) Biological factors make people more likely to develop BPD.
NEA’s position: The current theory is that some people are more likely to develop BPD due to their biology or genetics and harmful childhood experiences can further increase the risk.
Edward’s response: The current theory is a demonstrably false hypothesis. Constitutional vulnerability to stress may make it easier for some people to become overwhelmed by environmental stress, but that doesn’t mean that BPD is in any way a valid illness, nor that such people cannot become well. Plus biology and genetics do not act alone in the way implied in this reductionist model (see – http://www.madinamerica.com/2015/06/are-dsm-psychiatric-disorders-heritable/ )

5) The prevalance of BPD can be quantified.
NEA’s position: BPD affects 5.9% of adults at some time in their life
Edward’s response: Does anyone really believe that a subjective, descriptive label with no biomarkers can have its prevalence reliably identified to a tenth of a percentile?

6) BPD is a life-long mental illness.
NEA’s position: People with BPD have BPD for life. (NEA stops short of saying this outright, but they imply it. Their website talks over and over about managing and reducing symptoms in “borderlines” of different ages, never once mentioning the possibility of becoming free of “the illness” or discussing the possibility of full recovery)
Edward’s response: This is one of the most damaging myths being promoted about BPD. Problems that are mislabeled BPD can be fully recovered from; people who once approximated borderline criteria can eventually live a satisfying, emotionally normal life. Many thousands of people have already done so. Getting better is hard work, but people do not have to cope with and manage BPD for life. People need real hope, not the discouraging prospect of a life-long illness.

My Manifesto Against National Education Alliance for BPD

As can be seen, NEA BPD set themselves up as the experts on how to define and treat the BPD “illness”, an illness label they obviously intend to keep. But they may not have considered that former “borderlines” can see through their propaganda.

My position on NEA’s “BPD as a serious psychiatric illness” notion is this:

  • Severely distressed people do not have accept the label BPD as an identity nor as an explanation for their problems.
  • Emotional problems are not reducible to “psychiatric illnesses”, nor are they the exclusive province of psychiatry.
  • Effective help which often leads to full recovery from problems mislabeled BPD already exists. Recovering does not require the assistance of “experts on BPD”, nor does it require DBT and medications, although these can help. Also, people can have their own definition of recovery and a meaningful life.
  • Emotional problems mislabeled BPD can be completely healed and do not have to be managed for life.

It’s time to say goodbye to National Education Alliance’s harmful theories about BPD as a life-long psychiatric illness, to end the borrowed time these theories have been living on.

Why Reducing BPD’s Stigma is Doomed to Failure

I also oppose the message of blogs that attempt to put a positive spin on BPD, like “Make BPD Stigma Free”. In my opinion, reducing BPD’s stigma and building “BPD Pride” is doomed to failure. To me, these efforts resemble shifting deck chairs around on the Titanic. Similar attempts to reduce depression’s and schizophrenia’s stigma have foundered miserably; the problem is that reducing complex emotional issues to medical labels explains nothing and fails to empower people.

Two examples of such programs are instructive:

  • “Defeat Depression”, a large scale British campaign to reduce the stigma of Major Depressive Disorder, failed to reduce stigma and did not improve outcomes according multiple follow-up studies.
  • “Beyond Blue”, an Australian attempt to reduce the stigma of so-called mental illnesses, also backfired. Studies investigating its effect found that those who knew less about mental illness diagnoses, or who were given a diagnosis but rejected it, had better outcomes than similar people who believed they “had a mental illness.” This unsettling finding has been confirmed in John Read’s research (e.g. Models of Madness).

The disturbing conclusion of this research is that accepting that you have a “mental illness” – as opposed to rejecting the medical model of emotional distress – actually decreases the chances of recovery. This shocking Youtube presentation by critical psychiatrist Sami Timimi covers this and other eye-opening facts about “mental illness”:

If Defeat Depression and Beyond Blue failed to destigmatize depression, why should a destigmatization program for BPD succeed? Alongside “schizophrenia”, BPD is the most unreliable, invalid, confusing, harmful, stigmatized, and useless label. Even if BPD were to lose its stigma, it would remain an unreliable term that explains nothing about an individual’s problems.

Abolishing BPD – The Ultimate Goal

Borderline Personality Disorder can and should be entirely abolished. BPD should be consigned to history as a tragically misguided way of
concretizing emotional distress.

Here is how a world without BPD would look:

1) No More BPD Diagnoses: Distressed people would no longer receive the BPD label during hospitalizations or psychiatric consultations. They would be understood as individuals using the Formulation approach to distress (see article #19 here – https://bpdtransformation.wordpress.com/2014/12/04/19-hope-meaning-and-the-elimination-of-borderline-personality-disorder/).

2) Label-Free Treatment: Psychotherapists and treatment programs would help distressed people without viewing them as borderline, no matter how much the client “fit” that outdated term.

3) Label-Free Family Understanding: Families would be helped to support their distressed members without being fed the fiction that their loved one “has BPD.” Parents, siblings, partners, and children would find that their loved ones’s problems can be understood without calling them borderline.

4) A New Research Paradigm: into severe emotional problems would cease to be focused around BPD. It would instead use the emotional dysregulation spectrum concept that I’m going to discuss. There would be more qualitative, experience-focused research, and less quantitative label-focused research.

5) Abolition of BPD and the DSM: BPD would be abolished from the DSM, as it has already been removed from ICD (Europe’s version of the DSM, from which BPD was recently voted to be dropped). Furthermore, as an unscientific fraud full of fictional illnesses, the entire DSM would be eviscerated.

In time, BPD would be viewed as an outdated relic, a sad symbol of an age where psychiatrists constructed bizarrely misguided labels for emotional distress. People in the year 2200 would look back on “BPD” in disbelief, much as people today look back at centuries-old conceptions of physical illnesses. BPD would be mocked alongside notions of evil spirits released by bloodletting and plagues caused by divine curses.

A BPD-free world is possible. People often underestimate what can be done over long periods of time with sustained, gradual effort. Perhaps BPD’s life is already growing short.

How Would We Understand People Without BPD?

What a scary idea! How could we ever understand people showing “borderline” symptoms without labeling them with BPD?!

How do we understand the problems of anyone we care about?

1) Listen to their story. Learn about what past and present experiences are causing their distress. Develop a shared understanding of their problems based on their history.
2) Learn about what they want to change in the future. Develop a shared understanding of their needs and dreame.
3) Understand fundamental human needs for security, dependence, respect, and independence.

These are the fundamental steps in the Formulation approach to emotional distress, as described here in the story of Emma:

https://bpdtransformation.wordpress.com/2014/12/04/19-hope-meaning-and-the-elimination-of-borderline-personality-disorder/

People labeled “borderline” can be effectively helped without labeling them as BPD. But because of the reductionist ideology that has crippled the minds of too many mental health “professionals”, abolishing BPD without a replacement label may be a bridge too far. The Big Pharma profit incentives which maintain the need for medicalization of emotional distress present another obstacle.

The First Step Toward Abolishing BPD – A New Name

Supported by the public’s ignorance about what a precariously perched house of cards “BPD” really is, the profit motives of psychiatrists and Big Pharma will likely block a total abolition of BPD, even though BPD paradoxically never existed and does not exist today. Therefore, I suggest the intermediate step of renaming BPD, something which has already begun to happen for other pseudo-illnesses such as “schizophrenia”.

If done well, renaming BPD would accomplish multiple goals:

1) Undermine the false conceptualization of emotional distress as an illness that is consistent from person to person.
2) Emphasize that emotional distress varies along a continuum and that people labeled “X” are not always “X” (i.e. are not always distressed, but are vulnerable to stress).
3) Reduce stigma by introducing a fresh name without negative connotations.

Despite these hopeful goals, one might argue that replacing BPD with another name would lead to just as much stigma and misunderstanding.

But could a new name truly aspire to be as miserably uninformative as Borderline Personality Disorder?

Would BPD by any other name smell just as bad?

I doubt it.

Japan, Jim Van Os and the Abolition of Schizophrenia

I’ve gone through some brainstorms about what BPD could be renamed, drawing on the campaign against “schizophrenia” for ideas. Many people are calling for schizophrenia to be abolished, and Japan legally abolished schizophrenia about 10 years ago

(Yes, there really are no more “schizophrenics” in Japan. They have a new, less-stigmatizing name for psychotic distress, meaning “integration syndrome” in Japanese, and people undergoing psychotic episodes are no longer called schizophrenic. The entire Japanese government-recording and psychiatric-labeling system for psychosis has been changed. See here – http://www.schres-journal.com/article/S0920-9964(09)00140-6/abstract ).

Jim Van Os, a Dutch psychiatrist, created a website labeled “Schizophrenia Does Not Exist” here: https://www.schizofreniebestaatniet.nl/english/

Van Os renames schizophrenia, “Psychosis Susceptibility Syndrome” , or PSS. The name implies that psychotic experience occurs along a spectrum of severity, involves vulnerability to environmental stress, and that people who have been psychotic in the past are not always psychotic today. In this model, “schizophrenia” as a discrete illness is meaningless and false.

Taking Van Os’s lead, I suggest replacing Borderline Personality Disorder with “Emotional Dysregulation Susceptibility Syndrome”, or EDSS.

