Tag Archives: psychiatry

#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.

#28 – An Interview with Lewis Madrona, M.D. about BPD and our Mental Health System

For this article I’ve interviewed Lewis Mehl-Madrona, a psychiatrist from Maine with 40 years’ experience in psychiatric hospital and outpatient psychotherapy settings. Lewis is a practicing psychiatrist and healer with his own website, his own personal blog, and his own online articles.

Lewis and I did a phone interview which I have transcribed below. Here are some highlights of Lewis’ thinking:

On BPD as an identity:  “What the label BPD is is a story or identity that people are encouraged to take on. And it’s not necessarily a story that’s conducive to feeling well or being well…”

On DBT and its founder:  “Marsha Linehan would say people get better, hope, you can feel better, you can do these things and you will feel better.”

On BPD as a lifelong illness:  “I think it’s really insane to say that the label (BPD) is lifelong… I mean how do you know that?… It’s not even logical. It’s a pretty cruel world we live in where we make people incurable – is it so we don’t have to work hard to understand them?”

On Recovery:  “(In response to my question about can people labeled BPD truly get well)… Oh absolutely, absolutely. And you know I think that it’s the same work whatever your label is.”

On the role of medication:  “I think the role for medication in our society has become a replacement for community… The medications don’t produce lasting change… no real solutions take place.”

On writing your own story:  “The science behind BPD is not good at all… I always remind people that the DSM is mostly created by white males over 50 years old sitting in hotel rooms around the beltway of Washington DC. These may not be the people you want to write your story… The story you create might be a lot more interesting.”

For more context, read on to the full transcript. Please note that Lewis’ views are his own, and his interview appearing on my site does not imply that he agrees with or endorses my positions. With that said, here’s the interview:

Edward: Lewis, thank you so much for making time to speak to me. I found you through the International Society for Psychological and Social Approaches to Psychosis (www.isps.org), and you know that I run a website dedicated to challenging the medical model of Borderline Personality Disorder and promoting a recovery model. I’m going to ask you some questions I’ve put together about the label BPD, and I’d like you to answer however you feel is best, which may or may not mean directly answering the question. First, so that readers can get a sense of where you are coming from, let me start with asking you to describe your professional background, your training, and what you do now:

Lewis: Ok well, I went to med school at Stanford, then did a couple of years of training at the University of Wisconcin, then went off and did a PHD in psychology and a postdoc in neuropsychology, and then I came back and finished my residency training in family medicine in psychiatry at the University of Vermont. Then I did some extra time to be certified in geriatric medicine as well.

Currently I’m teaching family medicine at the University of New England in Maine, so I’m one of their faculty, and I also do the psychiatry consulting service at Eastern Maine medical center [Lewis has worked on psychiatric wards]. And then I have my evening and weekend life as a person who dabbles in the healing arts. What that means is doing healing work with people – because I’m native American, it’s kind of a native American flavor, I try to help people using that background. I grew up with my grandparents who were part of the Indian culture.

lewis1                                                                 Lewis Mehl-Madrona

For many years I’ve also had a psychotherapy practice, more so earlier in my career; I don’t do much outside therapy at this point. I’ve always done a combination of different medicines, psychiatry, psychotherapy, other healing arts.

I’ve worked in medicine for 40 years, starting in 1975. Actually earlier, 1973. I started doing psychotherapy in training in 1973.

Edward: Ok thank you; I can see you’ve had a lot of experience in the psychiatric system. Do you have an idea of how many clients you’ve worked with who were considered “borderline” or who would approximate the DSM label for “Borderline Personality Disorder”?

Lewis: You have to clarify the term “borderline”. When it was first created, borderline was meant to refer to people who were not psychotic, but had severe emotional issues – I can’t remember if it was Otto Kernberg or someone else who coined the term – but it was supposed to mean people who under high stress crossed the border into psychosis but could then cross back. It was people who oscillated between those states.

I don’t remember when it happened, but somehow borderline came to mean people who are incredibly good at getting what they need from systems, like hospital systems. That’s how people are using it now, to refer to manipulative people that we don’t like in the system. I think that’s how the term is commonly used now.

Over the years I’ve seen a lot of people who fall into that category, as labeled by others. And yes I’ve certainly done psychotherapy with quite a few people who were given that label at one time or another.

Edward: Ok, interesting. I guess what I had in mind was more the first description; people who have serious emotional issues, can become psychotic under stress, are prone to splitting, can’t regulate their emotions, and so on. Can you say something more about how you understand the word borderline – how does it describe the functioning, feeling, defenses present in these people?

Lewis: My personal belief is that it’s a fairly useless label. I think people are more individual. Such a label really doesn’t say much about who the person is and what do they need help with. I think by and large all of the DSM labels are like that. For the most part they’re not really based on science of any kind. You can say in general terms things like depressed, anxious, psychotic, etc – maybe give general labels people fit into, with overlaps. But the craziness we have now is just something else.

Personally I don’t find BPD to be a very useful construct. What the label BPD is is a story or identity that people are encouraged to take on. And it’s not necessarily a story that’s conducive to feeling well and being well. So I think that’s the danger of the internet because people can get together and embrace their story about who they are as borderlines. And it makes it harder, if that becomes your identity, to not suffer in that way, or to see that it’s just one way to describe however it is you suffer, and there are other more helpful ways.

Edward: Ok thanks, that’s an interesting idea about how taking on the borderline label becomes a story, a kind of self-fufilling prophecy in a way. I do see that when I read online forums focusing on BPD at Reddit, Psychoforums, Psychcentral. Can you say something now about the causes of “borderline” states – are they mainly psychological, biological, etc? I realize now in asking this that the question may not make sense to you in these terms.

Lewis: I think trauma and isolation are the big things leading to mental health labels – if you’re surrounded by community, you can tolerate a lot more trauma than if you’re alone. And I think that’s been the process of the 20th century; the process was to eliminate community and get everybody alone in little boxes. It’s easier to manipulate people when they’re alone in little boxes; it makes a more malleable work force and prevents unionization and collective bargaining. It prevents people getting supported by each other.

So I think that a lot of what we see now [in terms of mental health and psychiatry] is so different from what we might have seen in the year 1900. People in general are so much more isolated now than in 1900 or 1800, and so it’s harder to build resiliency or regulate your moods when you’re always or mostly by yourself, and I think it’s crazy. For example the two parent child-rearing approach is insane; who ever thought that up was completely crazy. Healthy cultures have cross fostering, cross mothering, multiple mother figures at any given point, the idea of the whole village taking care of the children.

So I think some of this is political. And I relate these processes of isolation to more people getting these mental illness labels. I think more people are getting labeled everything, because there’s less social support and thus less resiliency. And some people of course have been severely traumatized in this isolation. When you’re isolated you don’t have anyone to go to to get nurturing, to help you feel better and regulate your mood…. almost everyone I see has trouble regulating mood, and are isolated, and the really amazing thing in the settings I work in [in psychiatric hospitals] is how little some of them are willing to do about it.

Often people come in and they want a drug to make them regulated and feeling happy, and that drug doesn’t exist; it’s not going to happen. I don’t know when we made that transition, I think it was probably in the 80s, when I was in training we used medication to make unbearable affects bearable so you can work with the feelings.

But as a a profession now we’ve trained people to think you should just take a pill and feel fine, and if it doesn’t work try another one and then everything will be great. And that embarks on the perpetual search for the right pill, which is a never ending story. I don’t meet many people who have found the right pill.

Edward: Ok, thank you and of course I agree with these ideas about medication. Now let me ask you about the way other therapists use the label borderline. Many therapists, including probably some you’ve heard, use the label borderline in a pejorative way to refer to people they consider difficult or unlikely to get better. Did you ever feel that way?

Lewis: Since I didn’t believe in the label borderline I wouldn’t have ever talked that way. It’s interesting because I’ve always given my cell phone to everyone I work with, which therapists who believe in the label BPD would say is insane, but I’ve never had anybody abuse that. The issues they have with clients; it seems it’s a side effect of a certain kind of power relation and not intrinsic to people, so I always give my phone to people and say if you’re in crisis I want to hear from you; it’s our goal to keep you out of hospital so I want to hear from you early. So my approach is probably a different approach than the people who roll their eyes and label people borderline.

Edward: Ok that makes sense. Let me jump in now and ask about therapists or psychiatrists who say that BPD is a lifelong mental illness and something that cannot be cured. Do you agree with that?