The Emotional Dysregulation Susceptibility Syndrome

If BPD were renamed Emotional Dysregulation Susceptibility Syndrome, what would that mean? The EDSS concept would contrast with BPD as follows:

1) Spectrum, Not Illness: EDSS represents a spectrum or continuum of increasing vulnerability to emotional distress. Despite similar appearances, people vary along this spectrum both in degree and kind of distress experienced. People would have more or less “EDSS” in relation to others and themselves at different times. EDSS is therefore not one illness, but a spectrum of related conditions – it refutes the misrepresentation of BPD as an internally reliable illness.

2) Vulnerability, Not Illness: EDSS represents a heightened susceptibility or proneness to emotional distress, usually correlated with neglect and abuse in childhood. EDSS itself does not cause distressing symptoms; rather, it represents the heightened likelihood of environmental stress causing these distress experiences. Compared to BPD, EDSS gives more weight to what happens around a person, rather than to isolated non-contextual internal experiences. EDSS is a syndrome – again meaning it represents similar-appearing experiences which do not necessarily reflect a consistent underlying illness.

3) Recovery and Freedom, Not Management: EDSS represents a psychological state that someone can be in at a certain time of their life, but can grow out of and be free from at a later time. It is in no way a lifelong condition. With effective help, people have a good chance of moving out of the EDSS spectrum for good. This refutes one of the most damaging lies about BPD: That BPD is a life-long illness.

(If you could rename BPD, what would you call it and why? Or would you keep BPD? Let me know in the comments.)

A Psychodynamic Model of the EDSS Continuum

Drawing on my psychodynamic background, I conceptualize Emotional Dysregulation Susceptibility Syndrome as a continuum marked by a relative deficit of positive self/object images, combined with a predominance of all-bad images of self/other within a person’s mind. The deficit of good internalized experience and the predominance of all-bad self/other images would usually correlate with neglect, lack of love, abuse, or trauma caused by parents and peers in childhood and young adulthood. I developed this model fully here, drawing on the “master theorist” of borderline-spectrum conditions, Ronald Fairbairn:

https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/

The deficit of all-good images leads to the inability to comfort oneself when under stress (i.e. emotional dysregulation), and to the increased susceptibility to stress relative to most emotionally-healthy people who had more consistent past and present support. All the other distress experiences commonly labeled “borderline” – e.g. destructive acting out, lack of identity, rapidly shifting moods, extreme rage, splitting, etc. – would be understandable results of having to cope with the missing self-comforting functions that can only be provided by a predominance of good self/other images over bad self/other images, i.e. enough good experiences in one’s past to reassure oneself when under present-day stress.

These distress experiences would also be understood as present-day replayings of past trauma; i.e. as the projection of the all-bad self-object images internalized in childhood onto others in the present, which make the person experiencing EDSS feel that they are “bad” and others are rejecting or unavailable.

EDSS might also be conceptualized as the spectrum encompassing the “Out of Contact” through “Ambivalent Symbiotic” Phases in this 4-phase model:

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

These descriptions do not represent an illness, but rather a dynamic state of relating to oneself and others at a certain time. One can function at any point along the spectrum from almost Non-EDSS to very severe EDSS – i.e. from approaching a normal range of being able to comfort oneself and function well, with only occasional regressions into serious distress – down all the way to very severe EDSS, in which the distress experiences are constant and severe to the point that normal functioning is not possible. Hopefully that the paradigmatic differences between BPD and EDSS are clear.

You Don’t Have to Accept the BPD Label

I hope these ideas will be encouraging and provoke thought about whether BPD really is valid and useful. Replacing BPD might seem unthinkable now, but there were times when women voting seemed impossible, when black people being free seemed impossible, and when tobacco causing health problems seemed impossible. Radical change can happen. Often, the process leading to a dramatic change is gradual and unseen, like when decades-long pressure building under the Earth’s crust goes unnoticed before an earthquake.

If a small but growing number of people reject the BPD label, this process can build momentum toward renaming and/or abolishing BPD. I encourage everyone reading this who has ever been labeled “borderline” to consider that you no longer have to identify with or accept BPD, period.

If a psychiatrist labels or has labeled you as BPD, or if the voice of people calling you borderline is stuck in your mind, I encourage you to tell them something like this:

“The BPD label you’ve called me is a simplistic checklist of distress factors, factors which anyone under stress for long enough can experience to different degrees. There are no reliable genes, brain-scans, or other biomarkers which can identify so-called BPD. In fact, BPD is in no way a reliable classification; it is an “illness” fabricated out of thin air without a basis in real science.
There is therefore no proof that I have an illness like you say, or that there is anything innately wrong with my brain; most likely, I am reacting in a perfectly logical way to the stresses I’ve gone through. There are other, better ways to understand my problems, and I do not accept the false label of BPD that you are putting onto me. If I get enough help, I can fully recover and live the life that I want.”

Psychiatrists and therapists need to hear this from more of the people they call “borderline”!

#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!

#18 – Heroes of BPD: Jeffrey Seinfeld

A few months ago I discussed Gerald Adler, a clinician who treated BPD using a psychodynamic method. Today I’ll write about Jeffrey Seinfeld, the New York-based social worker who pioneered a Fairbairnian approach to Borderline Personality Disorder.

On this blog, it has been discussed several times how psychodynamic therapists have already “cured” BPD. Here is an example of a borderline patient’s recovery from Jeffrey Seinfeld’s book, The Bad Object.

seinfeld1

I thought the reader might be interested to hear in detail about one of the “successes” in BDP recovery that are often referenced on this blog. Her story shows how complex, challenging, and interesting the journey may sometimes be. Some of this account is paraphrased, while the parts in quotations come straight from the text:

A Case Study: Kim (from The Bad Object, pages 101-123)

At the start of her therapy with Jeffrey Seinfeld, “Kim” was a 22-year-old Irish-American young woman. From ages 17-22, she been in regular treatment with another therapist, but had made little progress. After dropping out of high school at age 16, Kim lived at home with her mother. She did not work or attend school; rather, much of her time was spent abusing alcohol and illegal drugs.

With her first therapist, Kim showed no motivation to change, and indeed would boast about antisocial and destructive behavior, including tempting friends trying to quit drugs into again using them. She would regularly miss therapy appointments without calling to cancel. Her therapist as the time described her attitude as, “Who can blame me for messing up with all I’ve been through?”

Eventually, Kim’s first therapist referred her to Jeffrey Seinfeld. He had not lost hope for her, but felt that they had reached an impasse and that a change of approach might help her. Seinfeld scheduled Kim for twice-weekly appointments at a social-work center. For the first year or so of their work, she continued to regularly miss appointments without cancelling ahead, and to abuse drugs and alcohol regularly.

Kim’s Early Childhood

Seinfeld describes Kim’s childhood in this way: “Kim was an only child in an intact family. Kim’s mother alternately neglected and overindulged her. During Kim’s first year of life, her mother often ran out of the house to escape a psychotic husband… The mother would promise to return later in the evening, but often stayed away for days at a time. Kim therefore had repeated experiences of awakening to find herself abandoned by her mother. She grew to hate falling asleep if her mother was present, and she had frequent tantrums, insisting that her mother sleep with her…”

“Kim’s psychotic father had delusions that he was Jesus Christ and that demons possessed him. He underwent psychiatric hospitalization, and his condition was finally stabilized with psychotropic medication. Kim’s mother went to work when Kim was 3 years old, leaving her at home with her father, who was on disability. He would ignore her as he read the Bible or sat in a catatonic-like stupor. If she disturbed him with her romping and playing, sometimes designed to get his attention, he would beat her…”

“Throughout childhood, Kim was on a merry-go-round in her relationships with her family members. First she would side with her mother against her father. When her mother upset her, she would go to her father and side against her mother. When her father upset her, she’d go to her grandfather and side against everyone. As an adolescent, Kim took no interest in learning at school but instead “hung out” with peers and smoked marijuana daily. She dropped out of high school at the age of 16.”

Kim’s Early Therapy – The Out of Contact Phase

Seinfeld described how Kim’s life had little structure outside of her regular abuse of alcohol and drugs. She had trouble sleeping at night, and often slept during the day instead. Kim could not bear to be alone, and would often call her drug-abusing friends from high school to chat at all hours of the day. However, these friends were becoming less interested in her as they grew older and got jobs or moved away.

Kim felt that people were always too busy for her and would eventually abandon her. Thus, according to Seinfeld, her internalized bad object was a “busy object” who did not make time for her. Kim projected this image onto outside people based partly on experience with her real mother, who often did not take time to care for her.

(If the reader is not familiar with projection of internal object relations onto present day relationships, based on past bad experience with parents, the following article may be useful – https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/ )

Seinfeld notes that his main experience in relation to Kim early on was that she was oblivious to him psychologically. Seinfeld felt that Kim was unaware of his separate presence, but simply “told him stories” about her adventures with drugs, friends, alcohol, and other adventures. She did not expect any help, understanding, or admiration from her therapist. Referencing the out-of-contact phase, Seinfeld stated, “My position as an object was that of a witness as opposed to an admirer.”