Lewis: I’ve definitely heard that more than I’d like to believe, and I think it’s really insane to say that some label is lifelong… I mean how do you know that, you’d have to be at the end of someone’s life to know that, it’s not even logical. It’s a pretty cruel world we live in where we make people incurable – is it so we don’t have to work hard to understand them? At least there’s people like Marsha Linehan who don’t believe that. I think she’s interesting since she began as a service user and did her own healing which is mostly Buddhism.

If you think about DBT it’s almost entirely basic Buddhism. She did her own healing and then she came up with a therapy that matched her own suffering. But really DBT works for everything because it’s basic Buddhism and Buddhism works for everything. But she would says people get better, that’s her whole message, hope, you can feel better, you can do these things and you will feel better. So there are people like her who don’t believe in the inevitability of perpetual life long suffering. Of course I certainly don’t believe that.

Edward: Ok yes I agree with your ideas against the idea of a lifelong BPD illness being bogus; this is a large part of what my website is about. Can you speak now a little bit about what sort of results you’ve had in working with these people – I guess now I’ll call them people who’ve been seriously traumatized and isolated, rather than “borderlines”, since it seems like you don’t think that way. Have you had good results with these people in terms of their feeling better, having satisfying relationships, working in jobs they like, and so on?

Lewis: Oh absolutely, absolutely. And you know I think that it’s the same work whatever your label is, I mean, What do we all need to learn how to do? – we all need to learn how to connect with other people because we all need others, we all need to learn how to regulate our moods and each other’s moods, we all need to learn to manage our suffering, and to a large extent most of us need to learn to eat better, to exercise, to do things that are good for us like yoga, tai chi and chi gong. We all need to live a healthier lifestyle, that involves meaning and purpose, having good relationships with others, and to the extent you can move in that direction, no matter what mental illness label you’ve managed to earn, you’re going to suffer less and feel better.

And so I think the work that I do is more experientially narrative. I’m trying to get at people’s stories about why they are the way they are, and then to look for ways in which that story could be altered so they can live differently. And I use a lot of what of what you could call DBT or a Buddhist approach or some of it is native American ideas. One of the profoundest things that Marsha Linehan pointed out is that life isn’t fair, and you have to live anyway, radical acceptance. Thomas Merton said things are sometimes not ok, and we may not be able to change them, but because it’s the right thing to do we need to try to change them whether it works or not. Part of recovery is also making an effort to be helpful to other people, and/or to change the political environment we’re embedded in.

Edward: Ok. So with the people you work with who get better, what are the most important things that help them to get better? I guess you’ve aleady talked about a lot of them – community, close connections to other people, living a healthy lifestyle, and so on?

Lewis: All the things I mentioned above; by and large that’s what we all have to do regardless of whether or not we’ve managed to achieve labelhood [i.e. been labeled BPD or some other DSM label]. We all need to cultivate community and find each other and build social networks that are nurturing and healing. We need to feel like what we’re doing is meaningful, that we’re creating value with the lives that we’re living. And we need to take good care of ourselves physically, exercise, diet, all those good things. Regardless of the label someone’s given you, it’s pretty much the same, what you need to do to get better.

Although we may have a different story to explain how we got to where we are. That’s the unique thing about doing therapy, no one’s story about how they got to where they are is the same. Each person has a wonderful story that needs to be cultivated and appreciated, and if it’s not satisfying hopefully changed to get to a more well story.

Edward: Ok, I like that description of changing one’s story. It’s so different than the DSM idea of managing symptoms of an illness. Can you discuss psychiatric drugs now – As a psychiatrist, how much do you use them with people, and are they more helpful or harmful, generally speaking?

Lewis: I use them as little as possible, and I think the role for medication in our society has become a replacement for community. If you have enough people around you, you have incredible support and you don’t need so much medication. If you’re isolated and by yourself, then medication stabilizes you whereas otherwise community would. So I tend to use the least possible medication to keep people out of hospital. Because I know if they get into hospital that they’re typically going to be given much more medication than they need. I think medication does allow some people to stay out of hospital; I don’t think it’s a good long-term solution.