After several months, Kim showed the first sign of becoming aware of Seinfeld’s intent to help when she wrote about him in her diary. She felt concern that her life was “going nowhere,” and wished that she could work or attend school. Shortly after this awareness, Kim cut her wrist with a razor. Seinfeld describes how “the self-mutilation is an antidependent attack against the vulnerable, libidinal self’s expressed need for an internal holding object. The antidependent self thereby reestablishes a closed, internal, invulnerable position.” In other words, the patient identified with how people rejected her need for help and support in the past, and repeated the same behavior toward herself in the present, acting as the bad parent and punishing herself (the bad child) inside her own mind.

This early phase of Kim’s treatment was an “Out of Contact” emotional phase, as described here:

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

Dwelling on the Rejecting Object

Seinfeld acknowledged noted how Kim’s life was in reality extremely difficult. Her “friends” were self-absorbed and did not truly care about her, she had little support from her parents, and she had no structure in terms of a work or academic program, in addition to addictions to drugs and alcohol.

However, despite these severe difficulties, Kim did not respond by looking for positive ways out of her predicament. Rather, as Seinfeld describes,

“Kim was constantly preoccupied with how her friends and family exploited, rejected, and did not care about her. She would dwell on the rejecting object and rejected, unimportant self-image through the day and so would remain in a depressive, victimized position… Even when the external person did not in reality reject her, Kim would interpret the situation as rejection…. All of this is not to say that the external objects did not often treat Kim badly; on the contrary, they often did. But Kim had her own need to perpetually activate the all-bad self-and-object unit.”

Seinfeld noted that if one person in her life disappointed her, she would flee to a different person, but then find them equally disappointing. For example, Kim would go from her too-busy mother, to her drug-abusing and neglectful boyfriend, to her psychotic father, to friends who were moving on with their lives and did not care. Frustrated by each of these people, Kim comforted herself by using drugs, alcohol, and by stealing her mother’ car and “joyriding” despite not having a license.

Seinfeld said that none of his interpretations of her self-destructiveness worked at first. He stated,

“Throughout the first of fourteen months of her treatment, she seemed relatively out of contact with mer. She would recount her adventures and seemed to expect nothing from me but my continued presence… There was no spontaneous, gradual shift in her relatedness. She continued to miss sessions at the same rate as characterized her previous (five year) therapy… She used my empathy to justify her “who can blame me” attitude.”

The Safety of the Bad Object

Seinfeld began to intervene with Kim by gradually making her more aware of how her feelings of rejection and worthlessness were caused not only by the actual behavior of other people, but by how she responded to and interpreted their actions. Seinfeld states, “When she described a bad experience in reality, I empathized with how she felt but then shifted the focus to what she was doing to herself in her mind with that experience. It was not difficult so show that all of the external people she discussed reflected one image – that of rejection in relation to her own image as rejected.”

Seinfeld notes how Kim eventually became aware that she continually maintained a negative pattern of thinking and expectation about others, even when nothing happened in the outside world to justify such thinking. Seinfeld commented to her that such dwelling on negativity might occur because it felt safer to Kim to feel rejected than to feel accepted.

Seinfeld also beautifully described how, “I listened to all that she said and commented from the vantage point of the activation of internal object relations units. I listened to this patient as one would follow the stream of consciousness in a novel by Joyce or Proust, in which reality is always brightened or shaded by the narrator’s internal vision and experience. Kohut (1984) has suggested that such novels reflect the fragmented sense of self in severe psychopathology. One does not ignore external reality from such a vantage point; rather, close attention is given to the subtle but constant interplay between internal and external worlds.” In other words, when listening to a borderline patient speak, the skilled therapist constantly tries to perceive how reality is distorted or “colored” in a positive or negative direction by the patient’s splitting defenses.

Ambivalent Symbiosis

Seinfeld notes that the foregoing work gradually move Kim toward an ambivalent symbiosis. She gradually became aware that Seinfeld cared about her and wanted her to get better. For the first time, Kim asked her therapist in subtle ways about whether he was interested in her viewpoint. She was no longer only telling stories or complaining about abuse. She would ask Seinfeld if he felt that her mother and boyfriend cared about her. She wanted to know if Seinfeld understood the desperation and uncertainty she felt. Seinfeld described how Kim displaced many of her wishes for closeness and support from him onto the mother and boyfriend, because it was initially too threatening to get close to Seinfeld and trust him directly.

The relationship now assumed a stormy, emotional, push-and-pull quality. Kim would want support from Seinfeld but then be angry that she only saw him occasionally for therapy. She wanted him to understand her feelings about her family, but then criticized him as overly intellectual and detached. She became jealous that Seinfeld’s own family own family got most of his time and love, while she only got the leftover scraps. Outside of sessions, she began to cut down on her drinking, but then would return to it when she felt that two hours a week with Seinfeld was inadequate. She would perceive Seinfeld, “sometimes as a saint and at other times as a psychotic with delusions of grandeur, like her father.”

Seinfeld therefore described how Kim tried to take in his support and acceptance, but would then reject it, both due to her familiarity and loyalty to the rejecting object and to her fear of vulnerability and openness toward the good object. For example, Kim asked Seinfeld for help with getting a referral to a doctor who worked in the same hospital as Seinfeld for a minor medical problem. When Seinfeld responded helpfully, she rejected the referral as inadequate by viewing the doctor negatively. This related to her being threatened by feeling that someone truly cared about her.

At this point, Kim began attending therapy regularly and never missed sessions, even becoming upset if she was forced to be late. Rather than being upset with her mother or friends as often, she became intensely upset with Seinfeld if he did not meet her demands for caring and empathy in a perfect way. Despite Seinfeld making extra time to talk to her on the phone outside of regular appointments, she would become angry when he eventually had to leave to go see his family. She viewed him as a “too busy” bad object just like her mother and friends had been the “busy bad objects” before. She again felt angry with Seinfeld for expecting her to depend on him for support, but having only a few hours a week to spend with her. She continued to alternately view him as a caring, supportive person whose help she desperately wanted, and then suddenly to transform him into a too-busy, uncaring, impersonal therapist.

Seinfeld comments on this ambivalent symbiosis in the following way:

“The patient activates the all-bad self-object unit to defend against internalization of the positive self and object unit. The insatiable need serves the antidependent defense. By making her need for contact with the external object insatiable, the patient can perceive of herself as rejected regardless of the external object’s behavior. Therefore, the patient is always able to think of her needs as being unmet, to think of herself as rejected and of the object as rejecting. The activation of the all-bad self and object unit results in depression and rage. Insatiable need, the oral self-exciting object relationships (e.g. use of alcohol while rejecting a truly supportive other), is then activated to counter the depression and rage. In this regard, the all-bad self-object relations unit becomes a vicious cycle constituting both the rejecting and exciting objects… Insatiable need serves to maintain the perception of the object as rejecting in antidependent defense. This patient succinctly stated the antidependent position, “If I don’t think you like me, why should I bother to like you?”

In other words, it’s necessary to understand how the patient is an active agent in perpetuating their view of the therapist and others as rejecting (creating an impossible-to-fulfill, or insatiable need) rather than potentially helpful and positive.

The Transition to Therapeutic Symbiosis

Seinfeld now constantly remarked upon the ways in which Kim focused on the ways in which he (Seinfeld) was not available because this felt safer and more familiar than focusing on the ways in which he was available. Kim came to recognize more and more how she herself played an active in viewing the external world negatively and keeping herself in a depressed state. She realized that if she were not provocative and looked for positive things in the outside world, they would appear there much more often than she expected. In this way, she could become an agent of positive change.

Gradually, Kim became aware of how unstructured and vulnerable her current life situation was. She realized how she was hurting herself by her continuing alcohol and drug use, and by ignoring opportunities to return to school or work.

Regarding the developing therapeutic symbiosis, Seinfeld stated,

“Kim’s vulnerable self became more connected to the internal holding object (the therapist as supporter of independent functioning and provider of love) through the transference, and she experienced severe separation anxiety. She faced the fact that her life was a mess and that she felt like a vulnerable child. She began to believe that I really was going to help her, that our relationship could affect the direction of the rest of her life.”

Seinfeld continued to explain that, at the same time as these positive feelings emerged, Kim feared that letting Seinfeld get too close to her would allow him to overpower and dominate her sense of self. She still feared trusting another person closely due to all the rejection from her past. So, she had to be very careful and gradual in the way she came to trust Seinfeld, lest he turn “bad”. Occasionally, she had dreams in which the “good” Seinfeld would turn into a psychotic madman like her father.

Gradually, Kim let herself get more and more attached to Seinfeld, and as this happened she began to feel self-empathy for the first time in her life. She remembered the alone, fearful child she had been and wanted to help herself.

Strengthening the Therapeutic Symbiosis

Kim bought a pet parrot that she would care for at home. She imagined herself as a good parent nurturing a good child most of the time. When the bird became difficult and squawky, she would briefly view herself as the bad mother and the bird as bad child. As her relationship with Seinfeld improved, she came to nurture her pet more and more and to be bothered less and less by its noisiness. As a projective container, it reinforced her positive internal self-and-object images via the fantasies of love she projected into it, supported by her relationship to Seinfeld.

Over the next year, Seinfeld described Kim’s progress as follows,

“As Kim became less depressed and angry , her vulnerability and strivings for autonomy emerged. Having decided that she must do something to change her life, she managed to earn a high school diploma. She then pursued college courses and part-time work… She brought to me her ambitions and interests for mirroring admiration. Her ambitions, which were originally grandiose, gradually became realistic. She informed her drug-addicted boyfriend that he had to stop using cocaine if he wanted to continue to see her. She saw him less as a rejecting object and more as a person with problems that interefered with his capacity for intimac. His family eventually arranged to have him go for detoxification. Kim remained in contact with him but also started to see other men.”

Seinfeld then described how Kim gradually focused more and more on her own goals and independence, and became less dependent and close to Seinfeld as she had been at the height of the therapeutic symbiotic phase. Thus she transferred into a more “resolution of symbiosis”-like phase, as described in Article #10.

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Comments on Seinfeld’s Case of Kim

In this case study, one can see how in the early phases of treatment, Kim was at first oblivious to Seinfeld as a potential helper, due to the extreme neglect and abuse she experienced as a child which left her with a structural deficit of positive internal self and object images. She literally could not recognize help and love when she saw them.

As she gradually became aware of Seinfeld as a potentially helpful therapist, her fear that he might reject her like her parents had done, as well as her general unfamiliarity with and distrust of genuinely kind people, caused her to distance herself from him as a potential good object. It required painstaking work to become aware of how she herself continually viewed others (and later Seinfeld) as “all-bad” while rejecting the good aspects of the outside world in order to overcome this phase.

Eventually, the therapeutic symbiosis took over, and Kim was able to trust Seinfeld and take in his love and support. At this point, she was no longer “borderline”, and began to feel well and stable much of the time. She resumed school and work, developed new positive relationships with other men, and gained a healthy capacity to view people like her mother and abusive boyfriend as troubled people rather than persecutory rejectors.

In reading this article, I learned how important it is to identify the subtle ways in which we distort others into “all-bad” and “all-good”, when we are borderline. We can apply these case examples our own lives, since we all distort external reality to a greater or lesser degree. Since they are often based unrealistic projections from past negative relationships, learning to “distrust” or question our initial negative perceptions can be a positive, corrective process. It allows us to realize how the world outside is much more positive than it sometimes appears when we are viewing things through the lenses of “bad objects.”

Seinfeld As An Author

Seinfeld is one of those authors I read about a certain topic and say, “Wow, this guy is brilliant! That really is how things are!” I remember being struck right away by his penetrating descriptions of borderline problems and what was necessary to transform them. The reader is again recommended to his book, “The Bad Object”, which is available used on Amazon. Its case studies of successfully treated borderlines are some of the best of any book I’ve read, especially the cases of “Kim” described here, along with similar-length successful cases of “Justine”, “Diane”, “William”, and “Peggy.”

To understand Seinfeld’s concepts, it may again be useful for the reader who is unfamiliar with the psychodynamic explanation of BPD to skim through the following articles:

https://bpdtransformation.wordpress.com/2014/02/02/the-fairbairnian-object-relations-approach-to-bpd/

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

Seinfeld adapted an object relations theory of trauma, building on theories developed by Ronald Fairbairn working with abused children in the early 20th century. Seinfeld understood how parental neglect and abuse became internalized by the (future borderline) child, and then was constantly replayed in their adult life, causing the borderline symptoms. He adapted the four phases that Harold Searles pioneered with schizophrenic patients, and modified them for use with less-disturbed borderlines. These phases – Out-of-Contact, Ambivalent Symbiosis, Therapeutic Symbiosis, and Individuation – involved “reparenting” the borderline individual so that they learned to love themselves and eventually became able to love other people.

It’s hard to summarize everything else from Seinfeld’s book on how to treat Borderline Personality Disorder (The Bad Object). So, as with the post on Gerald Adler, I will focus on a few key points.

#1: The Concepts of Structural Deficit and Bad-Object Conflict

One of Seinfeld’s foundations for understanding BPD was seeing a borderline individual as having both “a structural deficit of positive self-and-object images” and “bad object conflict.”

What the structural deficit means is that, compared to a healthier or “normal” individual, a borderline has not taken in sufficient positive experiences with the outside world to feel secure psychologically. This results in an inner emptiness or psychic void that makes it harder for the borderline to take in new positive experiences in the present, since they have trouble recognizing them as positive. This is the same concept as Adler’s notion of introjective insufficiency:

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

In healthier people, who have had much nurturing, love and security in childhood, the high number of past positive memories serve as “receptors” that help them recognize, seek out, and take in new positive experiences. By contrast, the borderline-to-be child usually receives very poor responses to their need for nurturance. Instead of internalizing a sense of love, security, and blessing, the future borderline child is left with an emptiness or longing for love which then becomes repressed. That is the structural deficit as described by Seinfeld and Adler – the quantitative insufficiency of internal positive memories based on a lack of past external positive experiences.

It is the structural deficit that results in the borderline’s being relatively unreceptive to new positive experience. For the adult borderline, positive experience – for example, being offered friendship, acceptance, and interest by other people – will seem unfamiliar, strange, alien, and even threatening when they are encountered. This is why, early on in the therapeutic process, Seinfeld found that severely borderline patients often didn’t know how to relate to him in a positive way. Rather, they experienced him in his helping role as, “an alien creature from another psychic planet.”

#2: Bad Object Conflict

As for “bad object conflict”, Seinfeld understood this to mean that not only is there a lack of positive memories, but there is a predominance of powerful negative memories (or images of oneself and other people) in the borderline’s mind. These scary, traumatic negative memories don’t just sit there – they act to reject the internalization of new positive memories. They are like metaphorical demons or monsters that scare the patient away from trusting others.

The child who becomes borderline internalizes many memories of being unloved, rejected, and even hated by inadequate parents. These memories collectively form the unconscious “internal bad object” or “rejecting object.” Despite its painful nature, relating to a rejecting other as an adult often feels safer and more familiar than trusting someone new who might prove disappointing. Also, the borderline tends to feel a perverse loyalty toward the people who abused him in the past, and to feel he is “bad” and therefore unworthy of help from good people.

For both these reasons – fear of being vulnerable toward good people, and loyalty toward the bad people from the past – the borderline individual tends to reject potential help and remains attached to the image of themselves as a worthless, undeserving, bad person. This can be acted out in many ways – via remaining alone and isolated, via abusive or neglectful relationships with present-day partners, via staying attached to the original abusive parents in the present day, via self-injurious acting-out behaviors, and so on.

Therefore, Seinfeld described how the borderline acts in subtle and overt ways to actively maintain an internal negative view of themselves and others. I would call this, “Perpetuating the past in the present.” The bad-object conflict thereby works in a vicious cycle to maintain the “structural deficit” because as long as the activities focused around bad perceptions of oneself and others predominate, quantitatively speaking, then new positive experiences are not being taken in in sufficient amounts to “tip the balance” and effect lasting psychic change.

Seinfeld likened the negative and positive relationships of a borderline patient (as long as they remain borderline) to a mathematical equation. In his formula, negative relationships to external others are activated more frequently than positive relationships, maintaining the attachment to the internal bad object and preventing the internalization of a good set of self-and-object images strong enough to displace the bad object.

According to Seinfeld, unawareness of the good object (“object” meaning person or people) tends to occur more in the out-of-contact phase, and active rejection tends to occur more in the ambivalently symbiotic phase, as described in post #10 on the Four Phases. Active rejection is necessary in the ambivalent symbiotic phase, because the good-object images are strong enough in that phase to pose a threat to the internalized bad object, which the patient unconsciously fears losing (since it is what he is familiar with).

#3: The Exciting Object

Another key concept from Seinfeld’s writing is the nonhuman exciting object. The exciting object is any addictive, stimulating, non-human object that serves to fill the void created by the lack of the good object. Food, drugs, sex, alcohol, medications, excessive use of TV or internet, and other nonhuman “things” can provide an addictive fix to compensate for the lack of love that a borderline feels.

The exciting object is part of Seinfeld’s mathematical equation of how BPD works. Because of the structural deficit and the bad object conflict, the all-negative split self and object units are mostly dominant in the borderline’s mind. These all-negative images reject the taking in of new positive experience which could be soothing, and therefore the borderline feels mostly empty, unhappy, and unstable emotionally.

To try to assuage these bad feelings, the borderline turns to nonhuman exciting objects as described above. These exciting objects plug the “hole” or emptiness created by the lack of truly satisfying positive relationships to good people in the outside world. However, exciting objects can only do so temporarily, since they are not truly satisfying long-term. Once their effect wears off, frustration will set in, and the borderline will usually return to involvement with the bad self and object images. This will then lead to more psychic pain around bad objects, resulting in the need for more exciting objects to assuage it, and so on.

#4: Interrupting the Rejecting-Exciting Object Cycle – Therapeutic Symbiosis

The main focus of Seinfeld’s book was not on the negative aspects of how a borderline functions, but on how to heal them. Seinfeld believed this could be done by interrupting the constant oscillation between rejecting and exciting objects via the internalization of a new good object relationship.

In normal language, the borderline needs to overcome their fear of trust and dependence, allowing themselves to develop a satisfying, loving relationship with the therapist. Seinfeld emphasized that successful therapy must move beyond a detached, professional relationship, and should explicitly involve love and closeness between patient and therapist. This does not mean that the pair are friends outside the sessions; rather, it means that a parental-like relationship of vulnerability, tenderness, and support is nurtured within the frame of the sessions.