The biology is clear that the brain receptors, over the course of a year or so on medication, tend to move back to where they were when they started the medication. The medications don’t produce lasting change, they just make it harder to get off the medication; you have to keep increasing or changing the medication to get an effect. The external world is a much more powerful shaper of the brain than any pill that you can take. If you haven’t changed your external world, and you come off medications, then you’re going to fall back to the same neurophysiological state you were in when you started the medication. This can become a vicious circle. The meds have to be increased, and switched, and so on; no real solutions take place.

Edward: Ok, thanks and I totally agree with this view on medication. I would add that taking medication strengthens the false narrative and identification that a person “has” a certain mental illness label that needs to be treated by taking that medication. Can you say something now about how working with more difficult people – people who might more often be labeled borderline – how is it different than working with less traumatized people? Does working with very traumatized people help you to work more effectively less difficult people?

Lewis: I think so… I don’t know that the level of trouble has much to do with the difficulty of the work. I think that sometimes people who are deeply suffering can be easier to work with than people who are suffering a little. Because if they [the deeply traumatized people] just do anything different they feel so much better and it can be incredibly motivating for them. I just personally enjoy getting to hear people’s stories. And figuring out how they might have a little less friction in their self-to-world interface. Some of the worlds that people visit are incredible, and to some degree we have to be grateful to people who are visibly suffering because they’re the canaries in the social mine shaft; they’re showing us we’re all unhealthy but for some reason they’ve visibly taken it on for us. Because of that I think we have an obligation, those of us who are feeling more well, whatever that means, to help people who are feeling less well, to suffer less.

To me the label BPD and other similar labels is sort of like a cultural story that’s been created for people to put on. It’s kind of like clothing that you wear and everybody’s encouraged to put on this same kind of clothing and behave in this kind of way. It’s almost like a prescription for the label BPD, like here, “Be this way, be a borderline”. I think it’s really unfortunate because people think BPD means something inevitable or they think that it’s true because some authorities say that it’s true.

But the science behind BPD is not good at all. Even the director of the NIMH Thomas Insel, who’s as hardcore a biological psychiatrist as they come, he said the DSM 5 is not acceptable as a diagnostic tool just because it’s so divorced from science. I always remind people that the DSM is mostly created by white males over 50 years old sitting in hotel rooms around the beltway of Washington DC. They may not be the people you want to write your story. You may want to find your own story about your suffering and your strengths. Their stories aren’t very strength based. The story you create might be a lot more interesting.

Edward: Ok, thank you. I like the last part there about the old psychiatrists and writing your own story. The idea of clothing people are encouraged to take on is interesting; I hadn’t thought about it in exactly that way. Ok, next questions, what are some books and experts you find useful in the mental health field? I was going to ask this question about BPD specifically, but given your earlier answers I’ll make it more general.

Lewis: Well of course everyone should read Mad In America [by Robert Whitaker], just because it’s so amazing. But in terms of books about therapy I like Marsha Linehan’s work, she comes across as amazingly compassionate and practical.

I also like Narrative CBT of Psychosis by Jakes and Rhodes; they’re very funny – they say “now that you opened the book, you can forget we put CBT on the cover, we only put it on there because the establishment requires us to put it on there.” And the the way they work with people is completely different.

I love everything RD Liang wrote, I suppose that dates me. I like the narrative work of Michael Wyatt. I like the guys in Finland, the Open Dialogue guys, Juuka Altonen, Jaako Seikkula, I can’t pronounce most of their names, but they’re pretty cool.

Those are the people that I try to have trainees read. I have trainees read Whitaker, John Weir Perry, RD Liang, Jakes and Rhodes. I like to share my own books of course.

Edward: Ok. I didn’t know you had written a lot. What have you written about?

I have a book called Coyote Medicine. It’s an autobiographical story of being an Indian in mainstrream medicine and how crazy it can feel at times. Kind of a cross cultural work .Then there’s Coyote Miracles, about people who have miracles, people who work with traditional healers. Then there’s Coyote Healing, also about working with healers. Then there’s Healing the Mind through the Power of Story – The Promise of Narrative Psychiatry which is a newer book.

And my latest book with Barbara Mainguy is Remapping the Mind, The Neuroscience of Self-Transformation. The word borderline is not in that book! We don’t like diagnoses. It’s better to get the experience, to get people to tell you what their experience is, than to use a label. It’s gotten harder to get people to tell you their experience. People come in to a therapy session and say, “I’ve been manic this week”, and I say, “Ok what does that mean? Tell me what happened?” There’s not a lot of use of the labels in any of my books.

Edward: Ok thanks, some good references there. I didn’t know you’d done all this writing. I’ll have to check it out. Now my last question, which you’ve kind of already answered: Is borderline or BPD a useful or accurate word to describe people? Would you replace it with something else?

Lewis: I would get rid of it. I think that it’s great to help people overthrow their label. If I ran the world, I would just say that some people are more well than others. And those who are more well should help those that are less well. And leave it at that.

Edward: Ok thanks again Lewis. I’m really glad you made time for this. Since you’re an ISPS member, I was pretty sure you wouldn’t answer the questions in the diagnosis-based way I asked them. And that’s great. Because I want to show people that many professionals out there don’t think BPD is a useful word and that there are other more hopeful ways of conceptualizing our suffering. And in the way you’ve answered my questions you’ve shown that approach. It’s particularly interesting because you’re a psychiatrist working across mental hospital and outpatient psychotherapy settings, and you still think the way you do. So thanks again for your time.

Lewis: My pleasure. Take care.

————————

For more information about Lewis Mehl-Madrona, please see:

Lewis’ Personal Website

Lewis’ Personal Blog

Lewis’ Articles on Future Health

Lewis’ Books on Amazon

Lewis’ Professional Resume

[Note: Lewis knows me me under my real name, which is not Edward (see the “About” page). He consented to have the interview appear here, understanding that I disguise my identity because I prefer my employer not to know about my history in the mental health system.)

#25 – Who Was The First Borderline? – From Cavemen and Dinosaurs to Creationism and the FSM

Where did BPD come from, and how was it passed down to modern humans? This is one of the more vexing questions of our age. For an answer, we must turn to the all-knowing wisdom of American psychiatry, which proclaims:

Grandparent1

“BPD is strongly inherited.” This seems like an answer to where BPD comes from. But is it? According to psychiatry, BPD is mostly in the genes. But how could this dreaded disease have originally developed? It didn’t magically appear out of thin air. This begs the question:  From whom was BPD first inherited? Who – or what – was the real “first borderline”?

In this essay, I will take psychiatry’s thinking to its logical conclusion. If BPD is “inherited”, we should be able to track down the ultimate source of this nefarious malady. Prepare to embark on a fascinating journey of discovery. My theories are based on exciting new research by paleo-psychiatrists – scientists who study mental illness in prehistoric creatures.

Early Speculations on BPD’s Origin

Early paleo-psychiatrists raised questions like the following in their search for the first borderline:

Was the first borderline an Egyptian slave who began to have mood swings under the stress of building the pyramids, 4,000 years ago?

Pyramids2

Was the first borderline a Bronze Age Mesopotamian mother who, traumatized by hard farm work, began to view her fellow Sumerians as saints or devils, 8,000 years back?

MesopotamianSpeech

Or was the first borderline an Aboriginal hunter-gatherer who, after too many attacks by dingo dogs, developed identity diffusion in the Australian outback 12,000 years ago?

AboriginalNew

Did one of these ancient people first become borderline, and then transmit the invisible plague to their prehistoric children and on to us?

(Aside: Recent genetic studies by paleo-geneti-psychiatrists have suggested that, in addition to the normal gene-coding letters A, C, G, T, the nucleobases B, P, and D are present in the genomes of people with BPD. So genes in a healthy person, which originally read GATCGGCAGGAACAT, would come to read GATBPDCAGBPDGAABPD. This is why I’ve been terrified to get my genes mapped, for fear those cursed combinations will appear in my DNA strands, to be inevitably passed on to my children.)

BPD and Early Man

Returning to the main story, the answer is no. BPD extends back far past early Egyptians, Mesopotamians, and Aborigines. Paleo-psychiatrists recently found that cavemen exhibited Borderline Personality Disorder. Witness the following image, found on prehistoric cave walls at Laschaux, France, but concealed from the public until now:

cavemenSpeech

With this life-like painting revealed, it is scientifically proven that BPD extends at least to our caveman ancestors. This is so easy to figure out, even a caveman can do it.

So perhaps BPD originated with these forward-thinking cavemen, who would have been traumatized by living in rotten, damp caves.  But couldn’t cavemen have inherited BPD from earlier humanoids?