This is the phase of therapeutic symbiosis. Seinfeld described how, “In this phase, there is a full reemergence of the vulnerable, regressive true self, in the care and protection of the idealized holding-therapist… At first, the patient’s vulnerable self is increasingly related to the therapist as holding object. The Internal positive self and object representation unit is increasingly dominant over the negative self and object representation unit, as long as the external therapist is highly available to reinforce the strengthening of the positive unit… As one patient said, “So long as everything is all right between you and me, I feel that all is well with the world. The good internal object serves to neutralize the bad, persecutory, rejecting object….

“In the later part of therapeutic symbiosis, the patient internalizes and identifies with the therapist to the point at which he is no longer so dependent upon the external therapist… The patient can now increasingly comfort, soothe, and mirror himself, regulating his own affect, mood, and self-esteem. In unconscious fantasy, he is now the comforter, sympathizer, and holder, as well as the comforted, empathized with, and held… All goodness is taken into the self; all badness is projected into the external object world…. In this way, the patient can establish a psychic foundation (of primarily positive self and object images) to eventually integrate the good and bad self and object units into whole, or ambivalently experienced, self and object images.” (pages 73-74)

Seinfeld’s Model of BPD – The Inversion of the Normative Developmental Psychic Process

Seinfeld continues, “The healthy child tries to take in or internalize the good object and reject or externalize the bad object. In the model I’m developing, the borderline patient manifests an inversion of the normative developmental process. Instead of taking in the positive object relations unit and rejecting the negative object relations unit, he takes in the negative object relations unit and rejects the positive object relations unit. In Fairbairn’s terms, he is attached to the internal bad object. The out-of-contact phase and ambivalent symbiosis are manifestations of the pathological inverted symbiosis in terms of the attachment to the bad object and rejection of the good object. Symbiosis becomes therapeutic when the patient adopts the normative but primitive developmental position of taking in all that is good and rejecting all that is bad. In this way, the patient can establish a psychic foundation to eventually integrate the good and bad object relations unit.” (page 75)

To me, this is a beautifully clear model of what causes BPD – bad relationships are taken in during development and reenacted continuously during adulthood, whereas good relationships are not taken in and are rejected later on. Successful recovery from BPD involves an reversal of this process.

Through the phase of therapeutic symbiosis, the patient can gradually gain confidence and make progress in three main areas in their outside life: 1) Leaving behind negative relationships (for example, to abusive partners, friends, or parents), 2) Developing new positive friendships and relationships to replace the bad ones, and 3) Developing enhanced autonomous functioning, work and interests.

In this way, the formerly borderline patient reverses the mathematical equation that had predominated when they were “borderline.” Instead of remaining attached to the all-negative images of themselves and others, the patient engages in new relationships and activities that are good, encouraging and self-supporting. In this way they take in a quantitative predominance of positive self-and-object images, and “spit out” the bad self and object images.

How To Interrupt the Rejecting-Exciting Object Cycle – Insight

The reader is probably interested as to how a borderline may start to break out of the negative-exciting object attachments. What Seinfeld worked on in therapy (and what one can work on with oneself) is developing the insight into how one sabotages oneself, which allows one to start making more constructive and adaptive choices instead.

Attachments to bad objects from the past are like schemas or relationship-templates that one replays over and over in the present “perpetuating the past in the present”), even though one doesn’t have to keep doing so. A person needs to identify how they are replaying bad relationships in the present, and treating themselves in the way that their parents did, to begin realizing how their behavior could change. As they become aware of the structural deficit (of positive self and other representations, resulting in unreceptivity toward good experience), and of the bad object conflict (which actively rejects and causes a person to fear good relationships), the borderline can start to actively seek out better experiences.

A great way to illustrate how this process works is via a case example. Hopefully, in the case of Kim above, the reader should be able to identify the structural deficit, bad object-conflict, use of exciting objects, and the ways in which Seinfeld interrupted these activities and nurtured insight in the patient, to encourage internalization of the therapist as a good object.

Recovery as a Mythic Journey

Lastly, I loved Seinfeld’s view of the therapy process as a mythic or epic journey. Seinfeld states (page ix), “This volume shows how to help the patient overcome what has been decribed as the most serious obstacle to psychotherapy: the negative therapeutic reaction. It is the bad object that is predominantly responsible for this reaction. The patient and therapist enduring the travails of the therapeutic journey often resemble Odysseus and his crew forced to outwit the demons, sirens, witches, and Cyclops threatening to thwart the long voyage. In fact, those mythological demons personify the manifold masks of the bad object often described as exciting (but not satisfying), enticing, bewitching, addicting, engulfing, rejecting , punishing, and persecuting…

“The bad object is comprised of the actual negative attributes of the parental figures – often a composite of both mother and father along with later figures resembling them – and the child’s fantasies and distortions about these figures. In this regard, the unsatisfactory experiences with the parental figures give rise to frustration and anger, which color the child’s perception of the object… The designation “bad” regarding the other person does not refer to a moral valuation but rather to the child’s subjective unsatisfactory experience with it… Therapeutic progress threatens the patient and therapist with the terrible wrath of the bad object. The patient is conflicted between his loyalty and fear of the bad object and the longing to enter into a good object relationship that will promote separation from the bad object… Fairbairn believed that the term “salvation” was a more apt designation than that of “cure” for the patient’s subjective experience of his need to be rescued from the bad object.” (preface page x)

This article is getting long enough already! I hope the reader, whether having borderline traits themselves, or wanting to help or understand someone with BPD, has found some interesting insights in Seinfeld’s approach to treating Borderline Personality Disorder.

Lastly, here is an interview and memoriam for Jeffrey Seinfeld, who sadly passed away a few years ago.

http://www.orinyc.org/JeffSeinfeld_InMemoriam.htm

Please share any comments you have below!

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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

#16 – An Eastern Approach to Recovery: Lao Tzu, Sun Tzu, and BPD

Below are five quotes from the ancient Chinese philosopher Lao Tzu, author of the Tao Te Ching.

Please consider them first for their beauty and their applicability to any human being. I will then suggest ways in which they relate to the person recovering from Borderline Personality Disorder.

1. “Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.”

2. “At the center of your being you have the answer; you know who you are and you know what you want.”

3. “The snow goose need not bathe to make itself white. Neither need you do anything but be yourself.”

4. “If you do not change direction, you may end up where you heading.”

5. “Those who have knowledge, don’t predict. Those who predict, don’t have knowledge.”

Lao Tzu was probably an amalgam of several Chinese philosophers from the early centuries BC. As a symbolic figure, he is regarded as the father of the religious and philosophical movement called Taoism.

A statue of Lao Tzu in China

A statue of Lao Tzu in China

Some fundamental ideas of Taoism include: feeling contentedly at one with the “Dao”, which is an unseen, transcendent force flowing through all things; reaching a state of freedom from earthly desires called “wu wei”, which can be translated as “flowing with the moment” or “not acting”; and a return to nature. Taoism’s emphasis on inner peace make it an interesting philosophy for people with borderline issues who need to develop self-comforting capacity.

tangyin5a

A Taoist painting illustrating Taoism’s focus on nature and personal contentment

During the arduous years of getting better from BPD, I encouraged myself using quotes like these. They helped create a sense of purpose and motivation. I’ll discuss the quotes above one by one:

1. “Being deeply loved by someone gives you strength, while loving someone deeply gives you courage.”

This first quote implies the reason why borderlines feel emotionally weak. They do not feel truly loved, nor can they trust other people deeply. Being dependent on and vulnerable toward another human being is the most crucial experience a borderline needs to grow emotionally. It is trust in another person that leads to feeling deeply loved. This was described in the phase of “Therapeutic Symbiosis”, in article #10 on this blog.

I can attest that feeling loved as a person was the critical ingredient that helped me become non-borderline. It was a feeling I first reached in psychotherapy and secondarily with several trusted friends.

After one feels loved for oneself, one can then love others, and this gives courage. Loving someone else deeply makes one feel that one is truly alive, that nothing can stop you. It lessens the fears of failure, aging, dying, and unfulfilled potential.

2. “At the center of your being you have the answer; you know who you are and you know what you want.”

This is a lovely quote, but again not something that borderlines start with – they don’t know who they are. But at the center of their being, they have the answer – their innate desire to get better, to be loved, and to feel fully human.

This again relates to quote #1. Love, trust and dependence on other people is the simple answer to the question: What allows a healthy child, or adult borderline, to grow and become emotionally healthy? Finding the answer to this question allows borderlines to develop a personal identity, to know who they are and what they want.

After my abusive childhood, the awareness dawned on me that I fiercely desired to be loved and cared for. Following this desire led me to attend psychotherapy and support groups, to make new friends, and to take risks. These resources allowed me to grow into an individual with an identity, to know who I am and what I want. It’s really true what Lao Tzu said – in my heart I always knew what I needed to get better. The challenge was taking the risks, fighting through fears, and overcoming psychic defenses to reach human help and love.

3. “The snow goose need not bathe to make itself white. Neither need you do anything but be yourself.”