Through the theory of evolution, we know that humans evolved from early apes (or at least, people who think the earth is more than 6,000 years old know this). So maybe the situation looks more like this:

ApesSpeech

These monkeys are not going to tell us anything definitive, but that bonobo looks suspicious.

Prehistoric Megafauna and BPD

Early apes are an interesting potential source of BPD. But other evidence suggests that the vile pathology worms its way back further. Each of these early humans and apes evolved from other life-forms, any of which could have been the first carrier of the abominable affliction. The plot thickens, and if we want to know where BPD truly came from, we must gaze deeper into the past.

Paleo-psychiatrists recently found this fossilized face-off between the last saber-toothed tiger and the first prehistoric mountain lion. From their facial expressions, it was deduced that they were snarling the following at each other:

sabertoothlionSpeech

But of course, if prehistoric big cats had borderline symptoms, it begs the question of where they inherited them from. Peering further over the horizon, here is cave art drawn by a Paraceratherium, revealing fantasies it was having about the cause of its family’s BPD symptoms:

TRexParaSpeech

So in this image, we have evidence that BPD existed at least 15 millions years ago, in the age of the megafauna or giant mammals. But there’s more.

Psychiatry’s Return to the Days of the Dinosaurs

Excited by their study of the megafauna, paleo-psychiatrists dug ever deeper into forgotten times. The two creatures below were recently unearthed from a prehistoric swamp after being buried by a 65-million-year old mudslide. Paleo-psychiatrists determined that they were saying the following:

StegoAnkylosaurSpeech

Well, this picture is not exactly about BPD. But given the high comorbidity between Avoidant PD, Narcissistic PD, and Borderline PD, it can be said with confidence that BPD dates back at least 65 million years. If avoidant and narcissistic dinosaurs roamed early Earth, then giant reptilian borderlines would have been lumbering around too.

Indeed, all sorts of personality-disordered dinosaurs must have existed in the Cretaceous, Jurassic, and Triassic eras. This makes it much more difficult to trace who the first borderline was. But it does enable us to watch The Land Before Time and Ice Age: Dawn of the Dinosaurs with a new understanding of these monsters.

The search begins to seem endless. Who was the real first borderline? This situation brings to mind the Where’s Waldo? books, when you can never find the little guy in red and white stripes. Or perhaps it should be Where’s the Borderline?:

WaldoSpeech

Sorry. Back to the topic at hand.

Early Avian and Mammalian Ancestors

As I was saying, paleo-psychiatry keeps making new discoveries. To trace the passage of the fearsome plague that is BPD into humans, we should also investigate the earliest birds and mammals, who shared common ancestors and lived alongside dinosaurs. Early mammals lived in a traumatic environment, which we know is a risk factor for BPD. Perhaps the trauma of living with big, scary dinosaurs was transmitted into their genes, creating a vulnerability that led to BPD in humans.

One can imagine the following scenario:

BirdSpeech

As well as this one:

ShrewTRexSpeech

It makes sense that borderline traits might develop and be genetically transmitted in such an environment. But couldn’t BPD have developed in pre-dinosaur times, and been transmitted from an even earlier starting point?

A Never-Ending Goose Chase

We must commend paleo-psychiatrists for their efforts to trace the early animal origins of BPD, efforts which are as scientific and respectable as those of modern-day psychiatrists to study BPD in humans.

But despite heroic efforts, paleo-psychiatrists have not traced BPD’s ultimate origin, which remains shrouded in mystery. It seems straightforward to follow the evolution of BPD from modern day humans, past cavemen, through early mammals and dinosaurs, all the way to the earliest forms of life. But this process never reaches a satisfying conclusion. With evolution working as it does, there would always be another creature from which to inherit BPD.

We can even imagine unicellular cells, flitting around the primordial fires of early Earth, transmitting their borderline traits to the first multicellular organisms:

AmoebaSpeech

But let’s not go there.

Creationism – A Solution to the Conundrum?

There is another possibility. What if evolution is wrong, and another theory explains BPD’s origin and heritability? What if Earth is only 6,000 years old, as creationists solemnly preach, and as some of our finest public schools teach as an alternative to evolution?

Creationism would elegantly explain how BPD developed. Under creationist teaching, BPD would be a result of the trauma that early humans experienced living alongside dinosaurs and other “prehistoric” creatures. If God created the Earth 6,000 years ago, he would have put all the creatures in history together, even if it resulted in strange alterations to traditional Biblical stories, like this:

NoahSpeech

And this:

WiseMenSpeech

And this:

JesusDinosaurSpeech

No wonder the authors of the Bible wanted to cover up this sordid state of affairs. Living alongside dinosaurs would have made things scary and unpredictable for early humans. And as we know, such traumatic environments are a prime cause of BPD. Therefore, 6,000 year-old dinosaurs may have been the primary reason that BPD developed and was genetically passed down from early to modern humans.

Thus, the trauma of living alongside these monstrosities would have affected mankind’s genes such that BPD would quickly develop as a distinct disease.  As Jonathan Swift might have said, this is “a modest proposal”, but a convincing one.

Just imagine the following scene, which would have been a daily occurrence 6,000 years ago:

DinosaurBoatChaseSpeech

And this:

WomanDinosaursSpeech

Who would not develop borderline symptoms in such conditions?

And imagine having to live alongside abominations never preserved in the fossil record (the fossil record having been planted to trick creationists into believing in evolution, of course), like this:

AbominationSpeech

How horrifying! Thank goodness the dinosaurs and swamp-monster abominations were finally wiped out in an almighty Ragnarok-like battle against invading aliens:

DinosaursAliensSpeech

If dinosaurs and aliens had not annihilated each other a few thousand years ago, then modern civilization would never have developed. If dinosaurs did not die out, we poor humans would have been stuck with dinosaur-induced BPD symptoms, but without the gentle ministrations of modern psychiatry to help us manage them. So let us give thanks that aliens and dinosaurs wiped each other out, because DBT wouldn’t be possible with Tyrannosaurs constantly chasing us.

For me then, creationism provides the best explanation of BPD’s origin. It seems that we must renounce evolution, and accept the fact that the Earth is only 6,000 years old, since no other theory explains BPD’s origins so simply and elegantly. Remember Occam’s Razor – the simplest explanation is usually the correct one.

Alternate Explanations: Pastafarianism

However, there are other explanations. I was recently contacted by a Pastafarian paleo-psychiatrist, who suggested that the Flying Spaghetti Monster might be the cause of BPD. (For those of you who don’t know, Pastafarianism is the religion which teaches that a Flying Spaghetti Monster created the universe. Visit the Church of his Noodly Appendage at http://www.venganza.org )

So, instead of this scenario leading to BPD:

GodCreationSpeech

The following scenario would have accounted for the illness:

SpaghettiMonsterSpeech

However, try as I might, I cannot think of a real reason why the Spaghetti Monster would want to create BPD. His job is to create the universe and feed people pasta, not generate mental illnesses. So this doesn’t fly with me, even if the Spaghetti Monster “flies” in another way.

The Scientific Integrity of My Research

For those of you who think this is a joke, it is not. Do not hurt my feelings by commenting that these theories are unscientific. I am earnestly supporting the efforts of our nation’s finest  psychiatrists in tracing the source of BPD, a pathology which even they admit “the causes and origins of are unclear”. What could be more noble than shedding light on the origins of such a misunderstood affliction?

The Learning Doesn’t Stop Here

Despite their confusion around the inheritance issue, there is much more to be learned from psychiatry’s penetrating insights into BPD.

Psychiatry wisely teaches us that BPD is a “severe illness”, that BPD has a “course” and an “outcome”, that a certain percentage of the population “has it”, how psychotherapy and medications can “manage it”, and so on.

We must give thanks to psychiatry for creating such a wonderful and sympathetic way of understanding human emotional problems. Hearing the pontifications of psychiatrists on BPD is like listening to beautiful classical music.

If you want to learn more about these encouraging, scientifically-sound ideas via our government’s finest websites, as well as from many forums about BPD, make sure you are prepared. Before you research BPD’s cause and origins on Google, you will need:

  • A good sturdy chair.
  • A thick pillow to keep your ass from getting sore.
  • Eyedrops
  • Pain relief ointment for your mouse-clicking finger.
  • Tissues
  • Headache medications.

And take heart: Everything you learn about BPD from traditional psychiatry will be just as scientifically valid as my research above. Good luck!