This quote is attractive in the simple self-acceptance it implies. In my late teens and early 20s I hated myself. On the one hand, I felt pressured to achieve in academics, sports, and work so that others would like me. On the other, I believed my personality and appearance to be unlikeable and unattractive, and so never felt genuine or spontaneous. Instead, I was always trying to mold myself into what other people wanted.

How different I am today! I’m not afraid to say what I think, and don’t adapt myself for anybody. I am what I am, and if people don’t like that, too bad. I take delight in being myself.

This quote represents the ultimate ideal of self-acceptance that human beings, including borderlines, can aspire to. Like the snow goose which is naturally white, you don’t have to do anything to be yourself. Again, to approach this ideal, borderlines need the experience of being loved and accepted by an outside person, so that they can adopt the same attitudes toward themselves.

In article #15 on Gerald Adler, and in article #10 on Seinfeld’s four phases, it was discussed how self-acceptance – based on internalizing and believing the positive support of another person – is crucial to becoming non-borderline and developing genuine psychological stability.

4. “If you do not change direction, you may end up where you heading.”

This obvious but humorous quote really strikes home. It reminds me of the old-timers in my 12-step group who used to say, “If nothing changes, nothing changes,” and “Doing the same thing over again and expecting a different result is the definition of insanity.” Hard experience has taught me that transforming oneself  – while very doable – requires a lot of work and time, plus a willingness to take risks and try new things. Radically changing one’s emotional status quo is not comfortable, but it’s much better than stagnantly staying in an unhappy place. This was discussed more in post #14, about how risk-taking promotes recovery in BPD.

5. “Those who have knowledge, don’t predict. Those who predict, don’t have knowledge.”

This is true wisdom! A wise person understands how complex, ambiguous, subjective, and unpredictable the world is. Therefore, they don’t try to predict exactly what will happen to themselves or others.

While it can be fascinating to make predictions, such predictions, especially about mental illness, ultimately demonstrate a lack of knowledge. If prognosticators appreciated how people are extremely “complex” systems (influenced by many unpredictable sources of input) rather than “linear” systems (influenced by a limited number of clearly known variables), they would show more restraint.

I learned much about this subject from reading Dan Gardner’s book Future Babble. Two of his points stand out. First, the statistical study of past predictions made in various fields, including economics, politics, sociology, medicine, etc. indicate that the more certain someone is about a given prediction, the more likely they are wrong. Gardner thus warns the reader against trusting people who seem very sure of their predictions. He argues that those who think about a range of possible outcomes and speak in terms of ambiguity and uncertainty are more likely to be correct.

Second, Gardner showed how astonishingly quickly predictions can go wrong if even one factor inside the complex system unexpectedly changes. For example, with the weather, if the moisture level, cloud cover, wind direction, or one of dozens of other factors shift slightly, the whole outcome can totally diverge from the original prediction.

This is why human life courses are so difficult to predict over the long term. Human beings are not balls rolling down a hill whose paths can be precisely laid out! 🙂 They are complex systems like the weather, subject to millions of influences that we cannot map out in advance.

I have no respect for therapists who try to predict the outcome (via a “prognosis”) of people with Borderline Personality Disorder. Human emotional problems are way too complex to be medicalized like a physical disease. How someone does emotionally depends on literally millions of personal and environmental factors. Thus over the long term, we can only suggest factors that tend to promote success or hinder progress, while remaining humble about our lack of foreknowledge.

It is not only love and dependence, but aggression, cunning, and taking action that drive recovery from BPD.  With that in mind, I love reading a Chinese philosopher of a very different nature. Here are quotes from Sun Tzu, author of “The Art of War”:

1. “The general who wins a battle makes many calculations in his temple before the battle is fought. The general who loses a battle makes but few calculations beforehand. Thus do many calculations lead to victory, and few calculations to defeat.”

2. “The reason the wise general conquers the enemy and his achievements surpass those of ordinary men is foreknowledge.”

3.  “If you know the enemy and know yourself you need not fear the results of a hundred battles.”

4. “What is of supreme importance in war is to attack the enemy’s strategy.”

5. “The quality of decision is like the well-timed swoop of a falcon which enables it to strike and destroy its victim.”

6. “Let your plans be as dark and impenetrable as night, and when you move, fall like a thunderbolt.”

Sun Tzu was a Chinese military general and philosopher living around 500 B.C. during a period of warring kingdoms. In this era, rivals groups fought constantly over territory, and survival was a zero-sum game in which hesitation, unpreparedness, and lack of knowledge proved deadly.

sun-tzu

An artist’s impression of Sun Tzu

Sun Tzu recorded many of his strategic military insights in “The Art of War.” His writing emphasized the psychology of how to wage war, especially how to outmaneuver one’s enemy by understanding his emotional strengths and weaknesses. Sun Tzu believed that both objective (e.g. the physical landscape; the resources of each side) and psychological (e.g. the enemy’s mindset) considerations needed to be taken into account when conducting a military campaign.

Sun Tzu emphasized that a military strategy was not a fixed, unchanging list of actions to be followed; rather, the reality of war dictated that conditions and thus strategy constantly evolved. This meant that leaders had to be ready for the unexpected situations that arose when their plans interacted with the enemy’s plans in unpredictable ways.

A battle from the Warring States period of ancient China

A battle from the Warring States period of ancient China

Sun Tzu’s viewpoint has Macchiavellian qualities, in that it promotes doing whatever is necessary to survive and triumph. This is familiar for me, since I often felt forced to do “whatever it took” to survive the emotional war I was fighting after being diagnosed with BPD. I was somewhat ruthless back then, and am still a bit that way, as described in article 12, “Cracking the Borderline Code.”

So, how can someone apply Sun Tzu’s quotes to fighting for recovery from Borderline Personality Disorder? Here are his quotes again:

1. “The general who wins a battle makes many calculations in his temple before the battle is fought. The general who loses a battle makes but few calculations beforehand. Thus do many calculations lead to victory, and few calculations to defeat.”

As I recovered from BPD, this insight helped because it indicated that if I did not plan ahead, I was unlikely to prevail in the long multi-front war against BPD. I had studied many books about BPD, seeing which patients improved and which did not, analyzing which factors promoted recovery and which hindered it. I plotted out a rough plan to overcome Borderline Personality Disorder in an analogous way to how a general calculates a military strategy.

From my reading, I knew the primary goal was to develop dependent, supportive relationships in which I could be “reparented”. This process would develop the positive self-and-object units (see article #9, “A Fairbairnian Approach to BPD) and develop healthy ego functions to eradicate the borderline symptoms. I also knew that medication was ineffective at achieving these goals and so I stopped taking it, as indicated in article #13 on medication. Instead, I researched psychoanalytic-psychodynamic therapists and found one who had experience and success treating borderline conditions.

I started going regularly to therapy and continued for several years. To supplement this supportive relationship, I attended 12-step groups and developed friendships with people like Gareth, the older man who helped me work through my childhood trauma as described in Article #2. I was quite conscious about working to trust and depend on other people, because my research and experience indicated that it was only through building long-term positive relationships that I could recover.

So I had a long-term plan, and it worked. Today I enjoy my relationships, am successful in my work, and have no remaining borderline symptoms. Like the general in SunTzu’s quote, I made many calculations in the “temple” of my mind before beginning my battle against BPD in earnest, and they led to victory.

2. “The reason the wise general conquers the enemy and his achievements surpass those of ordinary men is foreknowledge.”

This quote is similar to the first. It could be viewed as a bit arrogant and presumptive to apply this to BPD. In truth, I did not know for sure that I would recover, or exactly how things would work on the journey.

What Sun Tzu probably means is that the successful general is better informed than most people from the outset– in this case, about the terrain, the psychology of the enemy, the enemy’s positions, strengths, weaknesses, and how to engage him. He studiously prepares in order to know as much as possible about what is likely and how the enemy might act. It doesn’t mean the general is clairvoyant and can see the future, because as indicated in Lao Tzu’s quote about prediction, that is impossible. But the general plans for a range of scenarios and is as well-informed as possible.

As indicated in other posts, education about BPD and how it is effectively treated is crucial. To me, knowing a lot about BPD and how others recovered from it is the closest we can come to “foreknowledge” about what facing BPD will mean for us. I benefitted greatly from studying many books, talking to therapists, and reading websites and blogs about BPD. Educating oneself is in my opinion the “wise” thing to do with BPD and it provides a better chance of getting the results you want in recovery.

3.  “If you know the enemy and know yourself you need not fear the results of a hundred battles.”

This is another similar quote to the first two. It is of course simplistic to apply these quotes to a complex emotional condition, but it can be inspiring and motivating.  Knowing “BPD” means understanding how the condition works in depth. Borderline defenses like splitting and projection are initially powerful, tenacious, and deceptive mechanisms. It is useful to understand how they work, and I intend to write future posts on how splitting and projection/projective identification operate.

The early part of “knowing yourself” when dealing with BPD, in my experience, was understanding how defenses based on past trauma (“the enemy”) were constantly coloring how I viewed the external world. They tricked me into distrusting and rejecting other people’s help, since I misperceived everyone in my present day world as untrustworthy like my father.

With a better understanding of how my mind was working, I felt more confident in stopping my defenses from recreating past trauma in my present day life. Although I didn’t win every battle at first, I felt more confident about defeating BPD in the long term.