The Scientific Process by which BPD Sprang Into Being

Now, if BPD first developed in early humans living alongside dinosaurs – who wouldn’t have referred to their symptoms as “Borderline Personality Disorder” – it is interesting to consider when the term BPD first emerged in modern psychiatric usage. Below is an imagining of the scientific process by which BPD may have developed.

A Conversation Between Two Medical Doctors of the Mind (i.e. Psychiatrists)

Date:  March 1st, 1939
Setting: Psychiatry Conference, somewhere in WW2-era America…
The players: Dr. Chillingworth and Dr. Hadley

(Setting – Drs. Chillingworth and Hadley are smoking it up outside a beautiful hotel, discussing the current state of the psychiatric art..)

Dr. Chillingworth: “I’m so thrilled to be back at our nation’s premier psychiatry conference. Our catalogue of mental afflictions is crying out for new names. You know, my dear Hadley, I don’t think we’re upsetting people enough by calling them neurotics and hysterics. The masses need to know when there’s something wrong with them, and those labels just don’t do it for me anymore. We need something to really get the blood boiling.”

Dr. Hadley: “I agree, dear Chillingworth. I call the crazy ones schizophrenic, but they don’t even react! It’s most disturbing. I wonder where we’ve gone wrong.”

C: “Ok, let’s put our minds to it. What name will really upset people?”

H: “How about “Weirdo Syndrome”? You know, for the bizarre folks who aren’t totally crazy, but we don’t know what else to call them?”

C: “Oh humbug! Is that the best idea you have?!”

H: “Forget that. What about “Queer Disorder”. It could be a brand new affliction. We know there’s something wrong with the homos; everyone suspects there’s a malignant germ plasm in their blood!

C: “No dice! Our friend Dr. Beavis beat you to the punch – he’s presenting this idea tomorrow. Don’t worry, homosexuality will be an official disorder. Come on, we need something original!”
(Historical note: Homosexuality was an official DSM disorder until the mid 1970’s).

H: “How about….. “borderline”? We can use it on the ones who aren’t neurotics, but aren’t raving psychotics? You know, the people who are always pissing me off.”

C: “Yes!! Yes. That’s it. … “Borderline!” Wow…. It’s a bunch of bullshit – it doesn’t mean anything. But that’s why it’s brilliant. People won’t know what it means, so it will work perfectly. Let’s use it!”

H: “But how can we be sure that people will buy it, Chillingworth?”

C: “That’s easy. We list things about people who aren’t raving psychos, but are “messed up”. We say if you fit enough of the criteria, you’re a borderline! We make it all sound very scientific and official. The criteria could be things like being irritable, having mood swings, having relationship problems, being impulsive, etc. etc. Things anyone can have, taken to an extreme. Anything we can make up about people we don’t like.

H: “But do you really think people will believe that? I don’t know…”

C: “Of course they will! Give yourself some credit, Hadley; stop overestimating your fellow human beings. Most members of our species are uneducated idiots. If psychiatrists repeat a made-up label loudly and often enough, people will believe it. Remember, the public think we’re experts.”

FreudJungSpeech

H: “This is great! But you know, I just realized something, Chillingworth. You’re pretty messed up yourself.”

C: “Tell me something I don’t know!”

H: “Indeed. Moving on… do you think that, many decades years from now, people might think this “borderline” label we dreamed up is real, and a whole industry will be based around labeling and managing these “borderlines”? I don’t know if I would feel good about that.

C: “Oh stop whining! The Borderline affliction will become real, because we say it is. We became psychiatrists so we can be exalted as experts and given bundles of money. Who cares if we have no idea why people act like they do? And who gives a damn about people in the future? Our genius is that we have no idea what we’re talking about, but people pay us anyway. Have faith, my friend.”

And thus was born “Borderline Personality Disorder.”

(Historical note: BPD was in fact “born” after psychiatrists in the late 1930s invented the term out of thin air. Perhaps not exactly like this. But close enough…)

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My thanks go to Sameer Prehistorica (http://sameerprehistorica.deviantart.com) and Harry Wilson (http://harry-the-fox.deviantart.com) for allowing the use of their beautiful art. Also, credit to http://www.speechable.com, a great, free resource for attaching captions to pictures).

I welcome any correspondance at bpdtransformation@gmail.com

If you are struggling with BPD yourself or would like to more effectively help someone who is borderline, 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

#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!

#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.