4. “What is of supreme importance in war is to attack the enemy’s strategy.”

This is more relatable to BPD than one might think. The “strategy” of defenses in BPD is that they cause a person to negatively distort the external world, tragically recreating their traumatic past into the present. It renders the borderline unable to take in support from other people in sufficient quantities to develop a healthy sense of self. In Article #15, Adler described the necessity of confronting psychic defenses which “block” the development of positive introjects, and in Article #10 Seinfeld analogously described how the bad internal object situation prevents the borderline from internalizing the therapist as a positive new person.

Although it’s a bit simplistic, and to repeat from the last quote, these defenses which “trick” the borderline into rejecting human help are “the enemy.” When I was borderline I had two selves – a “healthy” self which wanted to trust others and get better, and a “trauma” self which was emotionally frozen at the time of my physical abuse, distrusted others, and refused to believe that people cared.

I became able to track the operation of the “trauma” self and to reject its deceptive attempts to make me distrust others. I did this by understanding how splitting and projection pulled the wool over my eyes, so that I perceived emotionally only peopl’s negative aspects and refused to take in their good sides. I countered this tendency by putting myself in more and more “good” situations like therapy, 12-step groups, and with supportive family and friends.

Over time, I began to find more and more of the good in other people and in myself. Eventually others’ good intentions started to break through my resistance. I gradually learned that truly good people did exist, that it was safe to depend on others, that I was worthy of love, and so on. I attacked the strategy of the BPD defenses which were blocking my progress, and as Sun Tzu indicated, attacking the enemy’s strategy is paramount.

5. “The quality of decision is like the well-timed swoop of a falcon which enables it to strike and destroy its victim.”

I relate this quote to Article #14, “How Risk-Taking Promotes Recovery From BPD.” It’s a bit of a harsh description (poor victim!) but it emphasizes how good decision-making is decisive and timely. In the “Risk-Taking” article, I described how changing therapists, stopping medication, moving home temporarily after college, asking for help from Gareth, etc. were all situations in which I had to take decisive action. Over the years I’ve become more and more decisive about “pulling the trigger” on things that are in my best interest. The way the falcon quickly swoops down on its prey is a good metaphor for the way a tough decision must be made decisively to be effective.

There is only a very loose correlation between this quote and BPD, but effective decision-making is important when dealing with BPD or any other serious challenge.

6. “Let your plans be as dark and impenetrable as night, and when you move, fall like a thunderbolt.”

This quote doesn’t really relate to BPD. I just put it on here because it sounds cool! I’m a big fan of action movies, spy thriller novels, and adventure video games, and it’s too bad we don’t have Sun Tzu around to write snappy dialogue for them.

I hope this article gives the reader a different perspective on how to think about BPD reccovery. There are many useful approaches to healing from trauma, and we should not hesitate to use the insights from many  different people and cultures to help us.

The_Art_of_War-Tangut_script

Sun Tzu’s “The Art of War”

#13 – The Science of Lies: Psychiatry, Medication and BPD

Disclaimer: This article is not a recommendation for others to come off psychiatric medications. Any decisions about taking, continuing, or discontinuing psychiatric medications should be made in consultation with a medical professional. This article should not be construed in any way as professional advice – it is one person’s opinion and experience only.

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Seven years ago, I made a decision that would define my future. Against my psychiatrist’s advice, I began tapering off three different psychiatric medications. Within three months, I had stopped taking them entirely.

At age 21, I had already been taking multiple medications for four years. These included antidepressants, antipsychotics, mood stabilizers, and antianxiety pills. At different times, I took Lexapro, Effexor, Xanax, Wellbutrin, Prozac, Seroquel, Paxil, Zoloft, Depakote, Zyprexa and Lamictal. For brief periods, they made me feel less anxious and depressed. For the most part, they did nothing to reduce my overwhelming fear, rage, and hopelessness.

At this time, my core problems had barely begun to be addressed. These problems included being completely unable to trust others, having no identity or self-esteem, and never having had a secure dependent relationship with a parent figure. Nevertheless, my parents were spending thousands of dollars each year on psychiatric medications that barely influenced my symptoms.

Finally, I realized the futility of continuing to take the pills and acted accordingly. I stopped taking them with full awareness of the risks involved. Since I stopped seven years ago, life has only gotten better. I have not missed the medications for one day.

Tragic Borderlines on Web Forums

On forums for Borderline Personality Disorder that I frequent, individuals with BPD sometimes list their current diagnoses and medications beneath their username. Reading their posts is often saddening, since many of them are struggling with overwhelming life problems.

It is rarely apparent that the medications make a great difference to these individuals’ experience of themselves or others. They will sometimes ask for recommendations of medication that work better. There is often the sense that if they could just find the right medication, their situation would improve dramatically.

Many such borderlines appear to be trapped in a Kafkaesque nightmare. They are on many medications, but not in effective long-term therapy. They have been told that their diagnosis (BPD plus other “comorbid” conditions) involves biological and/or genetic factors that all but require them to take medication. The medications may slightly reduce their suffering, but at the cost of painful side effects and an inability to feel positive emotions.

They do not realize that they are missing the most basic ego functions, are using primitive defenses like splitting and projection, and that their terrible emotional struggles stem from a crucial lack of nurturance and support in childhood. Without awareness and insight, these borderlines keep repeating the same ineffective, self-destructive strategies. These strategies allow them to survive but keep them chained to BPD symptoms. Their borderline personality structure based on splitting endures, being immune to any effect from the medication.

Such borderlines usually accept what their psychiatrists tell them without questioning:
1) The scientific validity of mental health disorders and the DSM,
2) The validity of biological and genetic causes of “mental health disorders”,
3) The real long-term effectiveness of medications for these supposed disorders, and
4) The potential risks of long-term medication use.

Psychiatry: The Science of Lies

There are many well-researched books on the unscientific, fraudulent, and patient-damaging practices of psychiatry. Here are my recent favorites:

The Book of Woe – Gary Greenberg
Mad Science: Psychiatric Coercion, Diagnosis, and Drugs – Kirk, Cohen, and Gomory
Anatomy of an Epidemic – Robert Whitaker

In brief, these books assert that psychiatry is the biggest scam going. It manufactures fake diagnoses through the DSM, then creates medications with questionable efficacy and dangerous side effects to treat them (and yes, there are an incredible variety of real human emotional problems – just not in the pseudoscientific way that the DSM defines them).

(Psychiatric drugs can cause dangerous, irreversible side effects, including tardive dyskinesia. Tardive dyskinesia is an often incurable disorder characterized by chronic involuntary muscle spasms of the face and tongue. About 20-30% of long term users of antipsychotic drugs, which are sometimes prescribed for BPD, develop it.)

These books present studies showing that the majority of mental health patients, including those with depression and schizophrenia, do worse over the long term with medications. Yes that’s right – long-term medication use makes the average person with emotional problems less likely to recover. Patients who only take medication for short periods or don’t take it at all do best. I have no doubt that this also applies to Borderline Personality Disorder.

This does not mean that a borderline individual who has taken medication for years cannot recover. Good therapy and the support of family and friends can greatly outweigh the negative effects of years of medication use. I am an example of that.

My View on Medication and BPD

My opinion is that medication has very little use in the long-term recovery process for Borderline Personality Disorder. The extent of its usefulness involves management of extreme short-term symptoms such as overwhelming anxiety, depression, and suicidal thinking. For a period of a few weeks or months, medication can be effective in damping down these symptoms. It can make other interventions possible, and in some cases even save lives.

However, beyond a few months, the scales shift. Long-term medication use reinforces the myth that BPD is a biologically-caused condition from which the individual cannot fully recover. It dulls down and limits access to negative and positive feelings, both of which need to be worked through for recovery. And medication works against a feeling of agency and personal power, two qualities which borderlines are desperately lacking.

Why Is It Impossible For Medication To Cure Borderline Personality Disorder?

Let us assume that BPD is a reliable diagnostic entity, as ridiculous as that notion may be. Why shouldn’t we create a medication that can alter chemicals in the brain in the exact way necessary to cure BPD?

One problem is that our understanding of the brain is very primitive and poor. There are about 100 billion neurons, or nerve cells, in an average human brain. If they were stretched out end to end, they would span about 620 miles. One million of them would be about 33 feet end to end. These neurons are connected by about 100 trillion synapses, or specialized connections between cells. Therefore, neurons interact in trillions of subtle and complex ways with each other, exchanging chemical signals constantly in ways we understand only superficially.

Not only do neurons interact with each other, but they interact in a dynamic, unpredictable way with the external environment through the sensory organs and physical intake mechanisms of the body. Our 100 billion neurons are uniquely influenced trillions of times daily by internal and external factors trillions of times every day.

Obviously, the brain is incredibly complex, and we understand relatively little about its workings at a molecular level. What our psychiatric medications are good at is dulling down certain chemicals that we know to be genereally associated with emotion. Medications affect dopamine, serotonin, and norepinephrine in blunt ways that prevent a person from feeling their negative (and positive) emotions as strongly. That is why they may usefully reduce symptoms like depression, anxiety, and suicidal thinking.

However, medications do nothing to cure the causes of these symptoms. In BPD, the central problem is a massive predominance of negative past experience that is encoded in the brain through many thousands of memories of neglect, trauma, and/or unsatisfactory relationships. The dominance of negative memories and the relative lack of positive memories is crucial. This dynamic creates defenses like splitting, and generates all the borderline symptoms contained in the DSM.

Therefore, a borderline personality structure affects a person’s every waking moment, stretching back in time to their early childhood. The only escape is a long-term positive dependent relationship with a new person or group in the present.

Since medications cannot replace bad memories with good memories, they are hopeless at curing BPD. Curing BPD via medication would require some kind of ultra-advanced nanotech treatment that would rewrite a person’s entire personality. It would erase their old identity and encode new positive “memories” to suddenly give them all the ego capacities that come with a healthy childhood. It would trick them into believing they were a totally new and different person.

Unfortunately, such a magic bullet is not on the horizon.

The other problem is, of course, that Borderline Personality Disorder does not exist in a medical sense. It is a fictitious, non-scientific “non-diagnosis”. It is ironic that I mention the “disorder” so often in this blog, but don’t believe in its validity. In truth, there is no sharp dividing line between “borderline” and “normal”, nor can anyone reliably diagnose BPD. Human beings are so complex, the varieties of our problems so individual, that “disorders” like BPD simply cannot be scientifically applied, let alone “treated” via medication.

It does not make sense to even discuss how medication might cure BPD, given that BPD is not a unitary condition. As noted elsewhere, Borderline Personality Disorder finds better use as a metaphorical term, describing a spectrum or range of psychological difficulties, rather than as a medical diagnosis.

Why Do Psychiatrists Overprescribe?

Most psychiatrists working today in the United States have little training on how to do depth psychotherapy. They do not broadly understand emotional problems in terms of developmental experience. Rather, they are taught that mental health conditions are biologically based diseases needing to be medicated and managed, rather than understood and cured.

Why do psychiatrists prescribe so many pills to so many people, and increasingly to borderlines?

Reason #1 – Money

Underlying psychiatrists’ training is the profit motive. Psychiatrists – and the drug companies with which they are intertwined – have learned that seeing patients for “medication management” for 15-30 minutes at a time, one or twice a month, results in much more money than seeing the same patients for talk therapy 45-60 minutes at a time, multiple times a week. Psychiatrists often charge outrageous sums ($180-250 or more on average in my area) for these occasional, half hour or less sessions. They are making several hundred thousand dollars a year.

The move away from depth psychotherapy toward short-term treatment and heavy use of medication is therefore simple to understand. When hundreds of thousands of dollars per year are at stake, it is easy to convince oneself that psychiatric disorders really are valid, that psychiatric medication really is doing a lot of good, and that one is doing a service to society by promoting long-term medication use. Most psychiatrists are not bad people. However, many psychiatrists use defenses like denial, confirmation bias, and avoidance of contradictory information to maintain their belief that what they are doing is good for most people. It is amazing what people will deny when hundreds of thousands of dollars depend on it.

I am fully aware that there are good psychiatrists out there. There are psychiatrists who focus on therapy, on understanding the patient as a person, and on minimizing medication use. These practitioners are to be commended. The problem is, there are not enough of them.

Reason #2 – Simplicity

The other reason for psychiatric overprescription is that it’s easy. Working with a borderline patient in long-term psychotherapy, understanding their overwhelming pain, and helping their fragile inner self emerge is extremely challenging. It requires great patience and tolerance for managing negative emotion within the therapist.

Many less talented and committed mental health workers have unconsciously decided it’s easier to sedate difficult patients rather than understand them as complex individuals. How simple is it to give someone a pill and pretend that that is the best that can be done? Or to pretend that their problem is mainly genetic or biological, a simple matter of misfiring brain neurons, rather than a result of the individual’s unique personal history?

This situation is unfortunate, but it is incumbent upon borderlines to avoid these charlatans and find truly effective help.

Should Psychiatrists Be Blamed?

Should “bad” psychiatrists be blamed for overprescribing medication?

No.

Psychiatrists are able to overprescribe (meaning prescribe too many medications for too long) partly because consumers accept their practices. If we want the situation to be different, we need to look at ourselves and ask why we continue to buy their poisoned offerings. If more borderlines did what I did – stop taking endless medications, find ways to get effective therapy no matter the sacrifices involved, and reject the prevailing biological-determinist model of mental health disorders – then many more current borderlines would fully recover to become non-borderlines like me. None of this is easy, and in reality I am far more sympathetic than I sound in this paragraph.

In making these controversial points, I am fully aware that for a few mental health patients, long-term medication use is absolutely necessary. A few conditions like bipolar disorder have a proven biological component. However, that is not the case with Borderline Personality Disorder and many other so-called mental health “disorders.” As hard as drug companies are trying to increase their profits by to linking these conditions to genetic and biological causes – thereby legitimizing the prescription of more and more medication – they have so far abjectly failed. T

It is critical to understand the lack of any proven genetic basis for Borderline Personality Disorder, because that undermines a central argument of those who advocate medication. This topic is discussed in more detail in earlier articles on this blog including this one:

https://bpdtransformation.wordpress.com/2013/12/09/is-borderline-personality-disorder-caused-by-faulty-genes/

What Would a Good American Approach to BPD Look Like?

An effective approach to BPD in America would involve a massive increase in the number of therapists specially trained to treat BPD intensively via long-term therapy. It would include a massive decrease in the average cost of treatment, or the provision of greater subsidies, to allow the many poor and disadvantaged abused borderlines to fully participate in intensive treatment. It would also include a massive decrease in the number of psychiatrists treating BPD with medication, and an equally massive drop in long-term medication use (meaning medications used for more than a few weeks or months at a time).

Paradoxically, these changes would probably save our economy money in the long run. If good therapists treated more borderlines at lower cost using less medication, many more borderlines would recover. After several years of treatment, many former borderlines would become productive members of our economy for decades. They would generate much more money for employers, earn more money, and spend more money. The number of borderlines working part-time jobs in fields far beneath their capacity or interests would lessen. The number of borderlines not working at all, or on disability, would likewise decrease greatly, resulting in huge savings for our welfare system.

This scenario is a huge contrast to our current practices, which involves medicating borderlines (or not treating them at all) such that their symptoms remain muted but essentially the same. For these unfortunate people, their independent functioning and ability to contribute to the economy remains weak or nonexistent, and they are a continuing burden on the economy.

The positive scenario described above is extremely unlikely, due to the uniquely capitalistic and competitive ethos that characterizes American corporate culture, and due to the ease with which many people are tricked into believing its lies. Drug companies and psychiatrists have realized there is little profit in treating borderlines as complex people needing long-term psychotherapy and short-term medication. Instead, many psychiatrists, and almost all drug companies and their shareholders, are invested in prescribing as much medication as possible regardless of the damage done to the patient.

Borderlines as Collateral Damage

The current treatment of BPD means that many less borderlines are recovering than would be if psychotherapy were emphasized over pills. To drug companies and psychiatrists, these “non-recoveries” are essentially the collateral damage that is necessary as part of their profiteering operation.

In this way, the continued suffering of borderlines because of drug companies’ promotion of pills (relative to how much better borderlines could do under non-drug approaches) is loosely comparable to the environmental destruction wrought by industrial companies as they extract natural resources. Many oil, gas, timber, and mining companies have happily profited by damaging rivers, forests, and oceans in ways that only become apparent much later on. In their short-term worldview, it’s fine for others to bear long-term costs while they make off with short-term profit.

In a similar way, the CEOs and shareholders of drug companies are either unaware or unconcerned about how medications are hurting borderlines in the long run. The key thing for drug companies is that they are making money, not whether the patient is being cured. A carefully cultivated illusion of efficacy, built up around medication’s short-term symptom-dulling effects, supports the profit-making process. If the patient can be deceived into thinking their “disorder” is biological and into taking medication for a longer time at high cost, then so much the better.

In this view, borderlines and other mental health disordered patients are the “tragedy of the commons” of the psychiatric industry. They have to bear the costs of the long-term negative effects of overprescription and ineffectiveness of psychiatric drugs. Meanwhile, psychiatrists and drug companies are long gone with billions of dollars in profits.

Conclusion: Becoming An Educated Consumer

If you have been diagnosed with BPD or have a family member with BPD, do not let yourself become another victim of the psychiatric establishment. Educate yourself. Read books like the ones mentioned above by Greenberg, Whitaker, and Cohen which lay bare psychiatry’s lies. Read the emerging studies referenced in these books, which show that people taking long-term medications do less well on average than those who take them short-term. Question whether biological-genetic explanations of BPD are founded on solid scientific research. If you talk to your friends and neighbors about mental health disorders, discuss with them what you have learned about psychiatric drugs.

The only reason drug companies and psychiatrists continue to survive and profit is because we let them. If we stop buying their products in, they will mostly shrivel away, leaving a much smaller industry providing short-term, acute-need medication. The only weapon against these corporations is an educated consumer.

I am a mortal enemy of our present-day psychiatric industry, being focused as it is on the long-term prescription of medication alongside elaborate cover-ups of the long-term effects. I hope that people reading this article will open their eyes to the biggest ongoing scam in our society, that of American psychiatry. People that can see through their lies are an existential threat to the entire industry and the thousands of jobs that depend on it. I only hope that its house of cards will come tumbling down sooner rather than later.